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REPORTS ON PROGRESS est professional authority within reach; in a Comprising the Regular Contrlbutions of the Fortnightly De- word, without carrying the case to the nearest
and wisest medical suprenie court accessible.
4. The principles herein contended for should OBSTETRICS AND GYNECOLOGY be impressed on the members of the pro
fession, taught to medical students and W. H. VOGT, M. D.
promulgated widely among the people. 5. The Physiologic and Legal Status of the
Medical men should interest themselves to
see that the statutes of their respective state Fetus in Utero.-(W. H. Sanders, Jour. A.
are ample for the protection of the fetus in M. A., Feb. 24, 1906.)—If birth means the
utero. act of coming into life, as the dictionaries tell us, then unquestionably the baby came
The Surgical Treatment of Retrodisplaceiuto life at the beginning of conception, and
ments of the Uterus.—(J. W. Bovee, Ameri. at the end of nine months simply obanged its can Jour. of Obstetrios, Feb., 1906.)—In ad. domicile. The authoi thinks we should dition to the ligamentous supports of the abolish the term conception, which is liable uterus the following conditions are important, to be more or less misleading, and substitute according to the author: 1. The angle at for it the more scientific and correct term, which the uterus lies with reference to the birth. 1. It would be essentially and scien- vagina. 2. The potentiality of the vaginal tifically correct to locate birth where and canal, as opposed to the idea of an actual when it actually occurs, in spite of the fact space beneath the uterus. 3. The action of that several montbs would usually elapse be the strong perineal muscles and fascia in fore it could be known that a birth bad cer. maintaining the supporting strength of the tainly taken place. 2. It would place a vagina, and converting an actual canal into a pregnancy, from the first day of its probable valvular slit in the structures. 4. A postu
rence to its termination, or the high late balance between intra-abdominal presslegal and moral grounds it deserves to occu. ure, and that of the external atmosphere. py. 3. It would dignify the position of the He comes to the following conclusions: 1. fetus in utero, and would establish beyond That the complications rather than the uterall doubt or confusion the right of the fetus ine displacement furnish the cause for sur. to the same protection, moral and legal, as is gical interference. 2. All operations for the accorded to human beings who have com- correction of uterine displacements should pleted the period of the uterine existences. be based upon the pathological and anatom. 4. It would unify the terms, fluxion, abor- ical abnormalities of the uterus and adjacent tion, and miscarriage, under the one term, structures. 3. Any operation that changes premature delivery; then, two expressions, one dislocation of the uterus into another is premature delivery and delirery at full term, illogical, and hence unsurgical. 4. Most of would cover the entire subject. 5. It would the cases of retroversion which require specenable lawmakers to enact clear and definite ial operations are best treated by appropriate laws, jurists and juries could administer operations upon the round and uterosacral without doubt or confusion. 6. It would ligaments. have a strong tendency to promote virtue and The Treatment of Puerperal Eclampsia.to prevent crime, and to build up in every (E. G. Zinke. Amer. Jour. of Obstetrios. community a positive demand for the pro- Feb, 1906). The object of the treatment is
(1) to control and abbreviate the duration of most helpless period; it would tend to edu- the seizures: (2) to protect the patient from cate the people on a subject in reference to injury during the attack: (3) to remove the which they stand in great need of education,
cause. To control the seizures inbalations of
cause. To control the seizures and would thereby save the lives of many in. obloroform, injections of veratrum viride and pocent and undelivered babes. He submits
morphine,chloral per rectum and vepesection the following proposition: 1. The conjuno.
are advised. The withdrawal of cerebrotion of male and female germs constitute, spinul Auid he believes is dangerous and a
spinal Avid he believes is dangerou from a scientific standpoint, birth. 2. The doubtful procedure. The uterus should be term conception should be abolished and
emptied as promptly as possible, deep certhat of birth substituted therefore. 3. In pical or vaginal Cesarean section being the dealing with all stages of pregnancy, even operations usually made use of. Shook, exthe earliest, physicians should realize the cessive hemorrhage and prolonged operaextreme gravity of the condition, and should tions should be avoided. never condemn to death & fetus, however young, without the maturest consideration, Dangers of Ventrofixation.—(A. Colmann, and without calling to their aid the high. Zentralblatt fuer Gynaekologie, No.6, 1906.) -A case is oited in whioh a very difficult while in Dübrsen's record of women confined delivery followed a ventrofixation. The pos- by obsolete methods without the Bussi dilator terior lip uf the cervix lay above the sacral the percentage was 23.75%. Leopold says promontory and could not be reached even that Dübrsen has no right to criticise this with the whole forearm in the vagina. The method since he has never tried it, he also in. pregnant uterus had grown at the expense sinuates that Dührsen foars to use the instruof the posterior wall. When we consider the ment. The author, on the other hand, olaims large number of cases reported where difficult it is not the fear, but the impracticability of labor followed ventrofixation it becomes a the method wbich keeps him from using it, question whether we are justified in perform. and this bas led him to use methods that are ing this operation.
