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brought to me by her family physician with this history: On the day before, while her mother was dressing her for school, the patient took a pin out of her clothes and thrust it into her mouth. It slipped down her throat and she was immediately seized with a spasm of the glottis. The spasmodic coughing and difficult respiration lasted about a half hour. As soon as she was able to speak she said the pin was sticking in her throat. The mother sent at once for her physician, who examined her throat as carefully as possible without instruments and told the mother that the pin was nowhere in sight, that he thought it had passed on into the stomach, and that what she complained of was probably the irritation caused by the scratching of the pin. He directed the mother to let him know if anything further developed. The child continued in a highly nervous state and insisted that the pin was sticking in the throat. The next afternoon the mother again called the physician, and he found that the child had neither swallowed nor slept since the accident. He at once brought her to my office. It was then about thirty-three hours since she had swallowed the pin. She was in great distress and carried the head bent forward at an angle, as any attempt to straighten it caused intense pain. I examined her throat with the laryngeal mirror and discovered the pin sticking in the posterior opening of the larynx by the side of the right arytenoid cartilage.
I carefully cocainized the larynx, and after waiting ten minutes, proceeded to make the effort at extraction. I had just previously had made a modification of the Schroetter tube forceps, and this was my first opportunity to use the new instrument. Dr. Hale assisted me by holding the patient's tongue while I held the mirror with my left hand and managed the forceps with my right. After several attempt I succeeded in extracting the pin, which was buried to about half its length in the tissues. For a week the child had a temperature of between 100 and 101 degrees and was very nervous and restless. She was also quite hoarse and coughed considerably, but after ten days the symptoms cleared up and she has had further trouble.
Potassium Cyanid Poisoning. J. W. NOLAN, M.D., Chittabalbie,
Korea, in J.A.M.A.
Cyanid of potassium poisoning is not infrequent among workmen who “clean up” in the cyaniding process of gold reduction, but is rare in private practice.
After the auriferous ore has been crushed to a fine sand through which an 0.5 per cent. solution of cyanid of potassium is allowed
to filter, the solution passes into boxes filled with zinc shavings on which gold is precipitated from the auro-potassic cyanid in the solution. It requires some little force to dislodge these gold particles, and consequently scrubbing the zinc shavings with the hands is the method usually employed. It is in this scrubbing process, while the hands and arms are necessarily bathed in the solution that poisoning occurs with greatest frequency. Different individuals exhibit different degrees of susceptibility, some being apparently immune. The temperature of the solution greatly modifies the ease with which the effect is produced, the greatest number of cases occurring during the cold season when the solution is, of course, very cold.
Case 1.-A husky young man of 23 was having his first experience in scrubbing the zinc shavings. An itching sensation immediately followed the immersion of his hands in the solution. Scarlet specks soon appeared, irregularly distributed over the area with which the solution was in contact. These scarlet specks quickly enlarged until a well defined circumscribed area was produced, these finally coalescing and forming a large scarlet area, but the initial specks or papules maintained their identity, being slightly elevated and of a deeper color than the neighboring skin. The itching continued for about two hours and a burning, uneasy sensation developed which persisted until the redness began to disappear, twelve hours later. Slight giddiness and headache were the only constitutional symptoms.
A similar case occurred in a well-nourished metallurgist. I put the hands and arms of these patients into a very dilute solution of hot sulphuric acid for several minutes every hour. The redness soon began to fade and had disappeared altogether in twelve hours. The following formula shows the chemical reaction :
A Convenient Way of keeping Tab When Counting in Opsonic
Work. C. C. Bass, M.D.
One of the drawbacks to opsonic index work is the large amount of very trying microscopic work required. Anything that would tend to reduce this time or the strain on the eyes would seem of value. Simon has proposed a technic according to which the percentage of phagocyting leucocytes is ascertained, no account being taken of the number of bacteria per leucocyte.
The following suggestion will apply whether the original technic of Wright and Douglas is used or Simon's, with slight adjustment to the particular case. When counting in determining the Wright index, one observes the number of bacteria in each of several leucocytes, carrying the separate numbers “in his head" until he has as many as he can carry, say five to ten; then he jots them down, thus: 1, 2, 0, 5, 0, 0, 1, 0, 4, 2, etc., and after a sufficient number has been counted, the figures are added up and the calculations made. I take it that the most trying part on the eye is the frequent accommodation and reaccommodation of the eye to the microscopic field and tab figures, etc., as well as to the very different amounts and often qualities of light. I believe this is largely obviated by a method which has been used in my laboratory for several months.
