SURGICAL TREATMENT OF PULMONARY TUBERCULOSIS. Surgeons have in recent years and with such success entered so many fields that have formerly been supposed to have been closed to them that we are not particularly surprised at the recent advocacy of certain measures in the treatment of Pulmonary Tuberculosis. According to the Paris letter of the Interstate Medical Journal, a method that is giving a moderate degree of satisfaction has been introduced by a native of that city. It is described as follows: The method which is much more interesting is the one which is called artificial pneumothorax, and which in France has led to a number of interesting investigations. The following will explain how the idea arose. A pulmonary wound constitutes a cavity that has no tendency to retract; not only do the movements of the lung prevent the coming together of the margins, but the constant exercise of a centrifugal force by the empty pleura tends on the contrary to enlarge the wound. Pneumothorax would seem, then, a priori to place a pulmonary cavity in the best condition, so that its walls can come together and cicatrize. It suppresses, in fact, all centrifugal traction and it impedes the movements of the lung. Clinical facts have shown that this action is real. The observations made in a number of cases in which there was a pneumothorax show a retardation in the evolution of pulmonary tubercu losis and a total modification of the symptomatic manifestations, provided the disease does not develop too suddenly. Forlarini, of Pavia, was the first one to evolve the idea of systematically applying pneumothorax, created surgically, in the treatment of certain forms of pulmonary tuberculosis. In principle, pneumothorax ought to lead to total immobilization of the lung, so that upon auscultation the vesicular murmur would no longer be brusque, but, on the contrary, slow and even. The tension should not be variable, a condition which can be achieved by the injection of a gas, generally azote, and which is introduced by means of a special apparatus (Forlarini's or Jeunet's, of Amiens). INAUGURATION OF BOSTON UNIVERSITY'S NEW PRESIDENT. The inaugural exercises for the new president of Boston University, Lemuel H. Murlin, LL.D., will take place on Friday, October 20, and will occupy the day and evening. The inauguration will occur in the morning at Trinity Church, Copley Square, Boston, beginning at 10.30 o'clock, preceded by a procession of alumni and students from the Liberal Arts building of the University to the church. The afternoon exercises are to be held in Jacob Sleeper Hall, Liberal Arts building, corner of Boylston and Exeter Streets, and will include addresses by President Lowell of Harvard University, the recently elected dean, Brown of Yale Theological Seminary and Eugene H. Porter, M.D., Health Commissioner of the State of New York. The evening will be devoted to a reception at Jacob Sleeper Hall, with short addresses by representatives of the Faculties, graduates and student bodies of the various departments. For the Medical Department Prof. John L. Coffin, M.D., will represent the Faculty, and Dr. Edward B. Hooker, of Hartford, Connecticut, will speak for the alumni. PERSONAL AND GENERAL ITEMS. Dr. R. C. Cooper, of Bellevue, Pa., class of 1901 B. U. S. M., is in Vienna for the purpose of special study of the ear, nose and throat. Dr. R. E. Mitchell, until recently second assistant physician at Middletown (N. Y.) State Hospital has opened an office in Parker Building, Eau Claire, Wisconsin, for the practice of general medicine and surgery. Dr. Richard Hodgson, for many years located in Stoneham, Mass., died on September 14, after a lingering illness. Dr. Royal E. S. Hayes has removed from Farmington, Connecticut, to Waterbury, in the same State. Dr. Thomas E. Chandler has removed his office to 374 Marlborough St., Boston, where he will be found between the hours of three and four P.M., and at other times may be consulted by appointment. By the will of the late William E. Chamberlain of Cambridge, Mass., an amount estimated at nearly $100,000 will be divided between the Cambridge Hospital, the Avon Home, Cambridge, and the Holy Ghost Hospital for Incurables. The late Elizabeth P. Sturgis of Salem left legacies of $20,000 each to the Kindergarten for the Blind, the Boston Nursery for Blind Babies, the Industrial School for Crippled and Deformed Children, and the House of the Good Samaritan. Dr. Pearl S. Waters, recently house officer at the Massachusetts Homœopathic Hospital, has been appointed resident physician of the Ohio Hospital for Women and Children, 549 Seventh Ave., Cincinnati. Dr. Deborah Fawcett, B. U. S. M., 1903, has removed her Boston office from Hotel Kempton to Hotel Puritan, 390 Commonwealth