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PUBLIC SERVICE.

OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF MEDICAL OFFICERS.

UNITED STATES ARMY.

Week ending August 5, 1895.

The leave of absence for seven days granted Major C. K. Winne, Surgeon United States Army, is hereby extended twenty-three days. Captain W. Fitzhugh Carter, Assistant Surgeon United States Army, granted leave of absence for one month.

UNITED STATES MARINE service.

Fifteen days ending July 31, 1895.

W. H. H. Hutton, Surgeon, to proceed from Washington, D. C., to Pensacola, Fla., on special duty July 18, 1895.

J. B. Hamilton, Surgeon, granted leave of absence for three days, July 30, 1895.

W. A. Wheeler, Surgeon, detailed Chairman Board for physical examination of candidate Revenue Cutter Service, July 23, 1895.

D. A. Carmichael, Passed Assistant Surgeon, detailed to make physical examination of candidate Revenue Cutter Service, July 26, 1895.

L. L. Williams, Passed Assistant Surgeon, granted leave of absence for ten days, July 20, 1895.

G. M. Magruder, Passed Assistant Surgeon, to proceed from Galveston, Texas, to New Orleans, La., for temporary duty July 27, 1895, order to proceed to New Orleans suspended and directed to proceed to Eagle Pass, Texas, for special duty July 31, 1895.

J. C. Perry, Passed Assistant Surgeon, granted leave of absence for twenty days, July 16, 1895.

E. H. Sprague, Assistant Surgeon, to proceed from Mobile, Alabama, to Key West, Florida, for temporary duty, upon completion of which to rejoin station at Mobile, July 18, 1895.

A. R. Thomas, Assistant Surgeon, to proceed from Buffalo, New York, to New Orleans, Louisiana, for temporary duty, July 20, 1895.

H. S. Cummings, Assistant Surgeon, detailed as Recorder, Board for physical examination of candidates, Revenue Cutter Service, July 23, 1895.

J. B. Greene, Assistant Surgeon, to report at Bureau for temporary duty, July 16, 1895.

BOOK REVIEWS.

THE ART OF MASSAGE; Its Physiological Effects and Therapeutic Applications. By J H. Kellogg, M. D., Member of the British Gynecological Society, etc. Modern Medicine Publishing Company, Battle Creek, Michigan. Price $3.00. Pp. 282.

Dr. Kellogg, who has gained a long and carefully applied experience as superintend

ent of Battle Creek Sanitarium, gives in this comprehensive book the results of his work in this institution. The art of massage in various diseases and conditions is here explained and plates and anatomical data are supplied for the use of readers of this practical work. After a brief sketch of the history of massage, and an outline of the parts especially concerned in massage, the author gives in twenty pages an exceedingly lucid statement of the physiological effects of massage, in which the subject is brought up to the latest date. Many manipulations are described and examples are given directing the nurse or attendant. Massage is an important and little used remedial agent, which just such books as this one will help to bring into prominence. It is not a cure-all as many enthusiasts would have us believe, but it is a means within the reach of all intelligent nurses and attendants who will give the subject the attention it deserves.

The illustrations are numerous and in most cases are of use. On the whole this subject is one that can be best taught by practice and any book, even one as good as this, can only be used as an aid to practical work. An interesting chapter is that on the rest cure. An appendix contains a long list of cases. Technical terms have been avoided and as far as possible the directions are specific, even if in some places they are rather short. The book is well bound and clearly printed.

REPRINTS, ETC., RECEIVED.

Albany Medical College, 1895-1896.

College of Physicians and Surgeons of Baltimore, 1895-1896.

Georgetown School of Medicine, Washington, D. C., 1895-1896.

The Richard Gundry Home (Harlem Lodge), Catonsville, Baltimore County, Maryland.

The History of Medicine and Surgery in Georgia. By Luther B. Grandy, M. D., Atlanta. Reprint from the Atlanta Medical and Surgical Journal.

A Curious Anomaly of the Female Genitalia with Striking Resemblance to some of the External Male Elements Converted by Plastic Surgery into a Woman of Normal Appearance. By W. A. H. Coop, M. D. Laurenceburg, Tennessee. Reprint from the American Gynecological and Obstetrical Journal.

CURRENT EDITORIAL COMMENT.

OPHTHALMIA NEONATORUM.
Archives of Pediatrics.

PURULENT conjunctivitis of the newborn, although capable of inflicting one of the most terrible disasters which can befall a child, is practically a preventable disease. Prevention is not difficult. In few diseases is there greater unanimity of opinion as to the measures to be employed. There is little excuse for its occurrence on the ground that treatment is uncertain or difficult. Precautionary measures should be taken with every infant.

A NEGLECTED DUTY.

