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enfeebled by disease that its mastery is lost, and ignoble passions rule unchecked and unrestrained, and there is therefore an imperious necessity that he should be a man of sterling integrity and stainless purity - chaste as the untrodden and unsunned snow.

THE TREATMENT

OF ACUTE PELVIC INFLAMMATION IN WOMEN.*

BY H. R. COSTON, M.D.

FAYETTEVILLE, Tenn.

To take up all forms of pelvic inflammation would consume too much of the time of this association, and I shall therefore confine my remarks to non-suppurative cases.

Doubtless every one here has had cases in which the patient complained of pain in the lower abdomen; painful, difficult and frequent micturition; tenderness, more or less, of the abdomen, with a temperature of 100° to 101° F., pulse 90 to 100, and a face expressive of pain. The woman is either confined to bed or walks in a half-stooping attitude; bowels usually constipated; urine highly colored and scanty; sexual congress is almost impossible, because of the extreme pain attendant. Upon vaginal examination the uterus is found tightly wedged into the pelvis, and almost, if not quite, immobile from inflammatory exudate. There is a sense of hardness and swelling imparted to the examining finger of all the surrounding tissues, and an attempt to raise the uterus on the finger produces great suffering; in short, the uterus and appendages are impacted in a mass of inflammatory exudate. Upon examination with a speculum we find the vault of the vagina, os and cervix uteri deeply congested, and issuing from the os is a tenacious muco - purulent discharge. Gonorrhea, abortion and exposure during menstruation are the principal causes of this condition; and, in brief outline, these are the cases concerning the treatment of which I wish to speak.

If the woman is up and about the house, she should be put to bed and kept still. The bowels should be opened freely

帶 Prepared for the meeting of the Tennessee State Medical Association, at Nashville, April 11, 12 and 13, 1899.

with a saline; I usually prescribe epsom salts. To increase the action of the skin and kidneys, I prefer potassium acetate, with fluid extract of juniper and fluid extract of jaborandi. As a general tonic I give the following: R Liq. potass. ars., 3iss; tr. nucis vom., 3 vi; syr. ferri iod., 3ii; syr. sarsparil. co., q.s., 3 iv. M. Sig.: Teaspoonful t. i. d.

In many cases bichloride of mercury and iodide of potassium are beneficial-not that syphilis is necessarily present, but for their alterative effects. The same may be said of the salicylates, from the use of which I have seen much good result in many cases.

If the trouble is due to abortion, or failure of the uterus to undergo the proper amount of involution following labor, I add fluid extract of ergot, gtt. x to xx, to each dose of the above prescription.

If there are (as there frequently are) great nervousness and insomnia, I prescribe: R Fl. ext. pulsatilla, 3i; fl.ext.celery, fl. ext. piscid. erythrina, fll. ext. viburn. prun., ãā 3i. M. Sig.: Teaspoonful p. r. n. This, I find, acts very nicely quickly overcoming the nervous condition and allowing sleep.

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Opium or its salts I never prescribe as a routine, and never allow the patient to have it except when administered by my own hand, and then I try to leave the impression that I am using something else. Many morphine fiends are made by the carelessness of physicians in such cases as these.

The local treatment is very important. I place my patient in the lithotomy position, with her hips drawn well to the edge of the bed, and through a bivalve speculum I wipe the os and cervix uteri and vault of the vagina perfectly dry.

If the case follows labor or abortion, I wipe out the interior of the uterus, after dilating the cervix, which is easily accomplished, and after thoroughly swabbing the entire endometrium with equal parts of ichthyol and tincture iodine, I pack the cavity lightly with ten per cent. iodoform gauze, or bichloride gauze, 1 to 5000. I paint the vaginal vault with the same solution used on the endometrium, and introduce a large tampon soaked in the following: R Ichthyol, 3ii; boric acid, 3 iss; glycerin, q.s., 3 iv. M. Sig.: For local use. I order this tampon to be left in place for twenty-four hours,

when it is to be removed and a large hot-water injection used, at least one gallon of hot water. This treatment, with the exception of dilatation of cervix, is to be repeated daily, or every other day, until recovery takes place.

If the trouble is due to gonorrhea, I do not think it advisable to dilate the cervix, but with a sinus syringe I cleanse the endometrium by injecting, a few drops at a time, peroxide of hydrogen, followed by warm water, and then inject a few drops of the ichthyol and iodine solution.

By means of treatment similar to that outlined, I have known women to bear children after I had urgently advised removal of tubes by laparotomy.

I am not opposed to salpingectomy when needed. I do it myself when opportunity presents itself. But I am much more conservative than I once was-believing now that many women's tubes and ovaries have been sacrificed that could have been saved by prolonged, careful, internal and local treatment.

PROGRESS OF MEDICINE.

MEDICINE.

UNDER CHARGE OF B. F. TURNER, M.D.

Visiting Physician St. Joseph's Hospital, Memphis.

Salicylic Acid in the Treatment of Pneumonia.

Sebring (Med. Record, vol. 55, no. 16) has used salicylic acid or salicylate of sodium exclusively in his practice for a number of years in the treatment of lobar pneumonia. He thinks that by this treatment the mortality can be considerably reduced, as has been his experience. During a genuine epidemic of pneumonia in his section he treated 75 or 76 cases of pneumonia, with only one death, and this latter could hardly be attributed to the disease. The drug is administered in dosage of 8 to 10 grains every two hours. From observation he has come to believe that the results of the administration of the salicylate are these:

1. In the beginning of an attack it quickly quiets the tumultuous pulse. 2. It acts as a sedative to the general nervous excitement that is prevalent through that period. Indeed, it seems to act as a hypnotic all through the course of the disease in many instances, as a fair proportion of the patients have slept a major part of the time until recovery had become well established. 3. It almost surely and quickly gives relief from the pleuritic pains.

