62 



POPULAR SCIEiq^OE II^TEWS. 



[April, 1888. 



be, and easily gets well without treatment, although 

 more or less comfort may be obtained from appli- 

 cations, and it is even possible, if the case is seen 

 in the earliest stages, to stop it then and there, or, as 

 il is said, "abort the attack." This happy con- 

 summation is not often attained, and an acute 

 rhinitis, generally a distressing feature of a cold 

 in the head, usually runs its own course of a few 

 days, and gets well, or runs on into a more or less 

 chronic form. 



Chronic rhinitis has three forms of marked 

 difference in fact as well as in nomenclature. The 

 first is known as simple chronic rhinitis; that is, 

 an uncomplicated chronic inflammation. The 

 second is called hypertrophic rhinitis, because it 

 is attended by an hypertrophy (increase) of the tis- 

 sues involved. The third, directly opposed to the 

 second, is atrophic rhinitis, because it occasions an 

 atrophy (decrease) of the tissues involved. Simple 

 chronic rhinitis is the continuance of a trouble 

 once acute, and which goes on and on, scarcely 

 heeded by the sufferer. The discharge is constant, 

 is rather thin, and easily removed. There is no 

 obstruction of any moment to breathing, no altera- 

 tion in the sense of smell, no pain. The disease 

 is an annoyance, but not very hard to endure. 

 And so it is that after a while simple rhinitis lapses 

 gradually into a later stage, or hypertrophic rhinitis. 

 In this condition the discharge is thicker, more 

 tenacious, less easily removed. The membrane 

 which secretes it, and which covers the nasal cham- 

 bers, increases so as to take up part of the space 

 naturally allotted for the passage of air, and thus 

 occa.sions difiiculty in respiration, — a difficulty 

 ■which is likely to be re-enforccd at every fresh 

 attack, when a new congestion of the surface is 

 superadded to the existing hypertrophy. The 

 troublesome breathing, the nasal toae, the general 

 sense of discomfort, send patients in this stage to 

 a physician, whose examination will generally dis- 

 cover the membrane of the lower air-passages irreg- 

 ularly swoJlen, so as to occlude with more or less 

 completeness the air-channels, and covered with a 

 thick rauco-purulent secretion. The third and un- 

 common stage is due to the contraction of new 

 tissue that is formed by the inflammatory processes. 

 The new growths that blocked the way in the 

 former stage are shrunken in this, so that there 

 is no obstruction to respiration, and no alteration 

 in the voice. The discharge is altered ; instead of 

 being profuse and liquid, it is scanty and dry, 

 forming crusts and scales. In the cavities formed 

 by the irregular deposition of tissue, some of the 

 secretions may be retained and decomposed, the 

 resulting odor giving the name of fetid catarrh 

 or rhinitis to this condition. 



One of the main difficulties attendant upon the 

 cure of nasal catarrh is the time and patience re- 

 quired. We are all apt to prefer the incon- 

 veniences of the milder forms of disease to the 

 inconveniences of getting them cured. And the 

 cure of " the catarrh " demands not only the 

 physician's skill, but its oft-repeated exercise. 



[Specinlly compiled for the Popular Science Jfewa.] 



MONTHLY SUMMARY OF MEDICAL 

 PROGRESS. 



BY W. 8. WELLS, M.D. 



Successful operations for the removal of 

 foreign bodies in the windpipe are always inter- 

 esting reading, and one of the most important 

 eases of this nature yet published was brought 

 before the Medico- Chirurgical Society, London, 

 lately, by Drs. Cheadle and Smith. The patient 

 was a girl nine years old, who had drawn into her 

 throat the loose metallic cap covering the end of 

 a pencil which she had been holding in her mouth. 



Immediately urgent choking and difficulty of 

 breathing followed, which was soon relieved by the 

 passage of a probang down the oesophagus ; and it 

 was believed, notwithstanding the great pain and 

 coughing at the time, that the foreign body had 

 been pushed into the stomach. 



Four days after the accident, dulness on percus- 

 sion, and imperfect entry of air into the left side 

 of the chest, were noticed. A week after this 

 there was almost total absence of respiratory mur- 

 mur on the same side; air entering only over a 

 limited portion of the upper part in front, with 

 great retraction of the left side of the chest, show- 

 ing that the lung must have been much collapsed. 

 The pulse and temperature remained normal ; there 

 was no difficulty in breathing, but occasional short 

 cough, aggravated by exertion. The conclusion 

 arrived at was, that the metallic cap, measuring an 

 inch and a quarter, was lodged at the extreme end 

 of the left bronchus ; and it was decided to attempt 

 its removal by tracheotomy. 



Provision was made for dealing with whichever 

 end of the cap should present, though it was 

 expected that the open end would be towards the 

 mouth; and for this, a pair of suitably curved 

 forceps with external grip was provided. 



The isthmus of the thyroid was divided be- 

 tween two ligatures, the trachea freely opened, 

 and the edges of the tracheal wound attached to 

 the edges of the skin wound by silk sutures, so as 

 to keep the trachea widely open. A long probe 

 was now passed into the bronchus, and at once 

 detected the foreign body in the jiosition assigned 

 to it, and with the open end uppermost. 



