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Placenta Praevia.

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immediately turned out the placenta. The

mother and child did well and made a good BY D. R. PELTON, M. D., TOPEKA, KS.

recovery.

The next case of which I will speak is that of I know of no case that taxes one's self-pos

Mrs. K., age 28 years, spare but of general good session and judgment in obstetrics, more than health. She had borne three children. I was placenta prævia.

summoned to her bedside a distance of six To wait or not to wait is the question.

miles. Found her laboring under shock from These cases are, fortunately, quite infre- violent hemorrhage. Four or five quilts were quent when we sift out those of premature saturated with blood as well as the mattress, separation of placenta which causes hemor- and a large pool upon the floor beneath. rhage called by Dr. Parvin accidental.

. Upon examination I found total placenta Leaving each one to study the physiology prævia, the placenta quite large, with the atand pathology of his own cases, or rather al- tachment of the cord directly over the os, lowing that all do understand them, I will which was dilated to about the size of a silver pass in brief to two cases of placenta prævia dollar. The history of the case reported sevwhich occurred recently in my obstetrical eral hemorrhages at intervals of from one to practice, differing in their nature and treat- two weeks, dating back for two or three ment.

months. The pulse was hardly perceptible Mrs. O., aged about 35 years, spare and and the patient was unable to speak. I immeanæmic, had slight show of blood at different diately gave stimulants and ergot. The case times two weeks prior to confinement. On demanded immediate interference. I introthe occurrence of the pains slight hemorrhage duced my hand into the vagina and engaged took place, at which time I was immediately the point of three fingers within the os, using called. On examination I found the placenta

them as dilators to gain an entrance into the attached over the entire opening but only womb. I ordered the nurse present to give reaching a few lines to the left of the dilating the chloroform, as the patient was now rally

After the action of each pain the hemor-ing from the state of collapse in which I found rhage increased rapidly. I separated the edge her. The child was already dead. I passed of the placenta nearest the os, thereby reliev- my hand directly through the placenta, ing the traction upon the other portion which reached the feet of the child and with conwould otherwise have been torn loose by the joined manipulation performed podalic veroncoming child. The entire attachment sion, bringing the feet through the opening seemed below Baudle's Ring. Determining of the placenta. upon the expectant plan of treatment, I then

The pain now began to increase from the introduced a tampon of cotton carrying it ergot and the reflex action or the partly high up against the cervix and supporting it emptied uterus. The delivery was completed below with other of same material to control as rapidly as circumstances would permit. by pressure the increasing hemorrhage. This with my left hand upon the abdomen I folhad the desired effect, in increasing the pains lowed closely the descending head and graspas well as restraining the flow. I was soon

ing the uterus to prevent further hemorable to rupture the membrane on the free rhage, delivered the child and placenta. The side of the placenta, allowing the head to en- mother rallied with the use of stimulants. gage within the pelvic brim, so precluding all Lowering the head I placed bottles of hot possibility of fatal hemorrhage with good water to extremities. She made a slow but and efficient pains.

steady progress to recovery. The child was delivered naturally and in a

My experience in several such cases is that very fair condition, which I attribute to pre

there is no absolute plan of treatment but serving the attachments of the placenta as Whether the treatment shall be operative or

circumstances must be a guide to one's action. long as possible upon the right lower segment expectant, must rest with the judgment of the of the uterus. Upon delivery of the child I physician.

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VENTION.

Sanitary Instruction in Schools and Colleges. modification, and so secure to themselves,

and extend to those over whom their opporAN ADDRESS DELIVERED AT THE STATE SANITARY con- tunities have given them guardianship, life

and health, happiness and prosperity.

