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J. A. (Joel Asaph) Allen.

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Let her, prior to the beginning of labor, have an immersion bath daily
for several days, and with the first manifestations of pains let her abdo-
men and genitalia be rendered absolutely aseptic by the further appli-
cation of germicides in solution, adequate to accomplish the desired
end. 3. Let her have a warm vaginal douche, rendered aseptic. 4.
Let the lower bowel be thoroughly evacuated by copious lavements of
hot water prior to the vaginal bath. 5. Let her bedding be made as
pure and clean as careful laundrying can make it. 6. Let her cloth-
ing be made equally clean in like manner. 7. Let there be a number
of clean bichloride napkins placed in readiness for use. If all of these
injunctions are rigidly enforced, we have done much to lay the founda-
tion for a physiologic labor.

After all this careful preparation of the patient and her surround-
ings, we have not, however, done enough. The physician and all the
attendants must be rendered as scrupulously clean and aseptic as the
patient herself, else all the previous preparation has been in vain. The
nurse must be a woman of absolute cleanliness, both in the care of her
person and her clothing, and she must be especially trained in the
habit of keeping her hands clean. The physician must be trained in
all the details of aseptic and antiseptic principles, and must enforce his
rules as rigidly upon himself as he does upon his patient and her
nurse.

Now, while this is all perfectly correct practice in Buffalo or other
large cities where so many septic conditions abound, it is not called for
in the rural districts. Especially should every precaution be observed
at maternity or other hospitals where women are to be confined. Dr.
Potter deplores the fact that practitioners in the rural districts cannot
carry out every injunction given above, and seems to be impressed with
the idea that they must, therefore, have bad results.

We desire to remark for the benefit of Dr. Potter that nine out of
every ten country practitioners of twenty or thirty years' practice never
see a case of puerperal sepsis, in spite of the fact that many women in
the country, particularly the far west, are confined under the most
adverse conditions, many of them surrounded by filth, and living in
houses not good enough for horses, where the kitchen, dining-room,



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18 POTTEB : PUEBPEBAL SEPSIS.

drawing-room, parlor, bed-room and dog-kennel are all one and the same
apartment. Furthermore, they may not even receive the advantage of
a physician, but are delivered by some filthy old midwife, and left fo^
days surrounded by all the dirty clothing employed during confinement.
Yet these parturient women do nicely, and the so-called puerperal
fever, if not unknown to them, very rarely occurs. The truth is, the
pathogenic germs are rarely found in the country ; therefore, the care
of the patient in crowded cities is not absolutely necessary in country
places.

If Dr. Potter had made himself familiar with the facts, he would
not have made use of such suggestions as appear in the following para->
graph :

As a final thought, permit me to observe that with greater care
given by the general practitioner in the remote portions of the country
and away from the large centers, as well as in the populous cities, it is
my opinion that so-called puerperal fever may be eliminated as a fac*
tor of constant menace in the parturient chamber, and that ophthalmia
neonatorum may be absolutely and entirely prevented.

I need not detain you with a rejoinder to this ill-considered
criticism. I read it to you as a justification, in some sense, for
appropriating so much of your valuable time in cultivating ground
that has been well plowed and harrowed before.

When physicians can be found — and especially editors, who
ought to be leaders in sound medical thought and opinion — to take
the position of our Kansas City friend, then, I repeat, there is still
room for much agitation on this subject.

It will be observed that I have not advocated a complicated
technique, with never-ending formula for chemical solutions, and
complicated rules for their use that nobody could be expected ta
obey ; but a simple plan that anybody can carry out in the tene-
ment house, cottage, or mansion. But I detain you too long.

In conclusion, I beg to submit the following summary, embrac-
ing the principal points for discussion evolved in this paper :

1. — Obstetric engagements once accepted should be faithfully
fulfilled, no matter how awkwardly they fit. Apply the same rule
of cleanliness to rich and poor alike. Decline service when this
cannot be done. Human life is too precious to jeopardize it by
slip-shod, half-hearted, or indifferent service.

2. — The physician should be a model of cleanliness in body and
clothing, and should insist upon the observance of similar condi^
tions by all persons in and about the lying-in chamber.

3. — The delivery room, whether in hovel or palace, court, alley



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CLINICAL LSCTUBS. 19

or aveiiQ^ should be simple in its f arnitare and hangings, and be
cleaned with soap, water, and whitewash (if possible to use the
latter) immediately before occapancy by the paerpera.