American Medico-Surgical Bulletin. "MEDICAL fraternity" is an expression widely employed even by physicians themselves. Possibly they have caught the term from the lay public, a body easily satisfied with things which do not directly concern it. Just how widely a brotherly sentiment is disseminated among practitioners of medicine is a matter of some uncertainty. There is a professional etiquette, more or less strictly observed, which is not so much an evidence of goodwill as it is that of an armed neutrality. In the active rivalry which exists today, when new men are continually entering the field, and when the lack of money is becoming, more and more, an obstacle to success, it is neither surprising nor unnatural that the struggle is one of great activity, where every one looks out for himself.

UNNECESSARY NOISES.

Medical Record.

IT is unnecessary to allude to the widespread evil effects of noise upon the public health. If the accumulated agony of irritability could find a common voice it would dangerously jar the equilibrium of the public peace. The only mercy is that it has so many different vents through the thousand channels of individual protests that a general explosion of wrath is thereby averted. Appeals are often made to the Health Board for the suppression of such noises as may be construed as prejudicial to health. Practically all unnecessary noises are such, although the police catalogue places many under the designation of disorderly ones. The difficulties in the way of deciding which is which are not few. The Health Department, with all its power, cannot seemingly make a politic distinction.

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MEDICAL JOURNAL

A Weekly Journal of Medicine and Surgery.

VOL. XXXIII.—No. 18. BALTIMORE, AUGUST 17, 1895.

ORIGINAL ARTICLES.

ANTE-PARTUM HOUR-GLASS CONTRACTION.

A REPORT OF A CASE, WITH SOME INCIDENTAL CONSIDERATIONS CONCERNING THE ABUSE OF ERGOT

IN PARTURITION.

WHOLE NO. 751

Read before the Allegany CounTY ASSOCIATION OF PHYSICIANS AND Surgeons,
JULY 11, 1895, and Published by the ASSOCIATION.
By B. M. Cromwell, M. D.,

Eckhart Mines, Md.

ON January 4, 1893, I was called at eight o'clock in the morning to see Mrs. C., who I found was in the first stage of labor. An examination showed that the vertex presented to the left, and that the os was soft and yielding, and was dilated about the size of a nickle five cent piece. The pains were the slow grinding pains of the first stage, and were slight; she had felt them all during the night. She called my attention to the unusual size of the abdomen, -which indeed I had noticed myself and suggested she was going to give birth to twins. This caused me to make a very careful external examination by which I assured myself that it was a single pregnancy, and I reassured her on that point. The head was plainly felt above the pubic arch, and following the contour of the spine, the nates could be felt in the right hyprochondriac region. I concluded her unusual size was due either to a very large child or to an excessive quantity of water. It proved to be due chiefly to the latter cause, although the child was above the average size.

After explaining to her that all was right and that her labor would termi

nate when her pains became active and expulsive, I left her, to return again at IO A. M. and again at 12 M., at which time there was no change in the situation except that the os was perfectly patulous, soft and yielding, and the vagina was well lubricated with mucus. The pains however were of the same character as at my first visit, slowly recurring, slight and grinding. I left again, and returning at 2 P. M., found the condition of things practically unchanged-pains just severe enough to keep the woman in a state of anxious expectancy, but no advance of the head. I began to feel a little anxious myself; for in her four previous confinements, in all of which I attended her, her labors were not noticeably prolonged or severe, and in the one last preceding this the labor was of very short duration. But acting on the old and very wise maxim thatmeddlesome midwifery was bad," I made myself comfortable and awaited results.

At 4 P. M., the condition of things being still unaltered, while the woman was growing more and more anxious and despondent, at the, to her, unusual delay, and by her prolonged suffering,

and as the parts were in a state of thorough preparation for immediate delivery if the pains could be aroused to activity, I determined to rupture the sac and allow the escape of the water, for I believed that the uterus was partially paralyzed by over-distension. This I did, seating her over a chamber and puncturing the bag with a knitting needle. After the first gush of water I lifted the head from its position on the brim of the pelvis and allowed the free discharge of all the water, the chamber being about two-thirds full. At 5 P. M., the pains had become but little if at all intensified, and there had been a slight descent of the head, enough to engage it in the brim of the pelvis.

The woman's fears for her safety were becoming fully aroused, and I determined to administer a moderate dose of ergot, about ten drops of the fluid extract, but before doing so I introduced my hand into the vagina, and with my fingers swept freely round the presenting occiput, assuring myself in this way. there was no possible obstacle to the easy exit of the child when expulsive pains should set in. In about fifteen or twenty minutes the uterus began to respond to the ergot; the pains became almost continuous and towards the close, very severe, but except an additional slight advance of the head without material effect. This advance seemed to respond to the first pains after giving the ergot, but afterwards, when the pains became really intense and almost continuous, I could discover no advance whatever.

These pains continued for about one hour and then completely gave out, there being finally scarcely a semblance of one. I then sent to my office for my forceps (Bedford's), determining to effect delivery in that way. I had no difficulty in applying them but with all the force I could use I could make no impression on the delivery of the child. The advance made during traction became lost when the effort was relaxed. I continued the effort until I became quite exhausted, and after an interval of rest of about ten minutes, and after readjusting the forceps, I made another

vigorous and determined effort until I became again thoroughly exhaused. Again it happened that as soon as the traction force was suspended or relaxed the little advance made was lost, the head would recede to its original position.

