Abstracts and Selections.
The Influence of the Organism upon Toxins.—Metchnikoff (Ann. de l’Instit. Pasteur, November 25, 1897,) has applied the method of comparative pathology to the question of the mechanism by which the animal organism prepares antitoxins, and the laws which regulate their production. By growing bacteria and lowly fungi upon culture media containing toxines he was enabled to show that the virulence of the latter was in most cases diminished and sometimes destroyed. In any case these microbes have no influence in the production of antitoxins, and the idea of preparing them by this means must be abandoned. The animal organism alone being capable of producing antitoxins, the next point was to find out whether this was a property common to all animals, or limited to the superior. Metchnikoff found that the injection of large quantities of tetanus toxin into scorpions and the larvæ of other arthropods produced no antitoxin. The toxin remained for months in the blood or tissues without losing its properties; similar results were obtained when it was taken into the alimentary canal of the leech. It was hence shown that even those invertebrates in which antimicrobic phagocytosis is most marked are utterly incapable of producing antitoxins. Coming next to vertebrates, no power of producing antitoxin is possessed by fish or amphibia; it first appears in reptiles, but not in all kinds. Thus tortoises, like invertebrates, can retain tetanus toxin in the blood for a lengthened period without forming antitoxins; it is in reptiles that the production of the latter is first observed, but in them only when theyare kept at a temperature higher than 30° C. If the temperature is 20° C. the results are just the same as in tortoises and invertebrates. The establishment of the antitoxic property in these cold-blooded animals is not attended with any rise of temperature, and the same is true in warm-blooded animals such as fowls. With regard to the last-named animals, whose power of producing tetanus antitoxin was first demonstrated by Vaillard, Metchnikoff has some new and important observations. He finds that practically all the toxin injected into the peritoneum passes into and remains in the blood, none of the organs being toxic after their blood has been washed out. To this an exception is found in the case of the genital organs, ovaries, and testicles, which possess the power of fixing some of the circulating toxin. This they share with the leucocytes, to the toxicity of which that of the blood is due. After a while the toxic power of the blood diminishes, and after passing through a neutral period it becomes antitoxic. It is now found that with the exception of the generative organs, none of the organs when freed from blood possess any antitoxic power. The genital glands are found to be markedly antitoxic, but the author brings evidence to show that the antitoxin is not manufactured by them, but is absorbed from the blood, so that in the fowl the antitoxic property resides solely in the blood. Metchnikoff concludes that it is not possible to accept the idea that natural immunity depends on antitoxic power, and he further points out that the latter is evolved in the history of the animal kingdom at a much later date than the phenomena of phagocytosis.—British Medical Journal.
The Treatment of Tuberculosis with Tuberculin R.—Dauriac (Progrès Médical, December 4 and 11, 1897,) reports the results of the employment of Koch’s tuberculin R. in various cases of tuberculosis; fourteen of these presented local affections, such as suppuration over the sternum, enlarged cervical glands, ulceration of the skin, etc. All of the patients were satisfactorily cured. In a second paper he describes the results in fifteen cases of pulmonary tuberculosis in various stages of the disease; all were greatly improved, and many are described as cured. One of the cases was insufficiently nourished and clad, had no fixed residence, and, when the treatment was commenced, large cavities were found at the apices of both lungs. A case is also described in which, in addition to pulmonary tuberculosis, lesions were present in the kidneys and the bladder. This patient also made a complete recovery. The treatment, in spite of these brilliant results, is supposed to be most applicable to the earliest stages of the disease, and it is suggested that it would be advisable to detect the presence of tuberculosis by injections of minute doses of the original form of tuberculin. The treatment is usually commenced with a dose of1500mg. This should be increased daily until a dose of10500mg. is reached; this then should be increased150mg. daily until ⅕ mg. is reached, and this increased ⅕ mg. daily until 1 mg. is given. This can then be further increased if considered desirable, the maximum dose being about 20 mg. The immediateeffects of the injections are usuallynil. With doses in excess of ⅗ mg. a slight elevation of temperature is occasionally observed. Local reaction is extremely rare. The subsequent effects consist in reduction of fever, cessation of sweats, increase in appetite, and disappearance of tuberculous lesions. As none of the patients reported in this paper was admitted to the hospital, but simply came three times or less frequently a week to the dispensary for injections, improvement could not possibly have been due to any alteration in their hygienic surroundings.—The Philadelphia Medical Journal.
