« ForrigeFortsett »
and sedulous attention of his professional ope and all, feel that in him they had a sucolleagues.
perior officer with whom they could consult Having been intimately associated with Dr. and confer, and that ideas or suggestions Snodgras for the last three years, and for the made to him found always ready and careful last year coming in daily contact with him, attention. In his death the medical profession perhaps an estimate by me of his sterling loses a valuable member, the city an honest, worth and singular upity of purpose will not upright, and conscientious servant, and his be amiss. Dr. Snodgras was a man whose family a devoted and loving husband and mind had never been contaminated by any father. Thougb his publio life was indeed thing small or selfish. The one ambition short, yet it stands out clearly and boldly. that possessed him—that shaped his every It serves to set up a standard that those who act-was the desire to elevate the professional follow him must strive to emulate. If naught standing of medicine. He was just and rig. but this were left by him as a heritage his life orously honest. Simple in his tastes and has served a noble purpose. H.J. SHERCK. mode of life-eren obildlike in his simplicity-yet witbal the whole strength of his char.
MEMORIAL MEETING OF THE ST. LOUIS MEDICAL acter seemed encompassed in the idea of stalwart manhood and professional zeal. Had Exercises in memory of Dr. Charles A. it not been for his tenacity of purpose it Snodgras, health commissioner, were held by would indeed have been difficult for him to the St. Louis Medical Society in the society's attain that degree of scientific knowledge and hall, 3525 Pine street, at 4 o'clock Sunday, professional acumen which became his very April 15th. Dr. George Homan, president life, but which was accomplished by slow and of the society, presided. patient application in various and tiresome The invocation and benediotion were pro. struggles. Upon his promotion to the office nounced by Rev. John W. Day, pastor of of health comissioner bis entire energy was the church of the Messiah. Short addresses devoted to a complete study of the various were delivered by Dr. Homan, Mayor Rolla departments under him, in order that, before Wells; Dr. W. G. Moore, Attorney Henry T. attempting any improvement, he might be Kent, president of the Civio League; Dr. W. J. thoroughly acquainted with every detail. To Miller, president of the Eclectic Medical Soaccomplish this purpose he gave each and ciety, and John H. Matthews, bookkeeper in every department careful and consistent the health department. At the close of the adstudy, making an extensive tour of the im- dresses, a memorial to Dr. Snodgras, prepared portant pathological laboratories of the coun- by a committee composed of Dr. Robert try, with the result that in a remarkably short Luedeking, Dr. John Joung Brown, Dr. O. time the several departments, their work and H. Elbrecht, Dr. W. G. Moore and Dr. L. divisions, were entirely familiar to him. As H. Bebrens was read by Dr. Luedeking and a result of many important innovations had adopted by a rising vote. been begun. There was in contemplation by Dr. Homan spoke of Dr. Snodgras as one bim the establishment of a tuberculosis who, in the apparent prime of vigor and olinic, at which those unfortunates afflicted official usefulness, was called away when with this grave disease were not only to be great possibilities of worthy achievements treated but to be educated in the methods seemed about to be realized. which had for their object not only the Mayor Wells' theme was “The Man as an benefit of the individual but the protection Offioial.” He referred to Dr. Snodgras as his of those who came in contact with him. loyal friend and public fellow-worker; a man The idea of having diphtheria antitoxin sup imbued with purity of thought and whose plied to all worthy poor and administered by whole being had been conservated to the up. the pbysicians connected with this depart. lifting of mankind. ment was another of the aims which was Dr. Moore, on behalf of the medical so. shortly to be accomplished. The fight begun ciety, spoke on “Appreciation of the Man by by the St. Louis Medical Society against ir. the Medical Profession.” He reviewed step regular and irresponsible practitioners of by step the life of Dr. Snodgras, beginning medicine found in him a worthy ally and one with his birth in Lexington, Mo., January without whose aid the diffioulties of this fight 2, 1864, to his connection with the health dewill be greatly increased.
partment. In the space of this brief article it is indeed Mr. Kent, on behalf of the Civic League, a difficult task to enumerate the many accom. spoke on "The Appreciation of the Man by plishments and plans that he had in view. the Community at Large.” He possessed the confidence of each and every Mr. Matthews spoke of the kindness and one of his subordinates. His simplicity of consideration with which Dr. Snodgras maioner, his open-heartedness, made them, reated his subordinates.
