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

258
THE CHARLOTTE MEDICAL JOURNAL.
except with primary growths of the lung, not a common method of infection, but
when it often has the "red-currant-jelly" sundry cases are on record which prove its
possibility
appearance.
and indicate the undoubted dan-
9 Pleurisy is common with neoplasms, ger from that source. 5. Hospital infec- :,
10 The dullness of a neoplasm tends to tion. The statistics our author refers to do j
have an irregular outline and distribution, not testify to much danger of infection to i
11 A neoplasm mav appeal externally those who have the care of consumptives, i
and iiave transmitted pulsation. A distinct but show that with proper precautions such i
prominence is rare and the tumor need not service is quite safe. At the same time i
be in the line of the aorta. It is not ex- occurrence of tuberculosis among the porpansile
has no thrill and no diastolic shock, ters, especially among those who handle i
A svstolic murmur may be present, but is the sputum, demonstrates where the true |
rarelv conducted along the vessels. There dan gt^r lies, and inculcates the importance i
is no diastolic sound. of dealing effectually with this element o i
Gumma and aneurysm not infrequently d;niger. The writer says that ingestion of 1
coexist. In this and any case where gumma tuberculous material by the intestines is the i
is suspected iodide of potassium is a power- commonest, inhalation by the air passages ;
ful diagnostic instrument. In the general comparatively rare, except that which oc- •
diagnosis of whether or no an aneurysm be curs in the upper air passages, affecting the j
present Killian has recently been very sue- lungs through the lymphatics. Infection j
cessful with the aid of a bronchoscope. In througli wounds of the skin and mucous 1
all cases the X-rays should be employed, membrane is not common, but occurs :
but after rather than before physical ex- among those who handle sputum and other ,
amination. tuberculous material where proper precau- j
tions are omitted. Infection by coition, i
Tlie Infection ol Consumption.—Wil- though it occurs occasionally, is rare. «
Hams, in The British Medical Journal, dis- Finally, all infection from consumptive pa- ;
cusses the various sources of infection in tients can be avoided if the well recognized j
pulmonary tuberculosis. 1. Husband and precautionary measures are adopted and ij
wife infection. In one out of three cases carried out thoroughly.
where consumptives married three wives, . .
one wife survived, and out of nine cases Retroversion ol the Uterus.— Brewis, in ,
where consumptive husbands married twice. The Edinburgh Medical Journal, says that I
the last wife survived in three instances, after curetting the uterus, an incision should (
giving a total of thirteen husbands to thirty- be made immediately above the pubes, ex- j
one wives, of whom twentv-seven died and tending for a distance of about two and j
four lived in apparently good health. It one-half inches. The incision should be !{
would appear that the infecting husbands made through skin, superficial fascia, and
were often in an early stage of the disease fat. Retractors should then be placed at
when infection took place, and some sur- one end of the wound, one being placed
vived their wives bv many years. 2. Infec- parallel to Poupart's ligament, the other
tion throuo-h the air passages by inhalation, parallel to the inner aspect of the thigh.
Though it is improbable that inhalation is Strong traction is now made with those rethe
principal means of lung infection, there tractors, so that the edges of the wound are
is every likelihood of some infection taking widely separated, and the inguinal canal
place through the upper air passages, and area is exposed; but before reaching the inthat
the bacilli enter the lymphatics of the guinal ring, a well defined layer of deep
mouth and infect the lymphatic glands of fascia has to be reflected. This is bes'
this reo-ion and the tonsils, which are often done by dividing it parallel to the fibres o:
the seat of tubercle. The frequent occur- the external oblique until the external open
rence of strumous submaxillary and cervi- ing of the ring is exposed. The suprapubu
cal glands may be due to this cause. 3. In- transverse incision has two advantages ove
fection through the intestines. The most the one commonly used. Its position abov<
important item in this form of infection is the pubes renders it less liable to contami
that of milk and meat, and after the con- nation, and it also permits of free retractio*
elusive evidence of the British Royal Com- and good exposure of the inguinal area
missioners, confirmed by numerous other Before proceeding further divide the inter
authorities, there can be no longer any columnar fascia, pick up with a hook th
doubt as to the danger to the human body, mass, filling up the external ring, then sep
and especially to children, from bovine arate carefully the ligament from the fascia
tubercle bacilli contained in milk. The sheath. Having done this, you will be abl
danger of infection from the meat is not so to draw out the ligament. In doing sc
great. 4. Infection through the skin and make gentle, steady traction, and withdraw
mucous membranes by wounds. This is it until it presents a distinct shoulder. Tb
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