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avoided confining myself within the bounds renumeration. As an epicurean, Brillat Savarof specialism, sure that no specialty whatever in, who was also a man of distinguished abilican stand solitarily and securely alone. Real- ty, would have found the sameness too great izing that upon the education of the laity the in his proposed experiences. Variety, you success of the best practice of medicine ulti- will find to be, ever in labor, some refreshmately rests, just as charlatanism conversely ment to the weary worker. Expect your rests on the promotion of ignorance, it has difficulties. It is through them men are moldbeen my aim at all times to communicate ed. Look forward to a worthy goal. It will such sound information to the laity as they lesson your trials and reward your success. are capable of comprehending. The chief In concluding my address, I deeply regret hold that homeopathy has, is derived from to announce to you that Prof. James Garretson, ignorance of fundamental principles, and its your eminent Professor of Oral Surgery, invitation to the ignorant among the laity to whom we all love and venerate, and who ocplay baby-house in sickness, which may begin cupies a warm and dear spot in all students' with what is thought a trifle, but may end hearts, retires from his active duties. His with death. I have in preparation now a name, however, has been, and will continue work addressed to the laity, giving in popular to be, quoted and lauded in our college hails, form sound ideas as to all that conduces to as a great thinker, a skillful surgeon, and a well-being. If I intend that it shall be entitled careful and precise teacher to the future doctor " Health and Personal Beauty," my ulterior of medicine. In addition to his other exacting intention will be fully revealed when it is work, Dr. Garretson has always been a decidfound from the text that I regard the art cos- ed advocate of professional progress, and las metic as chiefly nature's art, and health, accomplished much for his profession by his beauty, and mind, conjoined, as representing choice contributions to medical and scienthe highest being, conditions which, if life tific literature. I therefore, in behalf of my were ideal, would be one and indivisable.
colleagues, upon this occasion tender to our All is not lovely in our profession. If it distinguished and only emeritus professor were, where would be the crown? There are our wishes for his future health, peace, patients who are stupid, who are weak-minded, and happiness. May his life be spared who disobey, who neglect the honorarium. many years, and may he be enabled during But no physician, I am satisfied, can be truly his allotted time to continue to give his adoptgood unless, as well as those whom he treats, ed Alma Mater his wise counsel. he be patient. Brillat Savarin draws a beauti
Gentlemen of the graduating class, I bid ful picture of an ideal practice when he says: you farewell. In leaving us, I trust that you "If I had been a graduated physician, I would, will not fail to cherish in grateful remembrance first of all, have written a good monograph your Alma Mater, that you will look back on obesity. Then I would have immediately upon the time that you have spent here as established my empire in that nook of science, having been fruitfully spent; that honor, and I should have had the double advantage comfort, reputation, happiness, may attend of having for patients the healthiest people, your way. When you think of us, your late and of being daily besieged by the lovelier preceptors, we trust that it will be with the portion of mankind, for to have just the right friendliness that we feel for you. We have amount of plumpness, not a whit too much striven to do our duty by you; to give you, nor too little, is with women a study of their during your three years' course, the most lives. . . . That which I have not done, some thorough grounding for your future medical other doctor will do; and if he is at the same
career. The rest remains with youselves to time skillful, discreet, and a good-looking fel. accomplish. We cannot part with you withlow, I predict for him a marvelous success.” out sadness at the thought that our pleasant
But, gentlemen, that does not describe the daily relations with one another must now be practice of medicine. It is the aspiration of severed. We are only consoled in looking to an epicurean for an easy time and plenty of you to shed lustre upon this, the institution of your choice. Gentlemen of the graduating fenestrated polypus-forceps, which I show class, I bid you, in the name of my colleagues you, and twisted off the now foreign body. and myself, with every wish for your health Or, indeed, if he had not this instrument he and happiness a regretful farewell.
might have plugged up the cervical canal with iodoform gauze, or with a linen handkerchief
made aseptic by being boiled; or he might Delivery of a Retained Placenta.
have tamponed the vagina. In my experience A Clinical Lecture delivered at the Universi
both these measures would have speedily dety Hospital.
tached the placenta and hastened its expul
sion. BY WIILIAM GOODELL, M. D., PHILADELPHIA.