4. — The delivery bed should consist of a new tick filled with'
sweet and clean straw, covered with a blanket, impervious dressing
and a folded sheet, with other clean covering to be allowed, accord-
ing to season. Exceptions to this simple bed should be as few as
possible, and in no event should a bed be substituted that has been
used by the sick, or that is not beyond even a suspicion of infec-
tion.

5. — The patient should be specially prepared for delivery by
baths and enemata, vaginal douches, and clean clothing; and
labor should be conducted on the lines of absolute cleanliness, with
few digital examinations, and a complete delivery of the secun-
dines.

6. — Lesions of the genital tract should receive careful atten-
tion ; rents of the perineum should be repaired, and so, too, in
some instances should tears of the cervix.

7. — Antiseptic solutions containing a germicide should be used
for cleaning the hands and instruments of the operator. Intra-
uterine irrigation with sterilized water should be carefully em-
ployed after operative midwifery, either manual or instrumental.

8. — Finally, if sepsis proceed to suppuration and abscess, the
abdomen should be opened, pus cavities emptied, irrigation used,
and drainage established. If the uterus and adnexa become thor-
oughly infected, they should be extirpated.

284 Franklin Street.



(^flnieaf Iseefure.



EXPLORATORY LAPARATOMY— PREGNANT UTERUS.

Bt MATTHEW D. MANN, M. D., Buffalo, N. Y.
Delivered at the Buffalo General Hospital, February 10, 1801, (Reported by A. L.

BENEDICT, M. D.)

A PATIENT was brought to me last week from out of town, the
physician stating that while he did not know exactly what the
condition was, he was quite sure that laparatomy ought to be
done at once. He thought so from the severe pelvic pain that the
patient suffered, from numerous hysterical and nervous symptoms
which prevailed, and from a long history of invalidism. I



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20 CLINICAL LECTURE.

examined the patient without being able to satisfy myself as to the
nature of her trouble, and I told the doctor and the patient's
friends that the only way to reach a certain diagnosis was by
examination under ether. With their consent, I made a careful
examination, and even then I was not able to recognize very much,
but it seemed to me that right in front of the cervix was a soft
cystic mass. I was very much at a loss to account for this. It
did not seem to be anything inside the uterus, for the cervix had
been dilated forcibly within a short time, the cavity had been
curetted, the sound had been passed, and every evidence had
showed that the uterus was empty. The cervix was hard and
firm, the patient was flowing somewhat at the time, and she had
menstruated only a short time before. I told the friends simply
that I could not determine what the condition was.

As the symptoms were very severe and the friends and the
patient herself were very urgent, I told her that I would make an
exploratory operation. Last Tuesday I opened the abdomen, and
when I did so, I came down upon a mass, a cyst apparently, which
had neither the color nor the appearance of an ovarian cyst, and on
pulling the omentum up over it, it struck me at once that it was
the uterus. I therefore enlarged the incision sufficiently to admit
my whole hand, and, to my astonishment, I found that the woman
was pregnant, and that I held in my hand a pregnant uterus of
the fourth month. I recognized this by passing my hand around
the uterus; but even when I had the abdomen open and the uterus
in my hand, it was so soft and placid, and apparently so thin-
walled, that it was difficult to recognize it. It did not feel much
more consistent than intestine. It was owing to the extreme
placidity that I had not recognized it by bimanual palpation even
with the patient under ether.

Having recognized the condition, there was nothing to do but
close the wound, and the woman had not much more reaction than
if I had not done anything. She had no elevation of temperature
until Sunday night, when it suddenly jumped up to 106 degrees
without apparent cause. She had a violent chill and then she
began to have pains, and about nine o'clock the house-physician
telephoned that the fetus had come away. I came over and
found the os fully dilated, with the placenta adherent. I there-
fore got it out with placenta forceps and washed out the uterus
with a sublimate solution. The management of the abortion was
a little complicated by the tenderness of the abdomen, due to the



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CLINICAL LECTUBE. 21

laparatomy. It was utterly impossible to make bimanual palpa-
tion and press the fundus of the uterus down in order to get my
finger up into the uterine cavity to separate the placenta. I was
therefore obliged to pull the placenta out with the forceps, bit by
bit, instead of enucleating it with the finger first. I could not
even pull down the cervix with the rulsellum, because I did not
want to put any indirect traction on the abdominal wound.