Cesarean Section by Transverse Incision of Fundus.—Braun (Centralbl. f. Gynak., No. 45,) has had experience of Fritsch’s cesarean section, the operation being the second of its kind ever recorded. Fritsch bases his practice on the course of the secondary branches of the uterine arteries which run horizontally, so that a longitudinal incision down the front of the gravid uterus can not fail to cause free hemorrhage. He is accustomed to extirpate diseased fallopian tubes completely, snipping a wedge-shaped piece out of the uterine cornu. Bleeding is always free, but the tying of a suture passed antero-posteriorly under the bleeding vessel stops it at once. The ligature lies at right angles to the vessel, the most favorable position. Hence Fritsch conceived the idea of making an incision straight along the fundus from cornu to cornu, in order to extract the fetus in a cesarean section. Braun publishes full notes of his own case. The patient was a rachitic primipara with a universally and irregularly contracted pelvis. The conjugata vera was two and three-quarter inches. Labor pains had set in. Care was taken to antevert the gravid uterus sufficiently, the upper part of the wound being held together with forceps during delivery of the child. Then the transverse incision was made. Braun found that it bled as much as the longitudinal incision in cesarean sections where he had operated during labor at term or in relatively early pregnancy. The placental site did not lie near the fundus. The delivery of the fetus, which was living and weighed six pounds, was neither harder nor easier than through a vertical incision. The wound in the fundus was under four inches long after the fetus had been extracted. The sutures had to be placed close together, fifteen deep and eight superficial being applied. Ergot was given after the abdominal wound was closed, as there was hemorrhage. The patient made a good recovery.—British Medical Journal.
Labor in Mature Primiparæ.—De Koninck (Revue Medicale, Louvain, October 30, 1897,) has compiled an instructive memoir on labor in primiparæ married for some years and relatively mature (twenty-eight years Bidd and Pourtad, thirty-two Ahlfeld). De Koninck gives thirty as the earliest year coming under “maturity,” the “primipares agees” of French authorities. He sets aside as curiosities certain cases of primiparæ almost “aged” in the English sense of the term, such as Cohnstein’s two women aged fifty andSteinmann’s woman aged fifty-two. It appears that in a genuine uncomplicated case of delayed impregnation the advent of the catamenia is always found to have occurred late in youth. Out of 401 such cases menstruation was retarded till twenty in 39, till twenty-four in 4, and till twenty-six in 1. As to the retarded first pregnancy, abortion, ectopic gestation, twins, and special renal mischief are relatively frequent. Above all, lingering labor is specially common, statistics even exceeding guesses anda priorireasoning in this respect. In 12 out of 17 noted by De Koninck labor lasted from forty to fifty hours, the remaining labors being yet longer; 1 exceeded ninety hours. Feebleness of uterine contraction is absolute from first to last, and independent of any obstetrical combination. They also cause far more physical and mental exhaustion than the vigorous contractions of a young uterus, and at the same time are more painful. There are discrepancies in the “pains” seen in mature primiparæ of the same age, probably homologous with the great variations in the age of menopause observed in otherwise normal women. The uterus may be older in one woman aged thirty-five than in another of the same age. The forceps and other obstetrical operations are often required in the mature. Most of the above facts are easily explained. The excess of male infants borne by mature primiparæ (thirty per cent) is a less explicable phenomenon. Hecker considers the predominance of male infants as a speciality of all primiparæ, but Rumpe turns attention to the fact that in a family of children the predominance of males is commoner the further the mother is from her first menstrual period.—Ibid.
