The Solutions of continuity in these organs, either as a result of concussion or from the penetration of a foreign body, are among the most dangerous visceral lessions. Rupture of the kidney occurs not only from violence applied immediately over the seat of this organ, but indirectly, as from a fall on the head or feet. conditions which result are practically identical, whether there is a penetrating wound or not. Hemorrhage is immediate and is proportionate to the extent of kinney involved, and to the vascularity of the part injured. Shock is usually well marked, vomiting is present, with palor, cold perspiration, rapid and weak pulse. Pain is severe, is felt in the region of the organ and is transmitted in the direction of the ureters, down the leg and into the testicle of the injured side in the male, which organ is usually drawn up towards the external ring. Extravasation of urine takes place, and when the capsule is torn, finds its way into the loose areola tissue of the retroperitoneal space. Hemorrhage occurs in the same way, as well as into the uriniferous tubules and pelvis of the kidney. The organ may be displaced by concussion, usually traveling downward and toward the median line. The symptoms, although varying with the extent of the lesion, are usually those of profound shock; pain not only local but extending in the direction just described, together with the presence of bloody urine in a patient who has received a wound in the lumbar region or a severe concussion, and who has no bladder or urethral disease to account for, hernaturia are symptoms which point quite clearly to the nature of the injury. Partial suppression of urine is nothing uncommon. A marked elevation of temperature usually follows the reaction of shock. The febrile movement is chiefly due to the inflammation which follows the escape of urine into the retroperitoned space. With the advent of pus formation local tenderness is increased, the area of inflammation spreads, the more superficial structures become tense, the integriment is reddened, and rigors or chills occur, followed by exacerbations of temperature.. The prognosis is unfavorable, but most chiefly depend upon the extent of the injury as determined by the earlier symptoms. The treatment may be radical or conservative. Immediate operation within the period of shock is scarcely to be thought of. If the symptoms of hemorrhage are alarming deligation of the extremities should be practiced; and if syncope is stll threatened, the intravenous injection of a saline solution should be preferred. Direct operative interference by cutting down upon the wounded organ will be rarely called for. With the earliest symptoms of abscess an exploratory incision should be made. It is advisable to insert the aspirator needle at the points of greatest tenderness and induration, and if pus is discovered the incision should be made along the needle as a guide. If pus cannot be obtained by using the aspirator the incision is still indicated if the symptoms of sepsis above given are present. The organ may be readily reached by cutting parallel with and about three inches and a-half external to the spines of the lumbar vertebra. The kidney is located just in front of the outer border of the quadratus lumborum muscle; its lower extremity reaching down to the level of the umbilicus. If an abscess is found it should be irrigated with 1.000 to 5.000 sublimate solution and free drainage established. The kidney is often the seat of morbid changes, which occur partly from internal violence, and partly from idiopathic causes, which may at times justify the surgical invasion of the organ. Pyelitis, pyonephrosis, calculus, hydronephrosis, and certain new formations, as cyst, carcinoma, adenoma, angioma, angionoma tuberculosis, and gumma, are among the chief diseases of a surgical nature, Treatment should be for the relief of pain, to the removal of the cause of the disease, and to the maintenance of the patient's powers of resistance by judicious feeding. Otherwise the diseased organ should be removed. Cedar Rapids, Iowa. RESEARCH FINDINGS IN MALARIA. BY S. R. KLEIN, M.D. Ph.M. Public Lecturer, Pathologist and Bacteriologist; formerly Professor Fordham University Medical School. Excellent work has recently been done on malaria by Bensfield, Belfour, Hunter, Craig, Cropper and others. Research findings were extended to recurrences, intracorpuscular conjugation, pernicious malaria, equally with trypanosoma in peculiar clinical cases. By recurrences are meant the appearance of symptoms due to the same group of parasites that caused the original infection and not a reinfection by another group. If the parasites be present in the blood in recurrent cases, between the attacks, the disease is truly latent, as it may be before the initial attack. By intracorpuscular conjugation is meant the complete and permanent union of the protoplasm and nucleus of two young amoeba within erythrocyte. It is assolutely necessary to the maintenance of the malarial infection in man and in these instances, in which it does not occur, the plasmodia undergo a sexual sporulation for a limited time and then perish, leading to spontaneous recovery. Intracorpuscular conjugation is the chief cause of the maintenance of the malarial infection. It maintains malarial infection by producing a resting or zygote stage of the plasmodia within the human body, which is resistant to quinine and