STURGIS, WEARN, TOMPKINS'. ATROl'IN IN EFFORT SYNDROME discrete and in one instance confluent miliary nodules in the paren¬ chyma, lesions that can be correctly estimated as of recent develop¬ ment, while, on the other hand, the lesions present in Case III (Figs. 2 and 3) are evidently very old, as evidenced by the extensive coagulation necrosis and the reactive fibrotic condition in the immediate neighborhood. Summary'. We have given clinical and pathological proof of the occurrence of cases of ascending renal tuberculosis, ascending at least in the sense that the renal and ureteral lesions are secondary to the bladder involvement; rve have shown that minimal tuber¬ culous renal lesions, when associated with extensive vesical and ureteral changes, are doubtless, in some cases, later involvements of the urinary tract, be they produced in the true ascending, canalic¬ ular sense of propagation by contiguity or in a more circuitous fashion by late embolic invasion of the kidney ; and, by the results of the removal of the kidney in two of the cases, have given ample testimony of the value of nephrectomy even in this type of urinary tuberculosis. Although the renal parenchyma is practically unin-Y'olved in some of these cases the retention of tuberculous urine in the pelvis of the kidney and the constant contamination of the bladder with tuberculous products elaborated in the ureter are sufficiently active factors in interfering with recovery.
This investigation was suggested by and started under the direction of Major Francis W. Peabody, M. C., U. S. Army, and completed under the direction of Capt. Bertnard Smith, M. C., U.
of the skin. Five per cent, sterile boric acid ointment is a good dressing covered by sterile gauze pad and bandage, or 10 per cent, sodium bicarbonate ointment.The eyes are washed with solution of boric acid and covered, and the lids protected for some time with bland yellow mercuric oxid ointment and fear of further injury dispelled. Later dusting powder of bismuth and zinc oxid, or of zinc stearate will prove satisfactory for abraded skin areas.Dugouts and holes where a person is likely to sit are to be suspected and carefully evacuated by an attendant wearing oil canvas protection. Then chlorinated lime is scattered in places suspected. Articles of salvage and waste should always be held under suspicion of being contaminated. The clothing is soaked in several changes of water at 70 C. Instead of . strong alkaline remedies, potassium permanganate, 0.05 per cent, solution, is recommended, or a 0.1 per cent, zinc chlorid, and between the fingers or folds of the , scrotum, a weak silver nitrate solution. In advanced respiratory cases, oxygen inhalations are used.Owing to the censorship, the photographic reproduction of many interesting cases is not permissible. These cases should be given careful attention, and after treatment one need not necessarily excuse patients with mild skin burns from duty.
the culmination of the research which has been in progress for several years in this laboratory on the development of a suitable apparatus for use with pathological cases. The dog respiration chamber, the infant respiration chamber, and the chamber for small animals, all of which have been previously described-, were steps in the development of the larger apparatus.In devising this apparatus a number of important points had to be taken into consideration from the beginning. In the first place it was necessary to reduce the volume of the chamber to the smallest possible limits consistent with the physical and psychical comfort of the patient. Secondly, since complicated and technical difficult gas analyses are precluded in an apparatus intended for clinical purposes, a method bad to be devised which should make these unnecessary. Of fundamental importance also, were a rapid and satisfactory temperature control, a graphic record of the degree of muscular activity or repose of the individual, and psychrometric determinations of the moisture present in the chamber. Finally it was necessary that the apparatus should be so adjustable as to make it likewise available for studying the respiratory exchange according to the Jaquet-Hasselbalch principle, by eliminating the gas meter and simply analyzing the outcoming air.The clinical respiration apparatus in its finished form consists of: (1) a respiration chamber, suitably illuminated and ventilated, in which the subject may lie comfortably upon a cot; (2) a universal respiration-apparatus with a rotary blower for ventilating the chamber, an absorbing system for purifying the air of carbon dioxide and water, and a. suitable oxygen supply; (3) accessory apparatus in the form of thermometers, a barometer, and apparatus for recording the pulse-rate and the degree of muscular repose.
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