case of diphtheria. Even the bacilli diphtheritically proved the case to all observers, and the serum was used. Raczynski cultivated the alleged bacilli and found them nothing more than those met with in any case of angina sclerosa. From this he reasons that many of our so-called cures accomplished by the use of serum are fanciful and not real. He is inclined to lean more on clinical facts than bacteriologic examinations for a differential diagnosis. GYNECOLOGY. UNDER CHARGE OF T. J. CROFFORD, M.D. Professor of Gynecology, Memphis Hospital Medical College. Hysterectomy. At the meeting of the Societe de Chirurgie M. Ricord (Med. Press & Cir., vol. 68, no. 3143) spoke on abdominal hysterectomy for uterine cancer, and said that he had performed that operation ten times, with only one death. The gravity of the operation was, consequently, in his opinion, not so great as was believed. None of his patients could have been operated on through the vagina, as the disease had in each case destroyed the greater portion of that organ. The speaker acknowledged that abdominal hysterectomy was a tedious operation, especially where the ligaments were infiltrated, but it had the advantage over the vaginal method that it permitted ablation of the infected glands. M. Segond said that he performed ninety-five times ablation of the uterus by the vaginal method with a total mortality of 14 per cent. Most of the unsuccessful cases were those in which the vagina and the broad ligaments were invaded by the disease. As to the ultimate results of the operations, out of 40 cases of relapse of which he had knowledge himself, the disease returned in 30 cases within the first year, 7 in the second, 1 in the third, and 1 at the end of the seventh year. Among the cases that might be considered cured, 1 has already survived ten years, another nine years, 2 four years and 2 two years. He only practiced six times abdominal hysterectomy for uterine cancer. Surgeons, considering this method is superior to vaginal hysterectomy in the treatment of uterine cancer, believed that it was less grave than the latter; according to them it was the only rational operation permitting the removal of all the ganglions, and they hoped that by and by the prognosis would be much more favorable than that given by vaginal hysterectomy. As to the gravity of the intervention, it was certain that, thanks to the perfecting of the method of operating, abdominal hysterectomy was as benign as vaginal hysterectomy, but it was none the less true that in cases where the extension of the lesions necessitated ligature of the iliac artery the operation could not be considered less grave than the vaginal method. Those who advocated the abdominal, method gave for one of their principal reasons the facility with which the infected tissues could be removed, but that pretension was impossible to realize, for if some few glands were removed could the operator affirm that he left no tissue susceptible to be attacked by the disease? However, he admitted that for a cancer of the body of the uterus or for those forms complicated with softening of the neck, so that it did not afford a hold for the instru ments, the abdominal method was the best. When the lesions were not limited to the uterus he never interfered, preferring palliative treatment, which eased the patient and prolonged her existence, frequently for a considerable period. Use of Parotid Gland Extract in the Treatment of Ovarian Disease. Mallett (N. Y. Med. Jour., vol. 70, no. 9) has made a study of the use of parotid gland extract in a series of twenty cases of ovarian disease of varying nature. His results are thus summarized: 1. It has seemed to relieve the pains of dysmenorrhea in all cases, without regard to the supposed cause or pathologic condition present, to a greater extent than any of the numerous so-called uterine sedatives, all of which he has used. 2. It relieves those dull, aching pains referred to the back and ovarian regions, usually designated by those familiar though vague and unsatisfying terms, reflex pains, ovarian neuralgia, etc. 3. Menstruation, when deranged, seems to become more regular as to periodicity, less in amount, and shorter in duration. 4. During its exhibition pelvic exudate seems to soften and become absorbed more rapidly under abdomino-pelvic massage. 5. The general health, strength, and spirits seem to improve during its use, and those dull headaches which constitute such a persistent and annoying symp tom in these cases are almost invariably relieved, and in some disappear entirely. 