The Medical Fortnightly

DEPARTMENT OF INTERNAL MEDICINE.

BY O. E. LADEMANN, M. D.

ST. LOUIS.

A Case of So-called Idiopathic Dilatation of the Esophagus.-(Lockwood, Brit. Med. Jour., June 13, 1903.)--A woman 27 years old had a dilated esophagus resulting from a spastic contraction of the cardiac end. Dilatation of the cardiac end was practiced several times daily by means of a sound, the lower end of which was inflated with air after its introduction. The case finally recovered.

To Facilitate the Microscopical Diagnosis of Malaria. ( Ruge, Deutsche med. Wochenschrift, 1903, No. 17.).-A thickly spread preparation of blood, before dried, is placed for 15 minutes in a 2 per cent formalin and per cent acetic acid solution, the latter dissolving the hemoglobin. The specimen is next thoroughly washed in distilled water and stained with eosin and methylene blue. The plasmodium shows the blue distinctly, even where several blood corpuscles lie on top of one another.

The Etiology and Therapy of Membranous Colitis.-Bottentuit, Brit. Med. Journ., June 27, 1903.)-The disease may occur at any age, and is usually associated with constipation, which no doubt plays a role in the etiology. Neurasthenics and gouty individuals are especially predisposed. The diagnosis is readily made from the character of the stools, which contain mucus and particles of false membranes. The disease is often mistaken for appendicitis and sometimes confounded with biliary and renal colics. One of the first steps in the treatment is to discontinue the prolonged use of the different cathartics which these individuals have been accustomed to using. Milk diet which is so frequently prescribed is contraindicated. The diet of such persons is to consist of tender meats, fish, vegetables, rice and macaroni. Acid foods, fats and coarse foods are to be avoided. The meals should be small and the food thoroughly masticated. Of medicaments, Carlsbad water, artificial or natural, is to be recommended. The obstinate constipation is best treated with castor oil or calomel. It is of the greatest importance to irrigate the lower bowel with one-half liter of warm water two or three times daily. In spastic conditions of the intestines prolonged warm baths are useful.

The Diagnosis of Diseases of the Lungs by Means of the Roentgen Rays. (Dolly, Lancet, June 27, 1903.)-The author concludes that by means of the Roentgen rays we have a valuable aid in the diagnosis of thoracic diseases. Unilateral diaphragmatic limitations which can be easily detected by the fluoroscope are often the first signs of a beginning tuberculosis. Occasionally the Roentgen rays also reveal the existence of infiltrated tubercular areas.

Ehrlich's Diazo Reaction as a Differential Diagnostic Aid. (Pelzl Wiener klin Wochenschrift, 1903, No. 31.)-Among 500 patients, the au

thor found a positive diazo reaction in the following diseases: 1. In all his cases of typhoid between the middle of the first to the end of the third week. 2. In measles before and during the first part of the eruptive stage. 3. In scarlatinous diphtheria. 4. In advanced tuberculosis of the lungs and serous membranes. 5. In sepsis.

Diagnosis of Carcinoma of the Stomach.- (Solomon Deutsche Med. Wochenschrift, 1903 No. 31.)-Having thoroughly lavaged the stomach with water, a normal salt solution is used to irrigate. The returned salt solution contains more nitrogen than in other gastric affections. (The N. exceed 20 mg. in 100 g. of returned water estimated by the Kjehldahl method.) There is also an increase in the albumin (an intense and rapid clouding with the Esbach reagent). This increased amount of albumin may possibly occur in other severe gastric affections.

Ankylostomiasis (Baker Brit. Med. Jour., March 27, 1903.)-As to the distribution, ankylostomiasis occurs almost in every section of the earth, but chiefly in warm climates among earth workers who live under unfavorable hygienic conditions and careless about cleanliness of their person, particularly their hands. In the majority of cases the infection is carried by means of the food, less frequently in drinking water, other sources only occur exceptionally. The first symptoms are insidious, consisting of slight gastric disturbances and rarely ever come under the physician's observation. Not until there is a marked anemia with its associ ated symptoms (headache, vertigo, palpitation, etc.) is the doctor consulted. Edema usually begins under the eyelids and towards the termination of the disease albuminuria and mental apathy occur. The diagnosis is readily made by examining the stools, which constantly contain the ankylostoma eggs and frequently the parasites themselves The autopsy, besides the changes secondary to the anemia, as fatty degeneration of heart muscle, kidneys and liver, shows numerous small ecchymotic areas in the mucous membrane of the small intestines, indicating a former hold of the parasites. In addition numerous parasites and their eggs are found adhering to the intestinal walls. In the peripheral cells of the hepatic lobules a deposit of yellow pigment is usually seen. The anemia is not

only due to a constant loss of blood, but probably also to a hemolytic poison which the parasites themselves produce. The author recommends thymol in doses of 0.5-3.0 grams in intervals of several hours. In debilitated dividuals large doses should not be administered. If after four or five days administration, eggs are still present in the stools another thymol treatment should be given.

