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engorgement of the pelvic and abdominal viscera from whatever cause; together with errors in dress, food and exercise, are to be remedied by directing the treatment to the predisposing causes, and local measures can only serve as a complement to the general treatment—are often unnecessary, and may do harm.
3. Many of the cases that recover under local treatment do so regardless of local measures, or by virtue of the additional general treatment.
4. The indiscriminate and wholesale use of tampons and the routine practice of intrauterine applications of caustics are productive of great evil, and should be condemned.
5. Douches should be given in the dorsal position; should be as warm as the patient will permit, and 4 to 6 gallons of sterile or antiseptic water should be given two to four times daily.
6. Pelvic massage deserves a prominent place in gynecologic practice. It is imperative that there be an absolute diagnosis in order that the indications and contraindications be clearly defined.
Organotherapy in Gynecology.
Dorland (Therapeutic Gazette, vol. 23, no. 4) reviews, in a most interesting manner, the subject of ovarian therapy through the administration of ovarian His article is summed up as follows:
1. The ovaries, in common with other glandular organs in the body, exert an occult, but very positive, influence upon the general organism.
2. When this influence is removed, either by the natural atrophy of the glands at the climacteric, by destruction of the ovarian stroma from pathologic processes, or by extirpation of the organs, there results a series of distressing phenomena, including hot and cold spells, nervous and mental manifestations, and neuralgic attacks.
3. The administration of ovarian substance or of the extract of ovarian tissue is promptly and generally followed by a marked amelioration of these symptoms. 4. The average dose required varies from two to five grains of the extract administered thrice daily.
5. Excessive doses of the remedy will be followed by cardiac and nervous manifestations, necessitating a diminution in the dose administered, or a complete, though temporary, change of treatment.
6. In some cases there appears to be developed a tolerance to the remedy whereby its effects are diminished in intensity. For this reason it is better to begin with small doses and gradually increase the amount as may be indicated in the given case.
Catheterization of the Ureters.
Casper (Med. Press & Cir., vol. 67, no. 3116) supplies a report comprising three interesting cases he had met with during the past four years. In the first case, after thirty-six hours' anuria the ureteral catheter was passed. Five ctm. above the bladder opening the instrument came on an obstruction that could not be removed. Oil was then injected, and less came away than was injected. The patient was then put to bed. In twenty minutes' time 200 grms. of fluid were removed, and the following morning 6 litres. The second case was that of a young woman with enlarged pelvis of the kidney and purulent urine. The kidney pelvis was washed out thirteen or fourteen times at intervals of six days,
with silver nitrate solution. The kidney tumor gradually disappeared, and all the other symptoms subsided. The third case was one of pyelonephrosis in a man of 24. The pelvis was washed out, but a rigor and high temperature followed. After nine washings out the urine was thicker than ever, and it was decided that the kidney was tuberculous. At this point, however, all changed; the urine became clear, the kidney tumor subsided, and at present the man was well and fit for work.
OBSTETRICS AND PEDIATRICS.
UNDER CHARGE OF E. P. SALE, M.D., MEMPHIS.
Rare and Interesting Obstetrical Cases.
Alfred Moore (Obstetrics, April, 1899) reports a number of cases presenting interesting features on account of their rarity.
Case I. Hemorrhage from premature separation of a normally - situated placenta. Mrs. B., small of stature, weight eighty pounds, multipara, had two previous labors, both instrumental, the first stillborn. Patient received a thorough antipartal examination two months before the expected date of delivery, Gestation was allowed to continue, as the pelvic diameters were sufficient. This being a multiple pregnancy, symptoms from pressure and distension were marked. Pains began two days before delivery, and continued irregularly until the day of delivery, when severe hemorrhage occurred, with shock. The membranes were not ruptured, and the presenting parts did not recede, nor could any portion of the placenta be felt through the os; a bulging of the uterus could be felt. Accidental hemorrhage was suspected. Both presenting L. O. A., the forceps as applied to each head, and labor terminated. The placenta, expressed after the method of Credé, contained large quantity of dark clots. Hemorrhage continued, and the uterus did not remain closed. The fundus was grasped with one hand and the other was passed into the uterine cavity, and a large quantity of blood and clots evacuated, which allowed complete contraction and retraction. Ergot and stimulants were given, followed by hot enemas, which were continued for several days. Convalescence was slow, due to loss of blood and consequent anemia, but mother and twins were doing finely one year after delivery.