not burdened with all the drawbacks and Immediate Examination of Uterine Mucosa
dangers wbich are connected with the Bossi and Myomatous Nodules after Hysterectomy
method. The methods made use of by to Exclude Malignant Disease.-(Thomas S.
Dübreen are: 1. Deep cervical incisions in Cullen, Jour. A. M. A., March 10, 1906. –
cases of effaced cervix. 2. Vaginal Cesarean In going over the large number of myoma
section in cases of ineffaced and rigid cervix. cases that have been operated on at Johns 0.
3. Metreurysis with automatic traction in Hopkins Hospital, the author finds a sur
cases of ineffaced but dilatable cervix. Vaprisingly large number of instances in which
ginal Cesarean section is reserved for special. myomata were associated with carcinoma
ists, the other two can be carried out by the either of the cervix or the body, and a rela
general practitioner. Vaginal Cesarean sec. tively frequent picture of sarcomata develop.
tion and Gigli's pubiotoniy will not only take ing in myomatous tumors He advises the
the place of Bossi's method, but also that of opening of the uterus immediately on its re.
induced premature labor, craniotomy to the moval as a routine procedure to see if by any
living obild, sympbisiotomy, and the classiobance carcinoma of the budy exists, and also
oal Cesarean section. In general Dührsen à careful examination of the myomatous
warns against the use of the instrument, or nodules. He reports a very interesting case
that recommended by Knapp, he says it is demonstrating how valuable this procedure
decidedly wrong to say of an eclamptic pawould have been had it been followed out.
tient tbat she died of eolampsia and not from The uterus in this particular case showed
the lacerations produced by the Bossi method. nothing unusual the mucosa of the uter.
They die of the combination of a severe ine cavity was everywhere intact and ap
illness and the injuries produced. parently normal. Later on an examination was made in the laboratory, where a section was made through the tumor and some de
THERAPEUTICS. generative changes noted. Two years later
. W. T. HIRSCHI, M.D. at a second operation a sarcoma springing from the cervical stump was found. Cullen Is it possible to Prevent Salicylic Nephritis believes these tumors should all be examined by Administering an Alkali?—S. Moeller, Die carefully before the cervical stump is closed, Therapie der Gegenwart, April, 1906.) and if malignancy is found the cervix should Various clinicians have observed cylindruria also be removed. Tbe reasons for not doing and albuminuria in patients receiving salioy. a complete bysterectomy in all cases are giv. lio acid or its derivatives, and tbis has led to en as follows: The supravaginal operation the term salicylio nephritis. Renal irritation is tbe easier one; it leaves a better support is more easily produced in females and in old to the pelvic floor, there is less danger of ty. people, than in males, and during the prime ing off the ureters, and as the blood supply of life. Active diaphoresis during the time of the bladder is little interfered with, there of administering salioylates minimizes renal is less likelihood of a postoperative cystitis. irritation. The writer also observed that if Concerning Obstetrical Dilatation of the Cer
the urine was made alkaline by means of
sodium bicarbonate while administering sal. vix.-(Professor Dührsen, Berlin. Translated by Ludwig Simon, Cbicago, Surgery,
icylates, less albumins and casts are apt to
occur. It is possible that the casts are Gynecology and Obstetrics, March, 1906.) –
quickly disorganized in an alkaline urine, In this paper the use of the Bossi dilator is
and if they were present, they way have generally condemned. He believes Leopold's
been overlooked. This subject must be praised clinical successes nothing extraor.
more thoroughly investigated before a defindipay since in total of 24 viable children, 9 (371%) died as a result of the Bossi method.
ite conclusion is reached. Leopold gives the maternal mortality as The Pharmacologic Action of Digitalis, 22.6%, in which the Bossi method was used, Squills and Strophanthus on the Heart.-(J.
