"NEC TENUI PENNÂ." VOL. 32. AUGUST 15, 1901. No. 4. H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors. Books for reviews, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER AND NEWS, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. SHUT YOUR MOUTH. Some years ago a distinguished physician in the United States Army, who had been stationed in the West among the Indians, was much struck with the persistency with which certain tribes of the red men kept their mouths shut; even the young infants were compelled to keep their mouths closed. He persisted in this study, and finally wrote a book upon the subject of keeping the mouth closed, the title of which was "Shut Your Mouth." With our present knowledge of the manner in which phthisis and other diseases are communicated, it would be wise to follow the advice of Dr. Catlin, the author of this book. We think there can be no doubt that a great majority of cases of acquired phthisis are contracted by the inhalation of the germ, as it is well known that this is one of the chief modes of acquiring the disease. It is transmitted through the medium of the air, and, once reaching a suitable spot, begins its deadly work; hence the advice to keep the mouth shut if you would avoid phthisis is certainly good advice. We remember some years since while riding on a street car with the late Dr. E. R. Palmer, he suddenly got up and walked to the rear platform. Some one asked him why he did so, and he remarked that the car was full of the germs of consumption, and he did not care to inhale them. There was much wisdom in his suggestion, although we did not know as much concerning the behavior of tubercle bacillus as we do to-day. We know that diphtheria affects children much more frequently than it does adults, and it is also a well-known fact that children keep their mouths open a great deal more than adults, as they are always talking and laughing, and are more likely to inhale the germs of diphtheria and phthisis than adults. It is also a noteworthy fact that the greatest number of people affected with phthisis are children and young adults, and there can be no question but that the ordinary follicular tonsillitis can be contracted by inhaling the breath of the person so affected. The effect of the facial expression depends largely upon the condition of the mouth. The mouth is intended to be closed except at the times when it is absolutely necessary for it to be open-that is, in eating, speaking, etc. Nothing detracts so much from a person, young or old, as an open mouth. It makes him look unsightly and awkward. The habit of keeping the mouth open continually finally results in a general distortion of the features. The wrinkled face and sagging jaw are largely due to the habit of keeping the mouth open. Current Surgical and Medical Selections. TREATMENT OF DYSENTERY.-Wilfrid Watkins-Pitchford (British Medical Journal), from experience in South African hospitals, concludes that in the later stages of dysentery, in which his cases were received, salines and ipecac are of very little benefit. Perchlorid of mercury, bismuth, and opium gave some relief, but the greatest benefit was derived from a mixture of bismuth, chlorodyn, and “izal." His formula follows: R Izal m. iij, bismuth subnit. gr. x, tr. chloroformi et morphini m. viii, mucilaginis acacia ad. 3j. To be taken every two, four, or eight hours, according to the severity of the symptoms. His experience shows that milk is not a suitable diet, pieces of casein stained with bile being found at autopsy as low down as the lower third of the rectum. Bread and butter, taken with beef tea, was usually satisfying and well borne. He finds that enemata are not usually well borne, and are not free from danger of perforation, especially when combined with abdominal massage.- The Chicago Clinic. THE LATER Results of tHE OPERATIVE TREATMENT OF PROSTATIC HYPERTROPHY.-Von Frisch, of Vienna, discussed the relative merits of prostatectomy and of the galvano-caustic incision by the method introduced by Bottini. Legueu, of Paris, regarded the amelioration of the symptoms which followed upon double castration as uncertain, and as disproportionate to the sacrifice of the testicles. The formation of a suprapubic fistula he regarded as the substitution of one infirmity for another; incontinence is the rule, and the bladder does not even empty itself completely. He regarded the procedures which attack the prostate directly as likely to be the treatment of the future. He objected to Bottini's operation as being one which is performed in the dark, and which is often followed by a relapse of the obstruction. Total prostatectomy by the perineal route, if performed early and before the occurrence of septic complications, is the procedure which affords the greatest prospect of permanent cure.-The Edinburgh Medical Journal. COLLECTIVE INVESTIGATION OF THE INFLUENCE OF THE SILVER NITRATE INJECTIONS ON PHTHISIS.-In 1892 the undersigned began a collective investigation of the action of cold in the treatment of acute pneumonia, and there is reason for believing that this procedure, which resulted in gathering four hundred cases of this disease thus treated, with a deathrate not quite five per cent, was an important factor in calling attention to the utility of that treatment and in introducing it to the profession of this country. That research was based on the conviction that no remedy can be called truly successful until it has passed the exacting crucible of clinical experience, and it is now proposed to apply the same ordeal to the silver-injection treatment of phthisis, which, in a large hospital, dispensary, and private practice, reaching over a period of three years, and during which many thousand injections were administered, has given me greater satisfaction than any other method that I have ever employed. In keeping with the above expressed feeling a cordial invitation is herewith extended to those members of the profession who have the inclination and opportunity to investigate this method of treating phthisis, and to whom a reprint on the subject, with full information and blanks to report cases, will be cheerfully sent on application. THOMAS J. MAYS, M. D. 1829 Spruce Street, Philadelphia, Pa. Plea for More Extensive OPERATING IN CANCER OF The Uterus. During the last two years Wertheim has been having many sections made of the glands and parametrium in every