A Case of Chloroma. (Weinberger, La Medecine Moderne, June 24, 1903.)-A boy 15 years old, who in July, 1902, had an attack of scarlet fever, since which time had a weakness and rigidity of the lower extremities. Later the cervical and inguinal lymph glands began to swell, with cutaneous hemorrhages, fever, cardiac dilation, enlargement of the spleen and hemorrhages from the nose and gums. The blood examination showed 4,500,000 red corpuscles, 45 per cent hemoglobin and 13,000 leucocytes (86 per cent being large lymphocytes). The patient rapidly declined and died in coma. Autopsy showed an enlargement and green dis

coloration of nearly the entire lymphatic system, including various other adenoid tissue as the tonsils, lymph follicles of the stomach and intestines. Greenish tumors were also found in the dura mater, the serous membranes and the parenchyma of liver and kidneys with proliferation in the vertebral canal. The bone marrow was red and consisted mainly of large lymphocytes.

Rhythmic Jerking Movement of the Head.-(Musset's sign). Herzog (Deutsche med. Wochenschrift, March 26, 1903.) The author has observed rhthymic movements of the head in almost every case of aortic insufficiency and aortic aneurism which came under his observation. In these cases he is of the opinion that the motion is due to an increase in the general blood pressure. He also observed this sign in alcoholism, atheroma, interstitial nephritis and hypertrophy of the left ventricle. In these cases he believes it to be due to increased local pressure, either the result of atheroma or stasis.

The Widal Reaction in Icterus.-(Kohler, Muench. med. Wochenschrift, 1603, No. 42.)-Out of 100 cases where a previcus attack of typhoid could be eliminated, Kohler found the reaction positive twelve times in the following dilutions:

The author classifies the condition where the Widal reaction may be positive in the following groups: 1. Typhoid. 2. Diseases of the liver with icterus. 3. The action of chemical substances, as formol. 4. Infection due to the colon bacillus. 5. Infections due to other bacteria which are of minor importonce, as pneumococci and meningococci (rare), etc.

Albuminuria in Aortic Insufficiency. (Prof. Leube Meuchner med. Wochenschrift, 1903, No. 30.)-Leube discusses the different forms of albuminuria in aortic insufficiency as follows: 1. In aortic insufficiency with a combined parenchymatous nephritis, both originating from the same cause, as the acute infectious diseases. 2. In lesions of both the pulmonary valves of the aorta and the kidneys, secondary to atheromatous changes in the arterial system (atheromatous induration of the kidneys). 3. Albuminuria resulting from a renal engorgement in incompensated cardiac lesions, leading to secondary interstitial renal changes (cyanotic induration of the kidneys). 4. Albuminuria in young individuals without an associated nephritis and a perfectly compensated heart. The author

calls particular attention to this form of albuminuria, which he demonstrated clinically and pathologically. The renal changes, which he terms as an arterial induration of the kidneys, are explained in the following manner. Owing to a constant difference of pressure in the arteries and capillaries, their walls become thickened (arterio-capillary fibrosis) with a peri-arterial formation of connective tissue, which encroaches on the vessels, thereby interfering with the nutrition of the golmeruli and tubules, with a secondary degeneration of the epithelium.

Gall-stone Colic without the Presence of Calculi.-(Krukenberg, Berliner klin Wochenschrift, 1903, No. 99.)-The author reports two females age 25 and 36 respectively, who were subject to frequent attacks of biliary colic. A surgical operation revealed the gall-bladder free from stones. In each case the gall bladder was anchored to the liver, as they were freely movable. The attacks never returned, which led the author to believe that they were brought about by the freely movable gall bladder twisting upon its neck.

A Case of Gonococcus Pneumonia. (Bressel, Muenchner Med. Wochenschrift, 1903, No. 13.)-A man 22 years old, with an acute gonorrhea, shortly after his admission to the hospital suddenly began to run a temperature with signs of a general intoxication and pain in the left side of the chest. After a few days observation, besides a diffuse bronchitis, dullness and bronchial breathing manifested themselves below the left shoulder. In the course of several days the temperature ended by lysis and the infiltration began to absorb. The sputum was moderately profuse, a dirty muco-purulent color, the microscopical examination showing numerous intra-cellular cocci which decolorized according to the Gramm method. Two cultures were made from the patient's blood, the colonies cultivated presented the morphological characteristics of gonococci in pure cultures.

Paratyphoid. (Ascoli, Zeitschrift fur klin. Medizin, Bd. XLVIII, page 418.)-The author reports an interesting case of paratyphoid, the clinical and anatomical changes (post-mortem) identical with a typhoid. The bacilli cultivated from the spleen and blood of the patient did not agglutinate with the serum of typhoid patients. The Gruber-Widal reaction was constantly absent, although the individual's serum agglutinated strongly the cultivated bacilli and the colon bacillus. Ascoli then discusses the question as to whether one is justified in classifying paratyphoid as a distinct disease caused by a specific micro-organism. Contrary to Schottmueller, who regards it as a distinctly separate disease, the author is of the opinion that this condition is caused by a different variety of the typhoid bacillus.

Tubercular Peritonitis.-(Carpenter, Med. Press and Circular, March 18, 1903.) Among 54 cases of the authors, 19 died, 10 recovered, 16 improved and 9 left his observation. Carpenter does not advocate surgical interference in tubercular peritonitis, preferring the conservative treatment as sea air, good diet and inunctions of the abdomen with blue ointment.