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case.

Dr. Reynolds closed the discussion, men- shock, and that cerebral anemia existed in a tioning a case of hip-joint disease, in which the boy of neurotic constitution. burrowing of pus simulated a rupture.

Dr. Griffith wished to know why cigarette Paper was received and will appear in the smoking caused tobacco heart and nervous November number of the KANSAS MEDICAL symptoms quicker than cigar or pipe smokJOURNAL

ing Dr. Gray, of Kansas City, read a paper on Dr. Pelton described a case of pericardial “Surgical Treatment of Tuberculosis of the pain under similar circumstances to Dr. Peers' Knee Joint. DISCUSSION.

Dr. Bidwell thought that cigarette smoking Dr. Griffith considered that most cases of was more dangerous than pipe or cigar smokbone disease were due to some organism.

ing, being carried on by a younger class of Dr. Sands, of N. Y., prefers thelongitudinal persons, and inhalation of smoke being also to the Ushaped incision. He thought that more frequent among them. fixation and extension were very often indi- Dr. Carpenter agreed with Dr. Bidwell, and cated.

found the tobacco heart was very common Ex-section was preferred to erasion because among applicants for life insurance. a better cleaning was accomplished, and nails Dr. Lindsay thought there was no indicawere preferred to wiring. The Dr. had put up tion of cerebral hemorrhage in Dr. Peers' case. some joints before taking off the Esmarch Dr. Lewis spoke of the symptoms resembbandage.

ling multiple neuritis, as in the case of arsenDr. Rodgers thought the opening of the ical poisoning. dressings for daily irrigation was inadvisable. Dr. Peers closed the discussion.

Dr. Jones favored daily irrigations to avoid Paper was received. the formation of sinuses.

A bill of $5 for postage and programs was Dr. Lewis stated that Dr. Thomas, of Liver- allowed. pool, was the originator of the practice of ex

It was moved and carried that the January tension and fixation, and Dr. Gibney was his meeting of the Society be held in Topeka. follower.

An adjournment to an elaborate banquet, Dr. Gray closed the discussion, stating that spread by the Topeka brethren, was then all the diseased tissue was not removed, hence taken. Peace and harmony prevailed, and at the necessity for irrigation.

an early hour the medicos sought refreshment Paper was received.

by Tired nature's sweet restorer, balmy Dr. Theo. W. Peers reported a case of “Pois- sleep.” oning by Cigarette Smoking.”

Moved and seconded that the paper be re- Sizth District Medical Society. ceived. DISCUSSION.

The Sixth District Medical Society met at Dr. Schenck opened the discussion by re- Downs, October 9, 1890. marking the action of smoking upon the Meeting was called to order by Dr. W. A. heart, and that vastly greater evil results were Leigh, of Stockton, President. brought about by the use of tobacco than any Dr. Poole was appointed secretary, pro tem. that had been mentioned.

Present-Drs. Leigh, of Stockton, Poole of Dr. Porter described a case of violent con- Downs, Daly of Scottville, Swigart of Beloit, vulsions in a young man similar to the one Lobdell of Beloit, Sawhill of Concordia, described by Dr. Peers.

Dillon and Chilcott of Osborne City, Brierly Dr. Tyree spoke of the swelling of the of Glasco, Cullimore of Atchison, and Wall of mouth and gums, so often occurring in ciga- Topeka. rette smoking

Moved by Dr. Daly, that all visitors wishing Dr. McVey thought the case of Dr. Peers to join do so by signing the constitution. was due probably to some severe mental Carried.

sensa

X

Drs. Brierly, Lobdell, Chilcott, Swigart, Cul- For several months this pataient has had limore and Wall, were elected to membership. "trouble in passing his water," giving history

Dr. Cullimore read a paper entitled “ Zonu- of a close urethral stricture with prostatic enlar and Congenital Cataract." He gave the largement. definition of these forms, stating their cause, On Monday night October 8, 1890, after an laying particular stress upon the advisability unsuccessful attempt to void the urine for of early diagnosis. Spoke of the cause as twenty-four hours and while still straining in being rachitis, scrofulous, and especiallycon- his attempts to relieve the urgent desire to do vulsive. Advised early operation; as early as so, he suddenly felt a “giving away 3-6 months.

tion in the perineum accompanied by a tearDr. Daily-Had never seen a case of zonular ing and distending pain and soon thereafter cataract. Considered the operation very sim- he noticed a swelling in front of the anus ple. Has no fears of suppuration from need- which rapidly extended to the scrotum and ling. Says he has no fear of pus.

penis until all semblance to the male genital Dr. Cullimore closing, said, that the child organs were destroyed. No urine escaped should not be left after the operation. Treat from the meatus. the child half an hour before operation by The escape of this quantity of urine from antiseptic washes, Boric acid gr. xx, aquæ the distended bladder, into the tissue caused a camph. 5i, aquæ Dest. 3111.3 Wash out, temporary relief of the urgent and uncontrolhoroughly. Should cover the eye with iodo-able desire to urinate, and as the case was beform and vaseline (gr. -3i). After the oper-ing treated (?) by a Christian Scientist, his ation atropine to avoid iritis. Should be care- faith prior to this time during the preceding ful in its use as it quickly reddens the eye. twenty-four hours had almost vanquished, but Says there is no retinal chorroidal changes. now with renewed assurances from this mira

