34-Pages Reading Matter in this Issue-34 THE CINCINNATI Tancet-Clinic A Weekly Journal of Medicine and Surgery. NEW SERIES Terms, 83.50 per Annum. Entered at the Post Office at Cincinnati, Ohio, as second-class matter. Vol. XXVIII.—No. 9. } Cincinnati, February 27, 1892. (WHOLE VOLUME CONTENTS. See Advertising Page v. LXVII. All communications for the Editors should be addressed to them, care of All business matters should be referred to, and all checks, drafts and money orders made payable to HENRY C. CULBERTSON, Publisher. 199 W. 7th Street, Cincinnati, O. See Advertisement "VIN MARIANI" on Insert page viii· FAMILIAR IN MILLIONS OF MOUTHS AS ANY HOUSEHOLD WORD." -The Times, London. Apollinaris "THE QUEEN OF TABLE WATERS." "The Apollinaris Spring yields enough water not only for present requirements, but also for those of a future which is still remote." "The existing supply is adequate for filling forty million quart bottles yearly." "The volume of gas is so great that it is dangerous to approach the spring on a windless day." THE TIMES, LONDON, 20tn Sept. 1890. "What a boon it would be to the Med ALE AND BEEF ical Profession if some reliable Chemist would bring out an Extract of Malt in combination with a well-digested or peptonized Beef, giving us the elements of Beef and the stimulating and nutritious BLOOD MUSCLE SOLD BY DRUGGISTs. DR. J. N. LOVE, St. Louis, says:-Since the product has been brought under my notice I have prescribed it in the sick room to one hundred recorded cases. Patients who have suffered from loss of flesh, dependent upon various forms of Dyspepsta, when they partook of the Ale and Beef, "Peptonized," felt much benefited. I have now under my observation three patients, the victims of the dread disease pulmonary consumption, in which the digestive tract is demoralized, and in which it seems impossible to bring to bear any form of nutrition which is not disgusting to the patient. In all these cases the drink is a Godsend. A number suffering from prostration, following serious attacks of the recent epidemic of La Grippe, accompanied by loss of appetite and a general feeling of worthlessness, were braced up and greatly benefited immediately after commencing the use of the Ale and Beef, "Peptonized." In half a dozen cases of typhoid fever, in which everything else was distasteful to the patient, the Ale and Beef, "Peptonized," pleased the palate, and nourished and strengthened the patient admirably. I feel personally under obligations to those who have presented so valuable a product to the medical profession, and many a tired and faded patient will be revived and strengthened by the life-giving drink, Ale and Beef, "Peptonized," which is a happy union, in that it contains mildly stimulating (alcohol in small quantity), gently tonic (a modicum of the active principle of hops), decidedly nutrient (malt and beef) and positive digestive (diastase and peptonoids) propertiesa union which is in harmony with well-known physiologieal principles, and will in my judgment be indorsed by careful bedside clinicians. DE. W. F. HUTCHINSON, Providence, R. I., says:-I have used Ale and Beef, "Peptonized," very freely during the past few months and am delighted with the effect obtained. One case was that of a hopeless paralytic, unable to retain any food and steadily failing, for whom I ordered one bottle daily. Her stomach never rejected it and has steadily gained since she commenced using it. PROF G. A. LEIBIG says: -J. MILNER FOTHERGILL, M.D. DEAR SIRS:-Answering yours of the 8th inst., will say that I have used the Ale and Beef, "Peptonized," in both hos pital and private practice, and am much pleased with it. My house surgeons (Drs. F. R. Smiley and Geo. F. Hamel) inform me that it agrees with the stomach in cases where food can not be retained, and this agrees with my own experience. I had one case of a delicate lady with a forming pelvic abscess which involved the ovary. There was constant vomiting and retching. She retained the Ale and Beef, "Peptonized." This, after I had tried a number of things which had failed. She drank it steadily for a month, and it seemed to be, in her case, food, medicine and stimulant, all in one. It is an excellent thing. Keep up the good quality of the preparation and it will readily Very respectfully, WILLIS P. KING, M.D., Ass't Chief Surgeon, Mo. P. Ry. sell. "A careful chemical examination of the Peptonized Ale and Beef shows a much larger per cent. of nitrogenous blood and muscle-making matter over all other malt extracts, and that it is also rich in ALE AND BEEF "Peptonized" MAKE Diastase, giving it the power to digest BLOOD AND MUSCLE Starch Foods." SOLD BY DRUGGISTS. PREPARED BY THE ALE BEEF COMPANY, DAYTON, O., U.S.A Two full-sized bottles will be sent FREE to any physician who will pay express charges. In Corresponding with Advertisers, please mention THE LANCET-CLINIC. THE CINCINNATI LANCET-CLINIC: A WEEKLY JOURNAL OF MEDICINE AND SURGERY. New Series Vol. XXVIII. CINCINNATI, February 27, 1892. Whole Volume LXVII. Original Articles. HYPERTROPHY OF ADENOID TISSUE AT VAULT OF PHARYNX. appearing most frequently between the ages of five and ten. It is not unfrequently seen in younger children and infants, and