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weaker solution was equally effective. The result of this method of treatment was an almost immediate relief from the pain. After each application of the dressings the patients complained of a slight sense of smarting thronghout the breast. Care was taken to wash the nipples thoroughly before putting the baby to the breast. In the cases reported by Dr. Haussmann the mothers were able to nurse the children within a few hours after the application of the acid, and the nipples were entirely healed within two days. The Treatment of Placenta Prævia. — In a paper recently read be

fore the Medical Society of the District of Columbia, Dr. J. T. Johnson calls attention to the high rate of mortality observed in cases of placenta prævia, as regards both the mother and child. The frequent recurrence of bæmorrhages so exhausts the mother that when the time of actual labor arrives she is in no condition whatever to bear the hæmorrhage which usually accompanies the dilatation of the os. The child, too, for the same reason, is very frequently sacrificed, even when the mother's life is saved. He strongly dissents from the treatment generally adopted in such cases, and advises that in all cases where the existence of a placenta prævia has been clearly diagnosticated, premature labor should be induced before the occurrence of exhausting hæmorrhages. In cases where labor has already begun, he favors the immediate introduction of a catheter, and the withdrawal of the liquor amnii. The uterus is thus at once provoked to greater activity, and, moreover, can act to a better advantage. The head, if that be the presenting part, is driven down, and, as the cervix dilates, the pressure of the head controls the hæmorrhage. The introduction of a sponge or laminaria tent, followed later by the use of Barnes's dilators, hastens the dilatation. In this way version may be avoided. Where version must be performed Dr. Johnson advises that bimanual version be tried, rather than that the hand should be forcibly carried within the uterine cavity through the imperfectly dilated os. In conclusion, he states that he is firmly convinced that in proper cases, and when seen in time, the induction of premature labor will save many lives, both fætal and maternal; and also, that when the above-mentioned gentle means of dilating and at the same time plugging the cervix are universally adopted, the fearful mortality in these cases will be greatly reduced.

Use of Disinfecting Injections into the Uterus after Delivery. — In our last report of progress we gave a résumé of several recent writings, all of which favored the use of disinfecting injections during the puerperal state. Since then two communications have appeared," written by Küstner and Fritsch respectively. In both of these the attention of the profession is called to the danger which is liable to follow a too free use of disinfectants in washing out the cavity of the uterus after deliv

i Centralblatt für Gynäkologie, xiv. 16.

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ery. In the cases observed by these writers the symptoms were unmistakably those of acute poisoning. Dr. Küstner's case proved fatal, and at the autopsy it appeared that the uterus itself had not in any way been injured by the introduction of the syringe. Yet there had been suddenly developed unconsciousness, contraction of the pupils of the eyes, rapid respiration, dyspnea, and a weak and scarcely perceptible pulse. The muscles of the face were convulsed, the head was thrown backwards, the jaws were fixed, and a cold sweat covered the patient. In from ten to fifteen minutes the patient improved considerably. Half an hour later the patient vomited a black vomitus, and the urine drawn by a catheter was black. The disinfecting solution used in this case was one part of carbolic acid to twenty of water.

Dr. Fritsch reports three cases in which most dangerous symptoms arose. In one of these cases the disinfectant used was salicylic acid, and in two carbolic acid. In all of them there was a sudden collapse, followed by unconsciousness and a very rapid pulse. In the two cases in which carbolic acid had been used there was observed the same discoloration of the urine. These three cases recovered. In all of them the uterus was imperfectly contracted.

Both observers regarded these symptoms as due to the very rapid poisoning of the patient by the entrance of the disinfecting agent into the circulation through the patulous sinuses of the imperfectly contracted uterus. They still strongly favor the use of a disinfecting irrigation of the puerperal uterus in all cases in which the attendant has reason to suspect any putrid absorption, but they both recommend that, in all such cases, the injection should be performed with the greatest care, and that especially the introduction of a forcible stream should always be carefully avoided.





