Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 101

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

USA > Ohio > Hancock County > Findlay > Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens > Part 101

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These findings are further submitted as additional evidence of the genetic relation between megalokaryocytes and blood platelets.

DESCRIPTION OF FIGURES.

Pseudopodia and megalokaryocytic protoplasm masses from Cases II, IV, V, VII. The figures are camera lucida drawings with the same magnification. The variation in size of the red cells is attributable to variation in the tension under which the smears were spread. In two cases (Figs. 1 and 3) the coverslip method was used in making the smears, in the other two (Figs. 2 and 4) the slide method.

PRIMARY GENERAL PERITONITIS WITH ISOLATION OF THE BACILLUS LACTIS AEROGENES IN PURE CULTURE FROM THE PERITONEAL EXUDATE.

By JOHN W. CHURCHMAN, M. D., Resident Surgeon, The Johns Hopkins Hospital.

Interest in the capsulated group of bacilli (B. mucosus capsulatus) has largely centered in the discussion as to the identity of the different members of the group with one another. On this single point a large literature has sprung up, but the question is still to be regarded as only ap- proximately settled. Friedländer's' announcement of the discovery of his organism was promptly followed by publica- tions reporting similar, but not identical organisms. These included the rhino-scleroma bacillus (Fisch, Paltauf, and Eiselsberg), the ozaena bacillus (Loewenberg and Abel), the B. lactis acrogenes (Escherich) and many others (Fasching, pr. "For. von Dungern, etc.). Indeed, Ficke was able to col-

lect from the literature, twenty-two varieties of the organism to which Fraenkel has given the collective name B. mucosus capsulatus. There have been many efforts to simplify the matter by showing the identity of some of these forms with one another and reducing them to a few group types. Un- fortunately this has not proved an easy matter. Nor has it been possible to simplify the question by applying the serum tests; for all attempts at agglutination have so far failed. (Landsteiner ') .*

* Von Eiseler and Porges (Centralbl. f. Bakteriol., 1906, XLII, p. 660) claim to have differentiated the ozaena bacillus and rhino-scleroma bacillus from the bacillus of Friedländer by agglutination and precipitation with immune sera.

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ave, sau, ve saiu to be complete agreement

on the subject the conclusions of Wilde represent approxi- mately the majority opinion of bacteriologists; and they have the very great value of standardizing these organisms so that intelligible description of the various forms is possible.

Wilde ' assembles the numerous varieties of the B. mucosus capsulatus under five type groups with the following dis- tinguishing characteristics :

1. Type : B. lactis innocuus.

Raised, rounded, porcelain-like colonies on gelatin plates, or colonies like those of Bact. coli. No gas formation in glucose agar, alkali formation in milk-sugar bouillon, no coagulation of milk, no indol formation, grey-brownish growth on potato (without formation of gas), very slight patho- genicity for animals.

2. Type : Scleroma bacillus.

Mucoid, raised, colonies on gelatin plates, no gas formation in glucose agar, no (or very slight) acid formation in milk- sugar bouillon, no coagulation of milk, no indol formation, bright grey, translucent growth on potato (occasionally with acid formation), moderate pathogenicity for animals.

3. Type: B. pneumoniae Friedländer.

Raised, porcelain-like colonies on gelatin plates, gas forma- tion in glucose agar, acid formation in milk-sugar bouillon, no coagulation of milk, no indol formation, creamy yellowish growth on potato (usually with marked acid formation), moderate or great pathogenicity for animals.

1. Type : B. aerogenes.

Raised, or flat, colon-like colonies on gelatin plates, abund- int gas formation in glucose agar, acid formation in milk- ugar bouillon, coagulation of milk, no indol formation, bundant growth on potato (with gas formation), marked pathogenicity for animals.

. Type: B. coli immobilis.

Flat, colon-like or raised colonies on gelatin plates, gas ormation in glucose agar, acid formation in milk-sugar ouillon, coagulation of milk, formation of indol, gas forma- on on potato variable, moderate or marked pathogenicity for nimals.

