there was ill-defined resonance high up on the left side. No opening into the rectum could be detected, although frequent examinations for this purpose were made. The patient was greatly emaciated, the weight having fallen from 125 pounds to 70 pounds. The operation was performed June 23. There was great difficulty in the administration of the ether. On opening the peritoneum all the parts were matted together. The abdomen was washed out by allowing water to run into it from a pipe and then syringing out what remained. Finally a cavity was reached in the left lumbar region. It was impossible to attach the walls of this cavity to the abdominal wound and as the condition of the patient was by this time alarming, a drainage tube was introduced and the abdominal incision closed with sutures. In the course of several hours the patient rallied from the operation. The temperature did not go above 100°. The cavity was washed out with a solution of iodine tincture in water. The upper two-thirds of the abdominal wound failed to unite. On the fourteenth day, a large quantity of fecal matter came through the wound. This continued to recur. In July, evidences of Bright's disease were detected. Since then there has been some improvement in the general health. I think that if the patient had consented to the operation when first proposed, the result might have been different. One of the principal objects of the paper has been to ascertain if, as has been stated, fecal fistula is an invariable consequence of laparotomy for abdominal inflammation in cases where pus has already escaped by the rectum? DISCUSSION. DR. J. SCOTT, San Francisco. I mention the following case. A patient was admitted to the hospital with prolapse, inflammation of the ovaries and cellulitis. After three months' treatment without improvement removal of the ovaries was recommended but declined by the patient. The patient was kept under treatment for six months longer, when enlargement of the right ovary began. Later pus discharged by the rectum, and subsequently the abscess opened into the bladder. The patient then consented to operation. The abdomen was opened, an opening made into the vagina and a drainage tube introduced. The improvement was not marked, and in the course of two months the patient was as bad as ever. The removal of both ovaries and tubes was then performed. Four or five days after the operation feces appeared in the wound. During the five months succeeding the operation the fecal fis tula has closed, the patient has gained ten pounds, and is able to walk about. DR. WILLIAM GOODELL, Philadelphia. The only case which I have had at all similar to the one reported was one of pelvic abscess opening into the rectum and bladder. I performed laparotomy with the intention of opening the abscess and stitching its walls to the abdominal wound. The abscess had been so constantly drained, that it was not larger than a pear. By compressing the abscess sac I was able to make it prominent in the vagina and forced into it a closed pair of scissors, which were then opened, and the opening gradually enlarged and a drainage tube inserted. This case gradually recovered, both the rectal and vesical openings closing in the course of time. DR. R. S. SUTTON, Pittsburg. In a case of pelvic abscess as large as a cocoanut, I performed laparotomy, and then stitched the peritoneum at the end of the incision to the peritoneum covering the abscess, which was then opened and a drainage tube introduced. The patient recovered. DR. JOSEPH T. JOHNSON, Washington.I would suggest that in such cases as the one described by the author, where time is a matter of importance, much can be gained by adopting the procedure employed by Drs. Bantock and Tait. In washing out the abdominal cavity they pour the water into the cavity with a pitcher, using gallons at a time. In this way the cleansing is rapidly accomplished. Adjourned. WEDNESDAY. SECOND DAY. Ergot after Labor, by Dr. John Goodman, Louisville, Ky. In the absence of the author, the paper was read by the secretary. The administration of a full dose of ergot immediately after the completion of labor, has become a general practice. It is claimed that it promotes involution, prevents after-pains and tends to prevent post-partum hemorrhage. Some years ago the author administered a full dose of ergot after a perfectly normal la bor. In fifteen minutes, severe pain appeared and increased. The tenderness in the uterus continued for a week. There was no milk, and the patient, previously prolific, never again conceived. This trouble was attributed to inflammation of the muscular coat of the uterus produced by the action of the ergot. On In a second case, treated in May, 1886, ergot was given after a forceps delivery. the seventh day the patient had a chill, fol lowed by a temperature of 104. The next day a clot was washed out of the uterus, and the temperature fell to 99°. Well marked septicemia