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

Miscellcincous.
THE CHARLOTTE MEDICAL JOURNAL.
Appendicitis and Adnexitis.
Henry Hartraaini describes appendicitis
accompanying adnexitis as Ijeing conveyed
by way of the peritoneum, there being no
direct connection between these structures
by way of the blood-vessels or lymphatics.
In the woman the appendix frequently descends
into the pelvis by pressure of the intestines
and of the corsets. Diagnosis is
somewliat difficult before operation. Pain
is generally located lower down in adnexitis
than in appendicitis. The history of the
case is of value. The absence of a history
of menstrual troubles and ascending infection
is in favor of appendicitis. The picture
of peritonitis is more marked in appendicitis,
the expression is more anxious, the
sensibility of the abdomen and the distension
are greater. Temperature is more elevated
and the condition is progressive, while
after a time in adnexitis it is regressive.
Treatment demands immediate operation
as soon as a diagnosis is arrived at.—Annales
de Gynecologic et d'Obstetriques.
Treatment of Some of the Severer
Forms oi Headaclic.—Harris (Brit. Med.
Jour. ) in discussing this subject classifies
the causes of headache as A, Superficial.
1, Diseases of brain coverings; a, scalp; b,
pericranium; c, bone; 2, reflex visceral neuralgias
of the scalp. B, Deep. 1. Reflex
cortical neuralgia. 2. Toxaemic. 3. In
creased intracranial pressure.
Diseases of the brain coverings are due to
morbid processes as rheumatism, syphilis
and tuberculosis and should be treated as
such. Reflex visceral and cortical neuralgias
are best treated by rest and anti-neuralgic
remedies as phenacetin, pyramidou
and that class of drugs. Toxamic headaches
are treated by establishing a regular
daily habit of the bowel. Increased intracranial
pressure causes the most severe
headaches and are usually only relieved by
the use of the trephine. If due to meningitis,
lumbar puncture may bring relief or
leeches applied to the temples or back of
the ears. The treatment of migraine he
divides into local and indirect by lowering
general blood pressure. The first includes
trephining, lumbar puncture, leeches to the
scalp, fomentations, hot bottles or ice bags.
The second includes nitroglycerine and
nitritis, opium, aconite, chloral, phenacetin,
antipyrin, purgation, diaphoresis and a hot
bath. Harris has had good success by applying
leeches to the .scalp, giving 10 grains
of Dover's powders, with a hot drink containing
'6 grain of pilocarpin and keeping
the patient warmly wrapped so as to promote
pefspiratiou.
Modification of the Original Wasserman
Test for Syphilis is published by Bauer in
the Deutsche Medizinische Wochenschrift.
The requisites of the test are, besides the
serum of the suspected individual, some
normal human serum; an alcohol extract
of the liver of a syphilitic foetus or infant;
fresh guinea-yig serum; and a suspension
in saline solution of sheep's blood corpuscles.
The two human sera are first heated
to 56° C, and then four small test-tubes
are prepared in the following way: One
contains the patient's serum with five times
the quantity of liver extract and of the
guinea-pig serum; the second has normal
saline solution substituted for liver extract,
and the third and fourth resemble the first
two, but contain normal instead of suspected
serum. After incubatioji at blood temperature
for an hour the sheep's blood suspension
is added to each. Hsemolysib occurs
in the third and fourth, and more
slowly in the second; whereas, if the patient
is infected with syphilis, the first rube
shows no haemolysis. One of the problems
connected with these serological tests for
syphilis is to determine precisely at what
interval after the incubation of the disease
the serum reaction makes its appearance.
On the analogy of the Widal test for typhoid
fever some such latent period would
be expected, and the point is one whose
elucidation will be observed with interest.
The claims that have been made on behalf
of the infallibility of the Wassermann reaction
have been great, but if extended research
really proves that the method gives
absolute assu.ance whether a patient does
or does not harbour the virus of syphilis
within him, it is difficult to name a more
important recent bacteriological research.
As yet, however, experts seem chary of
committing themselves quite as far as this,
and rightly so until more work has been
done.—The Hospital, London.
Dr. Livien discusses the identification of
the spirochseta pallida and the detection of t
specific antibodies in the serum of people ^
infected with syphilis. No serum therapeutic
treatment had been found effective.
Mercury and iodides remain the chief reme- i
dies. He states that mercury is best ad- •
ministered by injection or inunction, and
that atoxyl, given in efficient doses, has
proved experimentally to produce similar ;
results, but is dangerous to the optic nerve.
|
The diagnosis should be certain before!
treatment is started. Spirochseta should I
be found, or time given for the serum-test, I
or the appearance of the roseola. In most]
of tne cases where ihunctions and injections f
are employed local treatment is nnneces-ji/
sary. Mercurial plaster should be used to