From this it will be seen that the bacillus of Friedländer not regarded as identical with the bacillus of scleroma it is distinguished from it by its ability to form gas in ucose agar; nor with the B. lactis aerogenes, which has the wer (not possessed by the bacillus of Friedländer) of agulating milk. Wilde recognizes the existence of inter- ediate forms; but thinks the attempt to distinguish them

separate species unnecessarily confusing; and suggests ese rather sharp distinctions as a useful basis for descrip- n. Strong ' attempts even greater simplification by recog- ing only two groups, as follows:

1. Friedländer Group: Easily stained capsules, in tissues exudates ; pseudo-capsules occasionally in artificial media :

gas production most abundant on saccharose; slightly less on glucose, little or none on lactose : no coagulation of milk.

2. Aerogenes Group: Capsules difficult to stain and in- constant; no pseudo-capsules in artificial media : more abund- ant and constant gas formation on all three media; rapid coagulation of milk: equal amounts of acid on all three sugars.

Grimbert and Legros' go even further, claiming that the bacillus of Friedländer and B. lactis aerogenes are identical. All forms of both bacilli which they examined coagulated milk in from forty-eight hours to five days; and they cite Denys and Martin " as having shown that the bacillus of Friedländer, even if unable to coagulate milk at first, may acquire this characteristic by successive passage through this media.

It will thus be seen that there is justification for regarding the various members of the capsulated group as nearly, if not quite, identical; but that if any distinction is to be made a capsulated bacillus which produces gas in glucose and coag- ulates milk should be called the B. lactis aerogenes .* This has been my warrant for the name given to the organism here reported as found at operation in the exudate of a primary peritonitis.

Though the specific nature of the bacillus of Friedländer as the cause of croupous pneumonia could not be established, the pathogenicity of the capsulated group has long been recognized. For laboratory animals it has often been found fatal, though its variable virulence has been again and again emphasized. The discussions as to the distinctions between the various members of the group have rather overshadowed interest in its relation to human disease; but isolated reports of its occurrence in various pathological conditions have con- tinued to appear. In 1895 Etienne,' a year later Hébert' and two years later Léon ' collected the literature on this subject. None of these publications are absolutely complete; and several reports of the occurrence of a capsulated bacillus in human disease have since appeared.

The following table contains a complete list of the diseases from which the B. mucosus capsulatus has been isolated and thus renders the literature on its pathogenicity readily accessible :

TABLE.

Diseases from which the B. mucosus capsulatus has been iso- lated. The organism has been reported as the bacillus of Fried- länder; but also as the rhino-scleroma bacillus, and the B. lactis aerogenes.

Aphthous stomatitis (Cited in review by Etienne 7). =

Purulent rhinitis.

Rhino-scleroma.

Purulent parotitis.

Purulent dacryocystitis.

Ulcer of the cornea. Phlegmon of the orbit. Purulent otitis media.

* Or, B. coli immobilis, according to Wilde; the two are dis- tinguished by the ability of the latter to form indol.

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Bronchopneumonia (Cited in review by Étienne7). Empyema (Dieulafoy " has re- ported pyopneumothorax due to gas-producing organisms, without any connection with the lung). Serous and purulent pericarditis. Simple and purulent meningitis. Angiocholitis. Pyelonephritis. Pyaemia. Septicaemia. "

Ulcerative endocarditis.

Acute lobar pneumonia (Curry 10) .a Gangrene of the lung (Fortineau 11). Membranous bronchitis (Léon º). Osteomyelitis (Schlagenhaufer 12) .b Abscess of the brain (Sachs 13). Pseudo-membranous angina (Hébert ").

Salpingitis (Schenk 14).

Endomyocarditis (Josserand and Bonnet 15).

Abscess of scrotum (Halban 16). Cystitis (Montt-Saavedro 17).

Purulent conjunctivitis (Kiesentzki 15).

Empyema of Antrum Highmorii (Howard 19). Epidemic exfoliative dermatitis (Russell ").c Hemorrhagic sepsis (Blumer and Laird ").d

Hemorrhagic sepsis of new-born (von Dungern 22).e Typhus exanthemicus (Hlava "). Cholecystitis (Christian "). Bacteriuria (Wartburg =).f

Liver abscess (Ranzi =).

Peri-deferential abscess (Macaigne and Vauverts"). Gastro-enteritis (Fricke 2%) .g Tonsillitis (Curry ").