other injurious influences. It is the cause of latency and recurrences of malarial infection—the zygote stage remaining dormant or "latent" until conditions are favorable, when it gives birth to several young plasmodia, thus causing a recurrence of the infection. The above conditions are justified by the following considerations: The presence of the process in all acute and recurrent infections: the fact that during the time con sumed in conjugation in all protozoa, provided the conjugation is asexual, many generations of the organism could have been produced by division or sporulation in the usual manner; the fact that such a resting or zygote must exist, as proven by the recurrence of the infection after the discontinuance of quinine given for long periods of time; the fact that, in cases which have been treated at once with sufficient doses of quinine and for a sufficiently long period, intracorpuscular conjugation is never seen, and in such cases relapses are very rare, if they occur; the presence of numerous large pigmented bodies in the blood, in cases in which the process is most marked, both intra and extra cellular, and which are not seen in cases in which the process is absent; the argument from "analogy" which indicates that the significance of the process of asexual conjugation in the malarial plasmodia is similar to the same process in other of the protozoa. Craig reports of a case, where a parasite closely resembling a trypanosoma was observed. It differs from the hemogregarina forms, described by Billet, and as it was the first parasite found in the film, proved for the moment puzzling, although the case was clinically one of malaria. On the following day a few crescents were found. Quinine soon caused the disappearance of the endoglobular forms. Cropper exhibited very interesting blood films from a fatal case of pernicious malaria, which contained a phenomenal abundance of parasites in the peripheral circulation. The film showed clumping of infected fed cells, each containing a pigmented presegmenting body, suggesting a cause for the embolism or infraction of the different organs affected in pernicious attacks. Very numerous unpigmented rings, of 500 corpuscles counted at random, from 40% to 50% were infected, and in some fields more, so that in one field 100 parasites could be seen. Subtertian gametes or crescents could be seen in all stages of development-two sporulating bodies in one cell: polymorphonuclear leucocytes containing sporulating bodies; pigmented leucocytes containing 25 pigment masses, each indicating one sporulating parasite, and the protoplasm of the cells was very much enlarged. Cases of sporulating malignant parasites in the peripheral blood are rare. Cropper believes they must be commoner in some countries than others. They observe many in Palestine. As a rule, also, immature crescents are not seen in peripheral circulation. Rosettes and sporulating forms in the white cells are usually seen in the large mononuclears, but Manson mentioned a case of a complete sporulating form in a polymorphonuclear leucocyte. One may mention here the excellent German Blood Atlas of Meyer and Rieder (Atlas der Klinischen Mikrorkopie des Blutes. Leipzig) which contains good plates of the three types of malarial parasites and shows forms not usually seen in illustrations. These authors hold that it is possible to distinguish the young gametes in the red blood corpuscles. Special attention is directed to a ring form of gamete which only occurs in pernicious malaria. As regards benign tertian gametes, the young forms are recognized by the absence or relative insignificance of the nutrition vacuole, the older forms by their size, the compactness of their form (the protoplasm almost never showing amoeboid prolongations) and their undivided nuclei. Reference may here be made to Cropper's bodies, which are so apt to be mistaken in fresh films for malarial plasmodia. They were first described by Ross in India, then by Cropper in Palestine, and by Smith in the United States. A good account of these red spindle-shaped and mobile melon-seed bodies is given in an article on Proplasmosis, by Nuttall and Graham-Smith, who observed the bodies in the blood of normal dogs and of those suffering from the disease. In Palestine they appear to be specially numerous in the blood of persons suffering from so-called Syrian fever, which is not malarial. Plehn regards the supposed immunity of the black races as a mere tolerance, a symbiosis of the parasite and the organism, a relative immunity the equilibrium of which is liable to be disturbed by change of climate, excessive exertion, etc. This particular resistance to the malarial virus seems to be special, in a sense, for the black races. It appears to result from tolerance to the toxins, which will often commence in the fœtus, for if the parasites themselves can not traverse the placenta, presumably the toxins can do so. D'Allocco describes a case of malaria with cerebellor symptoms, i. e., speech slow, difficult and scanning in character, anxious expression, marked tremor, deliberation and incoordination of attempting voluntary movements, whether of upper or lower limbs. This tremor was more marked on attempting delicate movements. Worthy of note is the fact that when the patient got over the fear of standing alone, he could stand for a long time without fatigue. Some time ago many cases of malarial pneumonia were observed in a few neighboring villages of the State of New York -a real endemic condition. We may call that phyperparasitism, where he struggle with the malaria parasite continued for nearly a year. A species of nosema was shown on those films, a parasitic form together with a special form of mosquito. 