« ForrigeFortsett »
sible to aoid foods; eating picklee and drink. dences of gastrio uloers, past or present, but ing vinegar and other acids for their sup- there was an irregular tear along the fundus, posed therapeutic effect, and avoiding all fat following the greater curvature and situated producing foods. This bad been continued anterior to the gastro-splenic omentum; this up to the time of her death.
was about four inches in length, the peritoOn the evening of July 21st, she had neum was retracted from its edge, and at the seemed in usually good health, she had spent edge the stomach wall was of the thickness of the evening with a brother and his family in thin paper, and over the rest of the stomach a distant part of the city; he states that they was but slightly tbioker. The examination noticed that she was in unusually good spir of the other viscera sbowed the liver and gall. its. On her return home she retired without bladder normal, the common duot patulous; complaining of feeling ill. In the morning the intestines were empty,a chronic catarıbal she arose at supposedly the usual time (about duodenitis was discovered, but there was no 6 a.m.) and walked to the bath-room, a dis- other pathological lesion of the intestines. tance of about ten feet, and in the bath-room The pancreas was normal; the left kidney was fell forward striking her forebead on the edge movable, but the kidneys were otherwise norof the tub causing a contusion described be- mal as were the ureters. The bladder showed low. The family, on hearing the fall, bas. & mild cystitis at the trigone, it contained tened to the room and found her lying on about two drams of clear, ligbt colored urine. her face on the Hoor. A physician was bas. The uterus showed a subserous fibroid, about tily summoned and pronounced life extinct. one inch in diameter, situated on the poster. The case was reported to the police, and they ior wall, near the fundus, it was otherwise in turn reported to the corner, who ordered normal. Both ovaries were cystic. the post-mortem examination.
The sternum was then removed, and the The body was that of a white female, thoracic organs were found in normal posi. height 5 feet 34 inches and weight about 140 tion; the pericardial cavity contained about pounds; well nourished, but very anemic, an ounce of citron colored fluid, the heart having the waxy color, indicative of possible was normal in size and showed a slight deinternal hemorrhage. There were no external gree of fatty degeneration. The semi-lunar evidences of violence, except a small super- valves of the aorta were slightly tbiokened. ficial circular contusion about three-fourths The arteries were markedly atheromatous. of an inch in diameter, situated on the fore. The plural cavity showed pleuritio adhesion head, above the left eyebrow, close to the mar. on both sides, but no effusion. The lungs gin of the hair, and which was so insignifi. were normal. The mucous membrane of the cant tbat it could have played no part as a esophagus was silver white in color, very cause of death. There were no burns about thin and easily torn. the lips, tongue, or mouth and no odor was The scalp and skull were normal, the cop. discerned.
erings of the brain and the brain itself were A median incision was made from the su. normal. This narrowed the examination pra-sternal potch to the symphysis pubis, ex. down to a consideration of the conditions posing the abdominal viscera; the left side presented by the stomach. of the abdominal cavity was filled with altered Owing to the extreme thinness of the walls blood clots, and pure blood, much of which of the stomach and the congestion and dark had to be removed before the viscera could be color of the mucous membrane of that organ, examined; the blood clots covered both the a chemical analysis was made of the stomach anterior and posterior walls of the stomach substance, there being no contents, for the at the fundus, completely surrounded the following poisons with results noted; the regspleen, and a considerable quantity was found ulation tests being used. anterior to the left kidney. The space be. Carbolio acid-negative. tween the diaphragm and the left lobe of the Corrosive sublimate-negative. liver and between the left lobe of the liver Caustic potash-negative. and the stomach was filled. The hemorrbage Caustic soda-negative. area being the left side of epigastrium, left Phosphorus-negative. hypochondrium and the left lumbar regions. Nitric acid - negative.