Removing the sound, the forceps were introduced, 

 and the cap extracted without the least difficulty. 

 The lung slowly expanded, and fourteen days after 

 the operation the patient was substantially well, 

 the wound having been allowed to granulate. 



The chief point in the operation was the wide 

 incision made into the trachea, and the stitching of 

 this to the skin wound, which kept it wide open, 

 which was found to be a great convenience during 

 the operation, as, when the trachea is held open by 

 hooks, these are very apt to slip; and even if they do 

 not, the hands of those holding them are likely to 

 be in the operator's way. Mr. Smith said he had 

 taken the idea of the forceps from those used in 

 intubation, which have an external grip. 



lie pointed out the great difference in prognosis 

 according to the nature of the foreign body, and 

 related a case where a large sugar-plum had passed 

 into a child's trachea, and in the course of ten 

 minutes or so had become completely dissolved, all 

 symptoms of obstruction passing away. 



Pkostatic disturbances incident to advancing 

 years have hitherto been treated with such pallia- 

 tive though often ineffectual measures as could be 

 aiforded by the use of the catheter and the exhibi- 

 tion of drugs. 



But now operative procedures are claiming 

 notice, the most recent of which was advocated by 

 Mr. McGill at a late meeting of the London 

 Clinical Society. 



The operation itself consists in opening the 

 bladder above the pubes, in the usual manner, and 

 removing with scissors and forceps that portion of 

 the enlarged prostate which prevents the outflow 

 of urine. Mr. McGill reported three cases in 

 which the operation had been successfully per- 

 formed, affording in all the cases immediate relief 

 from years of misery. 



A CASE of re-section of the left lobe of the liver, 

 the disease having been caused in a woman about 

 thirty years of age, by tight lacing, is related in 

 the Berlin Klin. Woch. by Dr. Langenbuch. The 



tumor was of the size of the fist, dense, elastic, 

 not fluctuating, moving with respiration, and its 

 dulness continuous with that of the liver. It was 

 located in the epigastrium, and caused pain both on 

 standing and on lying down. The diagnosis lay 

 between hydatid tumor and deformity from tight 

 lacing. An exploratory incision proved that the 

 case was the latter, but involving the left lobe. The 

 portion of the lobe forming the tumor was practi- 

 cally isolated from the rest of the organ by a broad 

 but ligamentous pedicle, and therefore was func- 

 tionally of no service. Dr. Langenbuch decided 

 that it was advisable to remove the source of so 

 much distress. Accordingly the pedicle was trans- 

 fixed by ligatures, and the lobe excised. 



After running the gantlet of secondary hemor- 

 rhage and an attack of ascites, the woman recov- 

 ered. 



The portion of liver removed weighed about 

 twelve ounces. Injuries to the liver from tight 

 lacing usually involve the right lobe but this case 

 shows the feasibility of removing either lobe when 

 degenerated so as to become functionally inert. 



At the London ^ledical and Chirurgical Society 

 Dr. Gowers recently showed a patient from whose 

 spine a tumor was successfully removed. He had 

 suffered severe pain for about three years, located 

 just below and inside the angle of the left scapula, 

 and it was accompanied by absolute loss of motion 

 and sensation of the body and limbs below that level. 



Mr. Victor Horsely removed the spines, and 

 parts of the laminse of the fifth and fourth dorsal 

 vertebra?; but not until the third vertebra had been 

 similarly opened, did the tumor come into sight. 

 It was a small oval myxoma, compressing and 

 making a deep impression on the left side of the 

 spinal cord below the third vertebra. It was easily 

 shelled out, and under careful antiseptic treatment 

 the wound healed, but for three or four weeks the 

 pain did not abate. After that, however, it 

 decreased, until, seven months after, it is entirely 

 gone, and the sensation and motion of the body 

 and legs are almost completely restored. This is 

 stated to be the first time such an operation has 

 been attempted. 



In cases of greatly contracted pelvis, endanger- 

 ing both the mother and the unborn infant, Dr. 

 MacEwen suggests the substitution of subcufane- 

 ous osteotomy for abdominal section. He claims 

 to have demonstrated that section of the pubic 

 bone an inch and a half or two inches from the 

 symphysis pubis, and section of the ascending 

 rami of the ischia, would add one and one-half 

 inches to the antero-posterior diameter of the 

 pelvis, and that, in case more room is required, the 

 ilium could be divided on each side. The opera- 

 tion has never been performed yet upon the living 

 subject, but Professor MacEwen holds himself 

 ready to perform it when called upon. Candidates 

 for the Ccesarian Section will bear this important 

 announcement in mind. 



Chronic poisoning by coffee has received some 

 attention by Guelliot of Reims. Coffeeism is 

 found in a class directly opposite to those in whom 

 theism is found, the former being liable in well- 

 to-do overfed individuals, while theism is found in 

 half-starved women who are accustomed to carry 

 on the most severe toil, with scarcely any other food 

 than crackers and tea. The symptoms of coffeeism 

 are anorexia, or want of appetite, sleeplessness, and 

 nervous tremblings, with various evidences of indi- 

 gestion and non-assimilation, torpor of the liver, 

 and non-elimniation of tissue waste. The 

 emunctory system is clogged. In theism the 

 treatment is rest and nourishment; but, unless the 



