« ForrigeFortsett »
developing this boy's extensor power by must first be determined wbat power retransplantation.
mained, and how that power could best be Dr. A. E. Taussig, said that the compara.
transferred to the point desired. In this tive weakness of the fingers might be due to
case, the boy bad the main funotion of the the weakness of the biceps, the young man
band, the power to grasp. In the operation not having been trained to use the biceps, if
the pronator radii teres and the pronator so, an increased finger funotion might be ex.
quadratus were divided because they were
short and held the forearm in strong pronapected as a result of education of that mus. cle.
tion. Dr. Francis Reder mentioned an experience Dr. Schwab, in closing, insisted upon the of his which had oocurred some ten years care to be taken in a differential diagnosis. ago. A patient was brought to him, a lad of Oppenheim last year had called attention to some fifteen years, who stumbled frequently cases of muscular atrophy operated upon by while walking. The boy was found to have orthopedists. Of course no improvement bad suffered from infantile paralysis when three taken place. If the cases of anterior polio. years old, the muscles affected being the an myelitis were seen by the orthopedist early terior set of muscles of the leg. It occurred enough there was room for all sorts of mato him that some good might result by slic- nipulative interference. From the standpoint ing off a piece of the tendo Achilles and at- of the neurologist it was absolutely necessary taching it to the tendon of the tibialis anti. that he be able to exclude progressive muscu. ous. Inexperienced as he was at that time in lar atrophy, and this, from the neurologist's this work the result was reasonably satisfac- standpoint, was sometimes a very difficult tory, and in six months the boy was able to thing to do. But in all cases the diagnosis walk without falling. The result was most between the spinal and the cerebral types of gratifying to those interested in the boy. He paralysis must be made. wished to know wbat experience Dr. Hoffman had bad with the extensor muscles of
Dr. Hoffmann said that this was unthe leg, and would be not feel more encour.
doubtedly a case of the cerebral type and had aged as to a successful outcome to perform a at one time been spastio, but the condition tendon transplantation upon the leg than
of the boy when they got hold of him was upon one of the upper extremities?
such that there was no spasticity of the
flexors, which had degenerated and were Dr. Hoffmann, in olosing, said that opera.
flacoid. tions upon the lower extremity were as a rule more successful, because in the upper extrem. ity there was required a finer adjustment of the muscle balance. In the lower extremity,
MYOMA OF THE UTERUS. — when one supplied the ability to lift the foot. B Ext. mammae siccati.......... 3 ij a great deal was accomplished, as the main Ft. in capsulae No. xxiv Sig. One to four functions of the lower extremity were to bear capsules t. i. d. —Ex. the weight and clear the ground in a satis.
CURE FOR THE WHISKY HABIT. - It is factory manner. In the upper extremity claimed that a person cannot take the follow. the function required much more intricate
ing and drink whisko at
ing and drink whisky at the same time, i, e., muscle co-ordination. Replying to Dr. it will cure the whisky habit if a patient will Taussig's remarks, Dr. Hoffman said that in the biceps in his case, the power was per- B Apomorphine ........ ...... gr. ll. baps 50 per cent of the normal. This was
Strychnine.................. gr. ss enough, if it could be transmitted without
Fowler's solution............ 3 ss any interference at all, to give a good grasp.
Tinct.cinchona comp., q.s.ad. Zij But it also required training, and this would
M. Sig. One teaspoonful every three probably accomplish a good deal. The pa.
hours.—Burnett, Med. Summary. tient bad already learned to use a fork and could bring it to his mouth. He could ex. DIET IN DIABETES.–Osler says: Reduce ert quite a pull temporarily, but not for a starches and sugars to a minimum-gluten long time, so it appeared that training ought bread or a few ounces of ordinary bread daily. to do much for the boy. As to tendon trans. Avoid alcoholic liquors and restrict diet grad. plantation, there was danger of it falling into ually to nitrogenous and hydrocarbon foods, disrepute because in many cases it had not cutting off one thing after another. Sac. been a success on account of the operation cbarin, glycerin or levulose may be used in being done witbout due consideration of what place of ordinary sugar. A more liberal reg. power remained in the limb, and how best to imen may gradually be allowed within a redistribute it. In order to obtain success it month or two.-Denver Med. Times.
THE MEDICAL FORTNIGHTLY
stake, and no time should be lost in executing well-directed and positive measures.