is more rarely met with in adults. There is a normal atrophy of this tissue at puberty, so that even without treatment it shrivels. Abstract of Remarks made before the Academy up and disappears, in a large majority of Medicine, January 18, 1892, BY A. B. THRASHER, M.D., CINCINNATI. I desire to call your attention this evening to a condition which, while recognized and minutely described by Meyer, of Copenhagen, a quarter of a century ago, has in this community as yet failed to attract sufficient attention from the family physician. While at times the hypertrophy in this region seems to be mostly of the glandular tissue, Luschka's, the pharyngeal, or the third tonsil, yet, again, in other specimens but few glandular elements are found, the growth partaking more of the nature of lymph tissue; large masses of lymph cells bound loosely together by connective tissue stroma. At times the growth is firm and smooth, the interstitial connective tissue being abundant; in another specimen the lymphoid cells are but poorly bound together and break down easily. While the appearance of the growths in different cases varies so much as to possibly justify Woakes in dividing them into two general classes, viz.: Hypertrophies of Luschka's tonsil, and lymphoid papillomata of the nasopharynx, yet for clinical purposes I think the older term of adenoid vegetations preferable, although probably not more accurate. Age is by all means the most prominent causative factor in this disease, it of cases, with advancing years. The acute infectious diseases, more notably measles and scarlet fever, seem to predispose to this trouble. Not unfrequently does the growth manifest itself after one of these affections where there had been no previous symptoms of trouble in this region. Chronic inflammations of the naso-pharynx, or conditions which give rise to these, will promote the growth of this tissue. Over-heated apartments, the breathing of dry, hot air, the constant inhalation of irritants, anything promotive of irritation or inflammation of this region may cause the adenoid hypertrophy. It is doubtful whether heredity enters into the etiology. A scrofular or tubercular diathesis has been thought to promote this growth, but my experience agrees with the large majority of observers, in not recognizing any connection between these conditions. When there is present in a child ear disease or mouth-breathing, the postnasal region should be examined. Adenoid growths are a most prolific cause of middle ear disease. The tissue pressing on the pharyngeal orifice of the Eustachian tubes shuts the opening and gives rise to a formidable chain of ear symptoms-suppuration of middle. ear, aural polyps, chronic catarrh of middle ear, mastoid abscess, loss of hearing, etc. The ear symptoms, when once excited, do not always disappear on the removal of the vegetations. The longer the ear affection has been pres sent the more uncertain the prognosis. | adopt measures for temporary relief. Yet I have seen a brilliant improvement This is certainly bad, even dangerous, of hearing after the removal of adenoid policy. The ear affliction may become hypertrophies from a patient twenty- permanent. A chronic suppurative one years old, where the history of the otitis media may be induced which will case pointed to the presence of the not disappear, though the tissue thorgrowth for fifteen years or more. oughly atrophies at puberty. Long impairment of articulation may per The post-nasal obstruction usually gives rise to more or less mouth breath-manently affect the speech, and a very ing. This imparts a bad expression to disagreeable fault of pronunciation be the child, a vacant stare, stupid look; continued throughout life. The child is excites disease of mouth, throat, and unduly and unnecessarily exposed to lungs, causing snoring and imperfect dangers from diseases of the throat articulation. These children are much and respiratory organs. Then the only more subject to all lung and throat rational treatment is removal of the disdiseases, as pneumonia, bronchitis, eased tissue as soon as its presence is phthisis, laryngitis, pharyngitis, tonsil- recognized. Since the operation is a litis, etc. The voice has a dead sound very bloody one, I think chloroform and a nasal twang, and some letters should be used in patients under fourteen cannot be pronounced. A muco-pur-years of age. Occasionally one will be ulent discharge is frequently present, found that will allow you to operate manifested in throat, or nose, or both. after the use of cocaine, but complete These little sufferers are frequently anæsthesia gives the operator a better brought to me with the ready-made chance to completely remove all the disdiagnosis of "catarrh." These chileased tissue at one time. When there is dren are, for obvious reasons, usually poorly nourished and anæmic. They get the credit in school of being dull scholars with bad memories. They have trouble in concentrating their minds on their lessons, and are frequently punished for inattention, when the fault is due to imperfect hearing. At night they snore, are restless, and at times start suddenly as if in affright from sleep. The diagnosis is easily made by the finger. The