APRIL 1, 1878. Syphilis. — Dr. G. H. M. Rowe read a paper on Mental Derangement from Syphilis, which was reserved for publication.

Dr. Norton Folsom doubted if in many so-called cases of cerebral syphilis there is any other relation or connection between the cerebral manifestations and the syphilitic poison than that which exists in other debilitating or degenerative diseases. We see in asylums patients suffering from insanity who have subsequently contracted syphilis without producing any change in the course of their mental symptoms. He objected to the term “ cerebral syphilis," and thought it better to use the expression “ insanity complicating syphilis."

Dr. Ellis thought that to show that syphilis is a potent cause of mental disorder, such as the reader has described, it would be necessary to prove that insanity is more common in those suffering from syphilis than in those not so affected ;

he doubted if this point had yet been established. Dr. C. F. Folsom remarked that he thought it impossible to determine definitely whether syphilis causes mental disease or not until we intimately know what that condition of the cells of the brain is that produces insanity. Gummata or other tumors, local inflammations, thickening of the membranes, ostitis and periostitis, for instance, are all sometimes attended with cerebral derangement, and often not; why, however, we do not know, but we may reasonably conclude that the by no means infrequent cases of mental derangement which are not attended with much debility or general symptoms of ill health, and which recover rapidly under a judicious antisyphilitic treatment, are of syphilitic origin, or dependent on the pathological condition produced by that disease.

Dr. Rowe referred to various articles written by Wille, Skae, Cluster, and Stewart, which seem to show that there are special symptoms indicative of mental derangement depending upon syphilis, and said that he noticed a remarkable similarity in the symptoms noted in his cases and in those reported in the above-mentioned authorities. Dr. Rowe added that there was a wide discrepancy in the conclusions derived from English and German observations regarding the frequency of cerebral derangement in syphilitic disease. One English writer asserts that one in forty of all cases of insanity is of syphilitic origin, while a German investigator in the insane asylums of Germany reports only one case out of nine hundred.

Dr. Bowditch thought that we could never determine the relative frequency of the complication until each insane asylum had a pathologist connected with it. He asked Dr. Rowe how many were thus provided at the

present time.

Dr. Rowe replied that the number of insane asylums in the United States which have pathologists connected with them does not exceed six out of eighty; but the time was not far distant when the majority of enterprising asylums would have such an officer for the investigation of mental diseases.

Brain Tumor. Dr. C. E. STEDMAN showed a tumor, probably glioma, situated in the middle of the left hemisphere of the brain, and gave the following history of the case : The patient, a man forty-six years of age, was seized early in last December with a convulsive attack, losing consciousness and biting his tongue. This lasted nearly an hour, and recurred often during the following months. When first seen by Dr. Stedman, six weeks after the symptoms manifested themselves, his mind was clear, there was partial loss of sensation and motion of the right cheek, the orbicularis was unimpaired, and the tongue was protruded somewhat toward the right. There was partial aphasia and slight loss of the sense of taste. Large doses of bromide of potassium stopped the attacks, but his general health began to fail, the aphasia became complete, loss of motion on the right side followed, and he died three months after his first convulsive attack.

New Instrument. — Dr. Baker showed an instrument designed by himself

for measuring the vagina for the purpose of a proper application of pessaries. He also showed a flexible uterine sound made from delicate springs covered hy india rubber, the external end of the instrument giving the reverse position of the uterine flexion. Syphilis. — DR. J. B. Ayer reported a case of necrosis of the frontal