You may tampon the womb up to the fourth
month, because this organ by that time is not GENTLEMEN—The case that I have to show large enough to contain sufficient blood to you to-day is most interesting, because it is a destroy the mother by concealed hemorrhage. most practical one. It is this: A woman,
But if four full months or more have elapsed thirty years old, married for thirteen years and since the beginning of pregnancy, the womb with four children, miscarried one year ago, has become capacious enough to hold so much at the end of a three months' gestation. The blood that the woman may bleed to death in physician in attendance at the time frankly it, although no blood may escape from the confessed that he could not remove the after- body. I, indeed, have never tamponned after birth. It never came away; and she has since three months, but I think that desperate cases been losing blood off and on, more or less, of flooding after that period of gestation until she is now, as you see, quite bloodless might occur, in which the physician would be and very pale. Yesterday my son tried to justified in packing the womb itself, when measure the womb with the sound, but its everything else failed. It is related by Joulin, introduction was at once followed by such an I believe, that, in the days of knee-breeches, alarming flow of blood that he was forced to shoe-buckles and gold-headed canes, a physiplug up the cervical canal and tampon the cian finding a post-partum hemorrhage unvagina. He tells me that the womb measures controllable, pulled off his powdered wig, over four inches, and that the hemorrhage was crammed it into his patient's uterus, and saved the worst that he ever saw, excepting in some her life thereby. . cases of post-partum flooding. What is the The question now arises: Why is a misdiagnosis? Clearly that within the womb is carriage more dangerous than a natural labor imprisoned a placenta, so vitally attached to at term ? The answer is, because the very the uterine walls that it has not decomposed. fact of a miscarriage implies some lesionOf this I am certain: firstly, because the his- something abnormal; because, the placenta tory points to this interpretation; secondly, not being fully formed, the chorion villi are because so alarming a hemorrhage followed attached to the whole surface of the womb and merely the use of the sound; and thirdly, be some portions of the membrane are liable cause I have repeatedly had just such cases. to remain behind and cause either hem
Now, what should the physician have done orrhage or septicæmia. Then again, the under the circumstances? By hook or by cervix is not effaced, and the small canal is crook he should have removed the placenta. liable to close up on the retained fragments. By aid of ether he could, using every antisep- A criminal abortion is still more dangerous, tic precaution, have caught one lip of the cer- because gestation is abruptly interfered with vix with a volsella forceps, dragged the womb before any detachment of the membranes has gently down, and passed in one finger at least taken place, and their retention is therefore into the uterine cavity. He could then have far more likely to happen than in an honest scraped off the placenta and membranes. Or, miscarriage. A stung or decayed apple falls if that did not succeed, he should have intro- from its bough at the slightest breeze; while duced a blunt curette, or preferably, this to pull off a healthy green one, demands a force which often snaps the bough from which which in this case was equal to the most it hangs. This illustrates the difference be- formidable post-partum flooding. I know tween a natural miscarriage and a criminal better now than to use the dangerous curette. abortion. In the former, the process of de- What one needs here is an instrument which tachment is slow and usually complete. In shall both dislodge and immediately remove the latter, the detachment is violent, incom- the offending body. This instrument is the plete and traumatic. The result is, retention aforesaid fenestrated polypus-forceps, which of the membranes, from which come serious has no teeth yet holds securely; which will hemorrhages and still more serious septic in- catch an unsuspected intra-uterine polypus or fections. Should the patient fortunately es- a retained placenta with more safety than the cape these, she hardly will escape an arrest of surgeon catches at hap-hazard a stone in the involution, and its resulting discomforts. bladder.
