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Dr. George S. Brown commended the style and thoroughness of the paper-the style or taste in comprehending the main points without wasting the Society's time, and the thoroughness in regard for authorities, while still distinct opinions based on the writer's close and scientific observation of his own cases. He thought it was on the line of improvement for any society to have more papers based on just these points. He thought it might be of interest to the writer to look up a treatment of cystitis in the female recently being used by Dr. Clark, of Johns Hopkins: the practice of introducing a thin rubber bag smeared with twenty-grain ointment ichthyol ingelatin. The bag is then inflated and the ointment comes in contact with all parts of the mucus lining. It is probable that the distension of the bladder has a good deal to do with the benefit derived from this treatment.
Dr. Y. L. Abernathy mentioned as cause in the male stricture of urethra. If these are cured, the cystitis will get well. Dr. R. R. Kime read a paper entitled "Some Obstetrical Complications, with Report of Cases."
1. Unicervical septus uterus with abortion from right side. Foetal structures retained and removed disinfected, then uterus right side disinfected and drained. The right side was 3 inches in depth; left (non-gravid), 1 inches.
2. Uterine hemorrhage eight days after labor, due to typhoid fever. Had to be tamponed three weeks, changing every one to three days. The tampon had to be used and changed rapidly to prevent death from bleeding.
2. Placenta previa centralia with infection before delivery. Had been bleeding four or five days before seen. Immediately delivered by carrying hand up into the uterus and performing podalic version. Pealed off placenta, irrigated uterus, and dressed antiseptically. Symptoms of infection returned with renewed vigor, with severe pain and elevated temperature, which the physician in charge had not been able to control with morphia and phenacetin. Immediately administered salines; irrigated, disinfected and drained uterus. In a few hours patient was comparatively easy. No more opiates or coal-tar derivatives given. Drainage kept up six days, and discontinued as pulse and tempature were normal.
4. Tumor and infection complicating labor. Infection treated by irrigation and tubular drainage. Tumor completely absorbed. No evidence of tumor a year later.
5. Extreme toxic intoxication seen ten days after labor established the utility of tubular drainage beyond doubt, as when tube was removed constitutional symptom returned, controlled by re-inserting tube three times. Gauze failed to meet the indications. Use of gauze tampon in septic infection and curette condemned.
Dr. W. G. Bogart endorsed most heartily the position taken by the writer. He said the first case was one we often meet with, and we fail to appreciate the importance of a thorough drainage and antisepsis. The removal of all the foreign matter, and a thorough washing out of the uterus with a hot antiseptic fluid and free drainage, will generally result in recovery. Case 2 is one of rare occurrence-hemorrhage eight days after delivery. I desire to call attention to the manner in which the hemorrhage was controlled: packing with iodoform gauze and keeping it so until the hemorrhage ceased. The gauze also acted as a drain for the light fluid. I shall add that I would flush out the cavity with hot antiseptic solution.
Case 3 is one of great danger which demands knowledge, skill and immediate action. I heartily commend the Doctor for his action, especially in his manner of controlling the fever by antiseptics rather than antipyretics, followed by free drainage. I agree that tubular drainage is the only method of accomplishing the desired result, and will almost invariably bring down the temperature. I condemn the use of antipyretics, especially the coal-tar derivatives. Cleanliness, drainage, alcoholic stimulants and quinine I believe to be the rational treatment of these cases.
In closing the discussion, Dr. Kime said: "In answer would say that very hot water was used to check hemorrhage in Case II; also very hot solutions of iodine, of alum, of boric acid, but all failed to check hemorrhage. In ordinary cases hot water or iodine solutions will check bleeding. As suggested, saline solutions can be used to advantage in these cases sometimes. I wish to emphasize drainage most and condemn the gauze tampon, especially in cases of septic infection. Gauze tampon does not drain, but interferes with nature's method of drainage and elimi
nation. The curette should also be condemned in septic infection after labor, as it breaks down nature's barriers, opens up new avenues for absorption, and then the gauze tampon favors that absorption by holding the debris, germs, etc., in contact with the absorbing surface.
Nature after normal labor establishes a discharge, the lochia, which is a process of elimination, and should be imitated. This can only be done by tubular drainage. The ideal is to carry a strip of gauze up with the tube so as to have both tubal and capillary drainage, which will be effectual in any case, even in retroversion, by changing the position of the patient. Where the uterus is curetted, disinfected and tamponed, and yet dies, it might be said to be the result of the treatment. I wish to emphasize that drainage and elimination are essential, and far better than opiates and coal-tar derivatives for pain and high temperature.'
