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MINUTES OF THE SECTION
OBSTETRICS AND DISEASES OF WOMEN.
TUESDAY, June 6, 1882. DR. H. O, MARCY, of Massachusetts, in the chair, and Dr. C. V. MOTTRAM, of Kansas, Secretary.
Dr. W. H. GRAINGER, of Massachusetts, read a paper upon The Mechanical Treatment of Delivery from the Superior Strait. Illustrated by forceps of his own invention.
This was discussed by Dr. E. S. DUNSTER, of Michigan, Dr. G. W. NESBITT, of Ilinois, and Dr. J. MORRIS, of Ohio.
Dr. G. W. NESBITT, of Illinois, said he thought the attachment to the forceps might be a good thing, as the principle was correct; but he thought that too much emphasis was laid upon the fear that physicians would do harm by making direct traction upon the forceps; for he believed that the mechanism of labor was too well understood, and he believed, or hoped, that the principles of obstetrics were too well taught in our medical schools, to leave any grounds for such fears. He could not conceive of a physician of any intelligence or education attempting to effect delivery by direct and continuous traction upon the forceps. He had always used the left hand as a fulcrum, pressing downward upon the forceps near the pubis, as he made traction forward and upward with the right hand; and he believed this was the practice of all good physicians. If Dr. Grainger's attachment to the forceps acts better for that purpose, it certainly is a good thing.
Dr. H. L. GETZ, of Iowa: “I consider the device of Dr. Grainger a good one. I have for a number of years applied the same principle, by applying the force with hand placed directly upon the forceps, instead of by the instrument shown for the purpose by Dr. Granger."
Dr. R. BEVERLY COLE, of California, presented a paper entitled The Forceps and their Use, with the Introduction to the Profession of a New Forceps.
Paper was not read, but he exhibited his forceps, and it was discussed by Dr. C. McCLELLAND, of Pennsylvania, and Dr. R. BATTY, of Georgia.
Dr. C. McCLELLAND, of Pennsylvania, said:
I wish to make a few remarks upon two points of the subject under discussion.
First.For a long time I have felt the need of some means of obviating the severe pain inflicted upon women by the strong pressure of the shank of the forceps in ordinary use, upon the perineum, when the head is at or above the superior strait. Patients, when not under the influence of an anästhetic, have complained bitterly of the suffering from this cause. The curve in the shank of Dr. Cole's instrument will, I believe, remove this whole difficulty.
Second.—It has always been my custom to keep the index finger of one hand, during traction upon the forceps, in contact with the head of the child. It thus acts as a true indicator of the relation of the forceps to the child's head. The next two fingers are used as a fulerum, upon which the forceps acts as a lever. If additional traction is required, the little finger and. thumb can be used to aid the other hand. In this way the one hand is made to do a threefold duty,—that of an index, a fulcrum,
and a tractor. A paper by Dr. P.J. MURPHY, of the District of Columbia, entitled Condition of Cervix Uteri after Emmets Operation, esperially its Effects upon Subsequent Gestation and Delivery, was read by title, and discussed by Drs. R. BEVERLY COLE, of California, E. S. Jenks, of Illinois, H. L. Getz, of Iowa, and D. T. NELSON, of Illinois, and referred to Committee on Publication.
Dr. II. L. GETZ, of Iowa: “In addition to what has been sug. gested and said by these eminent gentlemen, I wish further to suggest that attention to position of patients after the operation, whereby the possibility of any discharge from the womb is prevented from coming in contact or between the newly freshened edges, would make material difference in the number of successful results."
The Section adjourned.
WEDNESDAY, June 7, 1882. Dr. H. O. MARCY in the chair. Dr. C. V. MOTTRAM, Secretary.
A paper was presented by Dr. M. GREELY PARKER, of Massachusetts, entitled A New Thermo Cautery.
A paper by Dr. DANIEL T. Nelson, Illinois, Especial Pathological Conditions of the Cervix Uteri, with Remarks on Hunter's Dilator.