A box containing 50 or 100 beans or beads (I use 50 beans) and a similar empty box (the boxes in which microscope slides come answer well) are placed on the table, at convenient places, on the right of the microscope. A handful of beans is taken up in the right hand, with which the mechanical stage is manipulated, and one bean is dropped into the empty box for each polymorphonuclear leucocyte observed, the left hand manipulating the fine adjustment, as usual. One counts the bacteria as observed; for example, with the above he would say: 1, 3, 8, 9, 13, 15, etc., until the box is empty. The number counted would be the number in 50 cells. There is no putting down and adding up of figures and the eye has not been removed from the field during the time. If more than 50 cells are to be counted, put down the number, or carry it on, as you preferred, exchange the position of the boxes and proceed as before.
When counting the phagocyting cells only for the Simon index, one may proceed as before, dropping a counter for each "poly seen and counting as one goes, only those cells phagocyting, as 1, 2, 3, 4, 5, 6, etc. If 100 counters are used, the number counted phagocyting would be the percentage of phagocyting leucocytes.
If one does not use a mechanical stage he can modify the above to suit his convenience.
Crude as the method seems, only a trial is necessary to convince one of the advantages in time and eye saving.
Nurses should be instructed not to massage the limbs of patients who complain of pain after operation or confinement, without the order of the attending surgeon. If phlebitis and thrombosis are present, the manipulation may loosen a clot and cause instant death.-American Journal of Surgery.
A Displaced Sigmoid in a Case of Appendicitis. W. A. Kick
LAND, M.D., Fort Collins, Colo., in J.A.M.A.
The following case is an interesting one because of the position of the sigmoid and the failure of the usual rule for finding the appendix, that of following the longitudinal muscular band of the presenting large intestine to its pelvic end:
Patient.-J. A., aged 35, a lather by trade, was referred to me by a physician in a neighboring town with a diagnosis of appendicitis. The history was the usual one of an acute attack in mild form lasting four days with no improvement. Examination showed tenderness over McBurney's point with muscular rigidity; temperature was normal and pulse 85.
Operation.-In operating, the gridiron incision was used and the large intestine immediately presented itself in the wound. It was drawn out from the pelvic end, following the longitudinal band of muscular fibers, and search was made for the appendix. The lower end of the intestine seemed so deep in the pelvis that suspicions were aroused and the introduction of a rectal tube showed this portion of the intestine to be the sigmoid instead of the cecum. Tracing it upward, it was found that instead of going up to the liver region, as might be expected in a case of inverted viscera, the colon went across to the splenic region. The sigmoid was dropped and the opening enlarged so that the abdominal cavity could be inspected more freely, and the cecum with the inflamed appendix was seen lying up under the liver. The appendix was removed and the recovery was uneventful.
Three or four drops of peroxid of hydrogen in the ear followed five minutes later by thorough syringing with boracic acid solution, will readily remove any impacted cerumen.
When there is a perforating wound of the cornea, necessitating enucleation of the eye, the wound should be closed so that the eyeball does not collapse during the operation.
Small stab wounds (one-half cm. long) in the course of a developing cellulitis of an arm or leg, followed by the application of a Martin bandage above for five to eight hours a day (Bier treatment), will relieve the patient more quickly than large incisions with drainage.—American Journal of Surgery.
Proceedings of Societies.
INTERNATIONAL CONGRESS ON TUBERCULOSIS.
The Central Committee of the International Congress on Tuber
culosis has announced the offer of the following prizes:
1. A prize of $1,000 is offered for the best evidence of effective work in the prevention or relief of tuberculosis by any voluntary Association since the last International Congress in 1905. In addition to the prize of $1,000, two gold medals and three silver medals will be awarded. The prize and medals will be accompanied by diplomas or certificates of award.
Evidence is to include all forms of printed matter, educational leaflets, etc.; report showing increase of membership, organization, classes reached—such as labor unions, schools, churches, etc.; lectures given; influence in stimulating local Boards of Health, schools, dispensaries, hospitals for the care of tuberculosis; newspaper clippings of meetings held; methods of raising money; method of keeping accounts.
Each competitor must present a brief or report in printed form. No formal announcement of intention to compete is required.
2. A prize of $1,000 is offered for the best exhibit of an existing sanatorium for the treatment of curable cases of tuberculosis among the working classes. In addition to the prize of $1,000, two gold medals and three silver medals will be awarded. The prize and medals will be accompanied by diplomas or certificates of award.
The exhibit must show in detail construction, equipment, management, and results obtained. Each competitor must present a brief or report in printed form.
3. A prize of $1,000 is offered for the best exhibit of a furnished house, for a family or group of families of the working class, designed in the interest of the crusade against tuberculosis. In addition to the prize of $1,000, two gold medals and three silver medals will be awarded. The prize and medals will be accompanied by diplomas or certificates of award. This prize is designed to stimulate efforts towards securing a maximum of sunlight, ventilation, proper heating, and general sanitary arrangement for an inexpensive home. A model of house and furnishing