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Thoughts About Obstetrics.
The cases of adhered placentæ, as set Editor MEDICAL WORLD:~I was very forth, are a very fair average. I think 81 much impresst with an article in the per cent. a little high for retained placente March number, pp. 114, “Obstetric Ex- from lack of proper contraction, etc. As perience,” by H. C. Sanders, M. D. The is also his experience with postpartum doctor certainly has bad an unusual experi. hemorrhage, I have never met with ence. In the first place, it strikes me that but about three cases that were in the the per cent. of abortions and premature least alarming. births is high, and that I should look upon I have never had a single death during so high a per cent. with much more sus- the puerperal state, nor from its causes. picion than does brother Sanders. He Have seen but one typical case of puerseems to look upon but three out of fifteen peral fever in my own practice. I do not with any degree of suspicion. In rapid use any medication, prior to confinement, labor and twins, I find his experience much in more than perhaps 2 per cent. of my the same as mine. But“ tedious labors, cases. During labor I find more use for lasting two days or more, twenty cases, chloroform than any other drug. This I or one in every five cases, seems much too use freely in the first stage. It aids greatly high. Dr. Sanders did not state the cause in dilating the os by its relaxing influence. of the delayed labor, neither did he say In the second stage it lessens the sufferwhether or no the patients were in active ing, and as the head sweeps the perineum, labor during all this time. Forty-eight if possible I give it to complete anesthesia, hours or more seems a long time to allow thus enabling the mother to pass thru this a woman to suffer, unless the circum- awful ordeal without even knowing what stances governing be entirely beyond con- has happened. The "classical ergot" I trol. I find the presentations found by use only when absolutely indicated. I use Dr. Sanders are about in keeping with my it more before than after delivery. own experience, but again, the number of I never allow a placenta (at full term) still-births exceeds mine by 50 per cent. or to remain six hours, very rarely more than perhaps more. The doctor has also encoun- half an hour. In abortion, I allow it to tered placenta previa three times in a hun- remain (if not expelled) unless untoward dred. It has never been my misfortune to symptoms present themselves, when I promeet with a single case.
He bas seen as ceed to the proper methods. many cases of eclampsia as I have-one. This article is not offered as a criticism “Os closed by adhesions," none; eight of Dr. Sanders' article, but to show the cases in which it would probably have been wide difference in the experience of two best to use forceps.” Why did he not use The foregoing is based on about 600 them?
cases. (I have not got a complete record Forceps (next to chloroform) do more to of my cases.) I consider this a pretty relieve suffering than any other agent. I fair showing. Can it be possible that I use them in 10 per cent. of my cases, and chanced to have only fortunate cases? I have the first bad result yet to obtain. do not claim to be an expert accoucheur, It has long been a question with me but only an every-day Hoosier doctor, and, whether a man could be justified in sitting like brother Sanders, in a "rooral deesidly by and see his patient suffer for hours trick." when he has at his command an instru. Andrews, Ind. J. C. BUCHER, M. D. ment so powerful for good when properly used.
Possible Neoplastic Growth of the Cervical Dr. Sanders has been fortunate in pre
Region. venting rupture or the perineum in Editor MEDICAL WORLD:—Permit me to large a proportion of cases. My experi. present the following case for consideraence has been that in all primiparæ we tion : have rupture to a greater or lesser extent. Mrs. B., age 24, has never bad a child, While it is not at all uncommon in multi- of small stature, fair complexion, came of paræ, I have never yet had a rupture to healthy parentage, menses regular and involve the sphincter ani. I wish to add normal. *About seven years ago the lymthat these ruptures are not due to the use phatics under her left ear began to enlarge of forceps, as I have failed to notice any and kept growing until they reacht the difference in cases where forceps have been size of a hickory nut before she applied to used over those in which they were not her family physician for treatment. She used.
derived little or no benefit from the treatWORLD one year and Dr. Waugh's book, $5. You need them (Norwood's), one-half teaspoonful every
ment given. The glands kept on enlarg. spoonful every three hours, alternately ing until the neighboring glands became with the veratrum viride, with directions involved and took on the same slow pro- to double the dose of veratrum viride in cess of enlargement until at this writing case convulsions continued. On my return the entire lymphatics of neck and face the next day, about noon, her husband are enormously enlarged, and seem to informed me that he had doubled the dose yield to no plan of treatment, either local three consecutive doses. She was lying or constitutional. There is no indication semi-conscious, with occasionally, every of suppuration, and but little tenderness. thirty minutes, a light convulsion.
