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J. A. (Joel Asaph) Allen.

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cine, April 94, 1894.



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724 CLINICAL BKPORTS.

normal. Family history good. Physical examination shows moist
rales throughout lung and some edema. Examination of urine
showed specific gravity 1010, no* sugar, albumin so abundant that,,
upon boiling, the urine became so solid that it would not run
from the test-tube when inverted. Hyaline and granular casta
abundant. By the use of cathartics, diuretics, hot baths, and milk
diet, the amount of urine was increased, the albumin diminished,,
as was also the edema of extremities and lungs, with consequent
improvement of the cough and the wellbeing of the patient gen-
erally. On the evening of July 4, 1892, she was delivered of a
healthy child, the labor being normal, and chloroform adminis-
tered. After the birth of the child, the patient seemed less bright
than before, but there were no convulsions. The next day,.
July 5th, the patient was not quite clear in her head, but
seemed to be somewhat improved mentally, had passed her water
freely, which, upon examination, showed much albumin and alsa
casts.

The second day after delivery, July 6th, I was summoned early
in the morning, on laccount of her having had a convulsion. I
found her comatose, breathing stertorously, face livid, lips and
nails blue, and with a rapid, full pulse. My brother. Dr. Eli H.
Long, now saw her with me. By the use of full doses of chloral,
oroton oil and the steam bath, further convulsions were prevented,
but the condition of the patient was so unpromising that an
unfavorable prognosis was made. The condition of the patient
gradually improved, however, but her mind was clouded for at
least two weeks. She was soon up and about, and after a couple
of months resumed her avocation of conducting a stall for baked
goods on the market. The albumin in her urine diminished and
she soon appeared as well and hearty as ever.

I warned her husband and herself of the danger which would
be incurred in the event of her becoming pregnant again, and
cautioned her to be careful of exposure to wet and cold, etc.

About September 1, 1898, 1 was informed by Mr. T. that his
wife was again pregnant and about three months advanced. I
obtained a sample of urine for examination, and found it normal
in every particular. Frequent tests, at regular intervals, showed
the urine always to be normal. The patient was delivered of her
third child, February 27, 1894, by a precipitous labor, the child
being born upon my arrival at the house. The child was healthy,
but small, and the mother made an excellent recovery, with no



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MEDICAL SOCIETY OF THE COUNTY OF EBIE. 725

untoward symptoms. Frequent urinary analyses after labor
showed the urine to be normal, save on the second day only a
trace of albumin was found.
620 Elmwood Avenue.



THE MEDICAL SOCIETY OF THE COUNTY OF ERIE.

Reported by FRANKLIN C. GRAM, M. D.. Secretary.

The semi-annual meeting of the Medical Society of the County of
Erie was called to order at 11 o'clock a. k., on Tuesday, June 12,
1894, by the President, Wm. H. Gail, M. D., at the rooms of the
Buffalo Academy of Medicine.

In opening the proceedings the president stated that as he had
not been present when elected to office he would take this oppor-
tunity to thank the members for the honor conferred on him. He
then called for the reading of the minutes of the annual meeting
beld January 9th, and the special meeting held January 23, 1894.
These were read and confirmed.

Dr. G. W. McPheeson, of the committee on membership,
reported favorably on the names of Drs. Ludwig Schroeter, William
<7. Taylor and Helene J. C. Euhlman. They were unanimously
elected members of the society. He also reported favorably upon
the names of Drs. Wm. Meisburger, Maud J. Frye and Wm. C.
Fritz, but stated that he had not been able to obtain the signatures
of the remainder of the committee to the applications. On motion
of Dr. Abbott these three applicants were also elected to member-
ship, subject to the committee's completion of the necessary for-
mality.

Applications for membership were received from Drs. N.
Victoria Chappell, Albert H. Macbeth, G. B. Hepp, Charles A.
Clements, Wm. G. Bissell and Arthur T. O'Hara. They were
referred to the committee on membership.

Dr. W. C. Callanan moved for the appointment of a committee
of three to draft a circular to be sent to all members, asking them
to donate medical works to the society's library. The motion was
adopted and the chair appointed Drs. Callanan, Eli Long and the
Secretary.



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726 SOCIETY PROCEEDINGS.

Dr. John J. Walsh moved that this society endorse the bill
relative to the office of coroner, now pending before the constitu-
tional convention. Carried.