developed, and the patient died one week later. In this case the retention of the clot was attributed to the spasmodic contraction of the uterus preventing its escape. The author had seen other cases in which injurious effects were produced by the administra tion of ergot. He claimed that ergot did not assist involution, which was a natural process and required a certain length of time for its completion. That we have in ergot a remedy capable of arresting after pains can not be doubted, but it does so by exciting a mode of muscular action at variance with all physio. logical laws. After-pains are conservative, and it is better to wait until they become of abnormal severity before resorting to treatment. Ergot is capable of preventing hemorrhage, but its use is attended with such dangers that it should not be employed except under exceptional circumstances. It should be an inviolable rule not to give ergot at the close of the third stage of labor, unless hemorrhage is imminent. It should then be used by hypodermic injection. DISCUSSION. The PRESIDENT, DR. THADDEUS REAMY, Cincinnati. I have in process of preparation a paper in which I enter my protest against the routine practice of the administration of ergot after the third stage of labor. This conclusion is based upon my experience, and upon a study of the action which is claimed for the drug. The contractions produced by ergot❘ are unlike those of nature. The contraction of ergot is persistent, while the normal contraction is intermittent. If the contraction is persistent, the circulation of the uterine wall can not reach a healthy state, and thus it not only retains what is in the uterine cavity, but it interferes with the process of involution, and lays the foundation for sepsis and inflammation. I think that in the course of the next five or ten years the practice of obstetricians in this matter will be revolutionized. DR. WILLIAM GOODELL, Philadelphia.-The author of the paper states that it is only since last May that he has given up the use of ergot. I think that he has not had sufficient time to form such positive opinions. In the first case I think that there must have been a fibroid tumor. The second case was a clear instance of septicemia. I do not think that after pains are conservative. As a rule we do not see them in primiparæ, these pains are in great measure the result of weaknesses induced by civilization. I do not believe that every woman who has given birth to a child needs ergot, but we do not know the cases which do require it. In twenty-five hundred of labor I have always given ergot after the completion of labor, and I have never seen any harm from its use. I do not believe that one dose of ergot has much effect in favoring involution. Involution is the result of fatty degeneration, and the greater the contraction the greater the interference with circulation, and the more rapidly should this change take place. I have used ergot for two purposes, one was to prevent hemorrhage, and the other to prevent the absorption of septic matter. Sinee the introduction of antiseptics which I think should be used in every case of labor, whether public or private, the use of ergot to prevent septic infection is not so important. I think that it does not do the harm which hat been mentioned. DH. GEORGE J. ENGELMANN, St. Louis.-I hold in the main the views which the presi dent has expressed. I use ergot much less. than I did a few years ago. I believe that we have equally effective measures in the hot antiseptic douche and in the faradiac current. After the contents of the uterus have been expelled, ergot will in certain cases always be a useful and effective remedy. I would not venture to say that after labor ergot is out of place, but I think that I may say that before the contents of the uterus are expelled it should not be used at all. A DR. THEOPHILUS PARVIN, Philadelphia.The effect of ergot varies with the dose. small dose acts simply to increase the normal uterine contractions. I must object to the assertion that ergot should never be given before the completion of labor. Statistics show that those who are most successful in the treatment of placenta previa are the men who use ergot. Again in a multipara, with the os dilated where a sudden rupture of the membranes has taken place with a cessation of labor, fifteen or twenty grains of ergot causes a rapid completion of the labor. After a protracted labor there is a weariness of the uterus and a failure to enter upon the normal re traction which is a preventive of hemor rhage and tends to promote involution. As long as in the third stage of labor we assist nature in the expulsion of the placenta, why should we not assist nature in securing nor mal retraction of the uterus after the completion of the third stage? In some experiments which I made at the Philadelphia hospital. [TO BE CONTINued.] CORRESPONDENCE. NEW YORK LETTER. NEW YORK, Sept. 25, 1886. Editors