Ave. Hours, 10 to 11 A.M. Dr. Anna T. Lovering, librarian of Boston University School of Medicine, 80 East Concord Street, has resumed confidential collaboration in literary work, with physicians and others. The annual Book Sale of duplicate and odd volumes, which has become such a popular feature at B. U. S. M., will be held in the library, October 20 to November 3, 1911. The works of Hahnemann (first edition), Hartmann, Gentry, Allen, Hale, Hempel, Hering, Jahr, Gross, Guernsey, Ludlam, etc., will be obtainable. The profession is cordially invited. Dr. Claude L. Payzant, B. U. S. M. 1910, has removed from Chatham to North Attleboro, Mass. BUSINESS FOR SALE. By replying to this notice, the right man can be put into communication with a business already established, which will pay him from $5000 to $10,000 a year. The present incumbent wishes to change for business reasons and will sell a fully equipped place and introduce purchaser to clientele. For further information address "X. Y. Z.," care New England Medical Gazette, 422 Columbia Road, Boston, Mass. Professor Dieulafoy died in Paris on August 18. His name has become widely known not only in France but throughout the world as a leading clinician and an able successor of the renowned Trousseau. Arrangements have recently been made for the erection of a new building for the Medical School of Bowdoin College. This building, which is to cost $140,000, will contain laboratories of anatomy, physiology, bacteriology, pathology and pharmacology, in addition to a dispensary. Dr. Richard Blackmore, B. U. S. M., class of 1902, has removed from Bellevue, Pennsylvania, to Farmington, Connecticut. TYPHOID IN BOSTON: It is gratifying to note that at the time of writing the number of cases of typhoid fever reported in Boston has been smaller than at any time since record has been kept. The total from January 1 to September I was 225 cases, as compared with 260 cases for a similar period the year before. COMPULSORY ANTITYPHOID VACCINATION: The Secretary of War has recently issued an order based upon the recommendation of the surgeon general of the army whereby anti-typhoid vaccination is made compulsory for all officers and men of the army who are under forty-five years of age. Dr. Howard A. Kelley, the well-known surgeon of Baltimore, was recently operated upon by the Mayos in Rochester, Minn., for adhesion around the gall-bladder. The Vincent Memorial Hospital of Boston receives $1200 by the will of the late Miss Cornelia F. Forbes of Westwood, Mass. James A. Patten of Evanston, Ill., has donated $10,000 toward the establishment of a Juvenile Home which is intended to supplement the work of the Cook County Hospital in its care of children suffering from contagious and infectious diseases. FURTHER BENEFACTIONS TO ROCKEFELLER INSTITUTE: A report as yet unconfirmed is in circulation to the effect that Mr. John D. Rockefeller has recently given to the Rockefeller Institute for Medical Research an additional sum of $1,000,000. NUMBER OF MEDICAL STUDENTS: The August number of the Journal of the American Medical Association contains its annual article upon the standing of the medical colleges in the United States. The tabulation showing the total number of students is of particular interest when compared with the report of last year. This shows a total number of 18,414 enrolled at the so-called regular colleges; at the homeopathic, 890; at the eclectic, 433. This is the smallest total number of students on record since 1900, when the statistics first began to be compiled. It is, however, somewhat encouraging for Homœopathy, in that the homeopathic schools were the only ones showing an increase over the preceding year. This increase, while not great, amounted to 23. The eclectic school shows a decrease of 22, and the regular school a decrease of 1,722. There are at the present time 120 medical colleges in existence, a decrease of 13 over the number reported in 1910. The statistics also show a steady decrease in the number of women studying medicine, the total number being 680 in 1911 against 907 in 1910. BENEFACTIONS FOR CHARITY: A former mayor of New York, Smith Ely, is reported to have left $1,000,000 to various charitable institutions in and around New York. This includes hospitals, day nurseries, sanitaria, children's aid societies, and similar philanthropic objects. - Exchange. THE NEW ENGLAND VOL. XLVI NOVEMBER, 1911 No. 11 ORIGINAL COMMUNICATIONS. OCULAR MANIFESTATIONS OF ARTERIO-SCLEROSIS. * Because in certain well recognized conditions the walls of the arteries are responsible for most of the damage to the human economy in those conditions, the term arterio-sclerosis has been generally used and accepted to indicate a series of changes in both the arteries