2321 Cambrilling Ave., Bronx, New York City. THE MAN WITH THE STOMACH-WINDOW. STE. MARTIN, THAT PER- BY FELIX J. KOCH. Almost as important as the "shot that was heard round the world," fired at Lexington, Mass., in the first American war for independence, was the shot that left a bullet-wound in the body of one Alexis Ste. Martin, an humble courreur-de-Bois, in such wise that physicians and others could peer into his stomach and witness the effects of digestion, long before such things as the X-ray had been thought of. In fact, every high-school boy or girl, well nigh, studying the science of elementary physiology, has learned of Ste. Martin, and how, by means of his wound, doctors discovered which food digested slowly, which rapidly, and the like, to the infinite good of sufferers with indigestion and makers of foods for invalids, ever since. The story of Ste. Martin and his wound, as recently unfathomed, is interesting as a romance. One who knows it best gives it as follows: "The memorable shot was fired by an unknown, on Macinac Island, one of the most beautiful spots on the American continent and one that, for nearly three centuries, has invited exploration. Macinac, in the early part of the last century, was the headquarters of Astor's American Fur Company. There was a garrison at the fort, which still mounts the hill back of the village, and here the post-surgeon was, for a time, a young Dr. Beaumont. "Early in June, 1822, Indians and voyageurs were returning to Macinac with the results of the winter's catch. The little village had awakened from its long sleep and the beach was again crowded with tents and wigwams, and a seething mass of strange humanity. New arrivals of canoes and bateaux were being heralded, and friends who had been stationed far apart, in the wilds of the north, were greeting one another. Some were pitching tents in which to sleep, when not otherwise engaged in carousing, newer arrivals were unpacking pelts, watching their appraisal by the officers of the fur company, and eagerly awaiting the figures that were to indicate the results of their winter's work. Others, whose fate had already been decided, were engaged in games, or watching the fight of two of the brigade bullies, for the proverbial "black feather." Others, still, were crowding into the retail store of the fur company, in an effort to buy buck-skin coats, moc"It was in this little throng that a tragedy casins, flannel shirts and gaudy neck bands. occurred, on June 6, which was to leave its imprint on the pages of medical history for all time to come. "A gun was accidentally discharged and a young voyageur dropped to the floor with a cavity in the left upper abdomen that would have admitted a man's fist. He proved to be a young French-Canadian, who had recently come down from Montreal, and who was about nineteen years of age. "This young voyageur was Alexis Ste. Martin. "Dr. Beaumont reached the injured man a few minutes after the accident. He found an appalling wound, through which the lung and punctured stomach protruded. The doctor did not believe it possible that the man could live more than a few hours, but he dressed the wounds and endeavored to alleviate the sufferings. It is not practicable to describe the long battle with Death that ensued. Dr. Beaumont's careful record of that heroic struggle to save the life of an ignorant, almost unknown voyageur forms one of the most fascinating chapters of medical history. It suffices to state that he won the fight. "Ste. Martin, after two years, during which time his wound was dressed almost daily, was able to walk about. Eventually he recovered his health entirely and lived to a great age. But there remained as his legacy from the accident, a hole in his side and a hole in the wall of his stomach. "It was this permanent aperture in the stomach which became a window, so to speak, through which Dr. Beaumont looked and saw the processes of digestion, as no man before or since ever saw them. "Shortly after the injury, Dr. Beaumont carried Ste Martin to the little hospital of the fort, up on the hill, and, after he had partially recovered, took him to his own family and kept him for a number of years. "The overseers of the poor had refused to care for him, He was without friends, and although Dr. Beaumont's salary was only $40 a month, he could not turn the poor fellow out to starve. It was three years after the accident before the doctor fully realized the extraordinary opportunity that had come to him for a scientific investigation of the phenomena of digestion. "The details of the long series of experiments which followed, interrupted for a time by the flight of Ste. Martin, who took no interest in science and who was unwilling to make any sacrifices in its cause, there is no time for. "The results, though, interest the veriest tyro. To understand the full importance of these, it must be recalled that before his experiments there was little real knowledge of the nature and processes of digestion, and that the researches of science, since then, have but confirmed the conclusions, while adding little real information. |