The measures selected will depend upon the Issued Tenth and Twenty-Fifth of Every Month. cause, location and extent of the laceration. Under the Editorial Direction of
Such ruptures are said to be "complete" or FRANK PARSONS NORBURY.
''incomplete,” that is, whether they pass enTHOS. A. HOPKINS. CARL E. BLACK.
tirely through the uterine wall, inoluding the With the following staff of Department Editors
peritoneum, or whether the peritoneum is 0. E. LADEMANN, Internal Medicine.
only stripped up and not lacerated. Also JOHN MCHALE DEAN, Surgery. R. B. H. GRADWOHL, Pathology and Bacteriology.
they may be classified as to whether or not W. H. VOGT, Obstetrics and Gynecology.
any or all parts of the ohild are entruded into WALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics.
the peritoneal cavity., The object of treatW. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology,
ment must be the immediate delivery of the HERMAN STOLTE, Laryngology and Rhinology. obild. This will usually be accomplished by F. P. NORBURY, Nervous and Mental Diseases. T. A. HOPKINS, Genito-Urinary Diseases.
forceps, by version, by embryotomy or lapar. ROBERT H. DAVIS, Dermatology.
otomy. In only about 10 per cent of the
cases is the child saved. In complete rup. EDITORIAL
tures the life of the mother is saved in only one-fifth of the cases, which go without treat
ment and in less than fifty per cent of the WE print in this issue a paper on the above
cases which receive the most prompt and effi. subject in which two cases are reported by oient treatment. In incomplete ruptures the
the author as oocurring prognosis is more favorable, athough even in
in his own obstetrical Rupture of
these the mortality is high. C.E.B. experience of less than the Uterus.
600 cases. The fact
that any practitioner, wherever located, may bave such experiences leads us to call attention to it. In 1875 TAE UROLOGICAL SOCIETY.-At a meeting Bandl called attention to the fact that rup- held at the Blue Grass Hotel, St. Louis, on ture was usually due to two principal causes: Friday evening, March 16, a society to be First, there is some malposition of the child, known as the St Louis Urological Societo which interferes with its descent and at the
was formed. The first contribution was a same time furnishes angular parts of the child
paper by Dr. Bransford Lewis, which was fol. against the uterine wall. Second, in such
lowed by an interesting discussion partici. cases the lower segment of the uterus becomes
pated in by all members. Dr. Bransford overdistended in Nature's effort to overoome
Lewis was elected president, and Dr. E. A. the obstacle, and the wall becomes corres Scharff secretary-treasurer. by the following pondingly thinner until the wall is ruptured
named gentlemen, who constitute the obarter by the angular prominence.
members: Drs. J. L. Boebm, C. E. Bur. A second, and much rarer ouuse of this ac. ford. T. A. Hopkins. H. Jacobson, Branscident, is the presence of projecting promi. ford Lewis. G. M. Phillips. A. R. Ravold. enences from the pelvio bones which tear the Wm. Robertson, E. A. Scharff. H.J. Soherck. uterine wall as the descent of the child forces O. L. Suggett A. S. Wolf. it out against them or pelvic tumors wbich obstruct the passage and lead to overdisten. IODINE AS AN ANTISEPTIC. —Nicholas Senn, sion of the lower segment by undue uterine professor of surgery in Rush Medical College, contractions. Ruptures rarely ocour above Chicago, concludes a scholarly study of the "contraction ring,” beou use that part of iodine in surgery, with special reference to its the uterus is in active contraction, and is use as an antisentic, with the following sum. much thicker than the lower segment. There mary: 1. Iodine is the safest and most po. is great difference of opinion among authori. tent of all known antiseptics. 2. Iodine in ties as to the frequency of this accident. proper dilution to serve its purposes as an Some place the ratio as low as 1 in 1200 antiseptio does not damage the tissues; on cases, while others say 1 in 5000 cases. It is the contrary, it acts the part of a useful tisso infrequent that it makes little difference sue stimulant, producing an active phagooyto the average practitioner. He is likely to tosis, a process so desirable in the treatment only meet one or two, at most, in a lifetime of acute and chronic inflammatory affections. practice.
3. In the treatment of simple hyperplastic The treatment of such an accident requires goiter actinomyoosis and blastomycosis, the the greatest care and expedition on the part local use of iodine is made more effective by of those in attendance. Two lives are at cataphoresis.-Ex.