This case presents some interesting features: The small size of the woman; the large size of the twins, weighing respectively eight and seven pounds; severe accidental hemorrhage, which occurs only once in 6000 or 10,000 cases; double forceps delivery, demanded by very poor uterine action; expulsion of the placenta (Credé), followed by severe post-partum hemorrhage, which occurs once in about 1000 cases.
Case II. Fetus born with membranes intact. A multipara, in her ninth preg. nancy, was delivered of a child surrounded by the membranes or "caul." The child is living. Hirst states that it is possible for the whole ovum to be extruded at term, but has only seen it as late as the seventh month. This was at or near full term, though it was a small child.
Case III. Precipitate labor; spontaneous rupture of the cord. A multipara. Labor was so precipitate that she could not get from the table to the bed. One
pain and the child fell to the floor, the cord rupturing about ten inches from the umbilicus. It was not tied for one hour after expulsion. Bleeding was slight.; The child survived.
Case IV. Precipitate labor. A multipara. This was another case of precipitate labor, but the woman dropped to the floor to prevent the child from falling, and was thus delivered. In neither of these cases were there lacerations or any complications.
Case V. Labor and chronic morphinism. This was a primipara, small in size, weighing seventy pounds. She was a snuff-dipper and a morphine habitué. Her daily amount for past two years was eight to ten grains. Pregnancy was complicated by a persistent diarrhea and threatened miscarriage. Gestation was permitted to continue to term, as the pelvic measurements were sufficient to allow delivery with the aid of the forceps or version, but on account of the opium habit it was thought that it would terminate gestation before full term. Labor came on at the thirty-sixth week, the breech presenting S. A. L., and was terminated with the aid of the forceps on account of impaction. The fetal pulse became almost imperceptible - the mother's pulse 120 and temperature 100°. After delivery the placenta was expelled a la Credé, and ergot given. The age of the fetus was approximated from its development and from the date of quickening. The woman had not menstruated for twelve months. The child increased in two months from three and one-half pounds to eight pounds, with the aid of artificial foods and a wet nurse. The mother's weight increased to 103 pounds after the reduction of the morphine to five grains daily and the use of tonics.
Case VI. Multiple coiling of the umbilical cord. A primipara; expected to be confined the last of December; suffered a severe hemorrhage in November, this ceasing after elevating the hips and rest. She was advised to go to the hospital, as vicious insertion of the placenta was suspected, but she declined; preferring to wait until term; this she did without further trouble. Labor occurred normally, and there was but little hemorrhage. The cord encircled the fetal neck thrice, and was easily removed. The placenta was inserted in the lower uterine segment, but was incomplete.
SYPHILOLOGY AND NEUROLOGY.
UNDER CHARGE OF C. TRAVIS DRENNEN, M.D., HOT SPRINGS, ARK,
Can Syphilis be Cured?
Diehl (Buffalo Med. Jour., vol. 54, no. 9) attempts to answer this question, In his opinion it can be cured, but he says that a large majority of physicians today regard the disease as incurable, and in this they are right, for when it reaches a certain stage it is incurable. By curability we are to understand the entire elimination of the disease consequent upon the destruction of the virus or toxin, whatever it may be. How do we know that syphilis is curable? By a reinfection. That syphilis is curable is demonstrated by the fact that every day we see people who had been infected in former years and today they are perfectly healthy, with absolutely no traces of the disease, and they are parents of healthy, robust children.
Of late years physician and patient have learned that results could be obtained only by long-continued and faithful treatment. Manifestations of tertiary syphilis are rare among the present generation. Gummata are becoming an uncommon lesion. In a vast majority of cases, where tertiary lesions have appeared, they were from three to five years after infection, though of course they have appeared as late as twenty years and more after infection. Morris Hyde has recently issued a publication, in which he states that between eighty per cent. and ninety per cent. of all cases of acquired syphilis never reach the tertiary stage; and as time advances, and the laity become better educated to the fact that the disease can be cured by faithful and persistent treatment, this percentage will become higher. Some cases, and those called malignant syphilis, will resist every method of treatment.
