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ceps, success was achieved by putting the patient in Walcher's position and by making traction in exaggerated downward and backward direction. A living child was delivered with Simpson's forceps, axis-traction being effected by the use of tapes.)
PRIMARY CANCER OF THE FALLOPIAN TUBES.
Eckardt (Ibid.) reports the following case of primary alveolar cancer of the tube, the fifth on record. Twelve other reported cases were of the papillary variety.
The patient, a multipara, aged forty-five years, had complained for four weeks of pains in the back and abdomen, with loss of appetite and rapid emaciation. On entering the hospital she was very pale; the abdomen was tender on pressure, and on vaginal examination a nodular mass the size of a child's head was felt in Douglas's pouch.
On opening the abdomen the tumor was found to be universally adherent; on separating it, it tore apart and a quantity of soft, brain-like material escaped from its interior. The left adnexa were normal. Examination of the specimen showed that it consisted of the enlarged right tube, the corresponding ovary being normal, as well as the uterine end of the tube. Microscopically the structure showed the papillary-alveolar type. There was no evidence of chronic salpingitis. It is impossible, according to the writer, to diagnosticate this condition before opening the abdomen. Total extirpation of the uterus and adnexa is preferable to salpingotomy.-Amer. Journal Med. Sci
Editorials, Reviews, Etc.
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An editorial in the Medical News of March 6th, 1897, by the distinguished writer, Dr. H. A. Hare, of Philadelphia, calls attention to the involvement of the vaso-motor centers as a frequent factor in the production of fatal results in the administration of chloroform for anæsthetic purposes. As the author points out two theories as to the manner in which chloroform kills have been held, one that it paralyzes the heart and thus brings about death, the other, that it is by its effects upon the respiratory centres. Dr. Hare himself, in conjunction with Dr. Thornton, has, under the direction of the Hyderabad Govern. ment, made a very exhaustive study of the subject. These investigations proved that chloroform is a depressant poison to all living protoplasm when brought in contact with it. They further show that chloroform is a depressant, and may produce its lethal effects sometimes by affecting the heart, sometimes by its action upon the respiratory centres, and more frequently than
all, by its influence upon the vaso-motor centres.
The following extract from the paper referred to explains the author's position:
"In admitting that chloroform exercises a depressant effect on the heart and respiration, particularly the latter, I wish to emphasize one fact, about which there is little or no conflict of opinion in laboratory or practical test, namely, that the dominant or over-shadowing influence of chloroform is upon the vasomotor centers; and I cannot lay too much stress upon the fact that an intact vaso-motor system is as essential to life as an intact heart. The action of the heart is so closely associated with the state of the blood-vessels as to be altered the moment the arterial pressure rises or falls, for the heart, after all, is nothing more than a highly specialized part of the vascular apparatus. The capillary area of the body is so many times greater than that of the arteries that, if the arterioles relax and allow the blood to flow freely into the vast capillary networks of the muscles and glands, no blood will find its way to the veins or to the heart. Even if the heart is intact, it cannot pump blood if none is returned to it by the veins, and the familiar condition of unconsciousness, or syncope, known as 'fainting,' takes place. This is exactly what occurs when a patient has a sudden 'bad turn ' under chloroform. The agent has caused sudden dilatation of the peripheral blood paths by depressing the vaso-motor center, and the patient faints. If so much chloroform has been used that the center cannot recover itself, death occurs, for the man is bled to death in his own vessels. This condition explains the loss of the radial pulse, the failure of respiration, and the sudden peril of the patient."
The writer's conclusions are that chloroform kills by its effects upon the vaso-motor centres, which deprives the heart and res. piratory centre of blood at the same time, that the drug itself exerts its poisonous effects upon these parts.
The following deductions are drawn from these conclusions: "1. In all cases when chloroform is to be given to a feeble patient the extremities should be tightly bandaged.
"2. Atropin should be given as a vaso-motor stimulant.
"3. A large compress should be tightly bound over the abdomen if this is at all relaxed, or if an accident occurs.
4. The patient should be inverted, if syncope occurs. "5. Artificial respiration, performed by compressing the floating ribs and precordium, should be employed to aid in the circulation of the blood, to pump the chloroform vapor out of the lungs, and to aid the respiratory center in its functions.
"6. During the use of chloroform the respirations should be watched for two reasons, (a) because the depth and rapidity of the breathing is a gauge of the amount of chloroform inhaled (for the amount on the inhaler is not the dose), and, (b) because as the blood pressure falls, the respiratory center becomes disturbed in its function and the irregular breathing shows that the chloroform is disturbing it. Further, irregular breathing means irregular dosing, for twenty deep inspirations a minute means more chloroform inbaled than twenty shallow ones. The respiration is the dose gauge.
“7. It is useless to resort to saline transfusion in chloroform syncope, for the vessels of the body can hold many times the amount of blood in them, and unless quarts are transfused, the relaxed vascular system simply absorbs the fluid and cannot be filled."
Our own observations of the poisonous effects of all general anaesthetics lead us to believe that more patients die from the remote effects of the anesthetic than from the immediate. Nearly all cases that die of what is called secondary shock are victims of an anæsthetic improperly administered. Too much of the drug has been employed. It is well known that after the anesthetic state has been produced that its continuance may be maintained by a minimum amount of the anaesthetic. Too frequently the mask or inhaler is assiduously replenished when there is actually need for only a few drops. As long as respiration continues the poison may be taken in, and the greater the amount the more the danger. Recognizing this fact, even in prolonged operations, we rarely use as much as three ounces of the A. C. E. mixture, and not half as much when pure chloroform is used. Greater
care in the employment of any anesthetic will, as a matter of course, lessen the dangers, and too much stress cannot be laid upon the injunction to use as little of the drug as the exigencies of the case demands.
COMMENCEMENT EXERCISES of the Medical Department of the University of Nashville will be held March 24th, at the Theatre Vendome. A large class will be graduated, and the exercises promises to be unusually interesting. A novel feature will be the appearance of the Faculty for the first time in classic cap and gown. The Charge to the Graduating Class will be delivered by Prof. L. B. Graddy. The Valedictory Address will be delivered by J. G. Johns, of Nebraska; while the medals will be awarded in an address by his Exellency Gov. R. L. Taylor.
OUR old publisher and friend, Herman A. Hasslock, is after a piece of pie from the governmental cuisine in the shape of the consulship to Calcutta. What he wants with such a place we do not know, but since he does want it we earnestly hope he will get it. There is no better man living for such a place
we are sure.
WM. R. WARNER & Co. announce the publication of a pocket medical dictionary comprising 10,000 definitions and covering about 300 pages. It is especially adapted for students and practitioners. The price will be 75 cents, which puts its within easy reach of everybody. It will be ready about March 10th.
AT a recent meeting of the Board of Trustees of the Jefferson Medical College, Philadelphia, Dr. J. Chalmers DaCosta was elected Clinical Professor of Surgery. Dr. DaCosta has been connected with the College for many years, and has recently been Demonstrator of Surgery and Chief of the Out-Patient Department.