As far as one can judge from the appearance of the fetus at
this period of pregnancy, it had been dead some time. The
woman has been flowing for some weeks, with a brownish dis-
charge. The placenta does not look like the placenta at term,
and it is well for you to see and feel it.

It may seem strange to you that anybody with experience in
examining the pelvic organs in women should have made such
a mistake. All I can say in extenuation is that the mistake has
been made by almost every operator of prominence in the world,
of opening the abdomen for some abnormal condition and finding
pregnancy. The mistake has been made dozens of times, and it
will be made dozens of times in the future, because it is some-
times impossible to diagnosticate pregnancy. In this case the woman
had had no symptoms of pregnancy. That matter had been dis-
cussed somewhat and thrown out of consideration. It was not
suggested to me, and I did not even think of it. The uterus had
been curetted within three or four weeks, the sound had been
passed, the woman had menstruated shortly before. I think that
almost anybody would have made the same mistake, although
some might have been in doubt and might have waited, but I
anticipated no trouble from the laparatomy, and I therefore per-
formed the operation. Under similar circumstances, I think, I
should do the same thing again. The exploratory laparatomy,
properly done, can do little harm ; there is not one chance in
300 of the woman's dying if it is done under proper conditions.
The laparatomy had nothing to do with the miscarriage nor with
the rise of temperature. I have seen such a high temperature
several times occurring for an hour or two before the abortion
begins. It seems to be of nervous origin; it is not septic, because
as soon as the abortion gets well under way the temperature goes
down and does not recur. I think I have seen some reference to
this phenomenon in some journal.

The main lesson which this case teaches is the importance of
recognizing the uterus when we find it. I do not want to



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22 SOCIETY PROCEEDINGS.

call attention to anybody else's mistakes, but I must refer to a case
which I once heard of. A practitioner thought he had an ovarian
cyst to deal with. He opened the abdomen, and without
endeavoring to ascertain the nature of the tumor which he came
upon, he thrust a trocar into the cyst and then a fetal hand pro-
truded through the trocar opening. He then enlarged the opening,
delivered twins, and did Porro's operation. I have no doubt he
did it correctly, but the woman died subsequently of peritonitis.
I did not blame him for opening the abdomen. I have three or
four times opened the abdomen and found pregnancy, but always,
except in this case, with some abnormality to cover it up. It
seems to me a man ought to be on his guard, not so much against
opening the abdomen and finding a pregnant uterus, as against
injuring the pregnant uterus because he neglects to make out the
condition of affairs by careful examination of the abdominal con-
tents with his hands. Our patient will doubtless make a good
recovery.

Note. — Recovery followed as anticipated.



MEDICAL SOCIETY OF THE COUNTY OF ERIE.

SEMI-ANNUAL MEETING, JUNE 13, 1893.
Reported by ELI H. LONG, M. D., Secretary.

Meeting called to order in the rooms of the Buffalo Academy of
Medicine, at 10.45 a. m., by the President, Db. John Pabmenteb.

The minutes of the annual meeting and of the special meeting
of April 20th, were read and adopted.

The Committee on Membership reported favorably upon the
following-named physicians, and upon motion, duly made and sec-
onded, they were unanimously elected to membership : Albert F-
Erb, Edward L. Frost, Franklin C. Gram, George J. Heame, Geo.
A. Himmelsbach, H. Corwin Jones, Chas. E. Long, Edward J.
Meyer, Ferdinand G. Mochlan, Duncan Sinclair, James Stoddart,
Clarence A. Tyler, G. W. Wende, J. F. Whitwell, Edward R.
Wiser.

The committee could not report upon the following, as they
had not yet exhibited their diplomas to the committee : Charles
H. Perry, Francis Metcalfe, Cyrus S. Siegfried.



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MSDICAL SOCIETY OF THE COUNTY OF EBIE. 23

Applications by the following-named physicians for membership
in the society were read and referred to the Membership Commit-
tee : A- W. Bayliss, Horace Clark, Francis A. Drake, Chas. S.
Jewett, Ada C. Latham, Albert T. Lytle, Harry Mead, DeWitt H.
Shennan.