S. Hayes, The Biochemical Journal, Vol. 1, frequently is also immune to sarcoma, and No. 2.)—The cardiotonic effeot of this group this does not differ even if the immunity of drugs depends on glucosides, whose quan- is active or passive, or natural. tity and quality is variable, and it is advisable to triturate them according to the physi.
The Treatment of Obstinate Cases of Sciatiologio effect. The writer experimented with
ca with Perineural Infiltration.- Umber, The tinctures (British Pharmacopeia) and ob
Therapie der Gegenwart, No. 4, 1906.) – The served that tbe strophanthus tincture is usu
injection if made with a needle at least 10 ally more active in cardiac affections, but as
cm, long at the site of the exit of the sciatic it is at the same time the most dangerous, it
nerve through the sciatio foramen. The pamust be used very carefully. Strophanthus
tient experiences a sudden severe pain, the is most readily absorbed and causes less gas
moment the needle touches the nerve, after trio disturbances than either of the others.
which the medicine is gradually injected. He In the conjunctiva digitalis and squills prim.
unes a :1% eucaine solution in .8% sodium arily act as an irritant, and later as an anes
ohloride, of which from 70-100 ccm. may be thetic. Strophanthus acts as an anesthetio,
used. Most patients felt great relief after the and before the introduction of cocaine, it was
first injection, some even felt entirely well. used for this purpose. All three drugs reduce
Several patients had a slight temporary elevathe frequenoy of the heart's action, stro.
tion of temperature, and others a temporary pbanthus again being the most active. Di.
peroneus paresis. The writer bas observed gitalis and squills cause a contraction of the just as good results by using normal saline coronary vessels, stropbanthus bas little
solutions in place of eucaine solution, which, effect on them. Squills has a more constant
however, also causes slight elevation of tem. cardiostimulating effeot than either of the
perature, but is preferable to eucaine, owing others, and indireotly is a valuable diuretic.
to the idosyncrasy which many patients have
for eucaine. The therapeutio effect of these The Present View of Cancer Research.
injections is very likely mechanical, but per(H. A polant (Ebrlich laboratory), Die Thera.
manent in many, and should always be instipie der Gegenwart, No. 4,1906).-Numerous
tuted when other well established internal experimenters attempted to prove that a can
remedies fail. cer is a parasitio disease, but the microscope The Aristol Therapy of Hay Fever.-Fink and efforts of infecting others have not cleared (Therapie der Gegenwart, No. 4, 1906) disup their views. Efforts to produce immunity cusses the etiology of bay fever, and of the by means of cytotoxins also have been unsuc. most common factors the direct' to
most common factors the direct toxin irritacessful. Transplantations of carcinomatous tion and reflex irritation the latter is the most tumors from one mouse to another have been frequent. He believes the source of irritasuccessful, but that is a metastatic aifection. tion in many cases is in the antrum, and be Ehrlich believes that a cancer: cell should uses aristol with good success. A cannula is be looked upon in the same light as a bac- inserted into the orifice of the antrum and the terium, if one expects to discover the eti- aristol is introduced through the tube. He ology. Transplantation of cancer from mice bas also treated cases of asthma with this to rats reduces its malignancy and it is method and has obtained good results. In again increased by replanting on a mouse. most patients one to three treatments were This is very similar to bacterial experiments. sufficient, wbile otbers required more. In Ehrlich believes animals of one species pos. some patients it is very difficult to locate the sess an unknown substance which is essential orifice of the antrum, but patience will usufor the development of a cancer, but animals ally help to find it. of another species do not possess this, consequently a tumor transplanted from mice to rats develop only as long as this substance which bas been transplanted with the tumor
OTOLOGY. is present, and then gradually degenerates.