Dr. Daily read a paper “How to Practice cle (?) performer and a temporary relief caused Antiseptic Surgery in the Country."

by the urethra giving away and a large periThe paper was freely discussed by Drs. neal and scrotal urinary infiltration, thus reBrierly, Sawhill and others.

lieving the over distended bladder, he immeDr. Daily laid stress on cleanliness; said diately renewed his allegiance to “faith cure" iodoform prevents the formation of bacteria. and postponed sending for a physician for Would not use bichloride in surgery. Thinks another twelve hours or until the capacity of that medicines are detrimental to wounds Buck fascid was taxed to its utmost capacity when used in wounds; says if wound is kept by the escaping urine and his bladder became clean will not get pus.

over distended again. Dr. Wall read a paper on

Mastoid Ab

Now for the first time he lost all faith in scess," which was discussed by Drs. Daily. promises, "that all will be well if you only Cullimore and Swigart. Society adjourned to have faith and think so,” and sent for a doctor. meet in Beloit the second Thursday in April, Dr. Burtt of Canton, was called, who called

[The JOURNAL, is under obligations to Dr. Dr. George of same town in consultation, both Wall for the above minutes.--Ed.]

agreeing as to the advisability of an imme

diate operation. The patient refusing to subStricture of Urethra.

mit to the more rational and radical operation

of external urethotomy. The physicians after LACERATION OF THE CANAL-URINARY long and tedious effort with the patient anæsFILTRATION-EXTERNAL URETHOʻTOMY thetized, succeeded in introducing a small hard WITHOUT A GUIDE.

rubber catheter, and in relieving the distend

ed bladder, the patient feeling much relieved BY A. H. CORDIER, M. D., M'PHERSON, KAS. as far as the desire to urinate was concerned.

The scrotum and perineum remaining disWhite male, age 50 years, of sober and tem- tended. perate habits.

October 10–

-Late in the evening of the third

IN

day after the urethra had given away, I was a success." The old saying, that the "operatelegraphed for to see the case with Dr. Burtt. tion was a success, but the patient died ” I I found the patient with a temperature of 102° was afraid could not be applied to this case. F, pulse 110 very feeble, with a countenance

In recent cases, I mean by recent cases, imindicative of a loss of sleep, suffering and mediately after the rupture of the urethra the much prostration. The bladder was full and operation is considered by the most expert tender to pressure. The scrotum as large as operators, to be one requiring much time and a good sized cocanut, very dark, bordering on considerable anatomical and surgical knowla gangrenous condition. The perineum was edge and skill. Dr. Keys says: “When you greatly swollen, very tender to touch. Has go to do an external perineal urethotomy not passed urine for nearly twenty-four hours. without a guide, have your patient facing a Will not submit to an operationi. After a window where you will have two hours of careful effort I succeeded in getting a very good and continuous light." This remark he small instrument through the stricture and makes in speaking of operating to relieve a on its passing through the stricture, it im- close stricture when the perineum is not dismediately entered a cavity, meeting with no tended and distorted almost beyond a semresistance for nearly two inches, it now re- blance to the normal perineum. fused to go farther. As soon as the stricture

Dr. George administered the ether, Dr. was passed a bloody purulent fluid began Burtt assisting in the operation Patient passing through the catheter, having the placed in the perineal lithotomy position. characteristic odor of decomposed or am

Thorough antiseptic precautions taken in mioniacal urine. I knew I was in the cavity of

getting parts ready for operation-Thiersch's the deep layer of the perineal (superficial) fascia solution hot for sponges and instruments. at the site of the rupture in the urethra, and

A groved staff was introduced as far as the that the fluid escaping from the instrument stricture or as far as it could be passed, a was decomposed infiltrated urine.

median incision was made, the back of the After patiently and carefully waiting for knife being turned 'toward the rectum in fifteen minutes I succeeded in striking the which the finger of left hand was introduced proximal end of the urethra, entering the to act as a guide to the knife on its hunt for bladder and drawing off its contents and wash the proximal end of the urethra. ing out its cavity.

The first thrust of the knife gave vent to a The instrument was left in, that as much of profuse flow of the pent up infiltrated amthe urine might escape by that channel as moniacal urine and pus, about eight ounces possible and thus avoid further infiltration, escaping. On introducing my right fore-fintrusting that nature (the patient refusing to ger into the wound I found a large abscess be operated on) would relieve the infiltrated cavity as a result of the decomposed urine urine by a fistulous opening in the perineum, remaining in the tissues so long. or by a slough as is the usual termination in

Two inches of the urethra was found entirelike cases where the art of surgery or death ly dead and sloughed off so that it came away does not relieve them of their suffering.

during the irrigation of the abscess cavity. During the night he removed the catheter After some little difficulty the proximal end and the next morning Dr. Burtt found the of the urethra was found and a soft Nelaton's bladder in a distended condition the same as catheter introduced and tied in. The bladder the day before, but all efforts at introducing was relieved of its contents and thoroughly the catheter were unsuccessful, so I was wired irrigated with hot Tliersche's solution, wound to come prepared to perform the operation of washed, an injection of hot whisky was given external urethotomy without a guide.