The peritoneum was found normal, the Silver nitrate-negative. stomach collapsed empty, and markedly con Hydrochloric acid could be detected, though gested, its mucous coat was dark brown, there not in abnormal quantity. A digest of porwas an entire absence of rugae; this even ex tions of the stomach was made which sbowed tending to its pylorus; its walls were very acetic acid very definitely. Test was made thin and slimy and were translucent when for acetic aoid by digesting the stomach subheld to the light, showing an evident atrophy stance with distilled water and filtering, the of the muscular coat. There were no evi. color of the filtrate was light straw with de. oided acid reaction; the odor of acetic acid In looking over the literature on this subwas marked. Neutralizing with ammonia jeot, I find according to Cattell, † that when water and ferric chloride test solution added the contents of the stomach are found in the a blood red color proved the presence of acetio peritoneal cavity, care must be taken to de. acid, this was confirmed by the color being termine whether the escape was due to (a) dispelled on the addition of sulphuric acid. post-mortem digestion, or autopepsia; (b) to The examination left us with a confirma.
trauma; (c) to perforation from a gastric tion of the opinion that death was due to the
ulcer, or from chemical erosion by poison, development of the condition by violence of
etc. ; (d) to the presence of (b) and (o) with diet. We were told that the deceased bas not
the factor (a) as the real cause. In the first only used an aoid diet, and that for a long
case, the ingesta are usually widely distributed time, but that she had been known to drink
throughout the abdominal cavity, though pure vinegar, and that at frequent intervals.
more plertifully in tbe immediate neighbor
hood of the perforation; the rent is large and The chemical analysis of the stomach con.
irregular and the walls are soft and slimy, firms these statements and demonstrates the while in disease the opening is apt to be small morbid effect thereof. Whether or not the and circular and surrounded by evidences of rupture of the stomach occurred before, at hemorrhage and peritonitis, undigested food or after death, is a matter wbich we cannot enters the peritoneal cavity through a breach definitely determine; its cause may bave been in the gastrio wall. hemorrhage in the stomach, or an accumula- Auto-digestion is especially frequent in tion of gases, the presence of either may cachectic obildren. I think while there is a have occasioned her arising and going to the possibility of there having been a certain bath-room where in falling the stomach was amount of post-mortem auto-digestion, after ruptured or the rupture might bave 00. a part of the stomach had ruptured, the precurred from the same cause even before vious history of acetio acid poisoning which she arose from her bed. It would seem we found so clearly before and after death, that spontaneous rupture of the stom. would correspond to the cause of rupture by ach rarely takes place, then only as Cattell under (o) chemical erosion, and the a post-mortem condition, or in the agony just positive evidence of recent hemorrhage. preceding death (Stengel). * In this case we Unfortunately the specimen passed out of bave absolute cause for the malacia by chem - my control before I made a mioroscopic exical examination and the previous history of amination, but the fact of such extremely the case. The fact that the deceased retired thin walls is in itself proof of atrophy of the in what was considered by her family normal muscular and the mucous coats wbich was health, in conjunction with the faot that undoubtedly the result of the diet. there was no terminal edema in either lung, My thanks are due to Mr. H. P. Leftwich proved conclusively tbat death was sudden, for his painstaking chemical analysis, and It seems possible that there may have been a also to Dr. Jules Baron, coroner, for allowtear in the mucous membrane, or that an ar. ing me the privilege of reporting this case. tery ruptured in the stomach wall (the arteries is being atheromatous) causing hemorrhage
1228 South Broadway. into the stomach, and that the weight of this blood and the effort of the stomach to get rid of it could have resulted in a rupture at the
REST CURE.-Six weeks in bed was the thinnest part, which in this case was at the
old treatment for acute artioular rheumatism. fundus. Had gases suficient to cause the
Six weeks in typhoid, six weeks in iritis, six tear been generated in the stomach, one
weeks in gonorrhea at its best, and six weeks would have expected to find distention of the
in so many other infeotions, all suggest that abdomen, which was not present. Such a
perhaps here there is the basis for some kind condition would in all probability have oc.
of a generalization. Perhaps the organism casioned great distress and caused the de
really requires six weeks to gather its forces ceased to gain relief, either by changes of po.
and manufaoture its supplies to defeat an sition or by direct pressure. In either or
army of invading parasites of certain species both attempts, the stomach could have been
and repair the damage they infliot. It is a torn. Another interesting fact brought out
thought well worth following up. Even if in this case was the marked atheroma of the
there is no such general law possible, it is a arteries in one so young, which no doubt was
good rule to impress upon patients even in oocasioned by the peculiar acid diet, bearing
the most trivial complaints—a cold-an in. out the theory that the condition was pro.
fluenza-a depression from overwork. -Am. duced by dietetic causes.