ALBERT F. KOETTER, M. D. Transplantation of a cancer in a mouse which is already afflicted with carcinoma is usually Surgical Interference in Tuberculosis of the unsuccessful and Ehrlich attributes this to · Meninges and the Brain.-Duret (Muenob. the fact that the original tumor consumes all ener Med. Wochenschrift.)-1. Acute diffuse of the essential substance so the transplanted tubercular meningitis. Some authors try to tumor must become disorganized. Some effect a cure by opening the vault of the animals possess active immunity, and others cranium and allowing air to enter, similar to can be rendered immune by repeated trans. tubercular peritonitis, others reducing the plantations of malignant tumors. An ani. brain pressure by withdrawal of cerebrospinal mal which is immune to carcinoma very fluid by means of lumbar punoture. The trepanning of the vault of the cranium and places that show swelling in diseases of the draining of the subarachnoid spaces the teeth; area fronto-nasclis in disease of tbrough the fossa Sylvia and the injection of upper incisors; area naso-labialis in disease medicinal remedies will no doubt have better of upper canines; area temporalis in disease results in traumatic meningitis. 2. Local. of second upper bicuspids; area hyoidea with ized tubercular meningitis up to the present simultaneous swelling of the lobe of the ear time, but seldom interfered with by operative and the external canal in disease of first and measures. 3. Tuberculoma.-In children second lower molars. He bas observed a case they are often multiple, and therefore not of deafness relieved and cured by extraction amenable for operation, in adults in whom of an upper wisdom togth which erupted with they simulate symptoms of brain tumor, they difficulty. H. A. J. Fairbank believes that are most often solitary, and should be removed an otitis media occurring during dentition as soon as possible. The cases successfully may be due to existing adenoid vegetation. operated upon refer to all tuberculomas of the He has observed a case where pain over mas. cerebral hemispheres, especially the motor toid was relieved by removal of a carious lower centers. The cerebellar operations nearly al. molar. ways caused death.
Stricture of the Eustachian Tube.-(W. Diagnostic and Therapeutic Value of the Sohier Bryant, Annals of Otology).-of a Lumbar Puncture.—(Quincke, Deutsche Med, series of one hundred post-mortems at the Woobenschrift.)-This work touches those Harvard Medical School the author did not points which are of interest to the otologist find a single case of organic stricture of the without relating much that is new. Author tube except in suppurative processes. He lays stress on the importance of measuring concludes therefore, tbat organic stricture of the pressure, whose normal he gives as 125 the isthmus are very rare, and tbat practically mm. water, especially in serous meningitis. only functional striotures should be consid. The latter disease of otogenio origin he de- ered. In obronio strictures we may find a clares though toxic diffusion, comparable to passive congestion or edema, soinetimes comthu tissue edema in the neighborhood of a bined with slight paralysis of the tubal ipus. suppurative focus. Author always makes the cles and adhesions, therefore circulatory and puncture in the horizontal side posture and mechanical strictures. Predisposing causes follows it by twenty-four hours rest in bed. are gout, syphilis, disturbance of circulation, High pressure always demands great care, hypertrophies, adhesions and scars in the Sudden sinking allows a diagnosis of incom. naso-pharyngeal space, rhino-pharyngitis. plete communication between spinal and The treatment consists in the application of oranial cavity. In this case the procedure adrenalin in the tube and silver nitrate in the should be interrupted, or the withdrawal be nasopharynx, besides an inflation and bougie. done very slowly.
Making a Chromic Acid Bead.-Sucher Discussion as to Headache, Neuralgia and
(Monatschrift fuer Ohrenheilkunde) recomOther Distant Actions in Affections of the
mends instead of the prevailing method the Teeth.—Urban Pritobard (British Med. Jour.)
following simple manner of preparing the thinks that affections of the ear su perinduced
chromic acid bead. Several chromio acid by diseases of the teeth are not so frequent as
orystals are dropped into a porcelain dish was formerly thought. The teething in chil.
which rests on a tripod over an alcohol lamp. dren may cause an otitis media acuta with
As soon as a few crystals melt the fame is perforation of membrane and suppuration,
on, extinguished, he dips the probe, made of sil. very likely through the medium of a ca.
ver and threaded, like a screw, into the so. tarrhal inflation in naso-pharyngeal space,
lution several times until the bead is of the
Jution several tin later on through lowering of the powers of
required size. This method has the advan. resistance and repair of tissue. Eruption
tage that the ohromic acid bead may be and caries of teeth may cause earache, fur.
prepared by the assistant. thermore swelling of the alveolar region may extend to mastoid process. Improvement of Some New Local Anesthetics.—(Stoavin, the bearing after removal of a carious tooth Alypin and Novakain.)—Braun (Deutsche be ascribes to an improvement of the general Med. Wocbenschrift) examined and judged condition. Septic disease of the teeth is these new anesthetics from the following known as a cause for suppuration of the ac- standpoints: 1. An anesthetic in comparicessory cavities of the nose, pharyngitis and son to its local anesthetizing potency, must angina. J. S. Russell emphasizes the fact be less toxic than cocain. The absolute toxicthat empyema of the antrum may cause pain ity measured by the percentage of the solu. that is often mistaken for neuralgia of the tion is not decisive. 2. The remedy must teeth. J. H. Mummery enumerates the not damage the tissue locally, or leave dis.
