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Acute Obstruction of the Bowels. which he could retain a teaspoonful of beef
tea occasionally. We abandoned all other REPORT OF A CASE TREATED BY HYPODERMIC medicines and commenced the hypodermic in
jections of sulph. morphia, which was given INJECTIONS OF MORPHINE.
as follows: Read before the Central Branch Medical Asso
August 19, 3:40 a. m., 18 gr.; 7:30 a. m., 18 ciation at Greenleaf, K's., June 5, 1890.
gr.; 1:00 p. m., 74 gr.; 4:15, p. m., 18 gr.; 7:30, p. m., 18 gr.; 9:55, p. m., 16 gr.
August 20, 12:45, a. m., 48 gr.; 3:15, a. m., 16 BY M. A. BRAWLEY, M. D., OF FRANKFORT, KS.
gr.; 6:10, a. m., 18 gr.; 9:15, a. m., 16 gr.; 12:10, On the 19th day of August, 1889, I was P. m., 78 gr.; 3 p. m., '& gr.; 6:20, p. m., 16 gr.; called in consultation to see Robert T-,
9:20, p. m., 18 gr.
August 21, 12:05, a. m., 18 gr.; 3:20, a. m., 16 age 13, who was suffering with a very severe pain in the bowels. On examination I found gr.; 10:35, a m., & gr.; 3.05, p. m., 78 gr.; 6:25, the following condition : Three days previous p. m., 18 gr.; 9:05, p. m., 18 gr.; 11, p. m., !
gr. the patient had been suddenly seized with an
August 25, 1:05 a. m., 16 gr.; 3:20, a. m., jó intense pain in the right iliac region, accompanied with a strong but ineffectual desire for gr.; 6:10, a. m., 16 gr.; 9:15, a. m., 1. gr. 1:25
p. m., 48 gr.; 4 p. m., 18 gr.; 7:35, p. m., a movement of the bowels. Constant nausea
10:50, p. m., 74 gr. and vomiting, intense thirst, dry, parched
August 23, 1:45 a. m., 18 gr.; 4:23 a. m., tongue, fever at 103°, pulse 120 and weak, re
gr.; 10:15, a. m., 18 gr.; 1:15, p. m., 16 gr.; 5:25, tention of urine and tympanites. The patient
p. m., jó gr.; 10:00 p. m., 74 gr. was lying on his right side with his legs drawn up, and suffered great pain from the lightest gr.; 12:15 p. m., 4. gr.: 4:45 p. m., 16 gr.; 7:30
August 24, 3:15 a. m., 18 gr.; 8:45 a. m., 16 abdominal manipulation. On inquiry I learned
p. m., 18 gr.; 11:20, p. m., 18 gr. the following facts: A few months previous
August 25, 10:10 a. m., |4 gr.; 1:00 p. m., the patient had been thrown from a horse and made complaint then of a pain in his bowels gr.; 4:50, p. m., lá gr.; 8:20 p. m., % gr.
August 26, 1:00 a. m., 18 gr.; 10:20 a. m., 16 for a few days. At the commencement of the
gr.; 3:00 p. m., 18 gr.; 9:40 p. m., present sickness the attending physician had
The bowels moved at 11 o'clock p. m. on resorted to the free use of cathartics without
August 26, without much pain, following an obtaining any movement of the bowels, and injection of a pint of sweet oil. The patient for twenty-four hours preceding my seeing the made steady improvement till August 31, case, had been using large rectal injections of when he got up and ate some fruit which had water every two hours with no effect.
been carelessly left in the room. This indulSuch, gentlemen, was the condition of the
gence was followed by a renewal of the abdocase when I Arst saw it, and I will say here
minal pain, at the first return of which the that I have never yet seen a face whose every hypodermic injections were commenced again, line and feature expressed more agony and
being given as follows: suffering than that boy's.
August 31, 6:30 p. m., 18 gr.; 8:00 p. m., 16 My diagnosis was acute obstruction of the
gr.; 10;20 p. m., 74 gr. bowels, and for the satisfaction of the family
September 1, 3:05 a. m., / gr.; 8:30 a. m., 14 as well as to furnish myself with an answer to the ever inquisitive friends, I said the trouble gr.; 4:00 p. m., 74 gr.; 6:05 p m., 4 gr.
September 5, 1:15 a. m., 16 gr.; 5:12 a. m., 18 was doubtless induced by the boy's fall from
gr.; 1:45 p. m., 18 gr.; 5:20 p. m., 18 gr.; 9:10 the horse.
p. m., 18 gr. Now as to the treatment: A three grain an
September 3, 12:35 a. m., 78 gr.; 6:00 a. m., tifebrin powder was given every four or five y gr.; 1:40 p. m., 16 gr.; 5:25 p. m., 16 gr.; hours, if fever exceded 1022°. To allay 8:30 p. m., 16 gr.; 10:15 p. m., X gr. thirst he was given cracked ice. He took no September 4, 1:40 a. m., |4 gr.; 5:00 a. in., nourishment for the first three days, after 18 gr.