† Hy. W. Cattell's Post-Mortem Pathology, 1905 edition, • Alfred Stengel's Pathology, 1903 edition, page 529.
THE MAN WITH WHOM YOU MUST LIVE. more eloquent plea. Or the request may
come from some respectable married lady, A. L. BENEDICT, M. D.
of wealth and influence, who has nothing to fear as to reputation but wbo, as a matter of
health, or convenience, or economics, or III.-TALKS TO RECENT GRADUATES.
whim, wishes to limit her offspring. The
request may come from some male acquaintSOME one bas said that everyone should try ance, perbaps your former chum, who is up to live in the society of his superiors and, against it-it may be his fiancee is involved some one else has asked what would happen or some other girl, when his wedding day is if the said superiors should, themselves, adopt already set. Perbaps the request comes the same rule. In a broad sense, however, from some older man or woman, to whom every man is, at one time or another and in you bave looked up for years, as an adviser, cne respect or another, the supericr of every a model of good morals, an active church other man. It does not seem a wise, certainly worker, a professional colleague. not a generous policy, always to seek the so. From wbatever source the request comes, ciety of those who can help us and yet, in the bear in mind two important facts: You long run, it is both wise and just to select do not need to explain the iniquity of an associates who will draw us upward rather abortion nor its serious risk; everyone who than downward. Every man has one asso. has any sense at all, realizes these points. ciate whose society he cannot avoid, with Neither can you summon any logic nor elo. whom he must spend more time than with quence that can equal the need and the anyone else-bimself.
earnestness of the person wbo wants the Right here, we wish to state that this arti. abortion performed. One more fact may be cle is not exactly a sermon, although it might stated: an abortionist who is aseptic and pot be prefaced with one of a number of Bible too clumsy, can enjoy a lucrative practice, texts, and that it is not a report of one's own with very few deaths and the man who refuses case. The physician who reports his own to perform abortions will lose a good deal of case, does not always have the proper per practice and will make enemies of many inspective and, besides, we dislike to report a fluential persons. case which has turned out not altogether suc Now, having these facts clearly in mind, cessfully, and in which we are not even sure make up your inind that you will not perform that the diagnosis is accurate.
your first abortion, refuse to discuss the It is scarcely necessary to state that tbis matter with applicants, and stick to your man with whom we must spend the greater principle, which is simply a corollary of the portion of our lives, ought to be decent and sixth commandment, regardless of financial honorable. We do not want to be tied down losses. It isn't pleasant to live with a murto the society of an abortionist, for example. derer, however successful his practice; and, Very early in your professional career, you besides, the professional murderer is bound, will be asked to do an abortion. The request sooner or later, to be found out. may come from a prostitute or a woman who, Abortion is about tbe only out and out without mercenary motives, leads a rather crime, to which the pbysician is particularly promiscuous sexual life. Such a woman has tempted. You will read in detective stories already had so many abortions that she thinks of physicians who administer poison to assist nothing of them, if she cannot induce you to in securing life insurance, who run slender perform the necessary operation, she will go needles into the medulla oblongata in order to this or that other physician, perhaps nam to hasten the execution of wills, wbo chloroing one of good standing and repute. At any form disagreeable relatives, or who prepare rate, as the abortion is going to be brought cultures of cholera spirilla to bring about a about anyway, you might as well perform it. change of political regime. But, whereas Or, the case may be the one of the melodrama any physician, however good his standing, or of the sexual morality lecturer or of the will be importuned to perform an abortion, novelist: the innocent girl betrayed and every few months, the average physician will struggling to maintain her reputation. Her nerer in his life, be asked to perform postargument is still more cogent and eloquent. natal murder. Neither will he, more than There is nothing that you can say to her any other man, be sought to perform other that she does not know and realize to be gross crimes. correct on general principles but, in regard You will, however, probably be tempted to to her particular case, there is not an argu. do many acts that, while not striotly criminal ment or an appeal to conscience or a cold. nor in gross violation of divine law are unblooded statement of practical danger that ethical and dishonorable. If you are a relig: she cannot meet with a better, stronger and ious man, don't imagine that you can live
roaching cede savagerye of savagery actual
simply with an idea of getting into heaven. Just a few words about sexual morality. According to the very best authorities, a Without regard to abstract right or wrong, great many very disagreeable, mean and nar. human experience has shown that anything row-minded individuals are sure to go to approaching free love is incompatible with heaven, and you don't want to spend your either advanced savagery or civilization, al. earthly existence with such a one, even if he though in a very low state of savagery or in will finally be renovated.