General gaseous emphysema with gas cysts of brain (Howard ") .h Peritonitis.i

There is then, abundant justification for Hébert's claim that the bacillus of Friedlander must be included in " la caté- gorie des microbes à tout faire "; and that, along with the staphylococcus, the streptococcus, B. coli communis, and B. pyocyaneus, B. mucosus capsulatus must be regarded as a saprophyte which becomes an infectious agent when its virulence is increased or the resistance of the host diminished.

It is striking that in the lists, given by Hébert, and by Léon of pathological conditions caused by the capsulated bacillus, no mention is made of peritonitis; and it is certain

a The relation of the organism to pneumonia is here discussed. b Streptococci were also found in the smears from this case; but the bacillus of Friedlander grew out in pure culture.

c The organism found was similar in many, but not in all, respects to the bacillus of Friedländer.

d The cultures were made after death.

e The bacteriological report is very deficient.

f Appeared with fever, chills and headache; symptoms left in three days; bacteriuria finally disappeared under urotropin. g Organisms found in the stools; presence of B. Friedländer as normal saprophyte in the intestines doubtful; Fricke, Lembke, Germano and others were unable to find it.

h Perkins (J. Exp. M., Jan., 1901) reports a laboratory epizootic among guinea pigs, associated with emphysema of liver, spleen and kidneys, from which the B. mucosus capsulatus was isolated. i These cases receive separate consideration below.

that a peritonitis of this origin must be both relatively an! absolutely, quite rare. The present case is unique in tlar the B. lactis acrogenes was grown from the peritoneal erudate during life in a case of primary peritonitis. The wor: " primary " is used in the sense of Flexner " who suggestel this term for that interesting group of cases in which an " inflammation (usually diffuse) of the peritoneal carita occurs without the mediation of any of its contained organs" or without any operative or other interference. It may arise independently (spontaneous peritonitis) or may accompany infections in distant parts of the body. Twelve of the ot? hundred and six cases examined by Flexner at autopsy, were of this variety; and the condition, though a rare one, is wai. recognized by surgeons.

Onset of illness suddenly two weeks before admission; acute, severe abdominal pains with nausea but no vomiting: then continuous pain, with exacerbations. No jaundice. I. 105.5° F. P. 120. Leucocytes 17,000. Pelvic examination negative. Signs of general peritonitis. Diffuse exudate fouRi in peritoneum at operation. No source found for the infor- tion. Appendectomy, drainage. B. lactis aerogenes in pur! culture from the peritoncal exudate. Blood cultures nega- tive. Slow convalescence; pulmonary complication (pras- ably tuberculosis). Recovery.

History .- The patient was an unmarried colored girl, eightera years old, a nullipara, with normal menstrual, and negative previous history. Two weeks before admission she had been suddenly awakened by severe, knife-like epigastric pain. This soon subsided, but some abdominal pain had been present from the onset to the time of admission to the hospital; and there had been several returns of the acute paroxysms experienced on the first night of the illness. She had also complained of some pain in the left hypochondrium. She had never vomited, bxt had been slightly nauseated. No jaundice.

On admission, the patient was suffering intensely from ab dominal pain. Temperature 105.5° F., pulse 120, leucocytes 17,000. The abdomen was uniformly distended and the res- piratory movements greatly restricted throughout. No visible peristalsis. The left lower quadrant was free from tenderness, which was, however, present in the left upper quadrant. Very slight rigidity of the rectus and oblique muscles on the left side. There was definite tenderness throughout the right side-quite marked at MacBurney's point (where there was muscle-spasm), but so exquisite in the right upper quadrant and accompanied ty such spasm of the rectus as to make further palpation here impossible. No mass could be felt anywhere. On percussion, dulness was made out in both flanks; the rest of the abdomen was tympanitic. The liver margin was about 1 cm. above the costal margin in the right mammillary line. There was a profuse vaginal discharge (containing Gram negative intra-cellular diplo- cocci) and ulcers on the labia. The vulva was marital but pelvic examination was negative. An exploratory laparotomy was in- mediately done through a right rectus incision. A considerable quantity of turbid fluid was found free in the peritoneal cavity. The abdominal viscera were uniformly injected, but there was no fibrin present, though the serosa of the intestines was quite red and did not glisten. The appendix and gall-bladder shared in the general inflammation; but were otherwise normal. The Fallopian tubes were quite red, but not distended and no pus could be pressed from their fimbriated extremities. The appendix was removed and two drains placed in the pelvis. Two days after the operation the patient began to cough. Her temperature re

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peritoneal symptoms gradually diminished; but signs and symp- toms of lung involvement increased.