forefinger, properly protected, can easily and quickly be inserted through the mouth behind the velum palati and the presence and character of the growth determined. The rhinoscopic mirror can at times be used, although in many cases it is difficult to advantageously see this region in young children. There is frequently present, as a complication, enlarged faucial tonsils and posterior hypertrophies of the lower turbinates. When the condition is recognized, what course of treatment should be pursued? Since the tissue, as a rule, atrophies more or less completely at puberty, it has been suggested, that unless there is present positive danger, it is better to do nothing, or, at most, to present enlargement of turbinates, I remove the redundant tissue, so as to render the nasal cavities patulous at the same time. If there is hypertrophy of faucial tonsils I remove them before attacking the adenoid tissue. On account of the profuse hemorrhage I always operate with the head forcibly extended, and dropped below the level of the body, so that the blood can not run into the trachea or down the œsophagus. I use the Lowenberg or Woake's forceps with different forms of curettes. Much of the tissue can be broken down with the finger-nail. Whatever instru ment is used care should be taken not to injure the normal parts, especially the orifices of the Eustachian tubes and the uvulva. The finger is probably the best guard when operating under a general anæsthetic. I generally use chloroform, as children bear the drug well, and the administration is much more pleasant than ether. As the operation is short, usually from two to five minutes, not much chloroform is required, and not a very profound anesthesia is desired. When the tissue is soft, and easily broken down, and there is but little of it, I sometimes break it all down and scrape the vault when I make my first examination, before withdrawing my finger. If the child can be easily examined with the mirror, and does not get frightened at the sensation of cocaine, a small adenoid growth can be removed by forceps or with a guarded galvano-cautery point, without resorting to general anesthesia. In babies the finger-nail and no anæsthetic is the rule. In adults cocaine is all that is required. The adenoid tissue itself is not at all sensitive, but there is always some injury to the adjoining structures. When the tissue is all removed, or thoroughly crushed, it is not likely to recur, although at times there is an apparent re-growth. For the accompanying nasal stenosis I use my nasal curette, and for enlarged faucial tonsils the Mackenzie tonsillotome. My method of operating does away with some dangers which have with others occurred. The blood can not run down into the larynx, and there is no danger from a clot of blood in the chink of the glottis. I do not find it necessary to have light for the operation, the previous examination of the case, and the sense of touch, giving sufficient information. I have a few times attempted, at the instigation of parents who feared chloroform, to make the operation while they held the child in their lap. The shock to the child's nerves from the operation is much more to be feared, in my judgment, than the evils of chloroform. There are certainly cases, the presence of the growth being accidentally discovered, where no bad effects are to be observed, in which cases I should advise no operation, preferring to assist the normal atrophy at puberty. But where there are ear symptoms, mouth breathing, or defects of speech, with adenoid hypertrophy, the adenoid tissue should always be removed. [FOR DISCUSSION SEE P. 272]. FISSURES OF THE TONGUE. Dr. R. Pfeiffer, assistant to Professor Koch at the Institute for Infectious Diseases here, has made detailed and accurate bacteriological investigations in thirty-one cases of influenza, six of which afforded post mortem observations. The following are his results: 1. In all cases a certain form of bacillus was found in the characteristic purulent bronchial exudate. In pure cultures from all uncomplicated cases of influenza the presence of this bacillus was established and in most instances myriads of the bacilli were present. Very frequently they were situated within the protoplasm of the pus corpuscles. In patients attacked with influenza who had previously been suffering from some affection of the respiratory apparatus, for instance tuberculosis with excavation, other organisms were found in the expectoration in diffuse numbers. From the bronchi the bacilli may penetrate into the peri-bronchial connective tissue, and they may even succeed in reaching the visceral layer of the pleura, where they were found in pure cultures in two cases upon which autopsies were made. 2. These organisms of rod shape are found in cases of influenza exclusively. A vast number of control experimentations established the fact that they were not present in ordinary cases of bronchitis, bronchial catarrh, pneumonia and phthisis. 3. The number and presence of the The following (Le Bulletin médi. bacilli are in direct relation to the cal, No. 90, 1891) is praised: B Carbolic acid, gms. 2.5 (mxxxviij). Glycerine, J course of the disease; with the subsi- aa gms, 12.5 (fl.ziijss). |