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Details of an operation INVERSION OF for inversion of the uterus of five days' standing are given by Drs. Davis and Packard, of New York, in the New York Medical Record of Oct. 26. The modus operandi is thus stated:
The operation was begun by pressing the index and middle fingers firmly and steadily against the presenting fundus, at the same time making gentle counter pressure through the abdominal wall. Gradually the uterine wall yielded, so that at the end of fifteen minutes the two fingers were buried in the tumor as far as the distal joint. The whole hand was now passed into the vagina, and four fingers pressed firmly against the mass, thus pushing it toward the cervix by continuous pressure, the elbow meanwhile resting on the bed as a point of support. With the help of the thumb, some degree of massage to the uterine walls was accomplished, with a view to rendering them more pliable and thus more tractable to further manipulations. Very soon the uterine walls began to soften, whether from the relaxing effect of the anesthetic, or from the manipulations, or from both combined, and the cervix as felt behind the pubis grew appreciably softer. At the end of half an hour it was possible to carry the fundus before the four fingers fairly into the mouth of the constricting cervix, where they were steadily held as a wedge.
habit; but excessive smoking of tobacco in other forms sent 19 men and 3 woman to the asylums. One woman became insane through the extraction of her teeth, and one girl lost her mind through fear of punishment. An intemperate desire to acquire knowledge forever stopped the studies of 20 men and 12 women. Overwork broke down the minds of 252 men and 430 women. Intemperance in alcoholic drinks accomplished the undoing of 1,227 men and 212 women. No other cause claimed so many victims among men. Besides these there were some 200 who became insane through drink complicated with some other cause, and it is a curious fact that one of these was a man who drank essence of peppermint. The opium habit claimed 17 men and 22 women. Under the head of "Moral Causes" are grouped such troubles as loss of friends, religious and political excitements, disappointments, and so on. These causes crazed 902 men and 1,294 women.
It seems rather strange, but one man became insane through". military hardship." The use of a hair wash unseated one woman's reason. One man became insane because of the heat of the furnaces under the boilers he was firing.
The table of causes compiled from the New York asylums goes into greater detail. It shows that 13 men, but not one woman, became insane through disappointment in love during the six years. One man went insane because his wife eloped, but the women who lost their husbands in like fashion must have taken a more sensible view of the matter, for not one was sent to an asylum. More remarkable still is the fact that under the head of "Domestic Trouble" there were registered 59 men and not one woman. Six men, but not one woman, became insane through fright. So, too, hair dyes turned the brains as well as the hair of two men, but not one woman. Mesmerism also affected one man, but no woman. Jealousy was the undoing of one man, but of no woman.
On the other hand overwork by itself destroyed the minds of 44 women, but of no Overwork and intemperance combined, however, landed 134 men, but not one woman, in the asylums. Intemperance alone called for 976 men and 610 women
this out of a total of 9,146 men and women admitted to the asylums during six years. Overstudy deranged the minds of 11 men and no women. Koch's lymph ruined one man, and one man became insane from a 66 dog bite." The effects of what is called the " opium habit" made 4 men insane in the six years. No cases of women are recorded under this head, but under the title of “Morphine Habit" three women and no men are mentioned.
The N. Y. Medical Journal of Nov. 16 contains a valuable article by Dr. John A. Wyeth on "How to Amputate." He points out that in every amputation the preservation of the life of the patient is the first great principle to bear in mind; the second is to preserve the greatest amount of usefulness for that part of the member which is left with the body. Since hemorrhage is the chief factor of shock, to prevent loss of blood is essential. Practically every amputation should be governed by these laws.
HOW TO AMPUTATE.
When hemorrhage has not occurred before the case is in the hands of the surgeon, this element of danger may, thanks to modern surgery, be eliminated. There is not an amputation, from the fingers to the shoulder joint or from the toes to the hip joint, in which hemorrhage cannot be eliminated as a factor of danger to the patient's life. And even when extensive bleeding has occurred before amputation is undertaken, the introduction of hot salt solution into an exposed vein, or in a vein at the bend of the elbow, does much to eliminate the great danger of shock from hemorrhage. Beyond the saving of blood and of as much of the limb as is possible, says Dr. Wyeth, I have never practised any fixed rules as to how to amputate, even in the formation of flaps. We should make the flap always with a view of saving as much as possible of the limb.
Of the seven hip-joint operations performed by his own method, the only patient lost was a young man, about nineteen years of age, with a sarcoma of the knee. Dr. Wyeth says that in Syme's operation he has modified the incision and now carries it from the tip of the malleolus on
either side directly downward, parallel with the axis of the leg. He uses a drainage table through which aseptic irrigation is made every day or two.
In order to secure rapid amputation, Dr. Wyeth, after tying large arteries, passes deep catgut sutures through the masses of muscle. In this way, the muscles are brought together, compression exercised and bleeding prevented. His last hip-joint amputation, done by the bloodless method, was completed in twenty-five minutes.