case of cancer of the uterus that came to operation, thirty-three in all. In eleven some of the glands in the region were found invaded by the carcinoma, including five in which the neoplasm had been supposed to be in its earliest stage; that is, in twentysix cases of operable carcinoma of the cervix the glands were found involved in 20 per cent. In one case, a commencing cancroid of the portio, a cancerous gland about the size of a cherry was found close to the right external iliac vein. No traces of cancer could be discovered in any of the other glands, nor in the parametrium. In another case, a circumscribed nodule on the posterior lip of the portio vaginalis was accompanied by a cancerous gland the size of a hen's egg on the left external iliac vein. In the third case the cervix was entirely cancerous, and a cancerous gland was found close to the right uterine vein. In the fourth the cervix was cancerous, and the parametrium and neighboring glands were normal, but at the point where the left ureter crosses the common iliac a cancerous gland the size of a cherry was found. In the fifth a narrow strip of cancerous tissue in the right parametrium led to a very large cancerous gland adherent to the external iliac vein. Cancerous fibers and nests were found several times in the parametrium, when to the eye and touch it seemed perfectly normal. Wertheim considers these findings important testimony to the necessity of extirpating the glands in the vicinity, and the parametrium in all cases. His technique includes exposing and liberating the uterus and the iliac blood-vessels. The glands are carefully sought for along the vessels and excised up to the fork of the abdominal aorta, and the parametrium and paravaginal cellular tissue are extirpated with the uterus and the upper portion of the vagina. Omitting light inoperable cases, he has had three die out of twenty-five patients operated on, one from invagination of the small intestine, the others from peritonitis. The remainder recovered, and have shown no signs of recurrence to date. The operation requires seventyfive to ninety minutes. The ureters are easily isolated unless fixed by inflammatory processes. The vessels are readily exposed. Hemostasis has to be applied to even the smallest ramification of the veins, and trained assistance is necessary. Provisory ligature of the hypogastric artery was of no appreciable benefit. The extirpation of the glands is difficult only when they are adherent to the vessels. In future, he remarks, it may be possible to restrict the extirpation to those glands which alone are tumefied, as in none of his sections were traces of carcinoma to be found in the normally small glands. The general health and the state of the heart should be carefully weighed before attempting intervention. If these are favorable, unexpectedly gratifying results may be attained.-Wiener Klinische Wochenschrift; Journal of the A. M. A. PREGNANCY AND OVARIAN TUMORS. Richard Mond (Munchener Med. Woch.), from his own experience, and from a review of the literature on the subject of pregnancy and ovarian tumors, considers the following points as authorized: 1. Ovariotomy is the justifiable therapy as soon as an operable ovarian tumor has been diagnosticated during pregnancy. With the increasing size of the tumor there will be conditions favorable for firmer adhesions, thus complicating the removal; for this reason there should be laparotomy as soon as the diagnosis is certain. 2. According to present statistics, to obtain the best results for the mother the operation should be between the second and fourth months of pregnancy; for the continuance of pregnancy, between the third and fourth. 3. The dangerous complications resulting from delay, such as torsion of pedicle, suppuration of cyst, etc., demand immediate operation. 4. Puncture of cyst and artificial abortion are only makeshifts and not therapeutic measures. In dubious cases puncture is allowable, and. eventually, incision. 5. A growth of the tumor in pregnacy is observed in most cases. 6. If the pregnancy is far advanced when the patient is first seen, then also ovariotomy is indicated. 7. During labor even a reposition of the tumor under narcosis may be attempted. In case of small cystic tumors, puncture, or even incision, is indicated. 8. In case of a solid tumor and living fetus at the time of labor, Cæsarean section is indicated, with a removal of the obstruction to delivery. 9. After delivery we should wait one or two weeks before operating, until the question of puerperal infection is decided, and involution of the uterus far advanced. 10. During the puerperium an enlargement and growth of the tumor have been observed. - The Chicago Clinic. ANTITOXIN TREATMENT OF TETANUS.-As a result of a careful study of this subject, Moschcowitz (Annals of Surgery) appends the following résumé to his paper: All forms of tetanus are caused by the bacillus of Nicolaier; hence the diagnosis rheumatic or idiopathic should have no room in our nosology. The tetanus toxins appear to have a distinct affinity for the anterior horns of the spinal cord, which may be distinctly recognized by Nissl's method of staining. The cerebro-spinal fluid of tetanus patients is more toxic than the blood. The antitoxin therapy appears to have a distinct beneficial influence upon the course of tetanus. With the antitoxin treatment the mortality percentage has been reduced from about ninety to forty per cent. Although the use of the serum is a most important factor in the treatment of tetanus, the other recognized therapeutic measures should not be neglected. The Therapeutic Gazette. PROGNOSIS AND TREATMENT IN PULMONARY TUBERCULOSIS.-Robert Maguire (The Lancet). In this second lecture Maguire continues the subject of the prognosis of tuberculosis. Pyrexia, he thinks, is not so significant; it may be absent, and he does not consider that tubercular poisoning itself often produces pyrexia, but rather that it is due to staphylococcal and pneumococcal poisoning. An increased morning temperature, and the nearer the approach to evening temperature the worse the outlook for the patient. General weakening at the commencement of the attack greatly increases the gravity of the case. This is especially so if there is a cardiac or vasomotor weakness. Hemoptysis causes altogether too much alarm, especially in the early stages; it occurs from so many other causes that he |