drawn upon until the funds on hand are ex- generally as inflammation of the uterine veins. hausted. REID ALEXANDER, Chairman. J. E. MINNEY, Secretary. Puerperal Peritonitis. Read before the Southwest Kansas Medical BY J. D. HAMILTON, M. D., DOUGLASS, KAS. giving rise to the production of pus in these vessels and the general symptoms accompanying its absorption. The symptoms common to this form of peritonitis may come in a few hours, a few days and even so long as two or three weeks. after delivery. Pains and rigors are generally the first indications and pain on pressure especially in the hypogastrium more than any other part, the skin is hot, the cheeks flushed, the pulse is quick and the respiration hurried, By Puerperal Peritonitis, I mean a simple the pain soon radiates from the hypogastrium form of peritonitis which women are liable to into the iliac fossa and then to the other parts in the puerperal condition. Sporadic cases oc- of the abdomen. It is not always severe and cur from time to time without the diffusion is sometimes characterized by paroxysmal atof the disease, but even then the utmost cau- tack, the patient being free from suffering tion should be observed as so much doubt is during the intervals, pain is not a pathoalways involved with regard to its infectious gnomonic symptom Post partum pain may nature. Inflammation of the serous covering be urgent when there is no inflammation and of the uterus and its appendages may super- there may be inflammation with little or no vene as incidental circumstances without the abdominal pain. superaddition of a specific poison. The great effort of the organism, the irritable condition of the body after the exhaustion of expulsive efforts, the long distension of the uterus and the abdominal walls and their sudden contraction, the friction of opposed surfaces in the abdomen during labor and the great excitement given to the circulatory and nervous system may produce peritonitis. Other causes operate to produce this result, such as injuries in instrumental delivery, turning, adhesion of placenta, cold affusion and various other causes. Churchill asserts that he has seen several cases of intense peritonitis as proved by dissection in which there was neither pain nor tenderness. The abdomen suddenly becomes large -more quickly and to a greater extent than any other kind of peritonitis, which may be accounted for by the resistless condition of the muscular system of the parturient patient and recent distention of the abdominal walls. The lochial is arrested or suspended, the milk if began to flow is arrested, or if not began is prevented, the pulse varies but is always above, in a great majority of cases greatly above the normal standard. If however, after delivery the pulse shall have fallen to or near the normal and then suddenly begins to rise accompanied by local pain, higher temperature, By some it is maintained that peritonitis and puerperal fever are the same, that these terms express one disease. It is true that in a large portion of patients who die of puerperal fever the peritoneum is inflamed, but this mem- thirst and diminished secretion the cause is brane is not always involved although this form of inflammation accompanies this disease more frequently than other, yet puerperal fever is something still worse. Bartsch in a report of the Midwifery Institution, of Vienna, records the morbid appearance of 109 cases, of those who died of puerperal fever and in this report puerperal fever is distinguised from peritonitis and metritis. The cases of puerperal fever he says occured seldom under form of puerperal peritonitis, but obvious. After pains may be confounded with those of inflammation, they come on soon after delivery but decrease in force and frequency as time wears on. Peritonitis does not come on so soon and its symptoms become more aggravated instead of diminishing. After pains are associated with firm and contracted uterus. Peritonitis with relaxed uterus when the malady terminates in resolution, the pain abates, the tympanites decline, the pulse becomes slower, fuller and softer, lochia is es tablished, the breast becomes rounded the which I ordered quinine in full doses, omit milk begins to flow, the limbs can be extended, the veratrum but use the opium freely; conthe patient can lie on her side. The conditions tinued the fomentations and irrigated uterus of approaching dissolution are weak and with solution of bichloride of mercury. Mornsteady pulse varying from 120 to 160; the ab- ing of 21st found patient about the same as domen keeps distended and tender, clammy the preceding morning, continued the treatsweats come on, extremities cold, breathing hurried, shallow and thoracic, lies on her back with legs drawn up, the features sunken and the mind often remains clear and calm to the close. I will improve this opportunity to report a case that I treated, which to my