Shortly after the last injection the bowels (jected to the operation on the ground that the moved of their own accord.
child had recovered and would never have A tedious convalescence of some six weeks epilepsy, or other manifestation of the cerebral terminated in a full return to health.
injury. Such manifestations, however, did Most of the time when the patient was un- appear, and she has needed the constant care der the influence of morphine sufficient to re- of her mother, while her mind has not devellieve the pain, his respirations were down to oped to any extent. between eight and twelve, and his pulse be- The parents now applied to me for treattween forty and fifty.
ment, owing to the fact that she was becomI gave an occasional injection of ily of a ing, each year, more and more vicious in her grain of atropia.
habits. She had a few severe epileptic 'seizmake this report not for the novelty of the ures, and many times each day, attacks of case, but simply because I was fortunate petit mal. enough to have efficient nurses in attendance
A paralysis of the muscles of the opposite who followed instructions exactly, and whose or left side followed the injury, and on exam-. record of the case was perfect, thereby making ination a depression was found over the right this valuable for any one who may have a like side of the skull, beginning on the anterior case in the future, and who may have any border of the parietal bone above the temporal doubt as to dose and frequency of the use of ridge, and extending backward and downward hypodermic injections of morphine.
in a curved direction, to the posterior inferior
angle of the same bone. The deepest part of A Case of Trephining for Epilepsy and Im- the depression was found just below the paribecility.
I called in consultation Prof. W.S. Lindsay, Read before the Eastern Kansas District Med- who made a careful and systematic examina
ical Society at Leavenworth, Kansas., July tion, and he has furnished the following reS, 1890.
“In consultation with Dr. McClintock on BY J. C. M'CLINTOCK, PROFESSOR OF SURGERY March 22, 1890, I saw Anna Richey, aged nine AND CLINICAL SURGERY IN THE KANSAS years, who had the following history : Seven MEDICAL COLLEGE.
years prior she had sustained a fracture of the
skull by falling about eighteen feet, lighting The patient, Anna Richey, nine years of on a board walk, from the effects of which she age, has a history as follows:
was comatose several hours, but from which When two years of age, she was playing on she recovered with nervous disturbances. the portico of the State Capitol building in “I learned that she had had several epilepTopeka, from which she fell to a wooden tic attacks during the seven years, and had sidewalk below, a distance of eighteen feet, become destructive and difficult to manage. .striking on the right side of the head, causing Her manner was that of a child of three or an extensive fracture with depression of the four years of age. skull.
She had learned some things from books, Several physicians, members of the legisla- but was not able to study or engage in a coheture then in session, were summoned, and rent conversation. There was paralysis of the later the physician in charge objected to the left side of the body, and inability to walk advice of the other physicians, which was steadily. that the depressed skull should be raised. "I recommended trephining of the skull, His objections were first based on the ground which was done two days later by Dr. Mcthat death was inevitable, after such a severe Clintock. fracture as existed in this case, and that, “When we take into account that epilepsy therefore, it would be worse than useless to was increasing, and likely to result in impairattempt any such procedure. Later, he ob- ment of the mind, thus rendering the girl a
great charge on her parents, the operation was ing the scalp, and the patient returned to her warranted, even though she may not regain bed, where she was secured by having each perfect use of her limbs and complete restora- extremity tied to the bed rail, and a nurse detion to mental vigor.
tailed to hold the head. This was necessary “It will, of course, be necessary for her because the child was entirely uncontrollable, mental powers to develop, since at this early and she would undoubtedly have injured herage she knew but little.
self if left free, especially with the clamp in “I understand from the family that she is the wound. very much improved in every way since her The patient did well all day, but during the recovery from the operation."
night an elevation of temperature occurred I advised the operation of trephining for which rose to 105° Farenheit. In the mornthe removal of the depressed portion of the ing the dressing was removed, the clamp and bone, and obtained the consent of the parents the drainage tube were taken from the wound, to such a procedure. As the child became the wound washed out, and a dressing re-apworse all the time, they were anxious to try plied. anything that offered any prospect of relief. From this time on the temperature fell un
Accordingly the child was placed in Christ's til the next day it reached 100° and after this Hospital, the head shaved, well washed, and became normal, and so remained until the a compress, wet in a i to 2000 solution of bi- healing was complete, which was within ten chloride of mercury, was applied for twenty- days. In another week the patient was taken four hours previous to the operation.