Dr. Chas. E. Nammack, in the New York Medical Record, furnishes particulars of a case of Hodgkin's disease, which possesses special interest from the fact that only four cases of this disease were reported in English medical literature during 1893. It occurred in the wards of Gouverneur Hospital in 1894.
An Austrian, twenty years of age, was admitted to the service of Dr. Carlisle in July 21. His family history was good; but he belonged to what is popularly known as the "sweating class," and had suffered privetions incident thereto. During the first ten months of the attack he experienced pains in the soles of feet, extending to legs and arms, and finally ascending to head. Headache was a prominent feature, and during four months, he had a daily chill, followed by fever. Two months subsequently lumps appeared, successively, on neck, chest, limbs and head, the largest attaining size of baseball. Exopthalmos of the right eye existed, with complete loss of vision.
Physical examination at hospital was almost negative, anemia being a conspicuous feature of case. The only abnormalty observed was marked enlargement of one gland in roof of mouth. Temperature was almost continuously elevated until last five days of life, when it became subnormal. Langour, depression and stupidity, almost amounting to idiocy, existed.
The patient died ten days after entering hospital. Autopsy of principal organs showed slight enlargement of spleen, with increase of fibrous tissue. Kidneys were abnormally large, capsule adherent, and the microscope revealed sarcomatous nodules.
Dr. Robert F. Weir presents in the Medical News of Nov. 16 final results of his examination into effects of ether on the kidneys. He thus presents his conclusions :
That etherization in the vast majority of cases in normal kidneys, and even in abnormal kidneys, brings about no detrimental effects; that when any evidences of abnormality present themselves they are transitory in character and not productive of harm; that elevation of temperature, which I had before thought would aggravate the work of the kidney and bring about in conjunction with an ether narcosis abnormal excretions, does not appear to exercise any positive influence on this point.
Dr. C. M. Lenhart, of LAPAROTOMY IN Zanesville, O., reports in TUBERCULAR PERITONITIS. N. Y. Medical Record of Oct. 26, an operation for tubercular peritonitis. Half pint of blood was drained from the peritoneal cavity, and complete recovery followed. The cases most likely to be benefited by operation, in Dr. Lenhart's judgment, are those accompanied with considerable exudation, either free or encysted. Such cases are most likely to be primary in the peritoneum, the chances of general infection are less, and the general condition of the patient is usually better. In cases with purulent exudation and large caseous masses in the peritoneum the prospect for recovery is less hopeful, but many cures are recorded, and surprising results
often follow abdominal section in these cases. In chronic adhesive or dry tubercular peritonitis, when there is little or no serum or purulent exudate, and the coils of intestines are matted together, with probably enlarged caseous masses, little or no benefit can be expected to follow an operation.
Dr. S. G. Dabney, in the American Practitioner and News, of Nov. 2, writes that this disease constitutes about one-fourth of all the diseases of the eyes in children. It is often considered as two separate affections according as the conjunctiva or cornea is involved, but as the epithelium of the conjunctiva is continued over and forms the anterior coat of the cornea, and as the etiology, and, with certain important modifications, the treatment, is the same, it seems wiser to look upon the disease as a single one, sometimes implicating one of those structures and sometimes both.
It is often known as scrofulous or strumous ophthalmia. These terms, in a measure at least, indicate its causation. It is most common in delicate children with enlarged lymphatic glands, adenoid growths, and hypertrophied tonsils.
Treatment must be constitutional and local. Neither can be disregarded with justice to the patient. The diet should be simple, nutritious, and given at regular times. Candy, cake, pastry, and so on, should be carefully avoided. Milk, of course, should be given in place of tea or coffee. A daily sponge bath in salt water is often valuable. Plenty of out-door exercise should be insisted on, the eyes being protected from light by a shade or smoked glasses, or both, but never bandaged.
Among medicines, syrup of the iodide of iron and cod-liver oil hold the first place; quinine is often indicated. The local medication must be determined by the situation and acuteness of the disease. Where the sensitiveness to light is intense, with pain and great injection, atropia should be used.
The first cases treated by these means occurred in some Italian laborers, who contracted urethritis during their winter sojourn in the city, and who came to the class at the New York Dispensary. They were treated closely after the methods employed in treating gonorrhoeal ophthalmia, with the exception of the ice-cloths. This consisted in injecting once a day into the urethra by means of a hand-syringe about 2 drachms of a ten grains to the ounce solution of nitrate of silver, allowing it to escape almost immediately, and then injecting a saturated solution of boric acid. This solution was also to be used at home after each act of micturition, the urethra being first washed out with warm water. This method seemed to work well in some cases, while in others it appeared to be too irritating. A further modification was therefore necessary, and for this reason a weaker solution was used in order to determine whet strength was the most desirable.