Many cases of reinfection have been reported by different observers, which leave no doubt as to the possibility of the cure of syphilis. The author has seen two cases of undoubted second infection, which occurred at intervals of six and three years respectively. Diday recorded twenty cases of reinfection in six years, and mentions one case in which four reinfections occurred. Cooper had seen five cases of reinfection in one year. If the vast amount of medical literature were searched, many cases of reinfection would be found. As it is, the most reliable sources of information are in hospitals, where complete records of all cases are kept. It has been stated that, when the interval between infections was short, the disease pursued a mild course, and that, when a long period elapsed between infections, the symptoms were more severe.. This may be to a certain extent true, for syphilis occurring in a young healthy person is more apt to pursue a milder course than it does in a person of more advanced years, where the vitality is lower and the constitution undermined by previous excesses; for syphilis occurring in such persons is apt to be very intractable, and often 'assumes the malignant type. Again, it has been held by many that, though syphilis can be cured, yet when it reaches the tertiary stage, it then becomes incurable. Yet Gascoyne, in his number of cases of reinfection, reports that six were suffering from tertiary symptoms at the time of reinfection. This, however, brings up another question in connection with syphilis, which is, that tertiary symptoms are sequelæ, rather than symptoms, of syphilis.
Erb's "Symptom Complex."
At the Berlin Medical Club (Med. Press & Circular, vol. 67, no. 3126) Weiss recorded a case of a female, æt. 37, who had been received into hospital from the country. Six years ago she had suffered from an abortion, which was followed by pain over the whole body, but she seems to have shortly afterward recovered her normal health. Three years later she was attacked with severe - rigors, vomiting, subsequently becoming unconscious, and in this condition she remained for three weeks. On recovering it was discovered that she had difficulty in swallowing, associated with involuntary movements of the head. A few months later she was able to move about only with the greatest difficulty. About this time a discharge from both ears commenced. In the autumn of 1897 the limbs became stiff and movements impeded. The speech was also feeble and inarticulate, while double vision was also present. Since 1898 she has been an in-patient, and has become very emaciated, but is quite conscious and under
stands all that is going on around her. The muscles are flaccid, and can be passively or actively moved, possessing a good deal of tonus. These phenomena were common to all the muscles of the body. The movements in the eyes and vocal cords were slow. The internal organs were at first normal, although at present bronchitis, decubitus and albuminuria were present. The breathing is undisturbed, sensibility is intact, and there is no atrophy or trophic disturbance. The electric stimuli are normal, but the tendon reflex is exalted. The tonus of the muscular system increases the complication. The gray substance is undoubtedly affected, although the original acute fever three years ago may be accepted as the initial point, and probably connected with the pyemia derived from the aural discharge, while the meninges and medulla oblongata became finally affected.
CLIMATOLOGY AND PHTHISIOLOGY.
UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., Boulder, Colorado.
Treatment of Tuberculosis with "Antiphthisic Serum T. R."
Dr. A. M. Holmes, of Denver, gives results of use of "antiphthisic serum T. R." in a paper continued through two numbers of the New York Medical Journal, vol. 69, nos. 12 and 13. Cases are classified:
Pre-tuberculous and early stage cases without bacilli.
3. Chronic cases of long standing.
His cases were under personal supervision, blood and sputum carefully studied, and careful clinical record kept.
Under the first class, each patient having experienced a longer or shorter period of impaired health, during which incipient symptoms had developed, twelve cases were reported. The serum treatment was used alone. The results in this class uniformly good; the patients restored to good health, and with one exception remained so up to time of present report. Holmes believes in a "pretuberculous" state, during which there is a deficiency in the antitoxin generating power of the system. The "antiphthisic serum T. R." supplies this deficiency, he holds, and thus enables the organism to regain its normal power.
In the second class, early stage cases with bacilli, seven cases are reported. All were benefited, some apparently cured.
In class third, chronic cases, four cases are given. The first case with a cavity in the upper lobe of the right lung and numerous bacilli, the patient was apparently cured. Cases second and third were greatly benefited, and the fourth case was improving rapidly and still under treatment.
Under the fourth class are included cases which develop rapidly and tend toward an early fatal termination. Eight such cases are reported. In three of these the process was seemingly checked, and in one case it had been in abeyance eight months. The rest were not benefited.