REPORTS ON PROGRESS value in diagnosis is the succussion sound, Comprising the Regular Contributions of the Fortnightly De and the examination by the stomach tube repartment Stafi.
vealing the characteristio fluid and enormous
size of the stomach. The prognosis is grave, INTERNAL MEDICINE.
an extremely small number of recognized
cases have reouvered. Types of more moder0. E. LADEMANN, M. D.
ate severity probably occur and end in recov.
ery so that the prognosis, if these cases were Acute Dilation of the Stomach.-Herrick more accurately reognized, would not be so (Jour. A. M. A., March 31, 1906) speaks of grave as it is generally supposed to be. Some acute gastric dilation as a rare and extremely of the instances of late nausea and vomiting grave condition. Its recognition is not al. after anesthetics may be due to milder forms ways easy, yet important, as it is probable of acute dilation. Death when it occurs may that the earlier treatment is begun the better be within the first forty-eight hours, or it may is the outlook. He reports in detail two be delayed for more than a week. In general cases, one of them with a complicated pneu. the disease runs its fatal course within a monia ending in recovery, and the other ter week. Relapse may occur, and intermissions minating fatally. A comparative study of of several hours with cessation of vomiting the symptoms of these cases with those re. and improvement in symptoms have been corded in literature are in most respects quite noted several times. The treatment should identical. The onset is sudden. There may consist in frequent gastric lavage, saline sobe a complaint of abdominal discomfort and lution by the bowel and under the skin, nupain, the latter may be quite severe. Vomit. trient enemata, strychnin and other stimulants ing large amount, which may be offensive, of hypodermatically. Change of posture to the a brownish, grayish, greanish or black color right or to the abdominal decubitus should is quite characteristic, It almost seems to be tried to relieve the possible diag of the run out of the patient's mouth rather than mesenterio vessels on the duodenum or the to be forcibly ejeoted. The uripe is scanty; pressure of the overloaded stomach on the the bowels loose or constipated. The tem- same portion of the bowel. It has occurred perature is often subnormal, the skin cold to the writer that possibly the stomach might and clammy, small and rapid pulse, extreme be induced to contract by the application of ice thirst; in short the picture of collapse. to the abdominal wall, or of hot water or even The abdomen, especially the lower half, is hot air put into the stomach through the distended, thougb it may be flat if the stom. tube in the same way that the inert uterus aoh be well emptied for the time being after confinement can be induced to contract through free vomiting. A slight peristaltic through these means. That the stomach wall wave was observed in one case. The per has not entirely lost it elasticity and contraccussion note is drum like over the gas-con- tibility has been shown by its prompt shrinktaining part of the viscus and flat over the ing to the escape of gas when prioked postfluid. Fluotuation and the succussion sound mortem, as well as by the same contraction are clearly made out, the stomach tube with in the wall when at operation in a few cases draws a large amount, sometimes several the stomach has been opened and emptied of pints, of brownish, greenish or blackish rather its gas and fluid. In intractable cases gastrothin or gruelly fluid. This fluid generally jejunostomy is advocated. As etiologio faccontains bile, perhaps pancreatio juice and ors are given trauma,surgical operation, oversome altered blood. Free HCl, as a rule, is loading of the stomach, preceding or accom lacking; laotio acid has been found several panying diseased conditions. In some cases times. The odor is often offensive, almost the condition must be regrarded as idio pathic never feculent. The gas tbat escapes through as no cause whatever is discernible. Conthe tube or by belohing is often abundant cerning the pathogenesis, Herriok sayé that and may be of foul odor. H.S has been more careful histologic, chemical and becterfound in one or two instances. The stom. iologio examinations are necessary before this ach, with or without the aid of distension, condition shall be made olear, and morte atby air injected through the tube, can be out. tention should be given by the clinician to lined as greatly enlarged, extending to the noting the condition of the stomach as resymphysis. The abdomen fattens in contour gards location and size before and durfing as the fluid and gas are withdrawn by the operations and at the heginning of infeoti ous tube. The diagnosis is not as easy as one diseases. A previously existing gastroptosis might think. To be considered are periton. might predispose to acute dilation. So, too, itis, either general or local, intestinal obstruc- the condition of the stools during these attion, pancreatic cyst, uremia, postanesthetic tauks might show whether or not the same vomiting and acute pancreatis. Of especial peouliar blackish material found in the stomach is present in the lower bowel, and in this drops of the concentrated hydrochloric acid, way throw some light on the possible pres. diluting the whole several times with distilled ence of duodenal obstruction.
water, an amethyst-violet color appears. Santonin in the Urine.-Neuhaus (Deutsche
Fluids to be tested containing a large amount
of bilepigment should be diluted about ten Medizinische Wochenschrift, No. 12, 1906)
times with distilled water before testing. suggests the following as a reliable and effi.
