membranes were thickened, gummy masses had formed cavities in the lung, without notable sclerosis. The spleen was enlarged. The kidneys were sclero-gummy. No species of microbe was found in the pus contained in the lung and cultures produced no result. Notwithstanding the extreme rarity of the case it was one of hereditary syphilis of the lung.-Le Bulletin Médical. Laryngitis Following Typhoid Fever. Dr. M. J. Boulai writes of a case of typhoid fever which began insidiously and with mild constitutional symptoms, but suddenly a great change occurred. The fever became high, and was attended by headache, delirium, and finally stupor. Two months after the beginning of the disease an ulcerative laryngitis supervened with aphonia, pain, dysphagia, bloody expectoration, and expulsion of a cartilaginous fragment. Before asphyxia threatened the patient a tracheotomy of emergency was practiced. Upon laryngoscopic examination three weeks later it was seen that the whole posterior wall of the larynx was the seat of an enormous swelling which almost completely hid the vocal cords. The ventricular bands were strongly infiltrated.Revue Hebdomadaire de Laryngologie, etc. Traumatism and Tuberculosis. At a meeting of the Academy of Medicine MM. Lannelongue and Achard made the statement that they had already published a first work upon the subject at the Congress of Tuberculosis of Berlin in 1899. By employing sterilized tuberculous products from man and pure cultures of tuberculosis, which had not been used in a state of purity by Max Schüller, they had never obtained in the guinea-pig or rabbit tuberculous osteoarthritis at the spot of great or small contusions, fractures, dislocations or loosening of epiphyses. Nevertheless, all the animals, nearly 100 in number, died of tuberculosis. On the contrary, they had obtained suppurative arthritis, tuberculous arthritis, and osteoarthritis by employing, like M. Schüller, impure human tuberculous products, pus, expectoration, and fragments of lung collected at an autopsy. The Clinically the essential condition enabling the bacillus to localize itself in a traumatic focus is infection of the blood, and that is nearly always absent. blood of tuberculous persons is seldom virulent. The authors have never seen, although they have observed a large number of injuries in tuberculous subjects, a focus of tuberculosis appear at the seat of injury. Traumatism only discloses a latent or unrecognized disease. This conclusion agrees with the more recent work of Friedrich. Horsell, Petrow, and we see its importance in the interpretation to be given to the law concerning the relation of injuries to tuberculosis. It results in the second place from numerous experiments upon the rabbit that the animals whose joints have been rendered tuberculous, present a much more rapid evolution and special accidents if we make only twice a day, and for ten minutes each time, gentle movements of the joints rendered tuberculous. There appears at the end of a month, as in man, a contracture which soon becomes permanent and which flexes more and more the tuberculous knee. Furthermore, anatomical examination of the articulations in the animals subjected to the movements and who were killed on the one hundred and twenty-fourth day of the experiment, showed the existence of well-marked lesions of the cartilage, a denudation of the bony articular surfaces of the tibia and femur, ulcerations of the bone, and tuberculous ostitis. These results are identical with those in men with tuberculous joints. Violent traumatisms inflicted on animals under the same conditions, but not submitted to the movements, do not produce the same result. These results not only necessitate the immobilization of tuberculous joints in men, but they also at the same time illustrate the benefits of allowing freedom of movement, and especially of those made for the purpose of extending the range of movement.La Tribune Médicale. Mumps, Herpes Zoster, and Lymphocytosis. At a meeting of the Medical Society of the Hospitals M. Sicard reported a case of bilateral parotiditis, in the course of which there evolved a herpes zoster in the tract of the trigeminal nerve, accompanied by meningeal symptoms. Lumbar puncture revealed the presence of an abundant rachidean lymphocytosis. The herpes, which is an exceptional complication of mumps, should no doubt be ascribed to the propagation of the meningeal process to the Gasserian ganglion. M. Dopter remarked that the case of M. Sicard's shows that herpes zoster is only a symptom, the evidence of a nervous complication in the course of different infectious diseases. M. Landouzy said: "M. Sicard's case does not contradict the position which I have always sustained in regard to the specificity of true herpes of herpetic fever. The difference is recognized between the latter and certain eruptions which simulate it and which are symptomatic."-La Tribune Médicale. taste. The author concludes that strychnine penetrates the bone by the end of twenty-four hours sufficiently to be recognized by chemical tests.-La Tribune Médicale. Chronic Meningitis with Tetaniform At a meeting of the Medical Society of the Hospitals M. d'Espine, of Geneva, described a case of polynuclear meningitis followed by enlargement of the skull, with an arched and prominent forehead. The affection lasted for several months. The child died of broncho-pneumonia. At the autopsy no tuberculosis was detected, but there was considerable hydrocephalus. What was most interesting was the peculiar attitude of permanent contraction with the position of pleurothotonos presented by the patient. It was not genuine tetanus, for there was neither Trousseau's sign nor Chrostek's. Furthermore, the speaker had observed another case in which the symptoms of tetanus were exact, and in which the autopsy revealed nothing more than chronic meningitis. M. Marfan said that such phenomena were rather frequent in nurslings, who present permanent contractures resembling tetanus (tetaniform stiffness of the neck), and the lesions of meningeal hæmorrhage with hydrocephalus.