You may tell me that we have in every BY W. L. SCHENCK, M.D., OF OSAGE CITY, KAN. community members of a profession devoted

to the protection of health; that that is the (Continued from March No.)

business of the doctor, whose education It is not our purpose to discuss the various should qualify him for its discharge. The sources of disease to show the laws that gov

business of the physician, as he understands ern the origin and being of septic poisons, the it, is to relieve suffering and cure disease; yet methods of their detection and prevention, the you expect him to teach hygiene, and so does results of their infection or the means of their the state; and you not only expect him to removal. England's great statesman and his- abridge his income by preventing disease, but torian, who thoroughly comprehended the to do it free of charge, and so does the state. logic of events, in speaking of the death of When the state appoints a board of health it Good Queen Mary truly said, “That disease, expects physicians to gratuitously report vital over which science has achieved a succession statistics, and the board to protect the health of glorious and beneficent victories, was then of the people without law and without pay. the most terrible of all ministers of death. In this respect Kansas is not unique. SevThe havoc of the plague had been far more eral of the states, who very properly pay their rapid, but the plague had visited our shores governors and legislators, their judges and only twice within living memory; and the juries, even those they appoint to supervise small pox was always present filling the the health of cattle and swine, expect their church yard with corpses, tormenting with state boards of health to supervise the health constant fear all whom it had not yet stricken, of the people without authority and without leaving on those whose lives it spared the consideration. Whilst physicians do perform hideous traces of its power; turning the babe a large amount of this kind of labor, and perinto a changling at which the mother shud- form it not only without hope of fee or redered, and making the eyes and cheeks of the ward, and as no other class of philanthropists betrothed maiden objects of horror to her do charitable service as a genuine altruism, lover." Yet public sentiment has not de- destroying their means of support by gratuitmanded of the Kansas legislator protection ous labor in the interests of humanity, the against this dread destroyer which during the simple statement of the faci that the prevenpast year, has appeared at more points in this tion of disease is wholly in the hands of those state than any other in the union.

who live by curing disease, sufficiently emWhile it is easy to demonstrate that water phasizes the necessity for professorships of supplied from streams that drain a wide ex- preventive and state medicine in every normal tent of territory, must contain much of the school, college and university in America. animal and vegetable remains that lie upon

Until such professorships can be estabiishthe surface of the country drained, and may ed and bring forth fruit, the state should not contain the specific poisons of typhoid fever leave to school boards ignorant of sanitary and other septic diseases, and that we are sur- science, interests as vital as the life of its rounded by preventable sources of disease, children, but should provide a system of saniwe rather desire to press home the thought tary supervision, through which in every city that the educated people of every community and township, a competent sanitarian must should be so educated in sanitary science that be employed to inspect school buildings, they will be able to recognize the cause of school methods and schools, and their surdisease, and exert an influence that will secure roundings, and to give instruction to teachers the enactment of laws, and provision for their and pupils in the principles and practice of exécution, for their prevention, removal or sanitary science.

Life is not, as it seems to be considered in

If it is the purpose of education to store the our American civilization, the cheapest com- mind with such truths as shall be of the greatmodity in the market. It is the sine qui non est practical value to the individual and to sowithout which the opporiunity for enjoyment, ciety, what more important knowledge than improvement and progress are not. That that which will enable us to preserve health without which we are not.

and prolong life; and what knowledge will While our people would rise as one man and better enable us to earn the blessed beneavenge the death of a neighbor slain by the diction: “Ye served your brethren; ye seryassassin's bullet, as I saw them do the other ed the Lord?” night here in the capitol city of the state, a Hygeia was heaven born. Without her bullet from a pistol is not a more certain mes- blessing spiritual life is manacled, and every senger of death than the poisons by which ig-joy embittered. In her right hand are length norance, carelessness and cupidity contami- of days. How much that means we hardly nate our common inheritance of earth, air and know. While the editor of a medical journal water, and deteriorate and adulterate neces- said in one of his late numbers, “We cannot sary food and drugs, and thus bring to our expect to bring out any new theory and have firesides suffering and death in an hundred old men accept it;" that depends largely forms, and a thousand times more frequently whether the theory is too juvinal for facts and than the assassin's pistol. To protect our logic. At fifty years men are just prepared selves and our neighbors we must compre- to give to the world the rich fruitage of their hend the methods by which death thus in- accummulated wisdom. And as the years of vades the home as we comprehend the pistol man are three score and ten, the world is enshot. We must know the causes, their modes titled to the harvest. But, alas! when the of action, and their means of prevention. To harvest is ripe how few are the reapers. know these we must understand the laws of

Death crowds our pathway from the cradle life and sanitary science. This knowledge to the grave. The babe is scarce born before does not come by intuition, but is acquired as an ignorant attendant plies it with some indiother knowledge, through education. As life gestible mixture causing pain and intestinal is the factor, without which all knowledge is debility, when the nourishment nature has useless in this world, every institution that provided is blamed for the indigestion and educates should make this knowledge funda- suffering, and the changes are wrung on mental. And why not?