mind was a well defined case of puerperal peritonitis: ment as before. Morning of 22d found patient worse, temperature 105°, circulation 130, respiration 32, pain more severe, tympanites more marked, distention greater, bowels very hot, cheek flushed and ashy, some delirium, lochia scant and offensive, uterus did not seem to be much enlarged, nor its appendages involved in the inflammation. My opinion at this time was that I had a genuine case of I was called to see Mrs. C., December 18, 1888. Primipira delivery at 11 p. m., labor puerperal peritonitis; remained with patient natural and of about eight hours duration, most of the day and pushed my veratrum and patient somewhat exhausted, was also of a very antipyrin to their full extent, persisted in apnervous temperament. Placenta delivered in plication of hops, irrigated uterus, kept her as about a half an hour which was complete as I free from pain as possible with opium, she was observed it carefully. Left the patient clean laboring under some delirium, hence I comand as comfortable as I usually do, enjoined bined fl. ex. gelsemium with veratrum; I rest and quietude. Was called the evening of pushed every remedy to full extent, and used the 19th, found patient suffering intense pain all my energies, as no doubt you all do when in abdomen, it being greatly distended and the case looks to a fatal termination. very tympanitic and tender, severe pain in head, flushed cheek, temperature 103°; circulation 120, respiration 30, tongue heavily loaded, lochia scant. On inquiry found patient had rested reasonably well the forepart of night, but early in the morning her attendants moved her from bed to sofa and back again and that it greatly exhausted her, and that in less than two hours she had a severe chill followed by the above symptoms. My diagnosis was puerperal fever or at least the onset of it I prescribed calomel in full doses until bowels moved, with tincture veratrum to control circulation, also gave one dose of powdered opium, to be repeated when bowels moved freely, as pain indicated, ordered fomentation of hops to bowels, irrigated uterus, and ordered patient kept quiet. Returned morning of 20th, found symptoms somewhat modified, bowels having moved well, temperature 101°, circulation 110, respiration 24, severe pain and tenderness in abdomen with headache, lochia scant, not much appetite, but took some nourishment, continued opium in full doses, veratrum sufficient to control circulation, gave antipyrin in afternoon and up till midnight, after Morning of 23d found symptoms modified, temperature 102°, circulation 115, respiration 26, pain not so great, not so much distension, lochia scant with retention of urine, bladder being very much distended, relieved patient with catheter. Morning of 24th patient some better, temperature 101° pulse 110, respiration 28, distention of abdomen about the same, tympanitic and tender, retention of urine, bowels constipated, lochia very scant, moved bowels with enema, relieved bladder, irrigated uterus, continued the same remedies as the day previous. On December 25 found patient improving gradually but symptoms well marked, continued usual treatment. Morning of 26th patient some better, temperature 100° pulse 105, respiration 26 and deeper, patient had some appetite but was very weak, retention of urine yet annoyed her which continued for several days. I then depended more on tonic treatment which consisted mostly of iron and quinine; gave patient concentrated diet, such as beef tea, soft eggs, &c.; continued to irrigate the uterus and kept the abdomen well anointed with camphorated oil; the patient con tinued to improve, and by January 1 was convalescing as well as could be expected; in the meantime kept patient well nourished, quiet and clean, and used tonic treatment; the patient made a good recovery, but it was some weeks before she gained her strength sufficiently. other methods. for resuscitation of the asphyxiated new-born (especially catheterisms laryngis, with blowing in of air and compression of the thoracic walls in a warm bath), if an injury be present in the child.. Therefore I look quickly before I proceed to resuscitation for such injuries, (especially fractures of the clavicle humerus, femur or tibia), in cases where these may occur most frequently, e. g. pelvic presentation and extraction by the feet. -Centralblatt fur Gynakol. 