-La Tribune Médicale. Vegetative Tuberculous Endocarditis. At a meeting of the Medical Society of the Hospitals M. H. Barbier said that vegetative tuberculous endocarditis, considered as a rarity in the adult, is far from being exceptional in children. Nearly all who perish from granuloma present upon the valves of the heart, especially the left heart, the vegetations of acute endocarditis. An interesting point to emphasize is that in children who recover from a mild attack the lesions become sclerotic, and when they finally die the valves are thickened, with retracted borders and yellowish spots in their substance. These lesions manifest themselves in young tuberculous children. by such well defined physical signs that tuberculosis should be looked upon as a probable etiological factor in the valvular disease of the adult. M. Leon said that the lesions of endocarditis have the macroscopic appearance of tubercles, but have not the same structure and are composed of fibrin. At the same time the granular lesions observed in the myocardium are true tubercles.-La Tribune Médicale. The Causes of Iritis. Drs. A. Chevallereau and Chaillous have seen 131 cases of iritis, and classify them as follows: 55 patients were women and 76 were men, making 42 per cent. of women and 58 per cent. of men. Most of the patients were between 20 and 50 years of age. As regards the causes, syphilis had existed in 39 patients, gonorrhoea with arthritis in 9, rheumatism in 7, tuberculosis in 9. The clinical forms were serous iritis and plastic iritis. From the point of view of symptomatology syphilitic iritis has a special physiognomy. It is of a sluggish and painless form, developing from two to eight months after the initial lesion. The most acute and most painful cases were those consecutive to rheumatism and particularly gonorrhoeal rheumatism. In 27 patients no cause could be specified. - Recueil d'Ophtalmologie. Metastatic Dacroadenitis in Gonorrhoea. A man, 25 years of age, suffering from acute urethritis, had diffuse oedema of the eyelids with congestion of the globes. The inflammation soon became localized in the region of the lacrymal gland, which constituted a hard, lobulated, and movable tumor. Recovery occurred in fourteen days without any modification in the secretion. There was no local or general infection. In the eight known cases there has always been bilateral disease. The theory of metastasis, at first opposed by Fournier, has been established by Wassermann and Nicolaysen. Aside from cases of general gonorrhoeal infection, with endocarditis and multiple abscesses, there are other and more benign cases in the metastatic lesions of which the gonococcus is not found, obliging us to admit the transport and action at a distance. of the toxins without the microbe.-Recueil d'Ophtalmologie. Blindness and Lesions of the Cranium. Professor Goldzieher relates the history of a man, 38 years of age, who fell from a wagon. He was comatose and had several fractures of the skull. He was trephined, a clot removed, and an artery ligated. He was soon able to resume his occupation of locksmith, but his sight slowly failed. At present the pupil is fixed, the right eye slightly deviates externally, and vision is reduced. There is no patellar reflex. The case exhibits a mixture of beginning tabes and optic atrophy of traumatic origin. Atrophy is very rare in beginning tabes compared with muscular paralysis. The question is whether the traumatism acted through the hæmorrhage descending along the sheath, with degeneration accompanying the absorption of the clot.-Recueil d'Ophtalmologie. Epilepsy Caused by Atrophy of an Eye. It is classical that certain local accidents, traumatisms, visceral or sensorial troubles, are capable of awakening the manifestations of a local epilepsy. In this case, however, the local lesion played only the rôle of an occasional cause. Dr. Zoccali reports the case of a man, 33 years of age, free from nervous antecedents, either hereditary or personal, and who was attacked by epilepsy. The typical paroxysms appeared two years after an injury to the eye which determined atrophy of the globe. The patient had at the same time the symptoms of acute nephritis, but they had yielded to a restricted diet. The albumin disappeared, but the fits persisted. Dr. Zoccali examined the patient thoroughly and concluded that the epilepsy could be attributed neither to the nephritis (uræmia) nor to a vascular alteration nor to another intoxication. The ocular traumatism and consecutive atrophy should, in his opinion, be looked upon as the principal cause. This is, indeed, by no means an ordinary etiology. Furthermore, in order to establish it more fully the author brings forward scientific data. The experiments of Munk (1877), of Vulpian, Fürstner (1879), Colucci (1898), have demonstrated that removal or atrophy of an eye causes, according to the age of the subject and the species of the animal, disturbance of development of the cortical centers. Traumatism and atrophy bring about a consecutive ascending degeneration, whence the functional and anatomical asymmetry which is the predominant and constant note of epilepsy. Lombroso has, in fact, thus defined this neurosis: "The epileptic appears to be composed of two different but conjoined halves and personalities." On the other hand, it is clearly demonstrated that the lesions of the visual sphere may produce epileptic convulsions. Bickerton, Voisin, and Ferrier affirm this fact, and the last has experimentally produced the paroxysms by excitation of the occipital lobe. There is no lack of experimental and clinical cases of the kind. Brown-Séquard produced crises in dogs and rabbits by section of the sciatic nerve. This case, consequently, is one of ascending degeneration. More recently d'Abundo (1901) has made experiments which confirm these ideas. Finally Colucci (1898) has caused epileptic paroxysms in dogs and rabbits by ablation of an eye. Such are the bibliographical and critical data upon which our Italian confrere relies. It is not necessary to insist upon the importance of the subject.