Journal of the American Medical Association (JAMA)
This cut represents the author's bivalve speculum, grasped with the full hand ready for introduction. "O" is the obturator. It is a bivalve and tubular speculum combined, embodying the properties and applications of each. When it is introduced and the obturator is removed, a portion of the rectum equal to the area of the circumference of the instrument is at once painlessly exposed for inspection, and by slightly opening the blades this field is greatly enlarged. It being a tubular instrument,
... ubular instrument, by placing the patient in the knee-chest posture, you can inspect the entire rectum, semilunar valves and sometimes part of the sigmoid flexure. Miscellany. Elimination of Mercury in Milk.-Seven women who were taking large quantities of mercury in frictions or hypo¬ dermically, and nursing children, were tested, and in none could any trace of the mercury be discovered in the milk. The report, La Pediatria No. 9, concludes that we must abandon the expectation of treating heredo-syphilitic infants effectively by administering mercury to the mothers. Surgical Intervention in Medical Nephritis.-Pousson (French Cong, of Urology) has collected twenty-four cases of nephritis complicated with serious accidents, treated surgically, with two deaths. Nephrotomy relieves the tension and con¬ gestion in these cases and regulates the circulation, restoring the kidney to its normal function, with disappearance of the albumin, and normal elimination of urea and other excremental substances. The prompt subsidence of the reno-renal reflex on the other kidney attests the efficacy of the nephrotomy. Ne¬ phrotomy is also effective in the same way as enucleation in sympathetic ophthaimia. Long Vitality of the G-onococcus.-Before the Cernían Congress of Physicians and Naturalists, Wertheim re¬ ported that cultures of the gonococcus had retained their vitality eight to ten months, when cultures, could still be made from them, although no typical gonococei were to be dis¬ tinguished by this time, nothing but "involution forms." He consequently aserts that there are actually living "involution forms" of the gonococcus which it is impossible to recognize with the microscope as gonococei, a statement which under¬ mines the foundation of our present methods of treatment. He also found that the gonococcus was not destroyed by a tem¬ perature of 38 to 42 C, and hence the assumption that it is de¬ stroyed by the occurrence of fever is untenable. read a paper on the "Medical Autopsy." He animadverted upon the unsatisfactory system of necropsies, especially where there are legal issues, because of their being made at varying periods after death and in a slipshod manner. According to him the examinations should be made as quickly after death as possible, in order to combat even fractional doubts of crimin¬ ality. That the microscope should occupy its proper field along with the other accepted tests, Dr. Hamilton maintained with emphasis. Add to this procedure, as he said, substantially an expert in the employ of the commonwealth, for the purpose of presenting the facts without bias and reserve, the commentary of motives and probabilities, to the lawyer, and then the truth would be much more likely to prevail than at present. He cited instances where the testimony at present in vogue had been torn in pieces by opposing counsel, and the experts were made ridiculous in the eyes of the public on confessedly debat¬ able grounds. All agree that most of the parties who have been made to figure in these medieolegal affairs leave the arena with vague conclusions in which both judge and jury participate. Thus the state pays for what it does not get-information. other physicians who discoursed on the theme, which might have been indefinitely prolonged but for the crowded program. The prevailing sense of the meet¬ ing was that the remedy lay with the physicians themselves, but may not the evil be succinctly stated thus, that the em¬ ployed expert may be apt to state only what was of sole value to his own client? At all events, the whole matter seems now to be fully before the committee and the conviction is rife that the mills of the gods are yet grinding slowly. Piperazin in the Cure of Gouty Tophi.-C. Gioffredi calls attention to the important therapeutic aid of local injections of piperazin in ease of the gouty deposits which sometimes compromise the functions of a joint. His communication ( Gaz. degli Ospedale, xx, 100) states that its great dissolving power in respect to uric acid and the urates-superior to any other of the alkaline substances used in therapeutics-renders its local application rational as suggested by Biesenthal and Schmidt as long ago as 1892, and his success in a case he re¬ ports, confirms this assumption: a man of 36 with typical gouty arthritis and a tophus in the serous tendon sheath of the peroneus longus. Internal treatment-one gram a dayalmost entirely cured all the symptoms except those connected with the tophus, which was very painful. After experiments on animals Gioffredi injected 5 eg. (5/6 gì. ci piperazin in .5 c.c.-Ys minims) of water, directly into the tophus, followed two days later by another injection on the other side of the deposit. The first was followed by quite severe burning pain, at once relieved by application of ice, and all pain was pre¬ vented in the later injections by a preliminary ether spray. All trace of a calcareous deposit had vanished by the tenth injection, and all swelling a few days later. He believes that the same procedure would not be dangerous and might be found useful in cases of uric concretions in the articulations, using extremely weak solutions, with every antiseptic precaution, especially when all other therapeutic measures have failed to relieve.