But to come back to our patient, who is now Introducing my base-expanding bivalve wholly under ether. What is the present speculum, which well exposes the cervix, I restate of affairs in the womb? Taught by sev- move the sponges packed into the cervical eral very alarming experiences, I can tell canal and vagina by my son. The parts are you exactly what it is. The placenta will be now thoroughly disinfected by repeated injecfound perfectly sweet, rolled up at the detach- tions of 1.2000 solution of corrosive sublimate. ed end through pressure, like a scroll, with a Seizing the anterior lip of the cervix, so as to large portion adherent to the uterine wall, and steady it, I introduce the polypus-forceps into fed by sinuses of great size. Now, the sound the uterine cavity, immediately open it, and which my son introduced probably pushed now I have caught something. Withdrawing only one limited portion of the placenta off the forceps with a twisting motion I find a from a single uterine sinus, yet the flow was large placental fragment in its beak. The excessive. Three times have I passed a blunt hemorrhage which began briskly has already curette in the wombs of just such cases, and become less by the rapid contraction of the the hemorrage was so terrific that I had to re- uterine walls. Passing in the forceps a second sort to the promptest measures for its arrest. time I remove another piece, not quite so large One case was an inmate of my private hospital as the former one. Continuing the search I to which she had been brought on account of find other pieces, all of which will be passed repeated and exhaustive hemorrhages, dating around, so that each one of you can see for from a miscarriage which occurred five months himself the placental character of this false previously. She was placed on my examining polypus. Note how free from all decompositable, and, as I found the cervical canal too tion the mass is, although very near a year narrow to admit my polypus forceps, I passed old. Having emptied the womb I syringe it in a curette. Directly there occurred such a out, first with vinegar to cause the contraction, formidable flooding that although surrounded and afterwards with a 1.2000 bi-chloride soluby every appliance for such an event, I was tion. There will be no future hemorrhage, so not able to control it, until she had lost so not any kind of tampon will be needed. To much blood as to faint away and to make me insure continued uterine contraction she will very much alarmed about her. I stopped the be put on quinia and ergot. Her vagina also flow by plugging up the cervix with a sponge. will be syringed out twice a day with a 1.4000 A few days later I dilated the canal with tents solution of corrosive sublimate.- Practice, and removed a perfectly sweet fragment of Richmond, Va. placenta as large as a small apple.
The curette acted merely as a hook to lift up It is estimated that man gets a complete the placenta, uncorking, as it were, the uterine outfit of brains every two months. If the sinuses, but it was not able to remove so large average life of a nerve-cell is from two to three a mass, which, consequently, remained in the months, we would each get six new brains womb and kept these uncorked uterine sinuses every year, providing that every ceil is refrom contracting; hence the hemorrhage, placed in the same length of time.
Kansas Medical Journal.
Journal. If you suffer from foul air in
$2 00 25 Cents.
If you suffer from foul air in a palace, what of a second-class car, where are crowded
into — square feet of space? With its oxyPUBLISHED MONTHLY.
gen largely consumed and its atmosphere
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you enter from the pure air without you gasp Per Annum, in advance...
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Subscription may begin at any time. The safest mode you raise a window, the poor fellow next to of remitttance is by bank check or postal money order you, whose carbonized blood is readily chilled, drawn to the order of the undersigned. When neither is accessible
, remittances may be made at the risk of the pub- begs you to close it. With the wide range of lishers, by forwarding in REGISTERED LETTER. Address adaptation inherent in the human body, you Kansas Medical Journal,
soon become accustomed to your surroundings
and, perhaps, as your circulation becomes
723 Kansas Avenue. Editor-in-Chief:
loaded with effete matter a chilliness creeps J. E. MINNEY, M. D., Topeka, Kas.
over you that impels you to ask the conductor W. L SCHENCK, M. D., Osage City, Kas.
to close the last opening where oxygen cani S. G, STEWART, M, D., Topeka Kansas.
enter and carbonic acid gas escape. Associate Editors : W. D. BIDWELL, M, D., Leavenworth.
A better system of ventilation is demanded, W. A. PHILLIPS, M. D., Salina. W.F. SAWHILL, M, D., Concordia.
one that will remove the heavy carbonized air T. W. PEERS, M, D., Topeka. that surrounds the passenger and replace it
with pure air from without. Opening a wilTOPEKA, KANSAS, JUNE, 1890.
dow is no remedy, for the draft it occasions
may be more deadly to some debilitated pasRailway Hygiene.
senger than impure air.
The water closet on many roads and on Since the neigh of the iron horse is heard some of the cars on most roads is simply horall over the land and every considerable city rid, often contaminating with its poisoned air is a railroad center, with a large proportion of the entire car. The urinals may be well the people continually on the cars, railway enough for stationary closets, but on a movhygiene has become an important factor in ing car they permit the floor to become satulife.