We have gone thru the entire family of tinued the treatment, adding acetate of iodids, electrolysis, cod-liver oil and other potash and buchu as a diuretic, and caloalteratives without any beneficial results. mel, podophyllin and jalap as a cathartic, Have given Aulde's Nuclein a slight trial, giving her on this visit an injection of onebut not a sufficient quantity to pass upon half gallon of warm soap suds high it as a curative remedy.
up in her bowels. On returning the secOutside of the lymphatic trouble her ond day, found her resting well, passing general condition is perfectly normal. She urine copiously and bowels having moved does her housework and takes plenty out- four or five times copiously. I lessened door exercise.
the dose of veratrum viride and bromidia, Would there be any danger in vaccinat- but continued the diuretics and cathartics. ing this patient ?
On the third day she was entirely rational, Any suggestions will be very highly ap- but I kept up the veratrum viride and preciated.
D. C. DARNELL, M.D. bromidia in fifteen drop doses alternately Grand Saline, Tex.
every four hours for about four days, and [This case presents many characteristics also the diuretic, but changed my cathartic of a neoplastic alteration of the glandular to cream tartar, podophyllin and jalap structure of the region involved, which
every night at bed-time. Kept up diu.
retics and cathartics until March 30, '99, may soon develop malignancy. It is not
when I was called in haste, messenger advisable to treat too much before forming a conclusive diagnosis, and this is im- stating that the lady was suffering inpossible to make without inspection and tensely. On examination. I found a very à very close observation. We should ad. rigid os and scarcely any dilatation, but vise sending the patient to some hospital pains regular and bearing down in charac
ter. Gave chloral and gelsemjum ; also for diagnosis, and would not venture to express an opinion upon the data afforded. kept os completely bathed in a belladonna We do not think that vaccination would ointment, and kept worrying along with be contraindicated so long as evidences of her until April 1st, when Dr. Dollens was
We decided to continue malignancy have not developt, but it is again called in. always well to have the person vaccinated
the treatment and wait, and on the mornin the best possible physical condition.- ing of April 2d I was called again, and Ed.]
this time I successfully delivered a 6pound girl. Both mother and child doing
well. I am thoroly convinced of the Puerperal Eclampsia.
merits of veratrum viride in puerperal Editor MEDICAL WORLD :- I was called eclampsia, but I also push diuretics and February 4, '99, near midnight, to Mrs. cathartics (not laxatives). M., age 22 years; primipara. Messenger My favorite diet in this condition is said the lady was having fits. On arriv- skimmed sweet milk, with a little lime. ing I made a digital examination, and water added. Have the patient drink found a rigid os and no dilatation at all. freely of it. She was having a convulsion about every Success to THE WORLD, one of my fifteen minutes ; very severe. I adminis- monthly consulters, each number being tered chloroform, gave a hypodermic of worth the subscription price for, the entire morph. sul., gr., atropin 1.150 gr., year.
B. C. WRIGHT, M. D. and sent for counsel. Dr. T. C. Dollens, Indian Springs, Ind. of Trinity Springs, Ind., arrived that afternoon at 4 o'clock, and on consulta
WORLD for four years for $3. tion we put her on tr. veratrum viride
Don't neglect to send all notes on treatment. They will be *l ree hours, and bromidia (Battle's), tea
of value to somebody.
An Easy Cure for Fistula, etc.
Atropin in Pneumonia. Editor MEDICAL WORLD:-My experience Editor MEDICAL WORLD:--I had a case with a scrotum filled with knotty cords of pneumonia in a child six months old. and varicose veins and a discharging fistula Tho child was blue, cyanotic, and in arin ani after ten years of annoyance and in ticulo mortis. I gave 1-30 of a grain of which I secured a complete and permanent atropin hypodermically over the heart and cure of both within 60 days without the in ten minutes the cyanosis had disapknife or medicine may be useful to some peared. I then gave the child white of member of the profession, hence I give it egg, brandy and water, and a little sugar as it is very simple and can be performed every half-hour for twelve hours. The by anyone with ordinary intelligence. child recovered. I would like to know
First place a permanent band or belt whether any of your readers have bad exaround the waist, supported by straps over perience with atropin as a respiratory the shoulders to keep the belt in the proper stimulant, and whether Jas. Milner Fothplace. Then fasten to this belt behind a ergil's statement that children bear large cloth about six inches wide; bring this doses of belladonna is proved in practice. cloth between the legs and up in front, New York. ARTHUR A. COTTEW, M. D. leaving a hole for the penis to protrude but not the scrotum. Pass this cloth under
A Case in Practice.-Endarteritis With Sequel and over the belt and fasten firmly. Place
of Senile Gangrene. a wad of cotton or a cotton ball that it will rest firmly upon the rectum and be
Editor MEDICAL WORLD:-February 7 I held there tight by this cloth. This must was called to see James N., aged 71, wbom be done so that, no matter what the posi. I found with a temperature of 98°. The tion day or night, there will always be a right foot and leg half way to the knee firm pressure upon the rectum and the was as black as a boot and shrunken and scrotum will be held firmly up in place.