turbing hyperemia, inflammation, infiltration ing, simple dilatation of the veins, hematoma or necrosis. 3. The remedy should be solu- or abscess, may be associated enlargement of ble ip water, consistent in solution and easily the veins (Lermoyez's symptom) edema of the sterilized. 4. The vessel contracting quali hairy scalp, forehead and lids. Further obties of the suprarenal preparations must not servations must explain why these symptoms be disturbed by the renedy. 5. In application on surface of mucous membrane the remedy must penetrate rapidly. Stovain seems practicable cnly for medullary anesthesia for if used in other methods, viz., in
GENITO-URINARY. jection, like alypin, it causes considerable ir. ritation. As to the glowing reports of Seifert
T. A. HOPKINS, M. D. in the use of alypin, 10% solution, on mu. cous membranes Braun cannot speak from Joulie's Method of Ascertaining the Acidity his own experience. Novakain seems to be of the Urine. -The editor of the New York the most satisfactory in every respect. It is Medical Journal in a recent issue gives the more easily sterilized and is less toxio than detail of this very important urine test, a cocain.
test well worthy of our readers considera
tion: The urine is derived from the blood, A Characteristic Symptom of Suppurative and the explanation of bow the one, an acid Thrombosis of the Superior Longitudinal Sin- fluid could be derived by a process of filtraus.—(Giadenigo, Archiv fuer Ohrenheil. tion from the other, an alkaline fluid, has alkunde).-Farmer's wife, 31 years old, two ways presented a problem to the ourious. The healthy children, aborted twice; suffered problem in point of faot has been an imagin. from an acute suppurative otitis media with ary one because the acid urine is derived subperiosteal abscess. After the latter evac. from a fluid which though leaving a blne uated a fistula remained behind the ear. stain on litmus paper is nevertheless chemi. Short time after a fuotuating swelling ap. cally acid. The acidity of the urine is due to peared in the parietal region somewhat to the the presence of acid phosphates, and these right of the median line, painful to the touch, are also present in the blood and though also continuous pressing pain. Swelling was chemically acid salts, capable of taking up the size of half a nut, round and covered with another atom of base, pevertheless give a blue integument, which showed no cbanges. Po reaction with litmus. The alkalinity of the tassium iudide without result. Edema spread blood is consequently due to the presence of to forehead and lids. Fistula behind the ear bicarbonates, which are acid salts, so that it closed. First operation: Crucial incision is evident that, whatever may be the reaction over the swelling, granulations on galea apo. with litmus the blood is an acid fluid both neurosis removed. During the after treat chemically and practically. It is known that ment pus was discharged from a small open the phosphates of calciun and magnesium ing of the galea, probe disclosed roughened are so sensitive to any trace of alkalinity that bone. Symptoms the same. Second opera. they readily become precipitated, even in a tion: Piece of bone size of a half dollar ex. medium which is still faintly acid. Further. posed, discolored, removed. Dura in cir- more, it is known that these eartby phoscumference of discolored bone, granulating. pbates are very frequently present in the Dura fistula leads to the bloodless longitu- urine, especially during digestion. Now, in dinal sinus. Sinus filled by blood red order to enter the urine in a state of solution thrombus, which on aocount of absence of they must of necessity have been in a state of pyemic symptoms was not removed Outer solution in the blood, and inasmuch as they wall of sinus excised. Death five days later will not remain in solution in an alkaline after lumbar punoture twice revealed cloudy medium, there is no escape from the conclufuid, symptoms of meningitis. Section: sion that the blood from which they have Longitudinal sinus in anterior portion free been derived is acid and not alkaline. So to the proximity of lesion, from here to the much being established, one is justified in confl. sinuum was filled with suppurative concluding that the degree of the acidity of thrombus extending to the right lateral sinus the urine is a measure of the degree of the and part of the left. Sinus petrosi and jug. acidity of the blood. This acidity in both ular free. Eruption of isolated cells of cases is due to acid phosphates, salts of mastoid process into the right sigmoid H2PO4, that is, salts which like NaH,PO,, sinus. Diffuse leptomeningitis. Gradenigo Cal PÖ., and MgHPO4, are still capable of believes that swelling in the parietal region taking up one or more atoms of base. It is, should be characteristic of a thrombosis in therefore, obvious that the real urinary acid. superior longitudinal sinus. To the swell. ity is phosphorio agidity. The specifio grav.