Discussed by Dr. L. S. ELLIS, of Michigan, Dr. Ira Manly, of Wisconsin, Dr. J. F. CHAPMAN, of New York, Dr. D. PRINCE, of Illinois, Dr. H. F. CAMPBELL, of Georgia, Dr. S. M. Ross, of Pennsylvania, and Dr. C. L. HALL, of Missouri.
Dr. D. PRINCE, of Illinois, suggested as a preventive measure the administration, immediately after delivery, of sulph. morph.
grain, sulph. quinine 10 grains in one drachm of fluid extract of ergot, claiming that the ergot and the quinine favor uterine contraction, while the morphia favors the prevention of reflex action and the occurrence of a chill.
Dr. C. L. HALL, of Missouri, said:
Dr. S. M. Ross, of Pennsylvania, has made a statement with which I wish to take issue. This is in reference to the necessity of the continuance of the lochia after confinement. He states, in effect, that when we have this suppression we always have trouble following. Now sir, I am convinced that this is a mistake. It appears to me that this greatly depends upon the amount of involution-of tissue as well as organic contractilityand that, other things being equal, this is a condition not to be feared, but on the contrary. As for myself, I regard with much more anxiety a case where the flow is at all profuse or prolonged, than where the flow is scant or suppressed. I remember to have had cases in which the Aow discontinued on the second or third day, never to reappear, and without an untóward symptom. This, sir, is the point I wish to make—that the continuance of the flow for any given time, is not necessarily essential, but, on the contrary, to endorse the spirit of the paper read by Dr. NELSON.
A “Report of Progress,” giving one year's experience in Oophorectomy by Dr. Robert Batty, of Georgia, was discussed by Drs. R. B. COLE, of California, and D. PRINCE, of Illinois.
In response to the remarks of Dr. Cole following Dr. Batty's presentation of Bally's operation, in which Lister's position in the Medical Congress, in London, last August, was spoken of, Dr. D. PRINCE remarked that he remembered Lister's presentation of the employment of carbolic acid differently from the recollection of Dr. COLE.
Mr. Lister admitted that carbolic acid might be absorbed in poisonous amount, and that caution might, therefore, be necessary, and that the peritoneum exposed large absorbing surfaces.
He admitted the power of the peritoneum and adjacent tissues to produce an abundant exudation of rapidly organizing material, which gives these parts a power of defense against the agents floating in the atmosphere and developing septic influences, which is possessed in a much more feeble degree by less vascular tissues.
Mr. Lister, on the occasion referred to, presented a loose cartilage, which he said he had, a few days before, taken from the knee joint of a gentleman.
The operation had been done under carbolic spray; a drainage tube had been left in the wound, which was then enveloped in carbolized gauze in his usual method.
No inflammatory action had followed the operation, notwithstanding the open state of the wound in the joint.
This, said Mr. Lister, is the test of the antiseptic treatments,— the opening of parts feebly supplied with blood, not the opening of parts in which the vascular supply is abundant.
A motion was made, and prevailed, that the President be requested to present to the Section that part of his address relating to the treatment of uterine fibroids to-morrow afternoon.
Dr. L. ROBBINS, of Nebraska, reported a case of delivery of child of enormous weight, 17) pounds.
The secretary, Dr. C. V. MOTTRAM, of Kansas, also reported a case of delivery of child of same weight.
The Section adjourned.
THURSDAY, June 8, 1882. Dr. H. O. MARCY in the chair. Dr. C. V. MOTTRAM, Secretary.
Paper by Dr. Joseph H. WARREN, Massachusetts, Elastic Serrated Scoop, Curette, and Tourniquet, Three Instruments Combined in One, was read by the President.
Paper by Dr. D. PRINCE, of Illinois, New Instruments.
Paper by Dr. E. S. DUNSTER, of Michigan, Orariotomy during Peritonitis. Is it Justifiable ?
Discussed by Drs. R. Batty, of Georgia, and E. S. JENKS, of Illinois.
Paper by Dr. H. F. CAMPBELL, of Georgia, Grarid and Impacted Retroversion of Uterus.