shriveled to half.its normal size. The live At stool this cloth must be unfastened portion, about half way from the knee and removed in front and the rectum down to the ankle was a swollen and washed clean and then the cloth replaced. slufing mass, and stinking worse than
By this method there was but little valerianic acid, I at once took in the trouble or inconvenience, and cure resulted situation and informed the patient and in 60 days. The knotty cords and varicose friends that the only recourse would be an veins had disappeared and the fistula was amputation, at the same time informing well. Two years have passt and no re
the friends that the chances for recovery turn of the trouble and manhood restored. were slim even if the operation would be
The previous history of the case revealed
that some time in September last the man Three Aged Physicians.
had a paralytic stroke of the right side, Editor MEDICALWORLD:-Joseph Weeks, which affected his mental faculties. After M. D., of Mechanicsburg, Henry Co., In- treatment the paralysis and mind were diana, Daniel H. Stafford, M. D., of New both improved in a corresponding deCastle, Henry Co., Indiana, and R. H. gree. About this time as his mind and Homer, M. D., of Knightstown, Henry Co., appetite began to improve the friends beIndiana, graduated about the same time gan to notice that his feet began to swell, in a Cincinnati, O., College, and are all in he began to complain of pain in these exactive practice in Henry County, Ind. tremities, and in a few days after the foot The youngest of the three will be 80 years began to turn black and shrivel. Physiold in a very few months, and all now en- cians to whom they went for medicine injoying good health.
formed them that it was
í bone gangrene ?? How is this for Henry County? Is there and so the case ran on for days and weeks such a thing in any other county in the until, about December 15, the line of deUnited States ? R. H. HOMER, M. D. markation began to assert itself and active Knightstown, Ind.
slufing began. [This is a very unusual case of coinci- I took the case February 7 and immedidental longevity and we hope all three of ately put the patient on strychnin arseniate the doctors mentioned “will live long and (Abbott's granules) five per diem, and in. prosper.” Is the Fountain of Youth lo- structed the attendants to give him a lib. cated in the Hoosier State ?- ED.]
eral and nutritious diet. I told the friends that if left to my judgment I would put almost to perfection in the stump, and in the patient in the best possible shape by consideration of the restricted and defectbuilding up the system and then amputate. ive circulation these processes were perfect Death was inevitable in the case if left in tho they were slow. Only one spot on the that condition ; yet even at the advanced flap showed any signs of mortification and age of 71 with a tainted condition of the it was removed on the tenth day and did system and a probable endarteritis as the not reappear again. The stump healed prime cause of the gangrene, with an am- nicely up to the day of death. putation of that slufing limb I thought My opinion is that this was a typical case there was more chance for recovery than of endarteritis, with the sequel of senile to leave the morbid mass to taint the entire gangrene. The caliber of the arteries was body.
so diminisht that the flow of blood thru February 20 I amputated the limb as their channels was obstructed, especially close to the knee as I could without open- at some point above the foot and of course ing the joint, one and a half inches below, mortification took place. The brain lesion just missing the fibular attachment with the was also from the same cause, and the saw. We found the arteries very hard to brain was anemic from the lack of blood tie, as by the least tension upon them their supply. walls would tear like rotten leather. My The reader is referred to Bartholow in assistant put the knots as far up on the reference to this malady, also to Wyeth's arteries as he could by pushing back the Surgery, which has an exhaustive article tissues, and then we snapt on hemostatic for- on the subject.–Did we do our duty ? ceps, and left them on to serve in drainage Persia, Iowa.