Kinesitherapy in Heart Disease.—Colombo (Gazz. Med. di Torino, 48, N. 39, 40, 1897,) pleads for a more general use of kinetic treatment in heart disease. Even in advanced cases he seems to think such treatment is very advantageous. Milder forms of treatment, for example, the Swedish method of gymnastic exercise, should be started at first, and afterwards more active methods, for example Oertel’s, can be tried. The action of the Swedish method is most marked upon the peripheral vessels, while Oertel’s system acts more directly upon the heart itself, so that dividing heart disease into disease of central or cardiac, and that of peripheral or vascular origin, the different methods could be applied accordingly. The Swedish method, moreover, has this advantage, that it can be applied in severe cases which can not leave their beds. Barie (Sem. Med., November 12, 1897,) advocates the treatment of heart disease by Swedish gymnastics. The aim of the exercises is to facilitate the work of the heart by increasing its contractile power and by lessening the peripheral resistance. The exercises are a series of regulated, combined, or alternating movements of resistance or opposition. The movements employed fall under the main groups: (1) Kneading, rubbing, or stroking of the muscular masses in the limbs and abdomen; (2) movements of circumduction which facilitate the circulation in the main venous trunks; (3) movements which favor respiration. The exercises are very varied, and accomplished by means of passive and activemovements, numerous different manipulations, and by special apparatus. The average duration of the treatment ought not to be less than an hour a day during three months of each year. The treatment is suitable for cases of dilatation, hypertrophy, fatty degeneration, chronic myocarditis, and various neuroses and functional affections of the heart. Such symptoms as shortness of breath, palpitation, insomnia, cephalalgia, giddiness, gastric phenomena, edema, ecchymosis, cyanosis, improve or disappear under treatment. The pulse-rate is lowered, but rises again as soon as treatment is interrupted. Rational application of the treatment does not exclude internal treatment by ordinary medical means, and the two methods may often be employed simultaneously with the best results.—Ibid.
Live Frogs as an Antithermic.—An English practitioner of Constanta, Roumania, writes: On the evening of October 19th I was called to visit a Roumanian boy, six years old, suffering from typhoid fever. I found himin extremis, almost pulseless. The child’s head was completely wrapped over with a large white sheet, and as I looked at it this enormous white envelope seemed to be on the move, and while I was surveying this covering there crept from under it a small frog, which quietly sat over the child’s left arm. It seemed quite content. I immediately called the mother’s attention to it and requested her to take the animal away, thinking it had crept there as an intruder. “Oh, no!” said the old lady, “a doctor recommended that a lot of them should be kept to the head to keep it cool.” Seeing the head covering still on the move, I raised it for curiosity, and in a second out jumped about twenty other frogs and hopped away in all directions. I have often heard the expression “as cold as a frog,” but this was the first time I had seen a frog applied as a head-cooler.—London Lancet.
Treatment of Endometritis in Bromine Vapor.—Nitot (La Gynecologie, October 15, 1897,) maintains that the correct prophylactic treatment of parenchymatous metritis and chronic salpingitis consists in rapid cure of recent endometritis, which is the starting point of those troublesome diseases. To insure cure a remedy is needed which can penetrate to the deepest recesses of the muscosa, and even the tubes, without dangerous effects. Caustics and fluid preparations do not possess such properties. A gas is required, and it must be freely diffusible, antiseptic, and capable of acting on the epithelium so as to modify without destroying them (“anticatarrhal action”). Bromine emits gas with the necessary qualities; a saturated aqueous solution should therefore be placed in a bottle with double tubing like an ether spray or the chloroform bottle in a Junker’s inhaler. A hollow sound, connected with one tube, is passed into the uterus, while the solution is made to bubble by pressure on a ball connected with the second tube. Thus vapor is propelled into the uterus. Nitot claims the best results, and notes that the advantages of gaseous diffusion over intra-uterine injections or other medication are self-evident.—British Medical Journal.