Vol. 60, 1909 - University of North Carolina at Chapel Hill

Treatment ol Empyema of flie Nasal
Sinuses.
Mortens describes a suction apparatus of his own
construction, which he claims is of great aid in the
diagnosis of suppuration of the ethmoidal cells and
the sphenoidal and frontal sinuses. This apparatus
is especially valuable in diagnosing suppuration of
the ethmoidal cells. The apparatus consists of a
suction pump to which a muck nasal tip is attached
by means of hose with a vanknmeter intervening
lo register the suction power. Suction being continuous.
With the apparatus in motion and lo to 15 cm.
mercury pressure registered, the muck tip is placed
into one of the nostrils of the patient. The patient
is then instructed to repeat the word "Tik" to bring
about the shutting off ot the naso from the oral
pharynx. The patient's otlier nostril is then closed
by applying pressure with the linger. The lateral
opening of the nasal tip is closed with the physician's
finger, thus suction is brought about in the
nasal cavity. Fifteen to twenty-five centimeters
applied for three to five minutes suffices usually to
draw pus from the sinuses into the nasal cavity,
when it exists. If applying suction pus appears in
the nose previously free from purulent discharge,
the diagnosis of empyema is made. Not only is
this method valuable for diagnosis, but also for
therapeutics. Ridding the cells of pus frees the
mucous membrane and favors restoration. The
suction applied causes hypertemia of the tissues,
which, according to the Bier theory, tends to healing.—
Deutsche Med. Woch.
Adrenalin: Its Action on tbe Skin.
Sardou discusses the remarkable benefits to be
derived from painting the skin with adrenalin.
His results are based upon the results obtained in
54 cases during the last six years. Among the conditions
treated were toxic erythemas, urticaria,
acne, sunburn, bee sting, eczema, pruritus, nevus,
contusion, inflamed chilblains, headache, and congestion
of the facs from indigestion, sciatica without
neuritis, arthralgia, arthritis, varices, etc. The
adrenalin applied to the skin is rapidly absorbed
and acts on the vessels in the region. Durable
vasoconstriction is obtained by a moderate, graduated
application of the adrenalin, rrnewed according
to the effects produced. Too large a dose, at
first, paralyzes the reaction. Hffin.orrhoids are
benefited when moderate nnd recent, unless tliey
are the result of portal hypertension. The measure
may also fail on account of sclerosis and paresis of
the walls of the vessels. The effects of the adrenalin
are similar to those of constriction hypertemia.
When applied locally it re-enforces the local defenses
without waiting for general reactions, the
outcome of which it is impossible to foresee. The
adrenalin is able to act in the depths of the tissues
and to aid their defensive efforts, or the adrenalin
may arouse them to more effective resistance.
Annales generalcs de Medecine.
Hydrocepbalus, Chronic Iiilop&thic Internal,
Cured by Draizcage ol tbe
Ventricle.
Halben states that all the main symptoms have
retrogressed since the operation done by Pavr last
October. The patient was a girl of sixteen ; Payr
introduced into the right lateral ventricle a piece
of an artery about 2 millimeters in diameter taken
from a calf. The artery had been hardened in
formalin and dipped in paraffin, and was fastened
to allow couim\inicatiou between the ventricle and
the epidural and subdural space at the top of the
head. The headaches, choked disc, nystagmus,
—
THE CHARLOTTE MEDICAL JOURNAL.
abducent paralysis and tremor all vanished once 01!
by the end of a month, and vision, which had beeUi
1-2 on each side, was 4-5 and 5-5 when the patient
was discharged two weeks after the operation,]
Slight headache at times is the only trace left of'
the former trouble, except that the papilla look3i|
little dirty. The patient had always suffered mo
or less from headache, but the other symptoms i
developed about five months before the operatic
—Deutsche medizinische Wochenschrift.
Hypertropby ol tbe Lymphoid Tissua
ol tbe Pbarynx and Its Relation to 1
Tuberculosis. |
P. Nobecourt and Leon Tixier have examinedl'
twenty-two children from thirty-one mouths tAj
four years of age, all of whom had large adenoids;
and enlarged tonsils, but none of whom had pnlmonary
tuberculosis. They sought for appreciablej
tuberculous lesions and used tests for the presenoej
of tuberculosis; the subcutaneous method, ophthal-|
mic reaction and skin reaction were used as tests,:
A table of the results is appended. Bacteriologica'
and histological examinations of the tissues rt
moved were made. Of the children thirteen had;
no sign of tuberculosis; six had doubtful signsjj
three were considered clinically tuberculous, andj
two were clinically doubtful. The skin reaction;
was positive twelve times; the ophthalmic reaction]
was positive four times; only five infants out of thtj
twenty-two could be considered free from tubercu-|
losis, and yet almost ali enjoyed excellent health.;
The portions of tissues removed and examined!
never showed tuberculous foci. The authors conclude
that tuberculosis of the tonsils and adenoid]
tissues of the pharynx is rare. In these children]
who were openly tuberculous the inoculation ol;
guinea pigs with the tonsilla tissue never produced
tuberculosis. The lymphoid tissues didnotserv«j
in these cases as the door of entry for the bacillus 1
tuberculosis —Gazette des Hopitaux. ;
Pulmonary Empbysema and FaJty De-I
generation ot tbe Diapbragm in
Dipbtberttic Intoxication. I
G. :\Iya has observed in children «ho wert- sub-
ject to severe diphtheritic intoxication a cdiuiition'
of emphysema of the lungs, which may go .=0 fai
as rupture of the vesicles of the lungs ami sub-
pleural, and even subcutaneous emphysema. The
type of case in which this is .seen is that in >. liicb i
there is a necrotic angina with great enlarj;i;nienl 1
of the glands of the neck, myocarditis, albumniiiria, i
cutaneous hemorrhages, and muscular astiie nia '
Such cases generally result fatally. In life tlie arei |
of resonance of the lungs extends down to lli< ;
seventh rib in front and the twelfth behind, aiic .
the vescicular murmur is enfeebled, while inspira
,
tion is short and superficial. In these ca?es tber<
is no laryngeal stenosis, and hence the coulitifir I
cannot be referred to the extra effort required foi
resjiiration. At autopsy the clinical evidences i
confirmed by finding the macroscopic and micro
scopic characteristics of etuphysema. In thest
cases there is also found a fatty degeneration of tin
muscular fibers of the diaphragm, which aid:
lack i)f elasticity of the lungs, due to deficient
power of the elastic fibers in producing the euiphy
sema.— Rivista Di Clinica Pediatrica.
Graduated Rest In Pulmonary Tuber;
culosls.
It is possible to give the lungs approximate, nolj
complete rest. This latter measure should be pre^
scribed sufficiently early and for suBBciently lonfj
periods. .\11 patients who exhibit even the smallest
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