and veins and the adjacent tissues. The disease is commanding the attention of the profession by its heretofore unsuspected prevalence, for we now know that the predisposing cause of many cases of pneumonia. Bright's disease, apoplexy and heart disease is to be found in the weakened blood vessels characteristic of this disease. Owing to the structural peculiarities of the eye, we are able, by the use of the ophthalmoscope, to see continuously and in minutest detail the changes taking place in its blood vessels, and by availing ourselves of the opportunity we are able to obtain valuable information at the very beginning of this insidious discase which seems to be the peculiar heritage of the present day and generation. Wood in his recent "System" ascribes the majority of cases of arterio-sclerosis to senility, either premature or normal, and believes that a small minority are due to metabolic disorders such as gout, diabetes and a variety of chronic intoxications and intestinal derangements, as well as the abuse of alcohol, tobacco. and lead; and finally syphilis. When found to exist in the ocular vessels it is then usually merely a local manifestation of a general diathesis, although it may involve any portion of the vascular system, often indicating changes in the blood vessels of the brain. or kidney, these being the organs most susceptible to the disorder on account of structural peculiarities, or it may be purely local in the eye. Perhaps the earliest visible change in the retinal vessels is an increase in diameter and darkening of the veins having the appearance of a slight engorgement. The smaller arteries become * Read before the Massachusetts Homœopathic Medical Society, October 11, 1911. tortuous first, their terminal twigs often assuming a typical corkscrew appearance near the macular, while the larger arteries become paler, showing an exaggerated light reflex in the center, the so-called "silver-wire" arteries. Usually as the disease advances we find abrupt changes in the diameter of some of the larger vessels, giving a peculiar "beaded" appearance which with the kinking of the veins is considered pathognomonic of the disease. This "kinking" of the veins is produced in the following way. Instead of keeping its course when approaching an artery the vein runs along beside it for a short distance, turns suddenly, crosses at right angles, and then continues on its original course. Often the distal side of the vein is distended for a short distance just before passing the artery, which is not as transparent as under normal conditions. As degeneration of the vessel walls progresses still farther, stripes of white or gray appear along the arteries, and minute hemorrhages show as specks throughout the fundus. When the disease is well established retinal oedema occurs, the optic disk often becoming a dirty pink color, like that of brick-dust it has been said, and more or less numerous feathery or flame-shaped hemorrhages, due to extravasations in the inner layers of the retina, are to be seen along the course of the arteries. Hemorrhages may also take place in the deeper layers when they assume no characteristic shape but are formless and dense. When the changes in the ocular vessels are associated with chronic interstitial nephritis the fundus changes are more intense. The disk becomes indistinct or altogether indistinguishable in outline and intensely swollen (the so-called choked disk) and hemorrhages are numerous and large, usually in the inner layers. Later, patches of fatty degeneration appear, assuming a form which is pathognomonic of the kidney lesion. These patches when in the macular region take on a somewhat linear form radiating from the fovea in a glistening star-like pattern but not involv ing it. Often, too, the disk is surrounded by these areas which become confluent, forming a white zone known as the "snowbank" of albuminuria retinitis. With this brief resumé of the ocular changes in the various stages of the disease, let us carefully consider what may be the warning symptoms, that the physician may recognize the danger signals before serious structural changes have taken place and while his services are yet likely to be of real value to the patient. for it is only in its earliest stages that this affection is amenable to treatment. When the walls of the blood vessels have been weakened by degenerative changes, the physician, however skil ful, is powerless to avert the imminent peril in the shadow of which his patient must henceforth live. In a general way an appearance of premature old age suggests that the blood vessels are not properly performing their function and should lead to an immediate investigation of the blood pressure. If found to be high the probabilities are strong |