The President made an informal report concerning the library,
to the effect that progress was being made in locating the same in
the new library of the University of Buffalo.

The committee on revision of the by-laws, appointed at the
special meeting, held April 20th, presented and read the proposed
amendments, which, according to rule, were held for action at the
next regular meeting.

Communications were read from the Medical Society of the
State of New York, reporting list of officers, chairmen of commit-
tees, etc., and from the Central New York Medical Association,
announcing the next annual meeting to be held June 16th, in
Rochester. The resignation of Dr. P. W. VanPeyma, from the
Board of Censors, was read, and upon motion having been made
and seconded, the same was accepted.

The Secretary moved the matter of filling the vacancy upon
the Board of Censors be postponed until the regular time for elec-
tion. Carried.

It was moved and seconded that an order be d^awn for the
Bum of $20.00, in favor of Dr. J. F. Krug, to reimburse him for
payment of bill for legal services required by the Board of Cen-
sors. Carried.

The Society then proceeded to the scientific part of the day's
programme.

The discussion on the Use of the Metric System was introduced
by the report of the Committee on the Metric System. Dr. Bene-
dict, as chairman, reported at some length in reference to the
extension of the use of the metric system in foreign countries. He
also presented the following resolutions, which, after discussion by
Drs. Rochester, Long, and Benedict, were adopted :

BESOLUTIONS.

Whereas — We, the members of the Medical Society of the County
of Erie, believe that the increasing use of the metric system by physi-
cians, warrants a more formal recognition than has hitherto been
accorded ; and

Whebeas — ^We believe that the metric system, in addition to the



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24 SOCIETY PR0CBSDIN6S.

theoretical advantages common to all decimal systems of denominate
numbers, provides units of practical size and conveniently correlated.

Resolved — That yve recommend the use of the metric system to
physicians and pharmacists in particular, and that, to render its gen^
eral employment feasible, we approve of the thorough teaching of this
system in educational institutions, both professional and academic ; and

Resolved— ThsX copies of these resolutions be transmitted to the
President of the Erie County Pharmaceutical Association, the Superin^
tendent of Education of the City of Buffalo, the University of Buffalo,
the Medical Department of Niagara University, and the Buffalo
Medical and Surgical Journal.

At 12.15 a recess was taken until 3 p. m.

AFTERNOON SESSION.

The society was called to order at 3.15 by the President.

The following memorial of William D. Murray,M. D., was read
by Dr. R. C. Taber, of Tonawanda :

Dr. William D. Murray was born near Lockport, Niagara county.
N. y., September 1, 1833, and died at Tonawanda. February 23, 1898.
a span of three score years, lacking six months. He was reared on his
father^ s farm, and as a school boy walked to and from the Lockport
school, a distance of four miles, rather than content himself with the
limited advantages offered nearer home.

Later, w^ find him devoting the winter months to school-teaching,
returning to the farm work during the summer season.

He early decided upon the practice of medicine for his life-work^
and entered the office of Drs. Fassett and Kittinger, at Lockport.
Actuated by a persistent spirit and a love to gratify his work-habit, he
became a close student and observer. At the age of twenty-six years,
armed with the degree of M. D., conferred by the Columbia Medical
College, of Washington, he started out in his career— practicing medi-i
cine in Tonawanda, Erie county.

In 1861, he was commissioned Assistant-Surgeon of the 100th New
York Volunteers, serving honorably under his old preceptor, Dr. Kit.
tinger, until his discharge, after which he returned to Tonawanda,
to practice more effectively with the knowledge thus acquired in this
practical school. His career was marked by a constant application of
his best eflforts, always at work, never lured from his path by glitter^
ing promises in other fields, backed up by a robust physique and a wiU
lingness to do, he soon found himself in the list of successful practi-
tioners, a representative citizen, in touch with all classes and interests,
one whose presence is felt in the community and in the councils of hia
townsmen, as well as at the bedside.

His efficient work in the Educational Board of his native town has



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MEDICAL SOCIETY OF THE COUNTY OF ERIE. 25

been appropriately commemorated by giving his name to the beautiful
school building which has grown up under his administration.

He was one of the original members of the New York Medical Asso-
ciation. He became a member of this society in 18 — , and he will be
remembered as one who took an active part in the councils which
brought forth the Fee List of 1871.

