« ForrigeFortsæt »
as such, but to establish indisputable certain points of belief long held by the writer, and repeatedly contended for: that the Cæsarean operation should not be regarded per se as a very dangerous surgical procedure, and should not be held in the dread with which it was long contemplated, and which was a potent factor in forcing it to assume a character which properly belonged to its performance as a “last hope.” He has also believed for the past eleven years, and is confirmed in the opinion by many tests made by Philadelphia operators during this period, that the cases must be very exceptional in which it will not be safer to the woman to have the operation performed shortly before labor than after it has begun, unless, in the latter event, very little time is lost in preparation. Certainly the Mexican record of Cæsarean casualities teaches the value of ante-partum celio-hysterotomy. Under the knife, Mexico has one Cæsarean operation (1877)—woman saved, child dead; and one Porro operation (1884)—woman lost, and child saved. The woman lost was a rachitic, deaf and dumb dwarf, and died in twenty-eight hours from shock.
In ante-partum Cæsarean operations it may well to anticipate any possible risk of uterine quiescence by giving a hypodermic of ergotin half an hour before the operation is to be commenced. Second operations on the same subjects are rarely fatal if well managed, but the dangers of hemorrhage from the placenta presenting in the line of incision are increased because of utero-abdominal adhesions leading to atony; and this risk will not be entirely avoided, even if the woman is fully in labor. History. however, shows that the danger is rarely insurmountable, and that women have recovered after as many as four, and even six celio. hysterotomies, although no uterine sutures were used. Since the introduction of the Saenger method, as many as three operation have been performed upon the same woman with safety to her and the three children.-St. Louis Med. Review.
AFTER-PAINS.-Dr. E. J. Dennis, of Kansas City, Mo., says after-pains are much more severe and frequent in those who have borne many children than in primiparæ, the pains are apt to be more severe after an easy labor than after a long, tedious
The pains come on gradually after confinement, beginning, in many cases, an hour or two after delivery, and last for hours, or even days. After-pains, no matter how strong, are intermittent, with a latent interval; they are rather eased than increased by pressure; the lochial discharge is more profuse when the pains are bad. These symptoms will clearly demonstrate the difference between after-pains and peritoneal inflammation. In many cases the pains are so severe that the attending physician must do something to relieve them, and this is more easily said than done. I have used many so-called sure cures, but the following has given better results than anything I have ever used:
R. Pulv. camphoræ....
Эij. 2. .gr.x.
If the pain are very hard and intractable, and the uterus large and tense, it is an indicattion that there are clots within the uterus, in such cases the following is par excellence:
R. Fl. ex. ergotæ.....
Dioviburnia is an excellent uterine tonic. I never fail to prescribe two, and sometimes four ounces, after every case of obstetrics, of which I have a great many, and, consequently, I never have a case of subinvolution to contend with. I advise its use if you would have good success and good after-results.
I have had the opportunity of trying its merits in the Prison Christian Rescue Home, I being the physician of that institution, and nearly all the girls come from the jails of Kansas City and Wyandotte, Kas., nearly every one of whom is either pregnant or just convalescing from a miscarriage, or suffering from metritis, endometritis, menorrhagia, ammenorrhea, dismenorrhea, and, in fact, every disease that woman is heir to. I invariably put them on Dioviburnia, and it does wonders for them. It soon builds up the uterine appendages. Locally, I use tampons of glycerine and iodine.
I have a case now of a young married woman who has had three miscarriages, two or three months only elapsing between each, and nothing seemed to arrest it. I have kept her in bed for four weeks, and she would miscarry. She again became pregnant and I successfully carried her through with Diovi. burnia.
I cheerfully recommend Dioviburnia to the profession, although I do not on general principles use proprietary compounds, but having tried similar recipes and found them incapable of producing as good results.-E..
BLOODLESS AMPUTATION AT THE HIP-JOINT.—Dr. N. Senn describes an improved method of performing bloodless amputation at the hip-joint (Chicago Clin. Review). The paper is illustrated with a number of photo-engravings representing different stages of the operation. The following conclusions represent the principal points in the method:
1. Preliminary dislocation of the head of the femur and clearing the shaft of this bone of all soft tissues down to the proposed line of amputation through an external straight incision requires less time, is attended by less hemorrhage and shock than when this part of the operation is done after circular amputation, as advised by von Esmarch and others.
2. The external straight incision is the same as von Langenbeck's incision for resection of the hip-joint, differing only in length.
