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AORTIC ANEURYSM MISTAKEN FOR ASTHMA.
597 revealed limited dulness beneath the manubrium sterni-in the former case, of about the size of a shilling; in the latter, of a dollar, and therefore extending somewhat In neither case to the right and left of the bone. was any thrill, bruit, or pulsation detected, nor did the laryngoscope show anything. In both cases a skiagram revealed a shadow above the heart, which was interpreted as a dilated aortic arch pressing upon the root of the trachea. In the former case the shadow was small and circular; in The former the latter, large and somewhat pear-shaped. patient died, and the necropsy showed a sac more than an inch in diameter, of which tough clot and the anterior wall of the. trachea formed the posterior wall, while it communicated by a small opening with the transverse arch. What makes the cases worthy of record is that sudden dyspnœa was the sole symptom ; the ordinary signs of aneurysm were wanting; and incidentally to the constant dyspnoea paroxysms of increased distress, with wheezing and rales, misled the medical attendants to a diagnosis of asthma. But the suprasternal recession and stridor, indicating obstruction of the larynx or trachea, were incompatible with asthma. The possibilities were mediastinal growth or gumma, enlarged bronchial glands, peritracheal abscess, and aneurysm pressing on the air passages.
are employed to prevent the spread of other specific infectious diseases of the intestinal tract, more particularly enteric fever and cholera. Dr. Walker is now engaged in
experimental study of the parasitism and of the species of the genera amoeba and entamceba established by his present study. The results of this further research will be presented in another paper, and will in all probability be published in a future number of the Philippine Journal of Science. carrying
on an
pathogenicity
CURIOUS CASES OF
INCOMPATIBILITY.
IN a recent issue of an American pharmaceutical journal attention is drawn to the fact that an incompatibility between a medicine given internally and one applied externally may cause undesirable epidermal manifestations. Reference is made to a case in which hydrogen peroxide was applied externally, while potassium iodide was given internally. The result was a severe burning of the skin, the cause of which was not discerned for some little time. In another instance a colourless tincture of iodine, taken internally, in conjunction with an ointment of ammoniated mercury, externally applied, caused severe irritation of the skin, which was attributed to the toxic action of mercuric iodide. Other illustrations might be given of the importance of avoiding such cases of incompatibility. Thus, sulphur given internally and a solution of mercury used externally may be expected to cause a deposit of black mercuric sulphide in the skin These instances are of great interest to physicians as they afford an explanation of phenomena which might sometimes be attributed to idioscyncrasy or some other
except the right one. Within the last few months interesting case arose at St. Paul, Minn. A lady
cause, an
had used a certain advertised face-cream for the purpose of removing freckles, and she was horrified to find that her face became variegated in colour from yellow to brown and then to black. Since many creams of this nature contain some form of mercury it is probable that the trouble was caused by a chemical reaction between the ingredients of the cream and some medicinal substance she may have been taking at the same time. These illustrations emphasise the danger of indiscriminate self-medication ; they farther show that care should be taken not to use mercurial creams when undergoing certain courses of internal medication. The apparently harmless sulphur lozenge or compound licorice powder may cause much chagrin and discomfort, if not danger, when taken into the system at a time when a favourite brand of toilet cream is being used to beautify the
complexion. AORTIC ANEURYSM
I
-
MISTAKEN
FOR
ASTHMA.
IN the Interstate Medical Journal for Ja.nuary Dr. Solomon Solis Cohen has published a note on two cases of aortic aneurysm, in which the unusual mistake was made of diagnosing asthma. Both patients were syphilitic labourers who were suddenly attacked with dyspnoea, which was the only symptom. The ordinary signs of aneurysm-pulsation, There was constant thrill, and bruit-were wanting. dyspncea with paroxysms of increased distress accompanied by sonorous and sibilant râles. The patients were sent into hospital with the diagnosis of asthma. They sat upright in bed, labouring for breath, with marked suprasternal recession in one case and supraclavicular recession in the other. There was laryngeal stridor; in the former case loud, and both inspiratory and expiratory ; in the latter, low and expiraIn both cases the vessels of the neck throbbed tory only. violently and thejugular veins were much distended. In the former case there were attacks of syncope. In both cases Dr. Cohen made at sight the diagnosis of obstructive dyspnoea, possibly aneurysmal. Careful physical examination
I
THE TREATMENT OF GONORRHŒAL CONJUNCTIVITIS WITH STEAM. A NOVEL and somewhat drastic method of treating gonorrhceal conjunctivitis has lately been advocated by Dr. W. Goldzieher in the Wiener klinische ll’ocshenschmift (November, 1911). The procedure is based on the facts that the gonococci are rapidly killed by a temperature slightly exceeding that of the normal body temperature, and that they are situated in the epithelial layer of the conjunctiva, their presence in the subepithelial layer being of rare As compared with the mucous membrane of occurrence. the male urethra, the conjunctiva is superficial and easily exposed, and it therefore lends itself to local treatment by heat. Dry heat is liable to injure the cornea by the withdrawal of fluid, and steam is therefore preferable. It was generated by electricity in a boiler small enough to be as easily manipulated as any other instrument for operations on the eye. Below the tube through which the steam escaped another tube was fitted to catch the drops of condensed steam which would otherwise have scalded the patient’s face. The temperature of the steam impinging on a screen at a distance of 4 centimetres from the mouth of the tube was found to be 1130 F. This temperature causes considerable pain, and cocaine is valueless, for it has no influence on the sensations of heat and cold. After a while, however, the treatment becomes so painless that even children stand it easily. No ill-effects resulted from the treatment, but some difficulty was experienced in everting the swollen and brawny upper eyelids, which sometimes required the application of iced compresses to reduce the infiltration. The delay thus caused is not, however, serious, for corneal infiltration or ulceration seldom occuis at this stage. As soon as the eversion of the eyelids is practicable, the conjunctival sac is first syringed with a solution of permanganate of potash, and it is then dried with a strip of gauze, after which the steam is applied. When there is much chemosis, the ocular as well as the palpebral conjunctiva should be steamed, great care being taken to avoid injuring the cornea. The skin in the neighbourhood of the eyes is protected from the steam by layers of linen or wet gauze. In the course of three All these were months 15 cases were thus treated. severe, and in 5 cases ulceration of the cornea existed The gonoat the commencement of the treatment. coccus was invariably present, and with the exception of a
,
are employed to prevent the spread of other specific infectious diseases of the intestinal tract, more particularly enteric fever and cholera. Dr. Walker is now engaged in
experimental study of the parasitism and of the species of the genera amoeba and entamceba established by his present study. The results of this further research will be presented in another paper, and will in all probability be published in a future number of the Philippine Journal of Science. carrying
on an
pathogenicity
CURIOUS CASES OF
INCOMPATIBILITY.
