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General Surgery I

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GENERAL SURGERY.

I. A Contribution to Iodoforrn Poisoning. By DR. WILLY ANSHUTZ (Breslau). On two previous occasions, a male, aged thirty years, had received from eighty to ninety cubic centimetres of a to per cent. iodoform glycerin injection into a cold abscess of thigh without any outward symptoms. One year later, upon recurrence of cold abscess, a similar injection of ioo cubic centi metres was made. Within twenty-four hours thereafter the tem perature became elevated, and continued rising, with remissions, for days thereafter; but one week later most marked symptoms of iodism set in. The patient was covered with a diffuse acne. Added to this was a stomatitis, rhinitis, and conjunctivitis of such intensity that all the mucous membranes were coated with crusts. The urine contained a large percentage of iodine. On the part of the nervous system, the toxic symptoms manifested themselves in somnolence, great increase of patellar reflexes, ankle clonus, and increase of pulse. To evacuate any possible iodoform still existing in the abscess, an incision was made to afford an outlet. A saline infusion was given, but of no avail. The patient died with a temperature of Io4° F. Post-mortem showed a spondy litis in lumbar region accounting for the cold abscess. The adrenals were caseous in their entirety, and there also existed a fatty degeneration of the kidneys. Something extraordinary must be responsible for the non-occurrence of any reaction after the earlier injections. The late appearance of poisonous symp toms must be attributed to a cumulative feature of iodoform, which, though it is soon eliminated as iodine in urine, remains longer in the system than other iodine preparations.

The pronounced cerebral disturbances, the increased reflexes, the acceleration of the pulse, and reference in the history to a yellowish pigment and very dry condition of the skin, are, in the light of post-mortem findings, brought into harmony with the marked degeneration of the suprarenal capsules ; and, finally, the untoward fatal toxic symptoms are still further correlated to and enhanced by this pathological state of the adrenals which induced the pronounced cachectic condition, which in turn again favored iodism.

Conclusion : Saline infusions were futile. In view of pos sible fatal toxicity of iodoform, greater caution in its use should prevail, though so useful a remedy should not be abandoned. Beitriige zur klinischen Chirurgie, Band xxviii, Heft I.

II. Iodide of Potassium Treatment of Human Actino mycosis. By DR. V. LIEBLEIN (Prag). The author herein offers a much-needed critique of the status of iodide of potas sium as a curative agent in human actinomycosis. Sixty-two re ported cases are analyzed, of which forty-two were healed, seven improved, two successfully treated, one without success, in complete four, death six, the jaw being most frequently repre sented and the lung and intestine in about equal number. The iodide of potassium is most efficient in jaw actinomycosis, least in the pulmonary form. Where iodide of potassium alone was relied upon, three deaths ensued ; but these were too advanced to be even benefited by operative treatment.

Of greatest interest are observations on the use of iodide of potassium after unsuccessful operative interference. Once death supervened, once marked improvement, and three times cured. One of the last group was twice ineffectually operated. The necessity of operative interference after unsuccessful application of iodide treatment arose three times. In these latter instances the iodide was given for too short a time.

At this point the author passes on to the method of giving iodide of potassium. It was only found serviceable when given for several months or more. Treatment for one year or more was only called for in the severest cases.

As to the modes of action of iodide of potassium, it is pointed out that by the disintegration of the cellular infiltration, and its discharge through fistulous tracts, the expulsion of the ray fun gus is effected. In support of this theory is the bacteriological observation that iodide of potassium does not inhibit the growth of the ray fungus, and coupled to this the clinical observation that the cases with sinuses coexisting come to a more speedy ter mination under iodide of potassium treatment. The advent of any mixed infection retards, and even wholly prevents, beneficent action of iodide of potassium. The quantity of iodide of potas sium given fluctuated between ioo and 30o grammes ; one case taking, in toto, even 400o grammes. Recurrences were only apparent because of insufficient treatment, and disappeared wholly when properly administeied. But recurrence also took place after operation, no matter how seemingly thorough it was done.

Limitations of iodide of potassium treatment, because of its slowness of action, exist when the disease is of an acute phleg monous character, and when the individual is very cachectic. Here it is merely an adjuvant to surgical measures. In these respects we have analogous conditions in syphilis. Thus, while iodide of potassium is no specific, it is a remedial of no mean order antagonistic to actinomycosis, and worthy of an extended trial in proper doses for a long period in every instance. Thus, in Wolfler's clinic it is the practice to give three grammes in in creasing doses three times daily. The affected area is also cov ered with compresses of iodide of potassium, or a tract or cavity tamponed with iodide of potassium gauze. The diminution in size of the swelling is ever slow but steady. Beitrage zur klin ischen Chirurgie, Band xxviii, Heft i.

iodide, potassium, treatment, iodoform, symptoms, abscess and times