3. After dislocation of the femur the soft tissues are tunneled with a hemostatic forceps which is entered through the external wound on a level with the trochanter minor to a point on the inner aspect of the thigh behind the abductor muscles and about two inches below the ramius of the ischium where a counter opening two inches in length is made.
4. Bloodless condition of the limb should be secured by elastic compression or vertical position prior to tying the elastic constrictors.
5. An elastic tube three-quarters of a inch in diameter and about four feet in length is grasped with the forceps in the center and drawn through the tunnel made by the forceps.
6. After dividing the elastic tube in the center the base of the thigh is constricted by drawing firmly and tying the anterior constrictor in front of the anterior section, while the posterior constrictor after being drawn tight behind the posterior section the two ends are crossed and then made to encircle the whole thigh, when the ends are again drawn firm and tied or otherwise secured above the anterior constrictor.
7. A long and a short oval cutaneous flap should invariably be made in all amputations at the hip-joint.
8. In preference a long anterior and a short posterior flap should be selected.
9. The transverse section through the muscles should be somewhat conical in shape, the apex of the cone corresponding to the tunnel made by enucleation of the upper portion of the shaft of the femur.
10. Resection of the end of the sciatic nerve and ligation of all vessels that can be found should be done before the removal of the constrictors.
11. The femoral arteries should be secured by a double catgut ligature half an inch apart, the one on the proximal side including also the acompanying vein.
12. The posterior constrictor should be removed first, and all hemorrhage arrested by ligation and compression before the anterior constrictor is removed.
13. The upper part of the wound corresponding to the acetabulum should be drained with an iodoform gauze tampon, and the remaining part of the wound by one or more tubular drains.
-St. Louis Med. Review.
MEETINGS OF STATE MEDICAL SOCIETIES.--The following gives Secretary's name, with time and place of meeting, 1893:
Alabama.-T. A. Means, Montgomery; Selma, April 11. Arkansas.-L. P. Gibson, Little Rock; Batesville, May 31.
California.-W. W. Kerr, San Francisco; San Francisco, April 18.
Colorado.-A. S. Lobingier, Denver; Denver, June 20. Connecticut.-N. E. Wordin, Bridgeport; Hartford, May 24.
Delaware.-W. C. Pierce, Wilmington; Cape Henlopen City, June 13.
Florida.-J. D. Fernandez, Jacksonville; Jacksonville, April 4.
Georgia.—D. H. Howell, Atlanta; Americus, April 19.
Louisiana.-P. B. McCutcheon; New Orleans; New Orleans, May 9.
Maine.-C. D. Smith, Portland; Portland, June 14. Maryland.-G. L. Taneyhill, Baltimore; Baltimore, April 25. Massachusetts.-F. W. Goss, Boston; Boston, June 13. Michigan.-C. W. Hitchcock, Detroit; Muskegon, May 11. Minnesota.-C. B. Witherle, St. Paul; Minneapolis, May 21. Mississippi.-H. H. Haralson, Forest; Jackson, April 19. Missouri.-L. A. Berger, Kansas City; Sedalia, May 16. Montana.-T. H. Ellis, Butte; Great Falls, April 19. Nebraska.-Geo. Wilkinson, Omaha; Nebraska City, May. New Hampshire.-G. P. Conn, Concord; Concord, June 20. New Jersey.-Wm. Pierson, Orange; Spring Lake, June 27. New York.-E. D. Ferguson, Troy; New York, October 10. North Carolina.—R. D. Jewett, Wilmington; Raleigh, May 9. North Dakota.--D. S. Moore, Jamestown; Jamestown, May 25. Ohio.-T. V. Fitzpatrick, Cincinnati; Put in Bay, June. Oregon.--C. H. Wheeler, Portland; The Dalles, June 13.
Pennsylvania.—Wm. B. Atkinson, Philadelphia; Williamsport, May 16.
Rhode Island.--W.R.White, Providence; Providence, June 1.
South Carolina.-W. Peyre Porcher, Charleston; Sumpter, April 19,
South Dakota.—R. C. Warne, Mitchell; Huron, May or June. Tennessee.-D. E. Nelson, Chattanooga; Nashville, April 11. Texas.-H. A. West, Galveston; Galveston, May 2.Vermont.--D. C. Hawley, Burlington; Rutland, October 12. Virginia.-L. B. Edwards, Richmond; Charlottesville, Oct. 14. Washington.-G. D. Shaver, Tacoma; Tacoma, May 10. West Virginia.—D. Mayer, Charleston; Parkersburg, June.
Wisconsin.-C. S. Sheldon, Madison; Milwaukee, May 3.-St. Louis Med. Rcview.