to her home in an adjoining county. With the assistance of Drs. W. S. Lindsay, Union by first intention occurred at all M. B. Ward, J. W. Donaldson and R. S. Ma points, except that point which gave exit to gee, the operation was performed by raising a the tube and clamp. While open, the wound curved flap and exposing all of the depressed gave exit to quite a large amount of cerebral part of the bone. At the place of the deepest fluid, requiring an abundant quantity of abdepression there was an absence of bone. sorbant cotton in the dressing, and this was This part was bridged across by a tough, fi- changed every twenty-four hours, of necessity. brous membrane which, on being opened, The patient was liberated as soon
as the gave exit to quite a large quantity of cerebral clamp was removed, took nourishment, became fluid. The trephine was then applied, and more tractable, and in less than two weeks two buttons of bone removed. Their under from the time of the operation an improvesurfaces were very rough and uneven, and at ment was noticed in the paralyzed muscles, as the side of the deepest depression a piece of well as in the mental condition of the child, bone, with a long, needle-like process was which improvement the parents and friends found imbedded in the brain substance to a have informed me has continued to the presdepth of at least half an inch. This had evi- ent time. dently been a large piece of bone which had
This case should, undoubtedly, have been partly disappeared by absorption, until only operated upon at the time of the injury or this much was left.
soon after. It was wise, probably, to wait unThe remainder of the depressed or rough- til the recovery from the injury was assured, ened and splintered bone was removed by the before attempting elevation of the depressed Rongeur forceps. A branch of the middle portion of the skull, rather than to add the efmeningeal artery was cut during the opera- fects of the operation to the existing shock. tion, and gave rise to troublesome hemorrhage. An early operation would probably have Several unsuccessful attempts were made to avoided the cerebral and other manifestations tie it, but each time the vessel was cut into by of the injury presented in the history of the the least force in applying the ligature. It case. Any functional derangements would was finally clamped, and the clamp left in situ, easily have been corrected at an early day, alongside of which was placed a drainage tube. whereas, if allowed to continue, the abnormal An antiseptic dressing was applied after sutur- cell action becomes almost a normal action in that case, and its correction problematical in SOCIETY PROCEEDINGS. the future. Cells respond to a certain stimulus, and to that stimulus a second time more Topeka Academy of Medicine and Surgery. readily than the first, and after a time the habitual repetition of the same process renders
The Topeka Academy of Medicine and the action very easy, and whether that action Surgery met in regular monthly session at be a normal or an abnormal one, the habit is Lincoln Post hall, Tuesday evening, August established, and as time goes on its change 5, president Dr. L. H. Munn in the chair. becomes more and more difficult. This is as
There were present Drs. Hogeboom, Wall, true in the brain as in any other part of the Donaldson, Longshore, Righter, Cazier, W.E. body. Abnormal operations of the mind are McVey, McGuire, Magee, Gibson, Minney, difficult to change in a ease such as we have Bradley, Peers, Alexander, Lindsay, Stewart, reported to-day, where the trouble has contin- Chapman, Ward, Messrs. McClintock, Gilbert ued so long, hence the prospect for the ulti- and Boettger, the latter from Wilwaukee, Wis. mate recovery of this case is not so bright as
Dr. C. H. Guibor was elected to memberif the operation had been done soon after the ship. injury. I say a recovery; this is not the
Dr. D. F. Rodgers presented a case of aphaproper term, for we cannot speak of the re- sia in a little girl of seven years, who also had covery and restoration of a mind which was some mental peculiarities. The object in in a degree lost in a babe of only two years of bringing the girl before the academy, aside age. In reality, if this child is improved as a from the interest in the case, was to determine result of the operation, it will be by a process
whether she should be admitted to the deaf of education-a building up of a new mind, and dumb asylum, or the asylum for feeble and, what is more difficult, the unlearning of minded children. A committee consisting of all she has heretofore learned. This will be Drs. Lindsay, Peers and Alexander was apthe most difficult part of her training, for the pointed to examine the case and report. In cells have formed the habit of acting in a cer
addition to the examination by the committee, tain manner; that manner cannot easily be most of the physicians present examined the changed.
The conclusion reached was that the
girl should be sent to the asylum for feeble It is too early now to report this case as one
minded, as she was too young for admission of cure, for although there have been no re
to the deaf and dumb asylum. turns of the epileptic seizures, still we know
Dr. W. S. Lindsay read a paper on hypnothat they frequently do not return for some
tism, giving the different names under which time after many operations. The case will, however, be watched, and its future progress the present status of its uses. Thought it
it has been practiced, the early history and reported.
worthy of some thought and investigation,
for the possible good that might be derived Birch BEER.-- This pleasant and wholesome eral practical application, and said it should be
therefrom, but did not think it worthy of gensummer drink may be made by the following under the control of honest, conscientious formula, from the Pharm. Era:
physicians. Spoke of its dangers and the adBirch Essence......
vantages taken of even what virtue there Wintergreen essence. ounce.
might be in it, by charlatans. Sassafrass essence.. 1 ounce.