I then told the husband of the woman that I felt myself physically unable to effect the delivery, and that he must bring to my assistance another physician. In about a half hour Dr. McGann arrived and seemed surprised, after a careful examination, that there should be any difficulty about effecting delivery. So the woman was again given chloroform, the forceps carefully reapplied and handed to him for trial. Dr. McGann was too polite to say so, but I saw that he thought he was going to have a soft snap of it. He exerted all his strength until he in his turn became exhausted; when I relieved him and tried it again. But it was of no use; I was no more successful in this than in any of the previous efforts, and as a last resort I handed the forceps, after seeing that they were properly adjusted, to the woman's husband, a powerful miner, who was standing by me, and instructing him how, told him to exert all his strength. The force he put forth was that of a fresh and powerful young man, and I saw at once that the obstruction, whatever it was, was overcome, and taking the forceps from him completed the delivery without difficulty.

The child, which was large but not excessively so, was removed, and introducing my hand, I removed the placenta by Credé's method, thus terminating the labor as quickly as possible; for I was anxions for the condition of the mother after so much pulling and hauling. On introducing my hand into the uterus I met with an hour-glass contraction, a portion of the placenta being in the lower, but the bulk of it was in the upper chamber. My hand passed through the constriction with some difficulty, and in a few minutes the delivery was effected.

The above is almost a literal transcript of the notes of the case taken at the time of its occurrence. I say this

to show that after the lapse of over two years I have not trusted to my memory for the facts and incidents that make up the history of this interesting case.

The woman was thoroughly exhausted by the severe ordeal through which she passed, and excited my anxiety for the result, but her recovery was uninterrupted and complete and without any serious after-consequences.

The child was with some difficulty resuscitated. At first I was sure its neck had been broken or dislocated by the severe and prolonged traction it underwent. If left unsupported the head fell in any direction exactly as in an adult whose neck has been broken. He is now, however, a well grown boy.

This case was a puzzle to me for many days. I could not imagine what the difficulty was or where the obstruction came in. I knew there was no impediment in front of the child, and I failed entirely to appreciate the significance of the hour-glass contraction I encountered when I delivered the placenta. But I had done one thing I do not remember ever to have done before, and which was opposed to a cardinal maxim with me in my obstetrical practice; I had given a dose of ergot for the sole purpose of arousing a sluggish uterus and so to terminate a tedious and exasperating labor; and I could not divest myself of the belief that the ergot was directly or indirectly the cause of the trouble. The case weighed on my mind the more, because I had a dim consciousness all the time that I had seen some report of a case similar to it, but where I saw it or when I could not recall, until I suddenly remembered (unconscious cerebration!) reading a most instructive article in the MARYLAND MEDICAL JOURNAL by Dr. G. W. Miltenberger, giving an account of a case in which he was called in consultation with Dr. H. M. Wilson. The article was called "Tetanoid Falciform Contraction of the Uterus, or Ante-partum Hour-glass Contraction of the Uterus," and is to be found in the Journal for January 12, 1889. The article is so interesting in its details and so instructive in every way, that it would be well

worth incorporating in full did time and space permit. I must content myself by giving as brief a synopsis of it as possible.

Dr. Miltenberger was called to meet and assist Dr. Wilson in an obstetrical case, a primipara of 27 or 28 years of age. The membranes had ruptured five days before, and when the woman was taken in labor everything proceeded regularly but so slowly that Dr. Wilson determined, after satisfying himself that the os was well dilated and yielding, to apply the forceps and terminate a slow and exhausting, but not otherwise abnormal labor. He applied first a Simpson's forceps and finding that ineffectual he applied a Tarnier. With this he could bring the head down to the vulva but on relaxing his effort the head immediately receded to its former position. Being, like myself, unable to understand what the difficulty was inasmuch as it was positively not in front of the presenting head, he sent for Dr. Miltenberger who, on arriving, found the woman in articulo mortis. After her death, which occurred in a few moments, he, Dr. Miltenberger, was requested to deliver the child, which he proceeded to do by turning, having satisfied himself, by Dr. Wilson's failure, that it could not be accomplished by the use of the forceps. The following is his account of the operation :

"The os was perfectly soft and dilatable, not offering the slightest resistance, head movable, cervix soft and relaxed, not thinned nor distended, no strain upon the structure whatever. With the external hand I found nearly up to the umbilicus of the mother a deep furrow upon the external surface of the uterus corresponding to the so-called ring of Bandl, the contraction ring of Schroeder, the retraction of Lusk, the organ above this line being firmly contracted and retracted. The internal hand, readily passing the head, met with a ring or constriction corresponding to the external furrow, entirely too high for the internal os uteri, surrounding most closely and tenaciously the neck of the child, the head below in the soft, relaxed and not distended or stretched lower seg

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