[papers were then read on The Purely Physical Examination of
the Digestive Organs, by Dr. A.L. Benedict ; Treatment of Neu-
rasthenia, by Dr. Wm. C. Kranss ; Clinical Experience with
Smallpox During the Epidemic of 1888-9, by Dr. C. B. Le Van,,
ex-resident physician to the Buffalo Quarantine Hospital. Dr.
McPherson also read an original poem.

A discussion followed, after which a vote of thanks was ten-
dered to the essayists.

The secretary reported that he had received a communication
from the Medical Society of the State of New York calling atten-
tion to the fact that the Medical Society of the County of Erie is
now entitled to six delegates in* the State society instead of five as
formerly ; also that the president of each county society is now an
ex-officio member of the State society. He had also been requested
to call the society's attention to the Merritt H. Cash prize for the
best original essay on any medical or surgical subject The con-
ditions are that the competitor must be a member of a county
medical society in this State, and the essay must be sent to the
chairman of the committee, Dr. Franklin Townsend, 2 Park place^
Albany, prior to January 1, 1895. The secretary reported that the
by-laws and membership list of the society had been printed and a
copy mailed to each member.

There were no reports from the board of censors or from the
committee on hygiene.

The treasurer called attention to a resolution adopted at a pre-
vious meeting, by which all members who are three years in arreara
with their dues will be dropped from the list

Dr. Eli H. Long reminded the society that the Central New
York Medical Society would meet in Buffalo next October, and
that it will be necessary to appoint delegates and also to make
arrangements to entertain the society. Dr. Bartlett stated that
much valuable time had been lost at other places through formal
dinners and thought that a luncheon would be better. Other mem-
bers concurred in this opinion, and on motion of Dr. Krauss the
sum of *50 was appropriated for this purpose. The chair appointed
Drs. Krauss, Benedict and Eli Long as the committee to make the
necessary arrangements.

The society then adjourned.



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INTRA-PELYIC AND ABDOMINAL DISEASES. 727



^ePecfionA.



SURGICAL PROBLEMS IN INTRA-PELVIC AND ABDOMI-
NAL DISEASES.

Bt a. H. CORDIER, M. D., KanMis City, Mo.
[From the Kansas City Medical Recorder^ March, 18(M.]

Some time ago, while doing special work in a large Eastern city,
I had many opportunities to see the work of the various operators,
and it was a noticeable fact that, while one operator would have a
mixture of the worst neglected and complicated cases imaginable,
including old adherent and caseous Fallopian tubes and ovaries in
emaciated and septic patients, another operator's cases would be
confined to the removal of cystomas and plastic vaginal and cervi-
cal cases. This led me to inquire of one of the operators why he
did not have so many *< pus cases " as some of his confrh'es. He
replied that he believed that " the woods are not full of them," as
some would have us believe. A few days later I visited this same
gentleman's clinic, which is a large one, and in two hours I found
six pairs of old, sequestrated Fallopian tubes, full of pus, carried
around by six of the most careworn and miserable-looking women
imaginable. They had their vaults frescoed with Churchill and
were directed to return for another decoration the following week.

Conservatism is a grand principle, but, unfortunately, in the
hands of skilful men the application of this rule is only too fre-
quently responsible for destructive or complicative delays, if I
must use such a term. Conservatism is a prophylactic if early and
intelligently carried out or applied. It is equally injurious if used
with this same idea in view, in cases where time and experience
have demonstrated its futility.

Occasionally an article appears in some of the many valuable
medical journals of our country, entitled A Plea for Conserva-
tism, etc., etc. That these articles are well worded^ by conscien-
tious practitioners, in most instances, no one will doubt, and to
one unaccustomed to seeing the true pathology from a practical
standpoint, they carry with them weighty evidence that, with rare
exceptions, all surgical procedures for the relief or cure of same
are unnecessary and unwarrantable ; but to him who has handled
these cases surgically, and understands their progress, the position
of the so-called conservative is not well taken. Many are attempt-
ing to do this class of surgery (pelvic) who have not the anatomi-



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728 SELECTIONS.

cal or pathological knowledge or practical experience to enable
them to make a diagnosis between an operable or non-operable
case. To this class, sermons on qualifications and attainments
should take the precedence of lectures on operative conseryatism.