The writer urgently recommends this reacoient test for santonin in the urine: A few
W tion as more delicate than the tests of drops of Fehling's solution are added to sov.
ov. Gmelin, Brucke, Fleischl, Rosenbach, Smitheral co. of urine, whereupon a dark green color Marechaland Rogin. appears which changes to dark violet-red as the amount of copper solution is increased.
Aortic-Rupture and Arteriosclerosis in ChildOn adding an aoid, preferably acetio acid, the
ren.-Oppenheimer (Virchow's Archiv, Bd. color turns to a light green. Stronger acids
olxxi, Heft No. 1, 1906) reports in detail two render it a darker green. The reaction is ex. interesting cases of arteriosclerosis in boys, quisite in the urine of children taking the age 9 and 10 respectively. In the first case ordinary dose of satonnin, while adults re
the child died from spontaneous rupture of quire a correspondingly larger dose of the the aorta. Oppenheimer regards the high drug. The only drug causing a similar reac- blood pressure and a possible congenital tion which the author observed is rhubarb, al. weakness of the wall of the artery as responsi. though differing from the santonin reaction ble for the condition, while the cause in the in an absence of the violet-red color on the second boy was undoubtedly of toxio origin. aditional adding of Fehling's solution, and The pathologic findings in each instance were the light green appearing when an aoid is identical to those of typical arteriosclerosis. added is of a dirty tint.
Gastric Mucus.-Schütz (Archiv für VerSuicide by Means of Veronal.- Ebrlich danungs's Krankheiten, Bd. xl, Heft 5 and (Muenchner Medizinische Wochenschrift, 6, 1906) artiole embraces an elaborate disNo. 12, 1906) had the ocousion of observing
course on pathologio variations in the secretwo cases of suicide by this means. The
tion of muous in the stomach. His studies symptoms in each case closely simulated consisted in examining the expressed contents opium poisoning, consisting in cyanosis,
of a test meal one hour after its ingestion, unconsciousness, superficial respiration with an examination of the rising water obtained intervals of cessation. vomiting.cold extrem. after the stomach had been emptied, and the ities, pupil contracted to the size of a pin's stomach contents obtained by expression and head without any reaction, and a pulse vary. lavaging of the fasting stomach. He presents ing in volume (small) to complete impercep- in tabulated form the findings in 110 patients tibility. In the one case, a melancholiac
with various gastric affections who had been with suicidal tendency, age 57, death ensued subjected to these three tests. In 52 per cent thirty hours after the taking of 15 grams of the cases the mucus present was in exand the other twenty hours after 11 grams. cessive amount, while in the remaining num.
ber of patients it was either scanty or absent A Delicate Reaction for Bilepigment.—Kro. altogether. Among the latter there were 9 küwicz (Muenchner Medizinische Wochen. · cases of achylia gastrica, 8 of motor insuffischrift, No. 11, 1906) published this test for ciency, 7 of gastralgia, 9 of gastrio neurosis, the detection of bile in the urine in 1898, and 4 of anacidity, 3 of hyperacidity, 1 of ectahas since given the reaction a thorough trial sia, 2 of chronic catarrh, and one each of in testing for bilepigment in other fluids ulcer, subacidity, cioatrioial stenosis of the (stomach contents, etc.). In making the test pylorio end, gastrosucchorrhea, constipation, three reagents are required, namely: (a) one renal calouli, aoute dyspepsia and icterus. per cent aqueous solution of sulfanilic acid; In 28 cases of chronio gastrio catarrh, 6 cases (b) one per cent watery solution of sodium of cancer of the stomach, one case of hepatic nitrite; (c) chemically pure concentrated canoer and in one of gastric ulcer the hydrochloric acid. The solutions a and b mucus was found excessive at all three should be kept in dark bottles. One cc. each tests. In the second and third tests alone, of solutions 8 and b are thorougbly shaken the mucous was found excessive in ten in a test-tube for a short time, when all save patients, among them one case of eotasia, a few drops of the contents (one-half co. at two of motor insufficienoy, one of gas. the most) are poured out of the tube. To the trosucchorrhea, one of chronio nephritis oontents remaining in the tube an equal with dyspepsia and in three of gastric neuamount of the fluid to be tested is added rosis. The muous was found excessive in (about one-half co.). This mixture turns a only the second test in two cases of motor ruby-red color and by adding one or two insufficiency and in one case of gastri, neurosis. In the third test alone it was ulum it is so arranged that a rubber tube can excessive in seven cases, including two of be attached, and to this in turn can be atsubacidity and one each of anacidity, hyper- tached a syringe or air pump. The specuacidity, ulcer, neurosis and cicatricial py. lum is placed on the portio and then suoloric stenosis. In healthy persons, the au. tion is established at first only very slight, thor's observations substantiate those of later gradually stronger. After a sufficient Schmidt and Tellering, who assert that the amount of suction is established the suction presence of muous in the stomach is insigni. is stopped, this operation is done every other ficant. After reviewing carefully these vari. day for a period lasting thirty minutes each ous affections he believes his work in this time. This form of treatment in cases of direction will establish the conception of endometritis seems to draw from the uterus catarrh of the stomach on a more solid the secretion and the increased blood circubasis, although he does not attempt to draw lation evoked aids in restoring the endomeany general conclusions.
