DEPARTMENT OF OBSTETRICS AND GYNECOLOGY. BY W. H. VOGT, M. D. ST. LOUIS. A Modified Axis-Traction Forceps.-(Richard Freuend, Zentralbl. †. Gynaekol., No. 37, 1903.)-The author finds the heavy handles of the axis-traction forceps an impediment to good work, since they sink through gravity and are apt to dislodge the forceps from the side of the head. He has advised a modification of the instruments in which the handle can be removed, thereby making the instrument as light as possible. So-called White Infarcts of the Placenta.-(G. Schickele, Zentralbl. f. Gynaekol., No. 37, 1903.)-Schickele believes that these so-called white infarcts are due to a disturbance of the circulation in the intervillous spaces. He believes these infarcts should be called "fibrin masses.” Should the Umbilical Cord be felt for About the Child's Neck as Soon as the Head is Born?-(B. S. Schultze, Zentralbl. f. Gynaekol., No. 37, 1903.)-Schultze maintains that feeling for the cord about the child's neck after the head is born is unnecessary and simply adds another element to the possibility of infection. He says the cord does not need loosening after the head is born. Should the cord not become lax and it becomes necessary to cut it, there is always time enough for this procedure after the shoulders have been delivered. Chloroform Death or Uraemia.-(F. Hammer, Zentralbl. f. Gynaekol., No. 38, 1903.)-Hammer reports the case of a woman who on account of severe bleeding was tamponed. A large placental polyp was found to be the source of the bleeding. The patient was anaethestized with chloroform and while under the anesthetic she became deeply asphyxiated. A few hours later tonic contractions appeared which were followed seven hours later by death. An acute parenchymatous nephritis as well as a myocarditis were found at the autopsy, and Hammer believes the death to have been due to an acute uremia arising during the narcosis. Asphyxia Neonatorum.-(W. Zangemeister, Zentralbl. f. Gynaekol., No. 39, 1903.)-The use of oxygen as a therapeutic measure in these cases has not been satisfactory as a rule. But in severe cases of asphyxia neonatorum it is proving to be extremely valuable, and the author recommends it in these cases. It should be injected very gently into the trachea by means of a tracheal catheter from a rubber bag. When the lungs have become distended he applies gentle external pressure to the thorax. air escapes along the outside of the catheter which must be of small diam. eter to allow this. This is to be repeated until the child breathes and its color improves. The narcosis from the carbon dioxid is dispelled in this way more rapidly than by any other means, and the stimuli applied become more promptly effectual. 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THE ABBOTT ALKALOIDAL CO. 50 W. Broadway. New York. ▾ Ravenswood Station, CHICAGO. - 13 Phelan Bldg., San Francisco Department of Clinical Therapeutics DEVOTED TO CLINICAL EXPERIENCE. Lecithin. During the last quarter of a century wonderful strides have been made in the domain of medicine in all of its departments, so that it is daily approaching nearer the position of an exact science. These advances have been made chiefly along the lines of pathology, and especially in the branch of bacteriology, helping more particularly surgery, and hand in hand with the increased accuracy in diagnosis by new and ingenious methods, have led up to a point where more exact knowledge in materia medica and therapeutics is necessary. The everlasting necessity always becoming the mother of invention has here held good, and has given birth to new impetus in chemistry and pharmacy, to such an extent that synthetical product after product has been evolved in such a progressive line of improvement, that today the modern materia medica is on an entirely new standard. Perhaps there is no better instance in which this advance could be illustrated than in the introduction of the organic compounds of phosphorus. Physiologists and clinicians have long conceded that genesis of force depends largely upon properly selected and assimilated reconstructors. The laws of molecular affinity are as fixed and invariable as the principles of atomic affinity. Physiologists and advanced therapists concede that the living organism possesses powers of assimilating and converting into. tissue proper elements of nutrition, as well as presenting resistance to microbic invasion. Of all the important organic phosphorus compounds, the most imporant is lecithin, as it is the basis of cell-formation and the keystone in the synthesis of protonucleins. Lecithin, which is so-called from a Greek word-hekoos-meaning the yolk of an egg, because one of its chief sources of existence is in the yolk of eggs, but is also found in semen, brain matter, nerve tissue and the leucocytes of the blood, was first discovered by Gobley and later studied by Strecher. Chemically, lecithin, or di-stearo-phospho-glyceride of cholin, is an oragnic phosphoric compound made up of certain acid glycero-phosphates, with a chemical formula of C4,H,,NPO2. Its therapeutic value as an assimilable form of phosphorus has been acknowledged by a number of authorities who have given the subject considerable attention. 