Review: The Pathological Society resumed its semi-monthly sessions on the evening of the 8th inst. The attendance was quite fair, considering the fact that many of the members have not yet returned to the city. Only a few pathological specimens were presented. Dr. Louis Waldstein showed organs removed from a German patient, male, æt. 64, who died with uremic symptoms. He had suffered from diabetes, his urine showing nearly one per cent of glucose and having a specific gravity running from 1025 to 1030. Dr. Waldstein only wished to call attention to the appearance of the heart, pancreas, and arteries at the base of the brain, not in connection with the disease from which the patient died, but because they presented independent organic lesions. While the patient had given no cardiac symptoms, the arteries of the heart were found completely calcified, and both semilunar valves were distinctly atheromatous. There was calcification also of the arteries at the base of the brain, but nowhere occlusion. The patient was excessively fat, and all the viscera were distinctly infiltrated with fat. The pancreas especially revealed this lesion, its own parenchyma being nearly destroyed. The splenic artery showed a patch of atheroma. The liver was fatty and cirrhotic. The kidneys were large, pale and of a grayish-yellow hue. They had not yet been examined microscopically. Dr. Wyeth thought it somewhat remarkable that the patient had given no anginoid symptoms in view of the condition of the coronary arteries. He thought that the dilation of the arteries might account for this absence of symptoms. he had removed several some years ago. The patient had had a stone in the bladder, and had undergone the operation of lithotrity. On coming under Dr. Wyeth's care, he had complained of difficulty of micturition. An examination revealed a calculus about 4" from the meatus, and there was a stricture at this point. The calculus was pushed back with a blunt instrument and considerable relief followed. The trouble returned, however,' and double internal urethrotomy was performed, and five calculi removed from the urethra. This was four years ago. Dr. Wyeth could not remove the calculi with either the alligator forceps or Sir Henry Thompson's straight blades, but by passing a bent curette behind the stones, he gradually "raked" them out. The urine showed a large amount of albumen but no casts. The patient had urethral fever, temporary suppression, and came very near dying. One year ago he again presented with similar trouble, having been well in the interim. The stricture had contracted. Dr. Wyeth now cut from below up on the stone and established a urinary fistula. The operation was done under cocaine and was painless. There were still a few small stones in the bladder. The same urethral chill and fever followed, and the patient died ten days after the operation. No autopsy was obtained. Dr. J. West Roosevelt has been appointed Professor of the Theory and Practice of Medicine at the Woman's Medical College of this city. He succeeds Dr. Henry N. Heineman, resigned. Dr. Thomas A. McBride, of this city, recently died while en route home on one of the German steamers, and was buried at sea. He had been ailing with Bright's disease for some time, and the immediate cause of death was uremic coma. Dr. McBride, though a comparatively young man, had attained a most enviable reputation as a general consultant, though devoting special attention to renal and nervous disorders. At the time of his death he was attending physician to the Presbyterian Hospital and a promiment member of nearly all the societies. He was a careful observer, a close student, and one of the most thoroughly scientific men in the professional ranks. His death is mourned as the premature close of what bid fair to be a most brilliant ca Dr. Hodenpyl presented a dermoid cyst of the right ovary, connecting with a similar cyst in the right broad ligament. Both were very small and had not been noticed by the patient (æt. 45), who died of pneumonia. Both cysts presented the usual contents of fatty matters, hairs and epithe-reer. lial scales. Dr. Prudden had been present at the autopsy, and said he thought it a matter of interest as to the relations of these two sacs to each other. They might have been simply different portions of the same original cyst, or they might have been originally separate, and afterward communicated with each other. Dr. Wyeth presented specimens of urethral calculi, removed recently from a patient from whom J. E. N. -The N. Y. Med. Monthly presents a long editorial in recognition of the importance of the new and growing specialty of Railway Surgery, but it forgets to acknowledge that the WEEKLY MEDICAL REVIEW first recognized this department. NOTES AND ITEMS. "A chiel's amang you takin' notes, And, faith, he'll prent 'em." -The Med. and Sury. Reporter says: "Puffendorf tells the following: 'A man who had sore eyes went