This extract was found to possess very marked toxic properties upon these animals, which manifested themselves by a depression of the higher nerve centres and of the heart. The depressant action upon the heart seemed to be exerted through the cardio-inhibitory mechanism, and is more or less completely antagonized by atropine.
The toxic principle he believes to be the result of the growth of the tubercular bacilli, and allied to the ptomaines. He found the quantity of the substance to be extracted from the sputum to be proportional to the abundance of the bacilli present in it. These observations are in accordance with the observations of various experimenters with other pathogenic organisms, and with the theory that seems to be gaining ground that immunity is the result of such by-products of the growth of these organisms.
SURGERY.
BY GEORGE R. FOWLER, M. D.,
Surgeon to St. Mary’s Hospital and to the Methodist Episcopal Hospital, Brooklyn.
CONTRIBUTIONS TO THE STUDY OF MYXŒDEMA FOLLOWING TOTAL OR PARTIAL EXTIRPATION OF THE THYROID BODY.
J. L. Reverdin (Congrès Francais de Chirurgie, 2 session, Paris, 1886.) This disease, following frequently in the after-history of cases of extirpation of the thyroid body, and called by Kocher, of Berne, cachexia stumpriva, was first described by Reverdin, and by him called “operative myxœdema.” His description of this disease coincides in general with the views now generally held, although we find some not unimportant deviations from Kocher’s conclusions; for instance, the latter observed the disease twenty-four times following thirty-four operations, it appearing to attack by preference those who had not attained their full development. On the other hand, R., basing his experience upon copious statistics, believes the disease is comparatively rare, following upon operations of the thyroid in only twenty-seven per cent. of cases. In his experience, it likewise preferably attacks children and young persons, but that it occasionally fails to occur after complete thyrotomy. Further, R. has observed a milder form of the disease, differing essentially from the graver type of the affection, which latter invariably tends progressively to a fatal termination. In the milder form, the disease is described as oscillating between relapses and improvement, lasting for years, cure sometimes resulting. Several cases are detailed supporting these observations. In two of these, it was supposed that the thyroid had been extirpated in toto, but it was subsequently discovered that a small portion of the gland had remained. Three cases are worthy of especial note. In these, after partial extirpation, in one the right lobe, and in two the left having been removed, an imperfect form of the disease made its appearance after several months. The characteristic signs, such as swelling of the face and limbs and hesitancy of speech and of muscular movements were absent; while the other symptoms, such as general weakness, pains in the limbs, chest, and head, greater or less loss of memory, chilly sensations, reminded one distinctly of the more complete form of the disease. In all these cases slow improvement followed. Another case is worthy of notice from the fact that, two months after the operation, the remaining lobe had so atrophied as to be scarcely distinguishable. Cases of this atrophy following partial extirpation have been observed both in Germany and in England.
UPON LUXATION OF THE HEAD OF THE RADIUS FORWARD.
Raestock (Deutsche Militärärztl. Zeitschrift, 1887, p. 331) has, by means of experiments upon the cadaver, shown that this accident occurs in forced pronation while the radius is resting upon the ulna at the point where the former crosses the latter, the ulna acting as a fulcrum. The head of the radius is pressed against its capsule and tears the latter. More rarely, the accident may occur in forced supination, by pressing the bone against the posterior edge of the ulna, the head of the radius being luxated through a rent made by a rupture of the external lateral ligament between the outer and inner sides; upon pronating the hand, this outward dislocation is converted into a forward one. The annular ligament is either torn or else the coronoid process of the ulna is broken. In either case the interposition of the annular ligament in the fold of the joint becomes an obstacle to reduction. In the experiments as detailed, great force was necessary in the production of the luxation.
Should active and passive movements, manipulation, etc., fail to remove the obstacles to reduction, the author advises a resort to secondary resection of the displaced head of the radius; this, with proper precautions, is certainly a most wise and rational procedure.