Dr. Guiteras used first a one grain to one ounce solution, and increased to ten or twelve grains to the ounce with success.
The Therapeutic Gazette SERUM TREAT- for November publishes MENT OF TUMORS. a paper from Dr. Coley, stating that, since 1891, he has treated eighty-four cases of malignant tumors with the toxins of erysipelas and the bacillus prodigiosus. Of forty-three cases of sarcoma so treated, eleven were successful. One patient has remained well for nearly four years, two for more than two
From the report just issued it appears that the eight retreats, licensed under the Inebriates Acts in 1893, were re-licensed last year, and one new retreat was added to the list. The number of patients adImitted has risen from one hundred and twenty-nine in 1893 to one hundred and thirty-three during 1894. The inspector considers that the formalities which have to be gone through before a patient who voluntarily applies for admission to a retreat can be committed, might with perfect safety be simplified. At present every application has to be supported by the statutory declaration of two witnesses and attested by two justices, and it constantly happens that the courage of the applicant fails before all the requirements have been fulfilled. It is suggested that the declaration of a single witness and the attestation of one justice would be sufficient. The maximum period of detention, it is thought, should be raised from twelve months to two years, as it is found that a twelvemonth is in many cases too short a period for the curative treatment to be successful. It is suggested that patients who escape might be made liable to recapture without a warrant of a justice.
in the kingdom, 38,113 patients were last year admitted to the various dispensaries and hospitals, the whole population only amounting to about 150,000. Of 3,704 births in Brighton during the same time, no fewer than 1,240 were attended by one charity alone; others were attended in the Union, and by a society for helping young women. From these figures it is argued that the charities of this fashionable watering-place are grossly abused.
Dr. M. F. McTaggart, in THERAPEUTICS OF the Therapeutic Gazette, for November, gives his experience of treatment of tuberculosis: Naming the drugs in the order of their value, guaiacol ranks first. Being powerfully destructive to bacteria, and tolerated by the human system in efficient dosage, make it preferable to its cognate, creosote, in all pulmonary or tuberculous conditions. Whatever may be said disparagingly of it, it ranks first, because it fills an office in nearly every phase of tuberculosis. The ingredients to be hereinafter named as adjuncts are secondary, not having so general application, but are indispensable to meet certain manifestations. When guaiacol is called for, we use it in two sets of formulæ -viz., No. 1 and No. 2-of varying strength, to be used subcutaneously and internally, as follows:
R Guaiacol, 5 per cent.;
No. 1 (4).
B Guaiacol, gr. iv; Salol, gr. iii; Glymol, 31. M. Sig. Internally.
The guaiacol combinations, salicylic acid, ichthyol, electricity as an aid to medication, massage, oils in abundance, internally and externally, rich, nourishing dietary, and well-selected stimulating drinks constitute the chief agents employed, and, as food, whipped eggs with brandy and milk, or milk with lime-water, beeftea, powdered beef, broiled steak, scraped steak, linseed jelly with lemon, cut raisins and lump sugar, fresh fish, raw oysters, cocoa-nut, walnut, buttermilk with oatmeal.
In its November issue, DIAGNOSIS OF the Therapeutic Gazette alludes to the immense importance of being able to make an early diagnosis of cancer of the cervix, since, when this is done, modern improvements in technique are such as to allow of successfully dealing with a local disease. He states that the diagnostic signs, to obtain the maximum amount of usefulness, must be comparatively easily found when looked for, and their verification must not require any processes which demand a large amount of time and care and special knowledge on the part of the practitioner.
If in any given case under examination the results obtained by palpation and the closest inspection are such as to leave any doubt in the mind of the practitioner as to whether the condition is or is not early cancer of the cervix, the doubt will be invariably cleared up by ascertaining the amount of friability of the tissues. If the suspected portion be thoroughly exposed by a suitable speculum, and the uterus held steady by the volsellum, if the disease is malignant, a firm scrape with a sharp curette or spoon will enable the examiner to obtain a definite distinct piece of tissue, larger or smaller, according to the extent of the infiltration and consequent friableness of the tissue thus operated upon. If it is not malignant, the firm scrape with the sharp curette will only make the parts bleed, and, at the most, some small thin shred or pellicle of semi-translucent epithelium or of granulation will be obtained.
Dr. Berthold Beer, in December issue of Popular Science News, recommends that the mucous membrane of the lips of the mouth be rubbed slowly with a piece of ice, the rhythm of the motion corresponding as nearly as possible to that of normal respiration. He claims that the inevitable result of the treatment is the return of respiration, at first in a very pronounced form, but becoming, on the continued application of the ice, very regular, quiet and deep. Ice used in this way has also a general sedative effect, and its quieting action has been successfully turned to account in the treatment of cerebral