"baby foods" until a "mysterious providence" If it is the purpose of education to draw out takes it where “the wicked cease from troubthe mind, to teach it to reason from cause to ling and the weary are at rest:”

If it escapes effect, and from effect to cause, and by anal- the pitfalls of infancy, where a majority are ogy, what better field than a study of the buried before they pass their fifth year, when laws of life, physical and spiritual, and of the school life begins, with hardly a properly venvarious causes and processes that change tilated, warmed and lighted school building in physiological into pathological action, and the the land, with no system of regulated exermeans by which they may be prevented and cise, and all sorts of unsanitary surroundings, restored.

it again runs the gauntlet of disease. If it If it is the purpose of education to interest again escapes and enters the college or uniwhile it instructs, what grander field than bi-versity, with over exercise or under exercise, ology?—the laws that govern our own being, with injudicious stimulants, to study for the following life from a simple embryonic cell, sake of success rather than for the sake of proliferating and differentiating other cells, knowledge; starving the body with a "potuntil a million lives are bound in one, work- luck” system of “batching,” and too often ing in perfect harmony, each for all and all graduating with a practical knowledge of disfor each, and the investigation of the various ease, but ignorant of the causes that produced causes and processes that disturb their har- it and that abound in all our surroundings, monious action and relations.

physical, social, and even religious, and of the

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means of detecting, preventing or removing show the education and legal enactments that them. With a degree, earned by a thorough shall protect against preventable disease and acquaintance with the college curriculum, but death, and secure the full development and with a broken life, and utterly ignorant of the preservation of the physical life, and the precept of Solon, gnothi seanton. What won- grandest possibilities to its immortal tennant, der that the wise man said, and that wise have been wholly neglected. men continue to repeat, “Man that is born The historian tells us the difference in of a woman is of few days and full of trouble. salubrity between the London of the nineHe cometh forth as a flower and is cut down. teenth century and the London of the sevenHe fleeth as a shadow and continueth not.”

teenth century, is very far greater than the National education is a necessary part of difference between London in an ordinary the American system. The glory and per- season and London in cholera.” Statistics petuity of free governments is in the intelli- show that during this period the average gence and morality of the people. Though length of life has been increased about fifty the institutions of America are sometimes per cent. With proper sanitary instruction slandered in the name of religion, and her in our schools and colleges, and as a legitischools denounced as “Godless” and “im- mate sequence, proper sanitary laws for the moral,” the state is probably as divine in its protection of life and health, and all they reporigin as any other, whether Hebraic or Ro- resent, may we not expect that e'er the close man, and the religion of its schools as pure of the twentieth century preventive medicine and uplifting

and surgery will well nigh cover the field of The state recognizes accountability to God, medical science, and that if men do not live to condemns' profanity, promotes temperance, the mythological age of Methusalah, England's denounces polygamy, abolishes slavery (up- great Octogenarian will have many peers. held by some churches), and says blessed are

And now do we hear you say, “physician equal rights—“For He hath made of one blood heal thyself." See that medical colleges give all nations of men”-free speech and a fair full and thorough courses in scientific and ballot. It feeds the hungry, clothes the nak- practical hygiene before you insist upon other ed, and cares for those who are unable to care schools engaging in the work. for themselves. It reforms criminals, protects "peccavi,” but still repeat that the average character and property, and pensions those, physician considers the cure of disease his who are weak and wounded, that it might be proper field, and that school boards and legisstrong. It taxes the rich that all may be edu- latures pay little heed to the suggestions of cated, and in its schools the children of every scientific sanitarians. The educator must station and religion meet upon the level, and reach the people. Only their voice is heeded are inspired with a patriotic regard for each or heard by the legislator; and if medical col

leges fail to give efficient instruction in any other and for a common country, and taught department of medical science, they will reto do unto others as they would others should spond to the suggestions of legislators who do unto them. They are imbued with the appreciate the importance of medical educaimmutable principles of righteousness and tion and public health. truth, taught to subdue self-will and strengthen self-control; encouraged in punctuality, per