THE REVIEWER'S TABLE Books, Reprints, and Instruments for this department, should
be sent to the Editors, St. Louis.
REPORTS ON PROGRESS comprising the Regular Contributions of the Fortnightly De
THE DOCTOR'S RECREATION SERIES. Vol. IV. A Book About Doctors. By John Cordy Jeaffreson, Author of
SURGERY. *The Real Lord Byron," "The Real Schelly," "A Book About Lawyers." etc., etc. Fourth of series of twelve volumes compiled for the amusement, rest and relaxation of
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Common Duct Cholelithiasis.-In Journal It is indeed fortunate that this interesting of Surgery, Gynecology and Obstetrios, W. and valuable contribution to the literature Mayo Robson discusses the subject of com. embracing bistory and tradition has been in mon duct cbolelithiasis. Many new and in. corporated in tbis series and placed at the teresting points are brought out by the aucommand of American readers. Mr. Jeaffre. thor. The author finds the occurrence of son's Book About Doctors, beyond any other stone in the common duct in 40 per cent of of his numerous works, made his reputation his cases. The symptoms of common duct in literature in Britain, it was his greatest stone are repeated "spasms” and jaundice. success. American readers will find it of in. The jaundice is not as deep as we find in can. tense interest from cover to cover. Though cer of the pancreas or common duct, and is largely historioal, dealing principally with more intermitting. This changeable jaundice characters of the seventeenth and eighteenth is caused by the movable stone in the duct centuries, it seems to picture present condi. Acting on the principle of a ball valve. tions and characteristios and depict them The author claims all cases of cholelithiasis immutable of the medical person, even though are accompanied by more or less inflammathe armamentarium is vastly enlarged and tion, and we frequently find as a result ad. changed with the years. The book is quite hesions. The obstruction of the duct is the equal in point of literary worth and vital seldom complete, and in consequence dig. interest of its fellows in the very attractive tension of the gall bladder is not always series.
present, as we would suppose from backward pressure of bile. The muscular coat of the
gall bladder contracts in an effort to expel "INDIVIDUALISM VERSUS SOCIALISM.”-Apy the stones. This contraction continues un. expectation of sensationalism in William til atrophy of the gall bladder ensues. The Jennings Bryan's discussion of "Individual.. author olaims that the differential diagnosis ism versus Socialism” in the April Century of common duct stone and cancer of the is likely to be unfulfilled. The paper, it is head of pancreas is not always an easy task. said, is a succinot presentation of the olaims By some elaborate chemical examination of and objects of individualism and socialism, the urine brought out by Dr. Cammidge cerwhich Mr. Bryan defines as tendencies tain acicular, sharp edged crystals arranged rather than concrete systems. Mr. Bıyan in rosettes are found. If these dissolve in also urges that there should be no unfriend. dilute sulpburio acid in 30 to 40 seconds im. liness between the honest individualist and pacted stone or pancreatitis diagnosis is the honest socialist, since both are seeking made. If these crystals are tbick and rounded that which they believe to be best for so- and dissolve in sulphuric acid in 1 to 5 min. ciety; and he points out how the one may utes cancer of the pancreas is the diagnogreatly aid the other in the common aim of sis. It is lamentable that the author did not both, the harmonious development of the bu. in his valuable article describe this elaborate man race, physically, mentally and morally. chemical process to enable others in using it But he holds that the socialist is inclined to in making a diagnosis. The author mentions support monopoly, believing that it leads to twenty-eight different conditions that may governipent ownership of monopolistic indus. threaten the life of a patient suffering with try; whereas individualists contend against common duot stone. The operation is renconsolidation of industries and "stand for a dered easier if with a longitudinal incision morality and for a system of etbics which the liver is turned upwards and outwards. they are willing to measure against the ethics In this rotation of the liver we bring into and morality of socialism."
view the common duot and the duodenum and an otherwise difficult and deep opera
tion is rendered more superficial and easier INFLUENZAL VERTIGO.-Stewart directs to in exeoution. Drainage of the common keep patient recumbent, and give tonics and duot by a rubber tube fastened by catgut nutrients with moderate doses of alcohol dur. suture in situ is used by the author, toing the later stages.