6. The only counter-indication that I have thus far met with to its use has been in cases of the artificial climacteric (following double salpingo-oophorec tomies), in which cases the flashes of heat and cold were made distinctly more frequent and severe. OBSTETRICS AND PEDIATRICS. UNDER CHARGE OF E. P. SALE, M.D., MEMPHIS. Management of Pregnancy Complicated by Abdominal Tumors. The ease with which some patients recover following removal of ovarian tumors should not mislead us into the belief that there is no danger from abortion and its complications following the operation. Abortion at this time is attended with more risk than at any other, and not a few of these patients die afterward, yet this fact should not deter us from advising and making the operation in all those cases where it is deemed advisable to do so after all the facts have been placed before us, even if the case is a desperate one. An operation promises something. We should not refuse to operate on any one where there is the slightest chance for recovery, if there is no chance for recovery without an operation. It is a duty that we owe to our patients to operate and give them the only chance, even if that is but one in a hundred. He would advise operation for the removal of ovarian cysts in all cases where the tumor is small and fixed in the pelvis below the uterus; where the tumor cannot be lifted out of that cavity. We should operate in all cases where there are any complications in the tumor itself, such as twisted pedicle or ruptured cyst. Patients with inflammation in the abdomen, caused by the tumor, should be operated on. He would hesitate to advise operation during the pregnant state for an ovarian tumor of moderate size that was above the uterus, and where the tumor itself was too large to occupy the pelvic cavity, if the woman had not suffered from the tumor and there was no indication of any complication. In fibroid tumors of the uterus the author would advise operation in all cases where the tumor occupied the lower segment of the uterus, and it was in such a position that it would interfere with or prevent delivery at full term. The question as to when the operation should be made, as to the period of gestation, must depend on each individual case. If the woman has passed four or five months of gestation, and it is possible to carry her to or near the full term of pregnancy, the question as to saving the child must be discussed. If the patient can be placed in good surroundings and operated on just before the full term, or at the time of the commencement of labor, we could save both mother and child. But in many of these cases seen at three and a half months to five months of gestation, their condition becomes so intolerable that we are obliged to sacrifice the life of the child to save that of the mother. Their condition will not tolerate deferring the operation even for a few days. The long-continued pressure of a solid tumor in the patient's pelvis, damming back the urine on the kidney by pressure on the ureters, as it must in many of these cases, should have much weight in favor of immediate operation. Even if the patient should go to the full term of gestation and then be subjected to an operation, she would be in great danger of afterward dying from urinary complications. This is more likely to occur if the tumor develops in one of the broad ligaments; but, unfortunately, there is no choice in the matter in many of these cases; we must operate and accept the situation if we are to do any thing at all for our patient. A man would be a coward to temporize in the face of such difficulties. The question of what operation should be made should be left with each individual operator to use his best judgment at the time of the operation. The question of enucleation of fibroid tumors and saving the uterus is being favorably discussed by many operators, but whether or not that operation would often be selected in the pregnant state remains to be seen. Belladonna in the Broncho-Pneumonia of Children. Hodghead (Pediatrics, vol. 8, no. 5) gives the following cogent reasons for using belladonna in the broncho-pneumonia of children: 1. In small doses it is mildly narcotic, producing a slightly sedative influence upon the nervous system, and having a tendency to make the child less irritable and its condition less uncomfortable. 2. It is, in small doses, a heart tonic, raising the arterial tension, increasing the circulation by stimulating the cardiac sympathetic, and in a corresponding manner depressing the pneumogastric, the inhibitory nerve. 3. It is a respiratory stimulant, influencing in some degree the diaphragm, but more especially does it affect the accessory respiratory muscles, although its action in this regard, it must be confessed, is not yet fully understood. 4. Belladonna produces a dilatation of the superficial capillaries, and in a corresponding degree and in the same manner, relieves the congested lungs. It might also be remarked that it produces an increased secretion of urine and of bile. 5. The most important influence, however, which the drug exerts, and the one which bears directly upon the question at hand, is to diminish secretion in the bronchial tubes and pulmonary tissues. The water-logged condition of the lungs is overcome or prevented. Its effects in such instances seem almost mechanical, as well as marvellous. The superabundant and dangerous secretions are diminished in quantity, and the threatened asphyxia, which becomes complete when these secretions increase so abundantly that the child is unable to rid its lungs of them, is averted. CLIMATOLOGY AND PHTHISIOLOGY. UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., Boulder, Colorado. Tuberculosis