Dr. Longshore was inclined to the belief Ground cinnamon ...... .1 teacupful.
that there was a great deal of deception prac-
ticed in its use.
Spoke of a lady who made a Steep ten hours; add sugar or molasses to practice of attempting to relieve pain in labor,
but when a hot cloth was placed to the pataste, and one cup of baker's yeast. It is tient's back the hypnotist lost her power. then ready for bottling. The essences are Dr. Peers said it was a question who were merely strong infusions.-Times and Register. able to produce hypnotism. Had seen nothing
of it except stage exhibitions. Judging from tize have no special magnetism. Thinks any what he had read, it could be used in minor one who studies and practices can do it. surgery. Every one has an individuality that Strong persons are as susceptible as nervous makes them offer resistance. Was not able to ones. Insane persons can hardly be hypnosay what harm it would do to the mind. tized. Hysterical persons susceptible. Dr. Magee does not think the hypnotist has ing in September.
Adjourned to meet the first Tuesday erenany special gift, it lies in practice.
D. H. RODGERS, M. D., Dr. Minney witnessed the hypnotising of a
Secretary Swede by Dr. Axtel at a meeting of the South
Labette County Medical Society. ern Kansas medical society. After the Swede was hypnotized, the doctor pricked him with
The Labette County Medical Society held a scalpel without pain. The doctor had the its first annual meeting at Parsons, Thursday, patient perform other feats. which if no ma- August 7, the physicians present being Drs. lingering on the part of the patient were re- E. E. Leggett and Hill, of Oswego; F. J. markable. Is persuaded that concentration to Smith, of Dennis; L. L. Wheeler, of Montaexhaustion is necessary, and that is liable na ; and Drs. Kleiser, Rockhold, Maser, Gato produce serious trouble with the brain. briel and Harvey, of Parsons. A larger gathThinks hypnotism should be practiced only ering was expected, but sickness in their own by the physician.
families and other professional business kept Dr. Ward.-It is a very dangerous proceed- away many who would otherwise have ating. Every physician has more or less influ- skin diseases was read by Dr. E. E. Leggett.
tended. A paper on the use of “ Ichthyol" in ence in that direction. Thinks every physi- of Oswego, and referred by consent for publician should have the fullest confidence of his cation. Dr. McEwen, of Mound Valley, who patients, and whenever we do not have their was to have read a paper on salol in the treatconfidence we cannot expect to do them much
ment of summer diseases of children, was pregood, and it would be better to have some ous sickness of one of his children, so his pa
vented from attending on account of the seriother physician treat them. Mechanical hyp- per was laid over to the next meeting, when notism is harmful.
he and Dr. Harvey were appointed to prepare Dr. Stewart said mesmeric experiments in papers for that occasion. The question of
how best to treat the summer diseases of inFrance were suppressed years ago by the au- fants and young children was fully discussed, thorities on account of insanity, etc., follow- each giving the treatment which in the past ing. Spoke of the ill results on the cases op- ten years has been found to give the best reerated upon in Vassar. Charcot says very few sults. persons can hypnotize and few can stand the The question for discussion at the next effect. Charcot exhibited a person who had quarterly meeting in November will be, "How
to best treat pneumonia." been operated upon frequently, and the result
The society now numbers sixteen members was imbecility.
and has applied for a charter; a president, secDr. Wall.- Persons with normal or even retary and a board of nine directors having strong organizations can be hypnotized. Not been elected. The president for the coming necessary that they be of weak or over-suscep-president is Dr. J. B. Hill
, of Oswego, and the
year is Dr. Harvey, of Parsons; the vicetible. As a therapeutic measure we have other
secretary is Dr. E. E. Leggett, of the same remedies more effective.
city, and the board of directors are Drs. KleisDr. Stewart said there was danger to the op- er and Harvey of Parsons, Geo. and E. E. erator as well as the patient. Related the case Leggett of Oswego, G. D. Boon of Chetopa, of a physician who died from the strain on Wheeler of Montana, C. W. Campbell and J.
W. W. McEwen of Mound Valley, L. L. the nervous system. Thought suspension W. Henderson of Labette City. from concentration not being the same as ex- The place of business will be Parsons, and haustion or tiring out.
the quarterly meetings will be held in accord
It is earDr. Lindsey spoke of the inhibitory influ- ance with the vote of its members. ence on the rest of the brain. The effort not nestly hoped that all responsible physicians of
in the same as exhaustion. Persons who hypno
DR. E. LEGGETT, Secretary.