gether with drainage of the kidney pouch. In other cases the incised duot is sutured continued up to the sixth day with abdom. with catgut and the gall bladder drained. inal distension. Patient died on sixth day Drainage is life-saving and very imperative after operation. Post-mortem showed enor. in cases accompanied by much inflammation. mously dilated stomach and duodenum. The The author further adds that when strepto. dilatation terminated sharply at a point cocci are found in the bile eitber in the gall where the descending limb of the duodenum bladder or duots an unfavorable prognosis dipped underneath the peritoneum. The should be made. The author reports 76 chol. stomach contained about three pints of green. edochotomies with three deaths. The first ish fluid. The above diagnosis might have from pyemia, the second from septicemia and been confused with acute obstruction due to the tbird from cholemia. The latter case as volvulus or intestinal paresis. well as the second the author states if drain. age was rigidly established the results might have been better.
OBSTETRICS AND GYNECOLOGY New Technic for Breast Amputation.
W. H. VOGT, M. D. In Jour. A. M. A. Jabez Jackson describes the quadrilateral flap operation originated by
(Abstracts contributed by Dr. E. S. McKee, Cincinnati.) himself in amputation of the breast. The Obstetrics in the Philippines.- Bell (Med. skin incision is begun at a point about one Record) says that the idea that semi-civilized and one-half inches below the middle of the women escape many of the pangs of child. claviole, in the sulous between the deltoid birth is entirely erroneous in regard to the and peotoralis major. The inoision is carried Philippinos. The Filipino woman lives a down along the outer border of the pectoralis short life, owing to her many pregnancies major, and then follows the lower fold of the and hard manual labor, insufficient food and mamma. It then forms an ellipse encircling most of all, the crude, brutal and ignorant the nipple with a radius of about two inches. practices employed as obstetrical aids. The The long diameter of the ellipse is parallel two chief aids used to assist expulsion of the with the first incision. The whole figure is child are: first, a stout band of cloth passed likened to a dipper the first incision forming round the woman's abdomen and pulled tight the handle and the ellipse the cup portion by four persons, who are seated two on each C. H. Mayo modifies this operation, making side of the patient, with their feet against the the ellipse more obliquely. The advantages body. Second, a plank six or eight feet long of this operation are manifestly evident. The bý a foot wide, which is placed across the flap covers without tension the chest defect woman's abdomen while another person and skin grafting is not needed. The draw. mounted on the plank raises on his toes and ing of the skin up the arm does away with descends on his heels forcibly. The birth of axillary fossa and with the space necessary the child is followed by the expulsion of the for nature to fill in with granulations and scar placenta after the above means, and should tissue. The operation after the skin flap is the process be delayed, forcible traction upon made does not differ materially with the radi. the umbilical cord is made with such energy cal Halsted. All vessels are ligated olcse to as to tear away portions of the placenta, and their origin, and both pectorals are removed. often large sections of this body are left to Mayo preserves the clavicular portion of the find their way from the uterine cavity of pectoral musole. The scar formed by this their own accord. Weeks and even months operation is small, and healing is rapid. The later the results of suoh practices are noticed author aptly illustrates by photographic pic. in the septic conditions which sbould natur. *tures of cases operated on thereby, showing ally follow retention of the membranes. the marked cosmetic advantage of this oper. Pregnancy Plus Appendicitis.-Fueth (Aration over previous technics.