and Insurance. Dr. John Hunter, in a paper read before the Canadian Medical Association (reported in the Jour. of the Amer. Med. Assn., Sept. 9), emphasized the duty of examining physicians furnishing true and accurate reports to the supervising medical directors of life insurance companies. He also strongly asserted the duty of the companies to see that the applicants receive the benefit of the medical knowledge of the day. We know that heredity practically counts for naught, yet the life insurance companies give it much weight. On the other hand, surroundings, occupation, environment generally, is of great importance, though given little attention by companies. A man in good physical condition and with good environments should not be rejected because of hereditary history. Intestinal Treatment of Tuberculous Peritonitis. Henry T. Byford (Jour. Amer. Med. Assn., Sept. 9, 1899) quotes from Osler, "The treatment of tuberculous peritonitis has largely fallen into the hands of the surgeons." Dr. Byford states that there is but little information on medical treatment of tuberculous peritonitis in any of the textbooks. He does not think the improvement after abdominal section is due to the operation, but rather to the preparatory and after-treatment to which such patients are subjected by the surgeon. He tried this in one patient brought to him for operation, with results as good as in cases operated upon. This is encouraging, and should be followed up by the general practitioner with such cases. His directions are: Keep the alimentary canal as aseptic as we do during and just after an abdominal section. Two or three liquid stools should be produced daily, by salines. If the stomach is irritable, calomel may be given at first. Eight or ten grains of salol, guaiacol, or an equivalent should be given three or four times a day. The diet should be entirely liquid and should be such as to produce a minimum of gas and of solid residuum. Dr. Byford gave his patients peptonized milk and beef peptonoids. The same rest in bed as in abdominal section. This is con tinued until pain has disappeared and the temperature is normal. We must, in all the acute cases, fight first the inflammatory condition, and not, as in most tuberculous cases, think first of nutrition. Afterward we can gradually change to a solid diet, always using those things that leave little solid residue and produce little gas. After the patient is permitted to be out of bed any return of pain or fever should send him to bed again. Tonics, stimulants and general remedies may be used. Systematic supervision and treatment should continue several months. Rest and Exercise in the Treatment of Phthisis. Dr. Arthur Ransom (British Med. Jour., July 22, 1899) emphasizes the value of rest in the treatment of phthisis. It results in gain of weight, better oxygenation of the blood, more continuous and equable warmth of the body, with less rise of temperature and more repose to the bony lever overlying the diseased parts. No exercise should be permitted that quickens the action of the muscles of respiration. The increase of blood pressure that comes with rapid respiration is a source of danger. The degree of rest employed should be decided by the presence or absence of fever and by the condition of digestive and assimilative powers. When the disease has not limited the movement of the ribs, and when there is considerable muscular and bodily vigor, quite extensive exercise may be permitted. But it should never go to the extent of exhaustion. Significance of Bovine Tuberculosis. Prof. Geo. Adami, of Montreal, in a paper read before the Canadian Medical Association (reported in the Jour. of the Amer. Med. Assn., Sept. 2, 1899), discussed three questions: (1) Is tuberculosis in cattle a source of danger to other cattle, so as to seriously affect their wellbeing and to be a source of loss to their owners? To this he answers yes, unequivocally. There is abundant evidence that a whole herd may become affected by one animal. All imported animals should be held in quarantine for a time and be subjected to the tuberculin test. His next question he also answers in the affirmative. (2) Is tuberculosis in cattle also infective from animal to man, and thereby a grave source of danger to the human race? Though the evidence is not so direct as in the transmission from animal to animal, yet it is enough to warrant an unhesitating affirmative. The third question is: (3) What are the commonest modes of infection from animal to man, and how are we to diminish the danger? Milk is probably the chief source of danger, though the use of tuberculous meat may transmit the disease. By way of prevention, a corps of inspectors might be empowered to visit all herds and inspect carefully, killing all animals that show clinical evidence of the disease. Those that show no clinical evidence but react to tuberculin should be isolated. The Memphis Hospital Medical College will open for its Twentieth Annual Session, Wednesday, November 1, 1899. The prospects for a very large attendance are unusually good. |