Blood cultures were done on two occasions, and were negative, as was also the Widal test.

One month after the operation she was transferred to the medical service. Her operative wound was then practically healed, her peritoneal condition negative; but there was a per- sistent cough with profuse, pale green muco-purulent expectora- tion. Her leucocytes were 12,600. Her respirations were rapid and shallow, expansion was limited over the left upper front; the percussion note was high pitched in the inter-scapular re- gion, below the angle of the scapula, and in the lower axilla. There was also some impairment over the lower right lobe. The breath sounds were harsh over both fronts, enfeebled over the backs below the spines of the scapulae, but nowhere absent. Expiration was prolonged and numerous fine rales were heard. The patient gave a first degree positive reaction to tuberculin in the left eye. Repeated examinations of the sputum for tubercle

June 17 18 19 20 21 22-23-24 25 26

Temp.

Pulse

109

190

108

180

107

170

106

160

105

150

104

140

103

130

102

120

101

110

100

CHART FOR FIRST TEN DAYS AFTER OPERATION. Solid line = temperature. Broken line = pulse.

cilli were negative. The Wassermann test was also negative. The patient slowly improved and was discharged with a normal nperature, though signs of lung involvement persisted.

The accompanying charts (condensed from the regular tem- 'ature and pulse charts of the first and the final days of her less), indicate the course of the disease.

Cultures made from the peritoneal exudate at operation wed an abundant, dirty whitish growth on agar. The ;anism was a bacillus of varying size, non-motile and Gram gative. Capsules were readily stained. Gas was formed on ato and in glucose agar. After forty-eight hours, there ; acid formation in milk but no coagulation. Slight coagu- on occurred in five days; complete coagulation in nineteen 'S.

"his finding, though rare, is not entirely without prece-

dent. No one, however, has reported the organism from a primary peritonitis in cultures made during life .*

The cases of peritonitis, to be found in the literature, in which B. mucosus capsulatus was reported as the cause are the following :

1. Breinl ": Great hyperplasia of the lymphatics of the small intestine; death from intestinal perforation. In the pus a capsulated bacillus was found which was Gram negative but did not coagulate milk. It was pathogenic for white mice.

2. Fraenkel " reports the bacteriological findings (appar- ently at autopsy) in thirty-one cases. .

The following members of the capsulated group were found :

B. lactis aerogenes.

1. Peritonitis from perforation of caecum.

. 2. Peritonitis with suppurative cholecystitis.

23 45 6

8 9 10 11

Pulse

109

190

108

180

107

170

106

160

105

150

104

140

103

130

102

120

101

110

100

CHART FOR LAST DAYS OF ILLNESS.t Solid line = temperature. Broken line = pulse.

B. lactis aerogenes with a Diplococcus pneumoniae.

3. Sero-fibrinous peritonitis with nephritis. Organism resembling B. lactis aerogenes.

4. Purulent peritonitis with pyelo- and para-nephri- tis.

3. Howard ": a. Male dead after castration. Multiple abscesses of both kidneys; peri-rectal abscesses opening into cul-de-sac; fibrinous peritonitis. Cultures from peri-rectal abscess, peritoneum, heart's blood, spleen and renal abscesses

* There is good reason for supposing that all the cultures in Howard's cases were taken post mortem, though it is not, I think, definitely so stated.

The high pulse throughout may have been accounted for by the enlargement of the thyroid which was present. There was also a definite tremor of the hands and a von Graefe's sign.

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Temp.

Discharged

120

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showed a capsulated bacillus, which did not decolorize by Gram. (Decolorization by Gram's method is an essential characteristic of this group of bacilli.)

b. Girl with chronic peritonitis; peritoneal cavity con- tained large amount thick, creamy pus from which a pure culture of the bacillus of Friedländer was obtained. (It is not stated that this culture was obtained post mortem; noth- ing said about appendix or tubes, or as to the origin of the infection.)

c. Man, dead of acute croupous pneumonia. Acute general fibrino-purulent peritonitis found. Cultures from pneumonic areas, peritoneum (and elsewhere) showed the bacillus of Friedländer.

d. Ranzi ": In the case of liver abscess already referred to (multiple liver abscesses, general peritonitis and endocarditis were found at autopsy), the bacillus of Friedländer was iso- lated in pure culture from the abscesses, the peritoneal exu- date and the cardiac vegetations.