a state of barbarism with virtual or actual First of all, let us consider out and out slavery for part of the people, various phases quackery. There is nothing essentially sin of free love or, at least, polygamy, may exist. ful in having a large sign or in mailing But it is a crude, hard fact, that in any large cards, dodgers and almanacs to persons community, there is very nearly one woman whom you do not know, nor in paying for to each man, and that whenever the stress of newspaper advertisements, nor in bragging living is great enough to make the life worth about yourself as wonderfully gifted, nor in while, the necessary effort of taking care of making a partnership with some fanoy name. the weaker and dependent part of the race, All of these methods are used in other busi. will not be made unless the average man is nesses. Some are, in and of tbemselves, per. sure of his own wife and bis own offspring. fectly straightforward, others are merely the It is true that a great many persons are harmless exaggeration and distortion of the too weak to resist temptation, and that peliteral truth, that people expect and discount culiar oircumstances and, especially, the apin advertisements. Why are they unetbioal? plication of excellent general laws to excepLet us answer this question with another: tional cases, do occasionally almost seem to Why are you tempted to resort to them? Be- justify the violation of the general princicause you expect they will increase your ples of sexual morality. But society oan trade. But why will they increase your trade? exist only as these principles, are generally Because most physicians are too gentlemanly adhered to. However, as a man, you must to employ them. There you have the gist of observe or break these rules according to the whole matter of etbical objection to your own understanding of right and wrong. quackery. It is not that any one means of As a physician something more is expected advertising is, of itself, sinful or dishonora. of you. The Hippocratio oath fully covers ble but merely that the man who resorts to the ground. It is one thing to be morally these means is oom peting unfairly and is re. bad, as a man; quite a different matter to lying on the fact that the majority of his op- take advantage of the peculiar trust imposed ponents are too honorable to resort to his own in you as a physician. If you are going to tactics. The quaok is like the man who play this game, at least play it fairly, against looks at his opponents band in a game of a woman fairly armed to resist you, mature cards, like the pugilist who strikes a blow enough to judge for herself, and with no when his opponent is giving him a gener. sense of obligation to you for favors of eni. ous chance to recover himself, like the man ployment as your assistant in any capacity, who slips into a seat in a crowded car that and not disposed to yield to you by reason the man abead of him is offering to a wo of a confidence or affection due to your proman. Don't tie yourself for life to this fessional ministrations. kind of a conipanion, rather pick out an The gross violations of morals have no honest thief or square burglar.