— bone in tertiary syphilis. The patient, thirty-five years of age, contracted syphilis from her husband. The first history of the case was in November, 1871, when she suffered from ulcerated sore throat and cephalalgia. In a fortnight the uvula was destroyed, in spite of free applications of nitric acid. Under mercury and chlorate of potash gargle she did well until October, 1872, when abscesses formed on the outer side of the thigh. These continued to discharge and heal for over a year. In October, 1873, the cephalalgia returned. She became cross and irritable, and lost flesh rapidly. In April, 1874, coryza was well marked, and in November of the same year pieces of the turbinated bone came away. The patient had been taking iodide of potassium, but now mercury was added. This she continued to take for five months. In January, 1875, a slight swelling like a pimple appeared on the forehead over the left eyebrow. This broke a few weeks later, showing necrosed bone beneath. The opening gradually increased in size, and a little over a year ago a similar swelling appeared over the right eye, which opened and gradually enlarged. Carbolic ointment was ordered, but she became discouraged, and only used the ointment until last September, when she was persuaded to begin treatment again. Iodide of potassium was ordered, and the dose gradually increased, until she was taking twenty-three grains three times a day. She also used a Ditric acid wash.

January 21st. The necrosed bone being movable, the patient was etherized at the Massachusetts General Hospital, and it was removed. Both tables of the skull were necrosed. The patient came out-of-doors in eight weeks, and is now attending to her duties in her shop. The wounds are slowly closing in around the edges. She has had a slight attack of erysipelas lasting two days, and an occasional headache, which yields to bromide of potash in a few moments. She has gained ten pounds during the past two months, and is greatly improved in every respect. The patient is now taking biniodide of mercury and iodide of potassium in a solution of gentian and cinchonia.

Tumor of Uterus. — Dr. BUCKINGHAM showed a body weighing two or three ounces, which had been examined by Dr. Fitz and pronounced fibroid tumor of the uterus. It came from a woman of fifty-two, who had been under treatment since the middle of January, at which time she was seen by Dr. Chadwick with him. The uterus was distended so as to be impacted in the pelvis, and to cause great annoyance by pressure on the urethra. She was given twenty drops of the fluid extract of ergot three times a day, which caused bo great annoyance for three days, when the pain became severe and pretty constant, so that although the ergot was stopped she was unable to sleep without an opiate. The pain disappeared in the course of ten days, and towards the end of February the ergot was resumed in ten-drop doses, gradually increased to fifteen, when shreds began to come away, and two weeks later the present mass was expelled after three hours' pain, since which she has rapidly gained.

April 21, 1878. Officinal and Unofficinal Preparations of Medicine. Dr. ROBERT Amory read a paper on Certain Facts in Regard to Officinal and Unofficinal Preparations of Medicine, as follows:

I visited four of our principal pharmaceutists in Boston, one in the central portion of the city, one at the West End, one at the South End, and one in Roxbury. I endeavored to select those pharmacists who were most ambitious in the professional standing of pharmacy. After an examination of their prescription books, covering the prescriptions for one month which they had actually dispensed, I subdivided these into the following six classes: (1.) Those which contained unofficinal preparations ; in other words, those whose formula is known, but which are not recognized by the United States Pharmacopeia. (2.) Those which contained certain proprietary medicines, or, in other words, trade-mark preparations, such as Horsford's acid phosphate, etc. (3.) Those prescriptions which called for proprietary medicine alone. (4.) Those composed of private prescriptions, known, for instance, only to the prescriber and to the dispensing pharmacist, but not published. (5.) Those containing only United States Pharmacopæia preparations. (6.) Preparations according to any other national Pharmacopæia.

By reference to the accompanying statistics of two thousand six hundred and seven prescriptions, we find that less than one fifth are unofficinal, and less than three fourths (sixty-five per cent.) are officinal, whereas seven per cent. are proprietary or patent medicinal preparations. A careful examination of this table will show that our Pharmacopæia in seven years and a half after its conception covers only sixty-five per cent of the physicians' prescriptions dispensed by our best druggists. This indicates one of two things,

that our physicians are unfamiliar with the Pharmacopæia, or that the latter does not answer the requirements of the medical profession.

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Diphtheria and Erysipelas. Dr. F. C. Shattuck read a paper on An Outbreak of Diphtheria and Erysipelas in a Small Hospital, which was published in the JOURNAL July 18, 1878.

DR. AMORY considered the question of diphtheria an open one. In his limited experience, during the past winter, of four cases, — three in one house and one in another, – the fact that these children, for weeks prior to the diph

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