chiv. fuer Gynecologie) finds appendicitis Acute Postoperative Dilatation of the Stom- a serious complication of pregnancy, espeach, with Report of Case Following Nephro- cially from its tendency to recurrence. Repexy.-Halsted in Jour, of Surgery, Gyne. currence was noted in 21 per cent of his cases. cology and Obstetrics, reports case of post. Monod and others advise the removal of the operative dilatation of the stomach. The appendix, as a rule, even when there are no patient, age 18, complained of right-sided symptoms, at the third or fourth month of abdominal pain. On examination movable pregnancy, if the patient has ever had appenkidney was found. Nephropexy under mor. dicitis. In a case of incipient appendicitis phine-ether anesthesia was performed. Pa in a pregnant woman he thinks operation tient vomited, complained of great abdom. offers the only chance for cure. He found inal pain after the operation. Temperature the difference in the temperature in the reo. and pulse rose and vomiting green Auid tum and axilla, higher in rectum, to be an
important aid in the diagnois. The anatomio endometrium and the blood acting as a for. condition of pregnancy favor the opening of eign body in the uterus may act as causative the abscess in Douglas' pouch. The abscess factors. can be opened through the reotum if there is
Intermenstrual Pain, Rosner (La Gynecoltoo much danger of interrupting pregnancy. ogie) concludes is really a pelvio neuralgia,
Unusual Complication of Labor.-Clark without apparent lesions, ocourring usually (Cleveland Medical Journal) reports a pa. in arthritio subjects and resulting from some tient in whom the lower part of the vagina abnormal action of the ovaries. Ovarian or was entirley separated from the upper with a pelvic neuralgia, at one time held in derision, transverse membrane. The anterior attach- has now gained recognition. ment of the membrane was one and a half and
Periodical Variation in the Menstrual Blood the posterior two and a half inches from the vulva. Pressure against the membrane
Pressure according to the observations of Van showed it to be firm except at one side, the
de Velde (Zentralblatt fuer Gynekologie) are left, which yielded sligbtly. The color of the
due to some chemical irritation proceeding membrane was the same as that of the va from the ovaries. He sbows the uterus, is ginal mucosa. Its thickness was about that distinotly enlarged at the time when inter. of ordinary blotting paper. The second case
menstrual pain is marked. It was formerly was one of congenital displacement of the held, and some still claim, that this latter urinary bladder. The cavity of the pelvis symptom is always associated with a cystic was well 6lled with what appeared to be a ovary, operation being consequently indi. cystic tumor attached to the pelvic wall. The cated. tumor disappeared on catheterizing. The Female Sterility.Is the treatment of stercatheter had to be passed upward, inward ility in the female justifiable without exam. and to the left and then downward before the ining the sperm of the husband ? Pincus urine could escape.
(Monatsscbrift fuer Geb. u. Gyn.) cautions Value of Ergot in Obstetrics.—Davis (Ther against the tendency among gynecologists to apeutic Gazette) says that he is acoustomed ascribe the fault too readily to the woman. to use ergot in some form in the great major. In every case he believes the husband should ity of cases of obstetrics. The only contrain. be questioned as to his power to have interdications to its use are excessive hemorrhage
a excessive hemorrhage course and a careful examination of his sperm with depleted condition of the vessels and a made. Pinous reports 58 cases of absence of feeble heart. Strychnia is given with the spermatozoa in 483 cases of sterility. Furergot because it rouses the ganglia of the ther he found 37 instances of persistent olig. uterus and stimulates the patient's nervous ospermia and 13 of necrospermia. Examin. system. He never gives more than two
ations should be made several times, and at draohms of ergot at one time. He has never
rather long intervals. Temporary azoosperwitnessed any untoward results from the use mia occurs after repeated intercourse hence of ergot. Hirst has used ergot as a routine examinations should be made. course of praotice in all cases of labor as soon
Placenta Previa.- Warren (Lancet) reports as the child is born. A very irritable stom
- a series of 94 cases in which six mothers died
å or 6.3%, while of 93 infants 49 died or 52%. tions to its use, but even in these cases after
As regards parity in the 76 cases in which the labor is over, Hirst has succeederl in hav.
in have this was mentioned 12 were primipara, while ing the ergot retained. If it bas been ne 36 bad bad five or more labors previously. cessary to anesthetize the patient he gives a
None of the primipara died, which is a matter deep hypodermio injection in the tbigh as
of interest since King in his series found soon as the uterus is evacuated. In case of
the mortality of primipara to be 30%, the gen. twins he gives a dose of ergot as soon as the
eral mortality of his series being 22%. Twin first child is born if there is no obstruction labors occurred twice in the series, of which · to the birth of the second. Cameron uses
on uses three infants and one mother died. Recur. ergot in all cases of labor after the uterus is
rences in one case is noted in the three preemptied, unless contraindicated. He has not
coding labors. Hyrdramnios was reported seen any untoward effects or accidents
in four cases, two of these being of the ten from it.
cases seen personally. Prolapse of the cord Uterine Colic is shown by Theilhaber (Zen. occurred in three cases out of the 54 in whiob tralblatt fuer Gynekologie) not to be the re. the de Ribes bag was not used, and in 4 cases sult of the passage of blood olots, for it is out of the 40 in which it was used. Post most severe from twelve to twenty-four hours partum fooding was noted in 14 cases, in after the flow appears. Fritsch has sug- four of which the placenta was adherent. Ad. gested that premenstrual engorgement of the herence of the placenta was found in two other