trium to its norinal condition. Under this
form of treatment the author has seen tense Rhythmic Lateral Displacement of the Heart
painful bands in Douglas' cul-de-sac soften, as a sign of Unilateral Pleuritic Exudate.
and finally entirely disappear. Greene's (Am. Jour, of the Medical Sciences, March, 1906) more extended observations The Hemorrhage of Placenta Previa.-(A. have convinced him of the accuracy of a . M. Dermid (American Jour. Obst., Dec., statement he made in 1902 regarding the 1905).—If in the early months of pregnancy value of rhythmio lateral heart displacements placenta previa can be diagnosed an abortion as a sign indicative of unilateral pleuritic should be produced. Later on, when hemorexudate. This dis palcement is most marked rbage bas ocourred, the vaginal tampon is in exudates of medium size. During inspir. recommended to control the bleeding, and for ation the heart approaches the side contain delivery Braxton Hick's metbod of version is ing the effusion, wbile during expiration it advised. If a piece of placenta becomes de. moves outward. The extent of the displace. tached severe hémorrbage may follow, and in ment is quite variable sometimes as much as this case the bead should be brought down two inches. The movements are easily con with forceps as soon as possible, in order trolled by the fluoroscope, auscultatory per to get the advantage of its pressure, the fur. cussion, or in case of right sided exudate byther delivery will depend on the urgency of deep percussion of the free cardiac border, or the conditions. It may at times be necessary in some cases even by mere inspection of the to do a Cesarean section. apex beat. Forced inspiration and expiration,
My Experience in the Treatment of Retroespecially the latter are prerequsite to success
displacements of the Uterus by Operations on of the phenomena, and to accomplish this the
the Round, Uterosacral and Uterovesical Ligaadministration of morphin must sometimes
ments.-(A report of 129 cases by J. Wesley be resorted to. These rhythmio lateral move.
Bovee, Surgery, Gynecology and Obstetrics, ments have not been encountered in pneu
Dec., 1905). — Retrodisplacements of the monia, pulmonary tuberculous infiltrations,
uterus has become the bugbear of women, malignant disease of the pleura or lung, or
but no woman ever applied for treatement for in subphrenic abscess.
uncomplicated retrodisplacement. Certain
classes of cases are successfully treated with. OBSTETRICS AND GYNECOLOGY out directly treating the displacement; yet
there are a large number of cases which must W. H. VOGT, M. D.
be treated surgically. The etiological features The Indications and Contraindications to the
and the existing pathology must determine Use of the Obstetrical Forceps.-J. Thomas
the nature of the procedure. After a fair ex. Sohnell (American Medicine, Dec. 30, 1905)
perience with various surgical operations for believes that more good results would be
the cure of retrodisplacements the author had, at least as to the condition of the pelvic
says that he is convinced that the Alexander floor, if chloroform were used for the short,
operation has a very limited field, which could low and easy forceps operations, and ether
be extended largely by Goldspohn's modifi. for the long, high and tedious cases, than
cation; that vaginal fixation is hazardous; with the brutal method of delivery without
that ventro-suspension is unsurgical and dan. an anesthesio.