special relation to medical practice, but However, if you are going to be a quack there are many little ways in which this life at all, at least be honest enough to proclaim companion ought to be trained. Don't live yourself as playing an unfair game. Don't with a man that has a petty, jealous disposi. compound your dishonesty by pretending to tion. If you find that it hurts your feelings be ethical. If you want newspaper advertis. to learn thut a friend is sick and has employed ing, pay for it like a man, don't pull the legs some other physician; if some one praises a of editors and reporters for puff's. Or, at rival and you have to pull bard to get up kind Jeast, don't be a hypocrite of the third degree words from your throat; if the news of anwho gets his assistant to look after the press other physician's downfall comforts you, go notices and then proclaims to his students and kick yourself until you are cured, other. and colleagues that he hates newspaper no. wise, eventually, others will kick you. toriety, who indirectly sends word to the Don't be narrow. There is something serpapers that he will operate on a rare case at iously wrong with a pbysician who is simply clinic, and then makes a sensation that will an appendage to a sign and an obstetric bag. certainly invite public comment, by ejecting You should always be advancing in your å reporter. It is unpleasant to live with an chosen art and science and, unless you are openly unfair man, it is worse yet to live so unfortunate as to justify the most modest with a second or third degree sneak.
estimate of yourself, you should be a pro.
the pelvic section less disturbing by requir. ing less separation of the divided bone.
ducer, as well as a consumer of medical knowledge. Be both a user and a maker of medical societies and medical journals.
However broad a physician, a man maybe, he is narrow if he remains only a physician. A thoroughly well rounded man must be medioore in everything but every man should have at least one hobby, intellectual or social, selfish or philanthropic, outside his life work. We oannot all be a poet like Holmes, or a genealogist like Stiles, or a muscial composer like Hemmeter, or a novelist like Doyle, or an executive or politician like Wood. But be something or do something, however humble and useless, so that you will know somebody besides those who are sick.
In short, spend your life with a man who is not only a fairly good and conscientious dootor, but a decent man, a gentleman and, not necessarily a scholar but an active, interesting fellow.
PUBIOTOMY AND ITS RELATIVE INDI.
DR. E. B. MONTGOMERY.
E. B. MONTGOMERY, M. D.
The various modifications of Gigli's tech. QUINCY, ILL.
nique of this operation are discussed in deAFTER a brief sketch of the history of tail, and a full bibliography of the subject is symphysiotomy from wbich pubiotomy is an
appended. outgrowth, both accomplishing the same ob. ject of equally enlarging the pelvic diameters, the author gives an extended review of “WHEN your position demands that you the literature of the subject giving all cases
use your own judgment, no other person's reported in medical journals and transac.
judgment will be as good.” tions, as well as verbally and by letter. The number has now reached about 300, with a
THE CONDITIONS OF FEMALE AND CHILD total mortality of 2-3 per cent, and a mortal. LABOR. – Mrs. J. Ellen Foster has been de. ity in cases aspetic before operation of O per tailed by the President from the Department cent. There has been no morbidity or im- of Justice, to investigate the conditions. pairment of gait. Comparing these figures femule and child labor throughout the United with those given in Rubinrot's exhaustive States. study of symphysiotomy, tbe author con.
“ETHER DAY" was celebrated at the oludes that pubiotomy should absolutely replace the former in all cases in which it
Massachusetts General Hospital on October would otherwise bave been done.
16th, thus celebrating the sixtieth anniverOn acoount of smaller mortality it should
sary of the performance of the first operation replace Cesarean section where that would
under ether at that hospital. The event is
commemorated each year, the custom bar. otherwise be chosen, in all cases buving a con. jugata vera of 7 cm. or over in rachitic or
ing been instituted ten years ago. contracted pelves. It should absolutely re At the annual meeting of the Denver Clin. place embryotomy in the living child, pre- ical and Pathological Society, October 20, senting praotically no greater risk to the Dr. C. B. Van Zant was chosen president; mother and saving the life of the child. It Dr. George B. Packard, first vice-president; should largely replace induction of premature Dr. George H. Stover, second vice-president. labor, or by combining pubiotomy labor may Re-elected were the secretary, Dr. Frank W. be induced at eight months, or later, increas Kenney; the treasurer, Dr. J. A. Wilder; the ing the chances of the living child and making committee on admission, Drs. Jayne and
Bergtold; and the executive committee, Drs. * Abstract of a paper read before the Mississippi Valley
Medical Association, Hot Springs, Ark., November 7, 1906.