(per rectum,) patient placed in bed and At time of operation patient's temperature warmth applied to prevent or ward of shock. was 102° F, pulse 110 and the general and The scrotum and penis were incised in a local state of affairs were not such as to cause number of places to allow the urine to drain one to feel that the “operation would ever be away that had been infiltrated.

The patient soon rallied from the effects of I have reported this case at length because : the operation and anæsthetic,

First, the extreme infrequency of like cases. The next morning October 12, temperature

Second, From the fact that two inches of 982 F, pulse 8o. Rested well during the the urethra sloughed. night. Takes some nourishment. Urine Third, that in a practice of ten years this is passed by catheter in perineum. Thinking it my second case. The first I did not report. impossible for the urine to ever pass by the Fourth, As a warning should this article natural outlet by the urethra and meatus, fall into the hands of a layman and should he from the fact that two inches of the canal ever have an urgent desire to urinate and an was lost I thought all we could expect from inability to do so, to send for a physician and the operation was to give immediate relief to not a christian scientist for relief. the suffering, prevent sloughing of scrotum and perineum, prevent or check the poisonous "I find that the action of Ponca Compound effects of the absorption of septic matter and is very favorable for inflammation of the cersupport the vital forces until nature would re- vix uteri and for irritation of the ovaries." pair the damage done to the perineum and

E. BRINKERHOFF, M. D., leave a fistulous tract for the urine to escape BRISTOLVILLE, Ohio. through.

October 18, one week from date of operation "I have used Tongaline extensively and the patient has been doing very nicely; tem- have been well satisfied with its results. perature and pulse have remained about nor- are to be congratulated on the value of the mal. The prospect for a recovery with a fis- article which you offer to physicians." tulous opening in perineum and good control

R. A. VANCE, M. D., of bladder are good at this time.

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VOL. II.

TOPEKA, KANSAS, DECEMBER, 1890.

No. XII.

one

now

The Water Supply of Leavenworth. ed in a less aggravated form, and enteric dis

orders of a similar character have been comRead before the Eastern District Medical So- mon ever since with a diminishing frequency, ciety, Topeka, Kansas, October 14, 1890. to the present time, varying in intensity and

character according to the season and the cirBY CHAS. R. CARPENTER, M. D.

cumstances.

It is a significant fact that it was just preIt has been a matter of common observa- vious to this date that the character of the tion among the physicians of this city that water supply of Leavenworth began to change. typhoid fever has been more prevalent of late In 1882 the ordinance was passed by the city years than ever before. In fact until about council authorizing the organization of the five years ago it was considered a rare disease, Leavenworth Water Company, but it was conand physician, who is not in siderably over a year before it was in actupractice says, that in an active practice al operation. This brought the date well of over twenty years he never saw a case down to 1884. During 1883 and '84 the presof genuine typhoid fever, the period spoken ent system of sewers was constructed. Miles of extending up to 1883. Another gentleman of great ditches were dug through the streets

says that the first case that ever occurred in and alleys, varying from three to sixteen or + this city occurred in his practice in 1875.

eighteen feet in depth. It was one of the It is a fact worthy of comment also that common experiences of the workmen who diphtheria, which is a disease incident to the dug these ditches and laid the sewer pipes, to same conditions that produce typhoid fever, find that neighboring vaults and cess pools was almost an unknown disease here until the were being drained to a greater or less extent last few years. It has never assumed an en- into the excavations and their work was not demic form, but cases have been reported with only impeded but rendered extremely offensufficient frequency to enroll it in the list of sive from this cause. our local diseases.

The proposition is here submitted that at In the records of Mount Muncie cemetery this time the purity of the well water in every it is scarcely possible to find the name "sum well in the city, not more than two blocks mer complaint” until about five years ago. outside the area covered by the sewers, was Of course this is partly accounted for by a either destroyed or rendered questionable. change in the current nomenclature of disease, The digging of these ditches over so extended but there is little doubt that the pathological an area, so disturbed the equilibrium of the conditions aggregated under this name as it is stratum of moisture as to place vaults and now used have been more prevalent during cess pools in direct communication with all the last five years than they were previous to wells extending to the same depth or below that time.

them. "Winter cholera" was never heard of in Scattering cases of typhoid were reported as Leavenworth until about the year 1886, when early as 1875 as has been said, but the increase it made its appearance in the form of a well in their number was so slight as to be readily marked endemic. The next year it was repeat- accounted for by the accidental contamination

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