Dr. W. C. Bilbro reported a case of bradycardia from ptomaine poisoning. The history was one of indigestion. The pulse was thirty standing after walking two blocks, and was down to eighteen at times. There were times when the pulse was but six, but regular. He laid stress on the apex beat. Improvement under arsenic, strychnia, etc. He divided bradycardia into two classes: physiological as a constitutional peculiarity and in the puerperal state, and pathological as from exhaustion and in stomach affections.
Dr. J. R. Rathmell would add to the classes above the neurotic cases. Physiological is probably a misnomer, as diseased conditions have been found post mortem. Symptomatic bradycardia is quite common.
Dr. R. R. Kime related a case where the pulse was thirty-six. Listening to the heart sounds, the beats were seventy-two, every other beat only being felt at the wrist.
Dr. Bilbro said that he had called attention to the importance of counting the apex beat rather than the pulse at the wrist.
Dr. J. R. Rathmell read a paper on "Scarlatina," and laid stress on the complications which are the cause of death and to which treatment should be directed. The contagion resides in the epidermal scales thrown off during desquamation; hence, the necessity of isolation, especially during desquamation, and also
the need of a vigorous effort to destroy the almost imperishable germs hidden in the room by fumigation, by boiling, and even by burning all articles of clothing, bedding, etc., used during the attack, and a thorough renovation of walls and woodwork with kalsomining and paint, in order to prevent a possible attack in future.
Dr. Y. L. Abernathy dwelt on the vitality of the contagion and its latency, and related cases illustrating these points.
Dr. G. W. Drake said the diagnosis of atypical cases was of more importance to the public than the treatment. On the mountain he had encountered a case where there had been none in the history of the place and the contagion could not be accounted for. There were three other cases, none of which could be traced to the first. The origin could not be accounted for.
Dr. G. W. Mills gave an account of an epidemic in which the origin of the first case could not be traced.
Dr. Rathmell, in closing, said that there was such a relation between this disease and diphtheria that when we had one we were very likely to have the other. He did not believe them to be the same.
Dr. G. A. Baxter described a new splint for fractures of the humerus below the surgical neck, and demonstrated the same on a subject. It consists of a blunt wedge of tin for the axillary space, to which is attached a right-angle splint for the arm which is adjustible on the humeral portion, allowing extension to be made and fixation before bandaging. The axilla is made the point of counter-extension, extension from elbow. It allows examination in case of compound fractures without disturbing extension.
Dr. D. S. Middleton related a case treated with plaster of Paris applied while swollen, and when this disappeared there was overlapping. This splint seemed more satisfactory.
In closing, Dr. Baxter said that statistics showed as much as 33 per cent. were ununited, and this splint was invented to meet the indications as found in his own cases. Fixation cannot be from shoulder; it must be from a fixed point. There will be no complaint from numbness of the fingers or pressure in the axilla. Any tinner can make the splint.
Dr. C. R. Atchison read a paper on "Treatment of Cancer
of the Skin," advocating the use of caustics in the treatment of epithelioma. There is much less destruction of tissue than with the knife. In the use of the latter, if there are any cells left there will be a recurrence; while if the caustic is used, the inflammation, etc., will cause the death of the pathologic cells beyond the point cauterized. The pain can be reduced to a minimum by mixing with cocaine or general anesthesia. Arsenious acid has a selective action, devitalizing the cancer cells. Caustic potash is specially useful on the lip. Chloride of zinc produces a dry slough.
Dr. P. L. Brouillette asked if any of the members had ever had arsenical poisoning from the caustic. In one case he had applied the acid over too large a surface and had poisoning. The pain was relieved with morphia. The final result was happy. In epithelioma of the nose he used the electro-cautery, which answers every purpose.
Dr. G. A. Baxter said that the argument of the surgeon was that by the knife the patient escaped the pain, which in some cases was excruciating. He would use the paste in proper cases, but believed the knife generally the best, shortens the time, gives physiological regeneration instead of suppurative results, and is equally efficient in elimination of diseased products.
Dr. Frank Trester Smith called attention to a paper read before the American Medical Association, and found in the Journal of October 8d, in which he had advocated the use of caustics for epithelioma of the lips and related a case.
Dr. W. C. Bilbro thought the Doctor pretty well covered the case, as he advocated the use of the knife first for deep-seated cancers, and, if refused, then the caustic.
Dr. J. B. Murfree thought caustics preferable in superficial epithelial cancers. In Dr. Brouillette's case the poisoning was due to the use of too weak a paste. There should be one part of acid to one of gum arabic, or it might be stronger so as to destroy the tissues and not irritate.
Dr. Brouillette said that he had used one part of gum arabic to two of arsenious acid, and the patient was seriously poisoned.
Dr. Atchision, in closing the discussion, said that he would be more cautious. He had looked up the literature and had asked, and had never before heard of a case of poisoning. In cancer