gerous; and that the mechanical features of
the forces that maintain the position of the Bier's Treatment in Gynecology.-J. Evers. uterus is too much ignored by all procedures. mann (Zentralblatt fuer Gynaekologie, No. He believes that the vaginal roof, including 18) makes use of a glass speculum closed at the uterosacral and uterosvesical ligaments, it outer end. Near the distal end of this spec. is the structure largely concerned in holding the uterus in normal position. Of the 129 of the ligament, passing with it beneath the cases 61 were operated by the vaginal route peritoneum, and when one-third or one-half and 68 by the abdominal route, with no mor way to the uterus it is pushed through the tality. By the vaginal route the round liga peritoneum and the ligament grasped at a ments alone were shortened twenty-one point from 11 to 24 inches from the uterus. times, the uterosacral alone sixteen times. This loop is withdrawn with the forceps. A and both in 24 cases. In the 68 cases done similar procedure is followed on the other by the abdominal route, curettage was done side. The loops are ligated together at the 62 times, trachelorrhaphy 12; perineorrbaphy lower part of the wound. 16; colporrhaphy 10; removal of both appen
Placenta Previa; A Series of 94 Cases.dages 51; herniotomy 6; appendicectomy 49. The round ligaments were shortened by the
(R. Warren, Lancet, Feb. 3, 1906).- In this Baldy method in 60 cases, and the uterosacral
able paper the following conclusions regarding in 52 cases. He tbinks his results as nearly
the treatment of placenta previa are arrived perfect us could be expected from any surgi.
at: The only certain means of arresting the cal procedure. The following deductions are
hemorrhage is by pressure on the bleeding drawn: 1. That the complications rather
points. The progress and completion of the than the displacement furnish the cause for
labor is secondary. In case of antepartum surgical relief. 2. All operations done, hav.
hemorrhages where the os will not admit a ing in view the correction of uterine displace.
finger, bimanual and abdominal examination ments, should be based upon the pathologio
should be made, to reveal whether the plaand anatomic abnormalities of the uterus and
centa be implanted on the lower segment. adjacent structures. 3. That any operation
These cases can almost certainly be saved if that changes one dislocation of the uterus
treatment be begun early. Labor should be into another is illogical, and hence unsurgi.
induced early, since its completion is the ultical. 4. As a rule, the largest proportion of
mate cure. Should the os not admit a bag, or cases of retroversion of the uterus that re.
the performance of bipolar version, it must quire special operations are best treated by
be dilated until one of the modes of treatproper procedures upon the round and utero
ment can be adopted. Having checked the sacral ligaments.
hemorrhage the next step is to keep up the
patient's strength. In severe cases this is The Technique of Shortening the Round Lig
best done by autotransfusion; i.e., raising ament.-(C. H. Mayo, Surgery, Gynecology
the foot of the bed with chairs; next, in and Obstetrics, Feb., 1906). —The following
rapidity of action, comes intravenous infusdescription is given by the author who has
ion. Rectal injections cannot be given until employed this method in many cases during
labor is complete. As regards the third stage the last two years: With the patient in the
of labor, it is often necessary to remove the Trendelenburg position, the hand is inserted
placenta manually. through a three or four inch median or The Gonococcus in the Puerperium, with Reslightly lateral incision in the lower abdomen port of Seventeen Cases.—(W. S. Stone and and passed into the upper abdomen, to ex. Ellice McDonald, Surgery, Gynecology and plore by touch the region of the gall bladder. Obstetrics, Feb., 1906.)-A review of the lit. As the hand is withdrawn the cecum is erature is given with a detailed report of 17 brought into the wound and the appendix ex cases in which the gonococcus was found amined. After dealing with such pathologi. either alone, or in conjunction with the strep. cal conditions as are found, the pelvis is iso. tococcus or colon bacillus. All cases were in lated from the general cavity by gauze and primiparae. In nine cases pain was located examined. The uterus is now placed in nor in one or both sides of the pelvic region and mal position. At the lower angle of the in- rigidity was marked in seven cases. The locision, a pair of curved forceps, Cleveland chia were distinctly purulent after the sfth ligature carrier, or other similar instrument, day and smears taken from the cervix after is passed laterally beneath the aponeurosis, the discbarge had become altered were much just over the muscle, to the point where the more apt to show gonococci than during the round ligament leaves the abdomen. This is first few days. Premature labor occurred in facilitated by lifting the wall of the abdomen three patients at periods varying from six and out and up with a tractor, also drawing the one-half to seven months. In one case there ligament tight with forceps from within. The was streptoccocus and gonococcus infection, .handle of the instrument is now elevated, suppurative salpingitis and general periton. and its point seen from within is made to itis. Another bad a vulva-vaginal abscess. pass over the pulley of the round ligament, The third was uneventful and made a good not under it, and only beneath the peritone- recovery. These three abortions were the um, but is made to traverse the true course only late abortions occurring in 172 lying-in