4. It seems to inhibit the manifestation of malign mental symptoms. Thus far none of the patients has developed the least delirium after beginning to take the drug, except the first, and five cases of drunkard's pneumonia, in which the delirium preceded the disease.

5. The pulse remains full and not over-rapid to the end; except in one case, cardiac symptoms due to the disease itself have been unnoticed, and symptoms of a "tired heart" do not often occur.

6. After the first few doses of the drug the patient will perspire freely as long as the diseased condition of the lung persists, but either from this cause, or from some other that the author is not cognizant of, the temperature seldom exceeds 103° F.

7. The cases will show a far smaller percentage of complications than is usual.

8. In 19 out of 20 cases the disease will subside by lysis.

9. The length of time required for recovery is less than is the rule with patients that recover under the usual treatment and by lysis.

10. The infected lung tissue progresses to resolution more slowly than it does with the average case, though complete recovery from an attack—that is, return to normal health-is more expeditious.

11. There is a marked diminution in the severity of the disease, all conditions being taken into consideration.

Sebring explains the modus operandi of this agent by stating that though he has carefully searched a good deal of literature, he is not cognizant of a single 'drug, with the possible exception of methylene blue and quinine, that has any real antiseptic action and is taken directly into the blood unchanged, except salicylic acid. He is inclined to believe that the salicylic acid acts as an antiseptic, perhaps destroying the pneumococcus.

Echinococcus of the Lungs.

At a recent meeting of the Berlin Medical Society (Med. Press & Cir., vol. 67, no. 3126) Hr. Zadek showed a case of echinococcus of the lungs. The patient was a butcher, 40 years of age, who had all his life had a good deal to do with dogs, and had become infected by them. In February, 1897, he had difficulty in breathing, cough and hemoptysis. Catarrhal rales were heard at the bases of both lungs, but no dullness. There was fever and expectoration of muco-purulent sputa, and emaciation from 78 to 53 kgms. Tubercle was diagnosed, although there was no bacilli, and the patient was sent to a health resort, from which he returned after a stay of fifteen weeks, with a gain of 20 pounds in weight. Cough and hemoptysis soon returned, however, and the patient observed skinny membranes in the expectoration. These appeared for a period of between one and two months, and their milky look and the microscopic appearance showed that they were the coverings of echinococcus cysts. There were hundreds of them, and they were expectorated easily and without much hemorrhage. They ceased to make their appearance from Christmas, 1898, the expectoration diminished, and pain ceased. The patient improved in health, and returned to work with a weight of 180 pounds. The physical signs were only slight, and after expelling quantities of cysts there were no signs of cavities remaining, and as percussion gave no evidence, the X-rays were tried. These showed clearly

the site and size of the collection of echinococci. A shadow the size of an apple was seen clear in the center on deep inspiration, with darkened edges. From the situation it was evident that an echinococcus of the liver had passed into the lungs. Adhesive pleuritis had prevented the stormy symptoms usually observed in such cases. There was also a shadow in the left lung, between the middle and lower lobes, plainly from a second echinococcus, and the patient, in fact, did complain of some disturbance in the left side of the chest. There being no mixed infection, complicated lung disease had not developed. What would be the end of the disease on the left side could not be foretold. The interesting features of the case were the mild course and the discovery by the X-rays, which had thrown light on the diagnosis, etiology, prognosis and treatment. The rays were clearly of great assistance in case of echinococcus of the lungs.

Hr. Levy-Dorn explained the technique of the use of the X-rays. The patient must be required to breathe deeply and then hold his breath. In this way only was it possible to study the relation of the tumor to the diaphragm, and exclude some relation to other objects, which moved on inspiration. The exact seat of the collection was determined by the florescent screen.

SURGERY.

UNDER CHARGE OF W. B. ROGERS, M.D.

Professor of the Principles and Practice of Surgery and Clinical Surgery,
Memphis Hospital Medical College.

Surgery of the Biliary Passages.

Deaver (Journal Am. Med. Assn., vol. 32, no. 16) thus discusses some points in the technic of operating for gall stones:

1. The incision is carried directly over and through the right rectus muscle, believing, as he does, that the resulting union from apposition of muscular as well as fibrous tissue offers a better safeguard against a subsequent ventral hernia. He regards this of special importance in this class of operations, as the incision for proper exposure of the parts is necessarily a comparatively liberal one.

2. The peritoneal cavity being opened, the proper disposition of sterile gauze is a sine qua non for a successful issue of the remaining part of the operative technic; this makes the surgeon master of the field of operation and enables him to guard against the possibility of peritoneal infection.

3. Freeing adhesions, exposure of the gall bladder, liberating same throughout, followed by careful palpation of hepatic and common duct by way of the foramen of Winslow.

4. Incision into the gall bladder or common duct, as the case may be.

5. Where the common duct is incised he has never found it necessary to use any mechanical appliance in suturing incision in same. He finds the best appliance is the index finger of either hand, depending upon the dexterity of the operator, engaged in the foramen of Winslow, with which the duct is brought near enough to the surface to suture it readily and successfully.

6. Where it is necessary to open the terminal portion of the duct, incision of the posterior parietal peritoneum to the outer side of the descending portion

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