At the time of his death he was a member of the Masonic frater-
nity, a very active member of the Grand Army, and Surgeon of the
25th Separate Company of the National Guard.

But the sturdy, robust, and genial worker is gone, and we are again
reminded of the limitations of our art and admonished to so conduct
pur affairs, that when the hour strikes for us, we will find placed to
our credit as many virtues as were possessed by our late fellow, Dr.
Murray.

Moved that the memorial be received and incorporated in the
minutes. Carried.

Dr. Irving M. Snow then read a paper upon A Gastric Neuro-
sis in Childhood. The paper, with reported cases, proved to be of
great interest to those present, and discussion was freely partici-
pated in.

Dr. A. A. HuBBBLL asked consent to introduce a motion at this
time, to the effect that Drs. Benedict, Crego, and Thornbury be
elected delegates to the Central New York Medical Association, in
addition to those who had been appointed. Consent was given,
and the motion was carried unanimously.

The remainder of the programme consisted of the following
papers upon Renal Insufficiency : Diagnosis, by Dr. Allan A.
Jones ; Treatment, by Dr. DeLancey Rochester. The papers were
regarded as possessing special merit, and the subject was further
discnssed by Drs. Hayd, Bartlett, Pryor, and Long.

Dr. Rochester moved that the secretary be authorized to issue
proofs of the By-laws, as reported by the Committee on Revision,
for use of the members at the next regular meeting. Carried.

Adjourned at 5.40 p. m.



Parasitic Origin op Cancer. — The facts showing that there are in
the cells of cancerous tumors small parasitic bodies of the nature of
protozoa, are continually accumulating. Dr. James Galloway, in the
Morton Lectures, reports the results of his studies of the life history of
analogous organisms in rabbits. He confirms the statements of Raufifer
and others, to the effect that the peculiar protozoa of cancer may bo
found in all the tumors.



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3d BOOIBTT PROCEEDINGS.

PHILADELPHIA COUNTY MEDICAL SOCIETY.— DIS^
PUTED POINTS IN HYSTERECTOMY.^

By JOSEPH PRICE, M. D., Philadelphia.

The mooted questions in surgery grow less as our experiences
enlarge and ripen. There is in our science and art some certainties,
some points upon which there is unanimity of enlightened opinion.
There is however, also, as in all other sciences and arts, as in all other
lines of human enterprise and endeavor, disputed points ; disputed,
we must take it, from the standpoint of conscientious opinion.
These differences are the chief factors, the motor forces of our
advances. Without them inertia would take the place of our activi*
ties. The fact of our advances is not disputed ; the lines along
which they have been made, direct the way of interesting and
instructive study. We have a profound interest in the names and
work of those toiling pioneers who have blazed the trees for our
guidance to lessen the difficulties of our following. What they
have done for womankind will always lie beyond the power of
biographical pen to narrate. We would find it difficult to dis-
tribute our debt of obligation when we come to consider the great
labors, the brilliant work of McDowell, Kimball, and the Atlees,
of P^an, Keith, Koeberle, Hegar, Billroth, Kaltenbach, Kleeberg,
Schroeder, Lawson Tait, Bantock, Thornton, and others. We
find stimulus in such names and such records for worthy follow*
ing. They have given us the sublime lessons of their experience.
What masters they are — all of them ! They represent the genius
of science, of practical skill ; they have enlarged our resources ;
they have helped us to make many lives worth living. Some of
these men are living today, are yet giants at the wheels, yet
students in the solution of great surgical problems.

In considering the definitions of hysterectomy we must bear
in mind nomenclature. Schroeder's term, myomotomy, is not
synonymous with hysterectomy ; is not hysterectomy ; it more
appropriately applies to simple extirpation of the tumor. Hyster-
ectomy is the removal (Kimball's operation) of the whole body, or
any section of the uterus, with tumor inseparable therefrom.
Such high authority as Thornton places within its field all cases
in which the uterine cavity is laid open and more or less of its
wall removed along with the fibroid ; whether one or both ovaries
is also removed, is a matter of no consequence. Sometimes it is



1. Read Aprilia, 1893.



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PHILADBLPQIA COUNTY MEDICAL SOCIBTT. 27

more convenient to remove one or both, applying the term vaginal
hysterectomy to cases in which fibroids, the utemay and the uterine
appendages are all removed.

The progress made in perfecting the operation has taken some



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 3 of 78)