IN a recent issue of an American pharmaceutical journal attention is drawn to the fact that an incompatibility between a medicine given internally and one applied externally may cause undesirable epidermal manifestations. Reference is made to a case in which hydrogen peroxide was applied externally, while potassium iodide was given internally. The result was a severe burning of the skin, the cause of which was not discerned for some little time. In another instance a colourless tincture of iodine, taken internally, in conjunction with an ointment of ammoniated mercury, externally applied, caused severe irritation of the skin, which was attributed to the toxic action of mercuric iodide. Other illustrations might be given of the importance of avoiding such cases of incompatibility. Thus, sulphur given internally and a solution of mercury used externally may be expected to cause a deposit of black mercuric sulphide in the skin These instances are of great interest to physicians as they afford an explanation of phenomena which might sometimes be attributed to idioscyncrasy or some other
except the right one. Within the last few months interesting case arose at St. Paul, Minn. A lady
cause, an
had used a certain advertised face-cream for the purpose of removing freckles, and she was horrified to find that her face became variegated in colour from yellow to brown and then to black. Since many creams of this nature contain some form of mercury it is probable that the trouble was caused by a chemical reaction between the ingredients of the cream and some medicinal substance she may have been taking at the same time. These illustrations emphasise the danger of indiscriminate self-medication ; they farther show that care should be taken not to use mercurial creams when undergoing certain courses of internal medication. The apparently harmless sulphur lozenge or compound licorice powder may cause much chagrin and discomfort, if not danger, when taken into the system at a time when a favourite brand of toilet cream is being used to beautify the
complexion. AORTIC ANEURYSM
I
-
MISTAKEN
FOR
ASTHMA.
IN the Interstate Medical Journal for Ja.nuary Dr. Solomon Solis Cohen has published a note on two cases of aortic aneurysm, in which the unusual mistake was made of diagnosing asthma. Both patients were syphilitic labourers who were suddenly attacked with dyspnoea, which was the only symptom. The ordinary signs of aneurysm-pulsation, There was constant thrill, and bruit-were wanting. dyspncea with paroxysms of increased distress accompanied by sonorous and sibilant râles. The patients were sent into hospital with the diagnosis of asthma. They sat upright in bed, labouring for breath, with marked suprasternal recession in one case and supraclavicular recession in the other. There was laryngeal stridor; in the former case loud, and both inspiratory and expiratory ; in the latter, low and expiraIn both cases the vessels of the neck throbbed tory only. violently and thejugular veins were much distended. In the former case there were attacks of syncope. In both cases Dr. Cohen made at sight the diagnosis of obstructive dyspnoea, possibly aneurysmal. Careful physical examination
I
THE TREATMENT OF GONORRHŒAL CONJUNCTIVITIS WITH STEAM. A NOVEL and somewhat drastic method of treating gonorrhceal conjunctivitis has lately been advocated by Dr. W. Goldzieher in the Wiener klinische ll’ocshenschmift (November, 1911). The procedure is based on the facts that the gonococci are rapidly killed by a temperature slightly exceeding that of the normal body temperature, and that they are situated in the epithelial layer of the conjunctiva, their presence in the subepithelial layer being of rare As compared with the mucous membrane of occurrence. the male urethra, the conjunctiva is superficial and easily exposed, and it therefore lends itself to local treatment by heat. Dry heat is liable to injure the cornea by the withdrawal of fluid, and steam is therefore preferable. It was generated by electricity in a boiler small enough to be as easily manipulated as any other instrument for operations on the eye. Below the tube through which the steam escaped another tube was fitted to catch the drops of condensed steam which would otherwise have scalded the patient’s face. The temperature of the steam impinging on a screen at a distance of 4 centimetres from the mouth of the tube was found to be 1130 F. This temperature causes considerable pain, and cocaine is valueless, for it has no influence on the sensations of heat and cold. After a while, however, the treatment becomes so painless that even children stand it easily. No ill-effects resulted from the treatment, but some difficulty was experienced in everting the swollen and brawny upper eyelids, which sometimes required the application of iced compresses to reduce the infiltration. The delay thus caused is not, however, serious, for corneal infiltration or ulceration seldom occuis at this stage. As soon as the eversion of the eyelids is practicable, the conjunctival sac is first syringed with a solution of permanganate of potash, and it is then dried with a strip of gauze, after which the steam is applied. When there is much chemosis, the ocular as well as the palpebral conjunctiva should be steamed, great care being taken to avoid injuring the cornea. The skin in the neighbourhood of the eyes is protected from the steam by layers of linen or wet gauze. In the course of three All these were months 15 cases were thus treated. severe, and in 5 cases ulceration of the cornea existed The gonoat the commencement of the treatment. coccus was invariably present, and with the exception of a
,