Dr. F. M. HILL. facility as well. We laid in a t-inch drainage tube with the exit to the outer angle
Perineorraphy, Etc. of the flap. February 26 we deemed it ad- Editor MEDICAL WORLD :-The followvisable to dress the stump; we found in ing brief notes are relative to my experithe place where the hemostatics were left ence with the new local anesthetic, eucain. considerable pus. The drainage.tube was CASE 1, March 27, 1898, I was hastily quite free of any accumulation. With summoned to see a Mrs. R. ; sanguine slight tension the forceps came away plethoric temperament, aged 37, a primibringing the torn end of the artery. The para. I had been called to her a week pus was laudable (of the Bliss variety). before, when she expected to be confined, Tho we had made as near as we could an but when the “ fullness of time”' came it aseptic operation the stump lacked “union was a precipitous labor, and as I lived six by first intention" by several degrees. miles distant, I could not get there in
From this time on the patient grew time. She was attended by an old lady, steadily worse. Tho his temperature had who, as soon as the placenta was delivered, not exceeded above 101, showing slight found the perineum ruptured clear to the traumatism, brain symptoms ensued and
She informed the husband and appetite failed. Heretofore be had eaten patient of the condition and I was sent well and relisht his food. The bowels for and an examination confirmed the became irregular, but the urine remained midwife’s diagnosis. As they desired an normal in quantity and appearance. operation immediately, I
I washt out On my visiting the patient March 1 I
sponges with a mercuric chlorid solutionfound his condition absolutely hopeless, 1:2000. The vagina was doucht with the and from this date and until March 14, he same, and all parts rendered aseptic as took no nourishment but whisky and water. nearly as possible. I plugged the vagina The reasoning faculties were becoming with a sponge, then with a hypodermic I less and less each day and the vital spark injected in each external labium one fluid was fast smouldering away. March 7 I dram of four per cent. eucain solution. found that he was bereft of his mental fac. In two minutes complete anesthesia was ulties, had a temperature of 95°, voided produced. I introduced a perineal needle his urine in bed and the peristaltic action deep enough to catch all parts needed for of bowels was lost. I, however, persisted continuity; used asepticised silk thread. in the use of strychnin arseniate granules Taking several stitches I approximated as long as he could swallow and I attribute the parts and dresst them with iodoform. to this agent the extending of his days. The urine was drawn with a catheter, and Thru these days of decline of the vital the bowels were locked with opii palvis forces the plastic deposits were carried on for five days, then opened with small
doses of olive oil. The thighs were kept server it might seem there is no necessity together with a broad bandage, so as to for any great demonstration on this subkeep the parts continuously approximated. ject, but when I say there are over 30,000 Healing by first intention ensued and 10 people in Chicago alone using some form days after the stitches were removed and of an opiate, and who have a drug-babit patient dismisst. The eucain (B) did not firmly fixed upon them, and that these sicken the patient; there was no accelera- habits exist in every other city in the tion of the pulse or rise in temperature; United States in about the same proporand to cap the climax, no pain.
tion to population, it seems there is CASE 2. A young man came to my office immediate demand of agitation of the suba few days ago suffering much from having ject, that further spread may be prevented the cortex of a large cane or reed thrust if possible. thru the ball of the third finger of the left Some of the brightest men in the medihand. The offending substance was one- cal profession, who once held high posiquarter of an inch long and one-eighth tions and had remunerative practices, who inch broad, coming thru enough to
enough to knew perfectly well the action of the elevate the root of the finger-nail. I drug and the danger ahead, are victims injected 15 minims of a two per cent. solu- to-day, earning barely sufficient to buy tion of eucain (B) in the posterior part the morphin required to support them. of the finger. In one and three-quarter No person is exempt from sickness, and minutes anesthesia was complete. With in my experience in treating this class of a sharp bistoury I incised down to the cases for the past five years, over 90 per cane and with sequestrum forceps re- cent. have contracted the habit during moved it. The patient said I could have some sickness, not even dreaming of such a cut his finger off and he would not have thing until too late. One patient whom I known it.
now recall, was caught by using a muchReferring to Case 1, I will say that the advertised nervine. When he first began full results of an immediate operation can- using it he thought it a regular elixir of not be fully exhibited unless the obstetri- life, but soon found to his sorrow he could cian fully understands the anatomy of the not live without it, and was finally adparts he is to operate on, and learns how vised by his physician to use morphin, as to approximate divided surfaces by sutures it was very much cheaper. Many of the carried up to the highest point at which much-advertised patent medicines are solution of continuity has occurred. He
He made to sell, and the opiate they contain must bear in mind the shape and dimen- is the winning attraction. Another fresions of the body he is about to restore, quent source of contracting the babit, and remembering that the shape is that of a especially is this the case among profestriangle, with the apex above and the base sional men, is that of taking morphin to below. As to the time of operating, I quiet nervousness produced by liquor. prefer immediate operation; some do not. When a drug-fiend attempts to stop the Harreldsville, Ky. J. S. Tatum, M. D. use of the drug there is at first a restless
ness or indescribable nervousness which "A Doctor's Wife” wishes to ask " the can only be realized by having seen World family” the following questions : experienced. This nervousness seems to
Can conception occur during menstrua- keep on increasing until the patient betion? What effect does intercourse during comes really frantic, sometimes even to menstruation have on the female ? By reaching a stage of insanity. The features what means can the menstrual flow be become pincht, the hair disheveled, and increast without the use of drugs? What the patient writhes in agony from aches drugs are most effective to produce an
and pains. Cold sweats break out, the increase in the menstrual flow?
patient complaining of a feeling of ice
water running down the back, and oftenThe Morphin Habit.
times the night-clothes are dripping with Editor MEDICAL WORLD :-As the mor- this cold perspiration. From this the paphin habit, or disease, more properly tient gradually sinks to a stage of comspeaking, is becoming so prevalent, and plete exhaustion, and death sometimes since preventative medicine is one of the ends the scene. Such is a perfect descripforemost subjects of the profession to-day, tion of a case I was called to witness only it seems not out of order to present some one year ago, where all opiates were taken views on this subject. To an ordinary ob- from a habitue of several years' standing.