10, 1890. My reasons for reporting this case, firstly that it was a well defined case of puerperal peritonitis; secondly, that it illustrates the importance of enjoining rest and attention to our patients for several days after delivery. I feel confident that if 'his patient had been Nervous Diseases Produced by Lightning. kept quiet she would have escaped the attack of peritonitis; thirdly, I give my treatment which in those severe cases is an important factor; fourth and lastly is that my patient recovered, which was beneficial to her and satisfactory to me. Any criticism will be kindly accepted by me. Inducing Respiration. CLINICAL LECTURE BY PROF. CHARCOT, PARIS. Charcot describes, in a lecture, the phenomena which presented themselves in a man who was struck by lightning. The phenomena were those which are generally observed in people struck by lightning. Further on, CharIcot comes to the conclusion that traumatic neurosis comes here into question (the electric SCHULTZE'S METHOD FOR INDUCING RESPI- concussion constitutes the trauma.) Also in RATION IN THE PRESENCE OF INJURIES IN THE NEW BORN. BY DR. LEOPOLD MEYER, OF COPENHAGEN. the patient under examination, who had already before been neurasthenic, and had led a very much excited life, complete hysteria had developed. The following conclusions may be drawn: I. In cases of strokes of lightning one must, irrespectively of the nervous phenomena, which are a direct consequence of the electric concussion, refer the symptoms to the hysteria associated with it. 2. Has a partial stroke produced simple paralysis, then, if hysteria appears, hysterical paralysis may add itself and thus replace the simple paralysis which has existed in the beginning.-Bullet. Med. 3, 1886. In reading the case reported by Dr. Heydrick, (Centralblatt fur Gynakol, F., 1890), where a lesion of the lungs was caused by the fractured end of of the clavicle, I was again reminded of what had often struck me, especially during service as assistant in the lyingin hospital, i. e., the injuriousness of Shultze's method, especially where there exists an injury in the newly born child (fracture of the clavicle, humerus, &c.) In the mentioned case I am quite sure that the lesion of the lungs were caused by the swinging movements connected with performance of Schultze's CHANGES IN THE KANSAS CITY MEDICAL method. In using Schultze's method it is im- COLLEGE.-Dr. J. D. Griffeth has been elected possible to keep at rest the fractured ends, president, Dr. T. J. Perkins chair of minor which is regarded as the first duty in the treat-surgery, Dr. H. O. Hanawalt chair of diseases ment of fractures. The surroundings of the of children. I FOUND Ponca Compound to act most fractured ends, muscles, &c., are more or less injured by the swinging movements. I will not at all underestimate the great importance satisfactorily in a bad case of menorrhagia. of Schultze's method, but believe that I act rightly and rationally in preferring to try the W. A. HOOD, M. D., Treatment of Chronic Vesical Catarrh. BY L. FREY, OF VIENNA. An excellent remedy for chronic catarrh of the bladder is the local application of iodoform, which even yields good results in a short time in severe, obstinate cases, with purulent urine of a very fetid odor. The bladder is previously several times irrigated with warm water, then the iodoformemulsion is injected. Frey recommends the following formula: R. Iodoformii 50,0 Glycerin 40,0 Aqu. dest. 10,0. Gummi Tragacanth 0,25. operation, in which restoration of the functions of the rectum and sphincter ensued. He also referred to a case precisely similar, in which the patient reported good health, no return and no inconvenience, after the lapse of more than a year since the operation was performed. Both operations were in females, and it was questioned whether the mucous membrane could be drawn down as well as in males.-Medical Press. The ever progressive house of Parke, Davis & Co., are out this month with some seasonable suggestions as to eligible remedies for prevalent diseases of hot weather. They have a very convenient list of intesti Sig. 1 tablespoonful in a half a quart of nal sedatives, antiseptics, antispasmodics and water. Shake. -Wiener Med. Presse, 20, 1890. HAPPILY the day is past when the gynecologist thinks it only necessary to treat locally diseases of uterus and pelvic organs. It is seldom one finds the sufferer from these affec tions free from evidence of impaired bodily vigor. In fact, the experience of most physicians is, that a constitutional weakness, congenital or acquired, is more often a cause than an effect of uterine and pelvic diseases. Of course, after being once established they aggravate the original cause. The anemia, glandular torpor, plastic deposits, etc., which go to make up much of the general pathology of these cases, are prominent indications for the Three Chlorides Elixir. In the chlorosis of young females and the leucocythæmic, it is an ideal medicine. Dr. H. C. Himoe, class of 1890,of the Kansas City Medical college, made us a pleasant call last week. He was on his way to Albuquerque, New Mexico, where he has received the appointment as assistant surgeon on the Santa Fe hospital staff. The doctor is energetic, and has prepared himself thoroughly for his work, and we are satisfied he will work for the top, where there is plenty of room. anodynes for diarrhoeal and dysenteric affections; some new expectorants of note for coughs and colds, and a normal liquid ipecac, always reliable as an emetic in cases of gastric disturbances due to accumulated fermented food, so frequent a cause of infantile diar rhoea. house is largely increasing its facilities for the By way of gossip, we may state that this manufacture of pharmaceuticals. Buildings now in process of erection will double their capacity for production this year, and a new laboratory very complete in its appointments is now being built for them in Canada. A DOCTOR REMEMBERED.