The rarity of this organism in peritoneal infections is illustrated by its absence from the series of one hundred and six post mortem examinations reported by Flexner."

In addition to its other better known pathogenic properties the B. mucosus capsulatus is, then, to be thought of in con- nection with five groups of cases.

1. Peritonitis. Cases of Breinl, Fraenkel, Howard, Ranzi a and Churchman.b

2. Hemorrhagic Sepsis (Infectious purpura). Cases of Blumer and Laird, Howard," Neumann," von Dungern = c and Léon.'

4. Liver Infections. Cases of Ranzi, Canon," d 30 d Wicklein," e Kockel,"f Wright and Mallory," & Clairmont " h and Eti- enne.' i

5. Pseudo-membranous angina.k

6. Diseases of the Eye.1

This patient was treated in the service of Dr. W. S. Halsted, to whose liberality I owe the opportunity of reporting the case. To the kindness of Dr. C. G. Guthrie, I am indebted for the bacteriological examinations made.

BIBLIOGRAPHY.

2. Landsteiner:

1. Friedländer: Fortschr. d. Med., 1883, XXII, 715. Wien. klin. Wchnschr., 1897, X, 439.

a In these four the organism was found post mortem.

b Organism found during life.

c Bacteriological report deficient.

d Septicaemia starting from abscesses of gall-tracts.

Organism reported as bacillus of Pfeiffer.

f Multiple infected liver cysts.

g Liver abscess following appendicitis and thrombosis of portal vein. Bronchopneumonia.

h Peri-cholecystitic abscesses and acute cholangitis.

i Mentions unpublished case of Neller (angiocholitis). k Paris Thesis of Hebert

I Perles " has demonstrated the marked pathogenicity of the bacillus of Friedlander for the eye. Kiesentzki " has reported a case of double purulent conjunctivitis in the new-born due to this organism; and Gourfein," in an experimental research on the rôle of Friedländer's bacillus in ophthalmology found the organ- ism in five per cent of four hundred and fifty cases of conjunc- tivitis, and in ten per cent of forty cases of dacryocystitis.

3. Wilde: Inaug. Dissert., Bonn., 1896. (Orig. Ref. Centralt! f. Bakteriol., 1896, XX, 681.)

4. Strong: J. Bost. Soc. M. Sc., 1899, III, 185.

5. Grimbert and Legros: Ann. d. l' Inst. Pasteur., 1900, XIT. 479.

6. Denys and Martin: La Cellule, 1893, IX, 268.

7. Étienne: Arch. d. méd. expér., 1895, VII, 124.

8. Hébert: Paris thesis, 1896.

9. Léon: Paris thesis, 1897.

10. Curry: J. Exper. M., 1899, IV, 169.

11. Fortineau: Compt. rend. Soc. de biol., 1904, LVII, 376.

12. Schlagenhaufer: Centr. f. Bacteriol., 1903, XXXI, 73.

13. Sachs: Wien. klin. Wchnschr., 1901, XIV, 999.

14. Schenk: Beitr. z. Geburtsh. u. Gynäk., 1898-99, I. Ret Centralbl. f. Bakteriol., 1900, XXVII, 273.

15. Josserand and Bonnet: Arch. de med. exper., 1900, XII, 52:

16. Halban: Wien. klin. Wchnschr., 1896, IX, 1002.

17. Montt-Saavedro: Centralbl. f. Bakteriol., 1896, XX, 171. 18. Kiesentzki: Ges. pract. Aertze zu Riza, March 7, 1901

(Ref. Baumgarten's Jahresb., 1902, XVIII, 544.)

19. Howard: Phila. M. J., 1898, I, 336.

20. Russell: Brit. J. Dermat., 1892, IV, 105. (Ref. Centralbl ! Bakteriol., 1894, XV, 324.)

21. Blumer and Laird: Johns Hopkins Hosp. Bull., 1901, XII. 45.

22. von Dungern: Centralbl. f. Bakteriol., 1893, XIV, 541.

