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

ABSTRACTS. 261
should be added those of 19 children who intention and the patient made a good resuffered
from exophthalmic goitre and scrof- covery. The uterus was closely moulded
ula, in some form, at the same time. All to the foetus: there was barely an ounce of
the signs of the disease were well marked somewhat turbid liquor amnii. The foetus
in 12 of these cases, whereas in seven the was the size of a full term child and, judgexophthalmus
was absent or only slightly ing by the general appearance, the length
marked. of the nails, and the amount of hair, it ap-
Eulenburg, who combines the thyreogenic peared to be fully developed. The skin
theory with the hematogenic theory pro- was of a dirty brown color; the cuticle,
pounded by Basedow, is inclined to assume wrinkled and easily detached, was covered
that the stimulus which strikes the thyroid in parts with a cheesy substance which was
gland,inducing the peculiarspecific changes deep yellow as if stained with bile. The
in the composition of the blood, is determ- bones of the skull were loose and moved
ined by a primary change in the constitu- easily as one pressed on the scalp. The
tion of the blood In view of the fact that wall of the uterus was about half an inch
according to the investigations of Lieber- in thickness; the muscle was pale and easily
meister, tubercle Ijacilli have been demon- split into layers. The placenta was situstrated
circulating in the blood in a very ated almost centrally over the internal os
high percentage of pulmonary tuberculosis, and lined the lower two-thirds of the uterus;
it is not unreasonable to assume that the it was of-very firm consistence. A thin
toxin formed by these bacilli represents the gray membrane separated the uterus from
actual etiological noxious factor, as far as the placenta and remained attached to the
tuberculosis is concerned. The nervous former when the latter was removed. The
disturbances, according to Eulenburg, are specimen was quite odorless. Microscopicprobably
due to the action of the tliyreo- ally, the placenta showed a finely scattered
toxin upon the nervous system. The ob- calcareous deposit, the villi had undergone
servations of Weonberg, to the effect that hyaline degeneration, and there was old
consumptives may suffer for years prior to thrombosisof the intervilloussinuses. There
the appearance of objectively demonstrable was a considerable amount of fibrous tissue
pulmonary changes, from nervous and neu- scattered among the muscle fibres of the
rasthenic disturbances, seem to be in favor uterus, but the muscle itself did not show
jf the possibility of a bacterial toxic action any marked change. The walls of the
upon the nervous system. arteries were thicker than usual, many of
the large blood spaces were filled with old
Case ot Missed Labor Treated by Ab- thrombi, and, in some, organization of the
lomlnal Section.— I'urslow ( Dublin Medi- thrombus was well marked.
:al I Journal mentions
hirty-three
a case in a woman,
years of age, married twelve Cancer of the Penis.—Don, in the Edinrears,
who had had four children and the burgh Medical Journal, says that syphilis
fear previously a missed abortion. She alone can be confounded with cancer of the
vas first seen in September, 1907. In Feb- penis, and a short, sharp course of iodides,
uary she had felt foetal movements; these with removal of a small part for microscopiontinued
up to June and then entirely cal examination, will clear up the diag-
•eased; since that time she had suffered nosis. The precancerous conditions are:
rom a rather severe constant pain in the 1. A surface shedding of the epithelium and
ibdomen from which she was very anxious a vascularity of the deeper layers, with
o be relieved. On examination she was much leucocytotic infiltration and induraound
to present the signs of. full term ges- tion. 2. At first only a marked thickening
ation, but there was very little liquor amnii, of the epidermis or leucoplakia, either uni-
.nd the uterus was hard and felt as though form or only over the papillae, producing
t were in a continual state of tetanic con- horny or filiform processes. 3. A condition
iraction; it was tender on palpation. The resembling "psoriasis preeputialis."' The
iervix was not typically softened and the mode of spread is: 1. Early involvement
s was closed. Two davs after admission by emboli of the nearest glands through
he was placed in the lithotomy position the lymphatic vessels. 2. Penetration lo-
,nder anaesthesia with the intention of dilat- cally into the neighborhood. This is a
(ig and evacuating the uterus: it was found comparatively slower process. 3. Permeapossible
to pass a Ilegar's dilator into the tion along the lymphatic vessels. Here the
erus and the same was the case with the infection must pass along the whole length
erine sound. As Purslow was at a loss of the penis till it reaches the trunk, and
explain this he susijected a fibroid in the consequently the spread by permeation is
wer segment. He therefore opened the
domen and removed the uterus by pan-
"ot of vital consequence. Infection of the
lymphatic glands is much earlier than perrectomy.
The wound healed by first meatiou of the lymphatic vessels would ac-