49 99 The most important studies connected with the role of lecithin in nutrition are due to Danielewski and Sorrono. In 1897 the Societe de Biologie de Paris received on this subject an exceedingly interesting communication from Charrin. Selansky (a pupil of Danielewski) has been able to show that its action on the red corpuscles is remarkably beneficial. Numerous authorities have since studied the physiologic effects of lecithin, and all agree that it assists nutrition and favors assimilation of nitrogen and phosphorus compounds, so essential to the human economy. The effect produced by "lecithin" appears to relate to the general condition, and it is not a specific for the nervous system in general, but is free from all inconveniences in whatever dose it may be given; even as much as fifteen grains can be exhibited at one time. Gilbert and Fournier have shown that it exercises a very favorable influence on the nutritive exchanges, with a notable increase of the nitro genous elaboration, a much greater fixation of phosphorus, and a marked increase in the weight of persons suffering from serious nervous affections, and in all wasting diseases. These conclusions have been confirmed by such men as Desgrez, Claude and Ali Zaky, who have studied the influ ence of "lecithin" clinically and experimentally. Neurasthenia.-Neurasthenia is an expression of nerve tire of the central nervous system and its consequence, which is invariably degeneration. In nerve tire of the central nervous system there is acceleration of the action of the excito-motor ganglia of the organs, with at first increased function of these organs and later exhaustion, with all its consequences; therefore, central nerve tire proceeding along the lines of least resistance, produces local expressions which are often considered the cause of the constitutional condition. However, these local expressions often form a vicious circle, which aggravates the original condition, but they are sequences rather than causes. As over-action of the organs causes underelimination, autotoxemia of a very poisonous type follows nerve tire, and the striving to get rid of these products of nerve waste causes renal and lymphatic disturbances which intensify the clinical symptoms. Neurasthenia may occur alone or be an expression and complication of any constitutional disorder. In such cases both the nerve tire and the constitutional disorder must be treated, for a neurasthenia resulting from phthisis, nephritis, diabetes or syphilis, is a true neurasthenia, and if not treated as such will intensify the disorder which gave it birth. There is a form of neuralgia which Jendrassik considers a neurasthenic type; it is a neuralgia occurring in neurasthenic individuals, which presents certain difference from the ordinary form. The pains are constant and not intermittent, as is the case in ordinary neuralgia. They are not strictly limited to a given location, but extend to the regions which are in greater or lesser proximity to the involved site. Paraesthesias are generally present. The objective symptoms are not observed. Thus, in neurasthenic facial neuralgias there is no local tenderness, nor redness, nor watering of the eyes; motion of the affected part gives relief, and the same frequently is brought about by pressure. The pains are usually less at night than during the day, because the trouble is invariably ascribed by the patient to some local lesion. Thus, in facial neuralgias, the teeth are often regarded as the seat of the trouble, but in all cases careful questioning will show that the patient is of a neurasthenic type, although at first sight it may not be apparent. The treatment presents the greatest difficulty. Operative measures are entirely intra-indicated, as permanent relief is never obtained, and internal medication is frequently unsatisfactory, save that the various narcotics and anodynes give temporary relief. The best results are only obtained by strict hygienic measures and medication directed toward the rectification of the neurasthenic disposition. Nerve Degeneration, The degeneration which follows in all these cases of neurasthenia produces and is due to chemical changes in the nerves themselves. Considerable attention has been given to the chemistry of nerve degeneration. Mott, who has done considerable work along this line, commenced by estimating the amount of phosphorus in the two halves of the spinal cord in which unilateral or nearly unilateral degeneration had resulted in recent cerebral lesions. He found that on the side on which the Marchi reaction |