23. Hlava: Baumgarten's Jahresb., 1893, IX, 320.

24. Christian: Med. and Surg. Rep., Bost. City Hosp., 1901, XII, 135.

25. Warburg: München. med. Wchnschr., 1899, XLVI, 955. 26. Ranzi: Wien. klin. Wchnschr., 1901, XIV, S01.

27. Macaigne and Vauverts: Ann. d. mal. d. org. génito-urin, 1896, XIV, 673.

28. Fricke: Ztschr. f. Hyg. u. Infectionskrankh., 1896, XXIII. 380.

29. Curry: J. Bost. Soc. M. Sc., 1898, II, 137.

30. Howard: J. Exper. M., 1900-1901, V, 139.

31. Flexner: Phila. M. J., 1898, II, 1019.

32. Breinl: Prager med. Wchnschr., 1904, XXIX, 354. (Ret. Baumgarten's Jahresb., 1904, XX, 701.)

33. Fraenkel: Wien. klin. Wchnschr., 1891, IV, 241, 265, 285. 34. Howard: J. Exper. M., 1899, IV, 149.

35. Neumann: Archiv f. Kinderheilk., 1891-2, XIII, 211.

36. Canon: Deutsche med. Wchnschr., 1893, XIX, 1038.

37. Wicklein: Centralbl. f. Bakteriol., 1895, XVIII, 425. 38. Kockel: Fortschr. d. Med., 1891, IX, 331.

39. Wright and Mallory: Ztschr. f. Hyg. u. Infectionskrankb., 1895, XX, 220.

40. Clairmont: Wien. klin. Wchnschr., 1899, XII, 1068.

41. Perles: Virchow's Archiv, 1895, CXL, 209.

42. Gourfein: Ref. in Baumgarten's Jahresb., 1902, XVIII, 548.

43. Dieulafoy: La Semaine médicale, 1900, 375.

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Studies in Dermatology. By T. C. GILCHRIST, M. D., and EMMET RII. FORD, M. D. 1 volume of 164 pages and 41 full-page plates. Price bound in paper, $3.00.

The Malarial Fevers of Baltimore. By W. S. THAYER, M. D., and J. HEWETSON, M. D. And A Study of some Fatal Cases of Malarla By LEWELLYS F. BARKER, M. B. 1 volume of 280 pages. Price. bound in paper, $2.75.

Pathology of Toxalbumin Intoxications. By SIMON FLEXNER, M. D. 1 volume of 150 pages with 4 full-page lithographs. Price, In paper, $2.00.

Pneumothorax. A Historical, Clinical, and Experimental Study. By CHARLES P. EMERSON, M. D. Price, in paper, $4.00.

Operations of 459 Cases of Hernia, in the Johns Hopkins Hospital, from June, 1889, to January, 1899. By Jos. C. BLOODGOOD, M. D. Price, in paper, $3.00.

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WIN JUDITUUUUS KESECTION OF THE NASAL SEPTUM, TECHNIQUE AND RESULTS IN THE WRITER'S PRACTICE .*

By SYLVAN ROSENHEIM, M. D., Baltimore.

The development of this operation rests on principles prac- iced long before the operation attained any great vogue. Various orthopedic methods had been used to correct these nasal deformities. Many surgeons, among them Trendelen- urg, Roux, Juracz and others attempted corrections, using he submucous method. For instance, Trendelenburg sepa- 'ated the movable septum from the upper lip, dissected up the nucosa, and then resected a small piece of cartilage. Among hinologists Hartman submucously removed in the early lays a small piece of cartilage. Peterson did the same mak- ng a flap with the base upwards.

To Krieg, however, belongs the credit of putting the opera- ion on a sound . basis. His first publication appeared in .886. His second report in 1889 records 14 cases and im- ›rovements in technique. In his third report in 1900 he jives the results of 130 operations and refers to the non- ecognition of his work. Krieg's operation consisted in a emoval of the deflected cartilage and bone with the sacrifice f the muco-perichondrium and periosteum of one side. He onsidered the operation at all times very difficult, at times a eritable " Kunststiick." The after treatment took a number f weeks; but the results were excellent and in 50 per cent f the cases, external deformities were corrected. There vere perforations of the septum in 12 per cent of his cases. n 30 per cent of the cases a preliminary treatment, usually auterization of the inferior turbinate, rarely resection, was lecessary.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 101

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189