-June 17 was the twentieth anniversary of Dr. Scott's residence in Holton, Kansas. His neighbors presented him with a one hundred and twenty-five dollar case of surgical instruments. A doctor will occasionally find an oasis in life's desert of professional labor. "Well done good and faithful doctor." THE Central Branch District Medical society is developing into one of the best district societies in the State. There are a number of first-class men in that section, and we are pleased to note their work. Several good papers have been received by the JOURNAL and will be published soon. The body of the JOURNAL was made up before the last reports NOTON reported at the Clinical Society at The Physicians Instinct. There is a point at which all forms of cultivated knowledge become instinct and are certain of their judgments, even when they are not able at the moment to produce a reason; and no man can have passed middle age without being struck with the sort of middle sight, as it may well seem, which is at the command of a competent physician.-CANON LIDDON. THE Journal of Medicine offers to prove that the published mortality of the Pasteur Hydrophobia Institute does not include onehalf the fatal cases. Potin, in a current number of the Journal, cites the case of an eightyear-old girl who received the regular treatment at the Pasteur Institute. She died seventy-five days after she had been bitten by a dog. The owner of the dog was bitten by him a day before the girl. He has not been treated by Pasteur and is alive and in excellent health. IT is claimed that the Russian Steam Bath retards the elimination of certain drugs from the system, notably iodide of potassium. That a prolonged sojourn of drugs in the system in contact with the tissues, constitutes a very important factor in practical therapeutics. The explanation given is that the bath drives the blood towards the periphery of the body and so ipso makes all viscera anæmic, such anæmic condition of the stomach and intestines naturally must retard the absorption, and a retarded absorption, means a retarded elimThe bath also favors decreased ination. cardiac action, lowered arterial tension, slackened speed of the blood-current, and weakened renal action. CHOLERA AND YELLOW FEVER.-The former has broken out in Turkey and Valencia, Spain. With proper quarantine regulations we need have but little fear of it on this side of the water. The latter disease has made its. appearance at New Orleans. The Marine hospital corps under the control of the effiTO PREVENT DISCOLORATION IN BRUISES. cient surgeon General, John B. Hamilton, -To prevent the blood from settling under a will do all within human power to restrict it bruise, there is nothing to compare with the to the place of its outbreak. All necessary tincture or a strong infusion of capsicum precautions have been taken, so, says the annuum mixed with an equal bulk of mucilage of gum-arabic, and with the addition of a few drops of glycerine. This should be painted all over the surface with a camel's-hair pencil and allowed to dry on, a second or third coating being applied as soon as the first is dry. If done as soon as the injury is inflicted, this treatment will invariably prevent the blackening of the bruised tissue. The same remedy has no equal in rheumatic stiff neck.-St. Louis Polyclinic. THE uncertain strength of Coca leaves make this drug very unreliable, unless a preparation is used which we know to be made from a good leaf. "ROBINSON'S WINE COCA" is prepared by percolating assayed Coca Leaves with Malaga Wine, and has always been found entirely satisfactory. VASILIEFF concludes after experimentation that the nutritive value of boiled milk is much inferior to that of fresh milk. Lancet and Clinic. REPRINTS RECEIVED.-Two cases of resection of cæcum for carcinoma, with remarks on intestinal anastomosis in the ileocæcal region, by N. Senn, M. D., Ph. D. Climatology, and diseases of Southern California, by F. D. Bullard, A. M., M. D. HARPER Hospital Buletin-A bi-monthly devoted to hospital work. Volume 1, No. 1, published at Detroit is on our table. It is void of fuss and feathers, but brimful of good solid work. PROFESSOR WILLIAM H. BYFORD, of Chicago, is dead. He was one of the leading gynecologists of the world. Rush Medical College has lost one of its best men. INSTRUMENTS used in the urethra must be aseptic. |