rated with a foul excrement. Whilst our great roads have done much to The draft at the seat is decidedly harmful to make travel comfortable and healthy, much certain persons. To protect them from this, remains undone. Even the Pullman and the and those along the line of the road from disWagner, with all their luxuries, can be im- charges that may communicate disease and proved. Comfortable and healthy during the engender wide-spread epidemics, there should day, when night comes they button you into be a cup on the lower end of the pipe, so ara space some three feet broad, three feet high ranged that it can be opened whenever desiraand six feet long, where for eight or ten hours ble and the contents emptied at proper places. with a temperature ranging from 70° to 90° There should also be ventilating openings in F., you are compelled to live on 54 square the pipe, and disinfectants and deodorizers feet of air. In the morning you feel that you ready for use. have not been well nourished, and realize that The railroad management seems to consider want of oxidation, rather than the novelty of its special relation to the passenger only exists sleeping on the rail, or the snoring of an un- while he is in the cars, and whilst it seeks to comfortable neighbor, caused your restless- make him comfortable there, its depots for ness, and, perchance, your headache.
exchange are the embodiment of every disThe double deck arrangement is bad. Un- comfort. Who can pass through a crowded til it can be remedied those who can afford it, union depot, especially at night, and see tired and especially invalids, should take a section children stretched upon the dirty floor, and leaving the upper berth unopened.
weary mothers trying to rest on its iron-barred seats, while they wait, one, three, five, seven to lessen the blood pressure, slow the pulse hours for a connecting train, without a feeling and reduce the temperature. When this is of sadness? Are not these people, ticketed accomplished, we have, in the great majority through, as much under the care of the roads of cases, done more harm to our patient than while they await their connections at the de. good, for the reason that will be plain when pot as when on the trains ? If so, why this we see that the effect is to weaken the nutricontrast? These depots as at present con- tion of the whole organism, and suspend alducted are only fit for the dissemination most entirely the nutrition of the nerve centers. among the tired travelers of such contagious How often we have seen patients that have diseases as may be en route. Why not have been under the influence of aconite until the at least a well ventilated chair room” into constitutional effect has been produced, with which a through ticket will admit a waiting livid color of skin, imperfect respiration, feepassenger as readily as it admits to his train? ble, irregular pulse, on the verge of convul
Every train should carry a strong rubber sions because of the peculiar effect upon the bandage and a tourniquet, absorbent cotton, spinal cord and medulla. and linseed oil, made creamy with white lead, The cases in which aconite is generally adand a stretcher, and to every train man should ministered would be much better treated withbe given the few moments necessary to in- out it. Physicians should not leave aconite with struct him in their use.
W. L. S. the directions so often given, viz.: “Give a dose
every hour until the fever falls." If the phyAconite,
sician thinks aconite absolutely necessary, he
should by all means remain and watch the efAconite is a drug found in almost every
fect, that he may be at hand to mend the misdoctor's case, be he regular or irregular
. chief he is very likely to cause. Many think they could as well dispense with
It is our opinion that the time is not far their thermometer or hypodermic syringe, as
distant when the treatment of febrile diseases with this potent drug. For a potent drug it will be conducted upon a more rational plan, is, and in my opinion, should never be given we might say upon a physiological plan ; and except under the immediate supervision of a we are glad to note as symptoms of this recompetent physician who should remain with form that the use of antipyretics is fast fallthe patient from the moment of its adminis- ing into“ innocuous desuetude," and that relitration until the effect of the drug has disap
ance is not placed on those drugs that induce
pathological conditions, but on those whose peared.
Let us look at the physiological action of office is to restore function and assist in aconite. Its action is on the peripheral ends the process of nutrition. of the sensory nerves, on the heart, and on the
We would emphasize what we have said by respiration. First noticed on the tongue, lips, adding that in the treatment of febrile diseases finger tips, face, breast, abdomen, and of children the use of aconite should be last the back. And the heart is quickly af- avoided. fected by very small doses. In children, even a single drop of the tincture may cause great
DR. GEORGE W. MILLER, of Girard, Kas., depression, slowing the heart's action due to was a caller at the JOURNAL Office recently. the effect of the drug on the vagus roots, but the doctor just returned from New York City in some cases the action of the heart is not where he has been during the past six months, affected so much, aconite being uncertain in attending the Polyclinic Post Graduates its action. And if the administration be school and hospital. The doctor, like many pushed, we will have paralysis of the vaso other Kansas physicians, proposes to keep motors, the blood pressure will be lessened, ahead of the times in medicine. followed by slow action of the heart, soon to become feeble and irregular. When aconite THE J. Marion Sims Medical College of St. is given in the febrile diseases, the purpose is Louis is one of the latest.
S. G. S.