STENOSIS OF the ESOPHAGUS.-M. H. severance and industry, and in the exercise of Secratan (Soc. Vaudais de Med., July 13, '89,) justice, obedience and order, and every com- communicated to the society that in cases of mendable virtue; and all are sought to be stenosis of the æsophagus, if the patient drank illlustrated by the living example of the a quantity of oil before the dilating bougies teacher-all this in addition to instruction in were used, the operation would be facilitated literature, art and science. So much has been to a marked degree. The operation perform

ed in this manner has been done with great done to protect, uplift and enlarge, that many ease in cases where the bougie, thoroughly seem to think that nothing has been left un-oiled, has met with considerable resistance, done; and yet, as we have endeavored to and occasioned extreme pain.— The Satellite.

We cry

Syphilitic Epididymitis.

I yet occasionally applied ungt. hydrarg. to

amuse the patient and quiet his imagination. Read before the Missouri State Medical Asso

Recently the swelling was examined and ciation, May, 1889.

found to have disappeared almost entirely ;

the result of treatment thus confirming the BY. G. W. DAVIS, M. D., KANSAS CITY, MO.

diagnosis.

Syphilitic epididymitis was first described in Peter S., æt. 26, single, laborer, born in Ger- 1863 by Droņ, of France.

The literature of the subject is very meager many, has always been healthy. Negative history of injury and denial of previous vene

and not altogether satisfactory. real trouble. No evidence of lung disease.

The best authorities speak of the disease as In the early part of last October he noticed of rare occurrence and unanimously state that an ulcer on the dorsal surface of the prepuce,

it does not soften or show signs of degenera

tion. which was diagnosed and treated as chancre. About one month after the first appearance

The fact is controverted (so far as I am aware) of the sore, patient accidently discovered a

in only one instance, and that by a case resmall lump just above the left testis.

ported in the New York Medical Record for Previous to my attention being called to the 1887, page 194. case, he was seen by several physicians and

The history there given is not to my mind the enlargement pronounced a "malignant proof conclusive that the case was one of syphgrowth ;” and then again, it was supposed

ilitic epididymitis, but probably gonorrhæal epthat it might be hernia from omental protru- ididymitis occurring in a syphilitic subject, as

the recorded facts show the patient with tight sion.

February 16, about four months after the urethral -1 ricture, complicated by urinary refirst appearance of the chancre, the patient tention and two attacks of gonorrhæal epididy

mitis before he became syphilitic. came under my observation. On examination I noticed the cicatrix of the

This is the only record I can find of a rechancre, papulo-pustular eruption, enlarged ported autopsy. glands at the angle of the jaw, alopecia, head

The case I have reported is one of excepache and the symptoms of secondary syphilis

. tional interest. On examining the testes found them normal,

In the examination of several hundred cases but discovered in the region of the globus

of scrotal tumors, I have never met one like

it. major of the left epididymis, and in fact involving all the epididymis and extending along the

The special features are its affecting only cord to the pubic bone, an enlargement indu- one side, while both sides usually are involved; rated and almost cartilaginous to the feel.

its large size; but most remarkable of all was As near as could be determined, this en

its involving the cord.

This exception is rare indeed, and only a largement was about three and a half inches long by one inch in width, and obviously not single reference is all I can find of such an

involvment. attached to the pubic bone, but seemingly nearly filling the opening of the external abdominal ring. The swelling was indolent and

The Influenza. only a slight amount of pain was caused by manipulation. Rectal examination showed The United States consul at Amsterdam some tenderness.

furnishes the following translation from the Placed the patient on anti-syphilitic treat- Algemeen Handelsblad, (Amsterdam,) February ment, pil. hydrarg. gr. i, three times daily, and 5, 1890: eleven days from the commencement of this As a proof that the influenza, or “griep,” treatment was gratified to find the tumor much belongs to the “diseases which threaten the smaller and the veins more distinct.

public health,” and whereof, accordingly, the Regarding local treatment as unnecessary, law should provide that physicians should

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