to a horse doctor for relief. The doctor applied to his eyes an ointment he had been accustomed to use on horses. The man I became blind, and sued the doctor, but the judge acquitted the horse-doctor on the ground that if the man had not been an ass, he would never have applied for relief from a horse-doctor.' I This recalls to our mind a story told by Billy Florence (Hon. Bardwell Slote) at a medical dinner at the Lindell Hotel some twelve or fourteen years ago, in response to a sentiment sprung upon him by the toast-master of the evening. He prefaced his remarks by saying that he felt as though he were a co-worker with the M. D.s, as he thought that fun and laughter many times assisted physic in throwing off bile and other ill humors from the system. He seldom found himself among so many doctors, and felt at a loss how to respond to the demand made upon him. He would retaliate by telling a medical story. "In the early days an old Pennsylvania Dutch truck farmer in the outskirts of Philadelphia, was much disturbed by the sudden illness of his better half. After consultation with her, they mutually concluded that a due regard for economy would preclude their securing the services of the eminent and able Pancoast, Shoemaker, or Frank Woodbury, but instead the nearest veterinary surgeon was summoned, because he was cheap. He responded promptly, and of course made the stereotyped inquiry as to the action of the patient's bowels, and found that they had not moved for two weeks or more. Whereupon he at once decided to purge her. He resolved upon his remedy, and remarked sotto voce: 'Now, if she were a horse, I would give her a quart of this medicine, but being a woman, I will give her only a pint.' Turning to the husband, he delivered the medicine, and left instructions that it be at once administered and be notified if the bowels were not moved. A week later the horse doctor met his patron and inquired regarding the outcome of his wife's case. The reply was, 'Oh, doctor, you fixed her.' Said the h. d., 'Ah! I am glad to hear that. Did her bowels move well?' 'Indeed they did,' was the response. 'They moved six times before she died, and four times after she died.' I. N. L. it introduces to the population (many of whom, gong and give the young man repose. It will do particularly the negroes, are peculiarly suscepti-him good. ble to fear and have a superstitious dread of hidden and unseen dangers), a new form of terror, and begets a feeling of uncertainty for the future. Some of the idle neurologists in the tranquil regions of the country might well emigrate to Charleston. -Dr. Cheron orders the following injections morning and evening for leucorrhea and fetid vaginal discharges: chlorate of potash, 3iii; laudanum, 3ii; aquæ rhenicæ, 3x. Two or three tablespoonfuls for a quart of hot water.-Med. Press and Circular. -Our friend, John J. Mulheron, M. D., of Detroit, Michigan, editor of one of the best journals in our country, the Medical Age, a journal always full of good things, thoroughly scientific, original and selected, is nothing if not poetical, as witness the following: "The French have taste in all they do, Nature to them has given goût; To us she's given gout." We suppose he would not sacrifice truth to poetry. That being the case we fear he lives too high. A rigid diet will bring relief. DEATH OF DR. JAMES G. WAKLEY.-The Lancet (Sept. 4) announces the death of Dr. James G. Wakley, who for twenty-five years was the editor and proprietor of this publication. Dr. Wakley was the youngest son of Mr. Thomas Wakley, the able and courageous founder of "The Lancet," and succeeded his father in the conduct of this journal upon the death of the latter some years ago. The son proved a worthy successor of the father, and through many years of hard labor succeeded in raising "The Lancet" to the first place among the medical journals of the world. Dr. James Wakley is represented by "The Lancet" as a man of simple and retiring manners, but an earnest and untiring worker in whatever cause his interests were aroused. He aimed to make "The Lancet" not only an exponent of the best medical thought of the day, but an agency for good in correcting and exposing medical abuses and public evils. He gave his whole life to the conduct of this work, which stands to-day a noble monument to the industry, talent and skill of Thomas and James G. Wakley, father and son. Dr. Wakley died on August 30, from epithelioma of the tongue. Sometime before his death, Dr. James G. Wakley made a special request that the following confession of faith should be introduced into any notice of his life which might appear in the pages of "The Lancet:" "Feeling my deep responsi bility to God for the position in which, in His providence, He has placed me, I desire to testify to the comfort derived during my sickness from a living faith in our Lord Jesus Christ, and that I die in the sure hope of a glorious resurrection." |