-Recueil d'Ophtalmologie. Ovariotomy During Pregnancy. At a meeting of the Society of Obstetrics, Gynecology, and Pædiatrics M. Lepage reported the consequences of two cases. The first patient operated upon by M. Hartmann in the second month of pregnancy on account of torsion of a cyst of the right ovary, recovered and went to term. The accouchement and its consequences were normal. A second woman, operated upon by M. Lepage in the fourth month for torsion of a dermoid cyst of the left ovary, was likewise cured and went into spontaneous labor near term. These two cases may be added to those, already numerous, of ovarian cysts complicated by accidents which render intervention necessary and in which pregnancy proceeded without interruption. In their case MM. Audebert and Cestan, fearing that the pregnancy would be ended immediately after the operation, waited for thirty-five days before they intervened. They judged correctly, for the day after the operation labor began. By reason of their conservatism the child had developed and weighed 2500 grams at birth. M. Lepage is of the opinion that the danger of delay in pregnant women with ovarian cysts which have given rise to accidents, has been exaggerated. The cases of rupture are exceptional. The phenomena of compression are not always a menace. As for torsion, it is not often immediately grave. The patient of M. Hartmann was operated upon at the end of two days; that of M. Lepage on the third day. In a recent work by Dr. Lapeyre, of Tours, are enumerated a number of complications of ovarian cysts during pregnancy. Nearly all the instances of torsion occurred near the end of pregnancy. In some cases he only operated on the eighth day or even on the twelfth, and with success, a fact which proves clearly that the accidents of torsion are not always threatening. Therefore, when the time of operation can be deferred, as in a sanitarium or hospital, or when the woman can be closely watched, we should do so in the interests of the parent and also the child. M. Pinard did not agree with the speaker and formulated the rule that every ovarian cyst diagnosticated during the first half of pregnancy, should be operated upon at once. Torsion is a frequent occurrence. M. Lepage, in advising non-intervention, cites the example of M. Audebert. The example, however, is not favorable to his view because circumstances forced M. Audebert to operate. His intervention took place at a period when interruption of the pregnancy often follows operation, and M. Audebert caused a premature birth.-La Tribune Méicale. Interstitial Keratitis of Acquired Dr. Verhaeghe has made an admirable study of the interesting question of interstitial keratitis due to acquired syphilis. He has collected about 80 cases which have been published. In comparing the different statistics concerning the frequency of this cause of keratitis he finds that out of 978 cases only 25 were ascribed to acquired syphilis (ie., 2/3 per cent.). The author has sought to learn whether in the evolution of this keratitis there are differences of symptomatology from the form due to hereditary syphilis, and arrived at the following conclusions: 1. This interstitial keratitis is, in a general way, an accident of the secondary stage. It appears during the second year of the disease, and is frequently accompanied by various other syphilitic manifestations. 2. The beginning is insidious. Opacity comes on more slowly, is less diffuse, and presents itself in the form of a whitish exudate limited to a segment of the cornea. 3. It is often complicated with profound alterations. 4. It does not generally affect the vascular form. The period of vascularization is less pronounced. Consequently, the reactional phenomena are but moderate. 5. It is always cured by mercurial treatment, does not last as long, and yields more readily to specific treatment. Verhaeghe has noticed less frequent returns (1 out of 11 cases). As to the clinical symptoms the author thinks that they are not sufficiently characteristic to justify the assertion from simple examination of the cornea that the kera-. titis is due to acquired syphilis. The diagnosis can only be confirmed by the result of mercurial treatment.-Recueil d'Ophtalmologie. Therapeutic Notes. Refrigeration in Treatment of Cutaneous Affections. Juliusberg states that carbonic acid is the refrigerating fluid preferred for this purpose at Neisser's clinic at Breslau. The surface is sprayed with the carbonic acid as when making frozen sections. The broad, perforated nozzle of the vial is held about 1 centimeter from the skin, and the fluid is forced out by a bulb. In half a minute the skin is frozen hard. There is anæmia at first; this is followed by intense hyperæmia, and half an hour later by profuse serous transudation. In twelve hours an inflammatory redness develops, with blisters. When the freezing has been very intense, actual ulceration may follow. When it is necessary to repeat the application, an interval of five to ten days is interposed. Three sittings in less than a month are generally sufficient. This method of treatment proved particularly effectual in 9 cases of lupus erythematodes thus treated. From three to nine applications were made and the patches healed remarkably promptly, but traces of recurrence be |