Good missionary work is being done in this field by educating
the general practitioner and the specialist that they should go
hand in hand in their work. By friendly discussions and exchange
of views on topics of vital import to both, the patients reap the
benefit of the combined council.

We have men of renown in this country as operators and
authors, whose utterances along the line of so-called conservatism
are producing much mischief and causing many deaths by the
adoption of these false doctrines by lesser lights. After seeing
much of the work of some of these men, I am surprised to see
some of their ideas in print so foreign to the practice actually
pursued by them in their work.

One is almost tempted to doubt the sincerity of some of their
titterances.

We should advise against the removal of sound organs, but, at
the same time, endeavor to impress upon our associates the neces-
sity for early surgical work where experience with like cases has
demonstrated the, futility of any other course.

Operations for the removal of diseased appendages are not fol-
lowed by the same amount of reflex disturbance as are those cases
where sound organs are removed to cure (?) a clavus hystericus or
a globus hystericus, etc., etc. — an unwarrantable procedure. Most
women with suppurating, diseased tubes and ovaries are unsexed
by the pathology, and I have had women with these diseases at
an age too early for a normal menopause, to present all the
climacteric phenomena. In many cases it is not a question of,
^' Will this woman have an exaggeration of the menopause pheno-
mena if we operate ?" so much as, "Will she be free from pain
after the operation, and can she recover without the aid of sur-
gery ? " These questions have been answered many times, both
by non-interference in the cases, with failures and by demonstra-
tions at the operating-table, — the successes. Women whose append-
ages are diseased to such an extent as to require removal are sick
women, and are necessarily in that low vital state that where there
is an inherent tendency to insanity or neurasthenia, the surgical
procedure for the removal of the diseased structures may precipitate
the mental phenomena to an exaggerated and disagreeable degree.



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INTRA-PBLYIC AND ABDOMmAL DISEASES. 729

If we are not to remove life-endangering and comfort-breaking
pathological processes when found, pray tell us what are we to do ?
Fold our hands and let nature (pathology) take its course ? Or do
worse, visit these cases with poultices, Churchill and hypodermics?
We can illy afford, as true surgeons, to cater to the plea that the
poor sufferer will be robbed of her womanly traits ; that she will
be despondent, lose her sexual desires, suffer from flushes and
flatulence, and that her husband (too often responsible for the
wife's sufferings) will become dissatisfied with the post-operative
condition of his wife. I have never seen a woman suffering with
diseased appendages, where the disease was of sufficient severity to
require the removal of the organs, who was not a sexually useless
and despondent wife, and a sick woman .as well. Sound organs
should not be removed. Any condition that may be induced by
the surgical procedure may likewise be induced by a continuance
of the disease requiring the surgery.

I believe the sexual system is located elsewhere than in the
tubes and ovaries. The nymphomaniac manifests not only an in-
creased sexual desire, but a loss of self-control, often with halluci-
nations and delusions, the whole cycle having its origin in the
cerebrum.

Radicalism is a dangerous expression to use ; equally harmful
is the term conservatism applied to a disease the tendency of
which is to destroy function, make life miserable or produce death
if too long a delay of a proper procedure for its cure is permitted.

Many cases early in the history of the malady are prematurely
cured by intelligent and skilled surgery. The same case, if allowed
to run an uninterrupted course for any length of time, may assume
proportions or characters of such magnitude or danger that to
attempt to relieve the same would not only be fraught with danger
from the operation, but the crippled surrounding organs would
preclude the possibility of a complete restoration to health.

These are cases that bring disappointment to the patients and
friends, as well as to the sanguine ))hysician and surgeon, run up
the mortality and give surgery a " black eye."

It is the early removal of diseased structures, the history of
which is to continue a downward course, that gives us a nil mor-
tality, the patient renewed health and the family physician in-
creased confidence in the justifiability of the operative procedure.

Early operations are not only curative measures, but prophy-
lactic methods as well. It is not only the diseased and worse than



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730 8ELBCTIOKS.

useless organs and structures the true abdominal surgeon is remov-
ing, but he is liberating sound imprisoned organs, the function of
which is essential to life. This is not only life-saving work, but
a comfort-giving procedure. No true surgeon is clamoring for a
thousand or ten thousand laparatomies, but is ever pleading for
timely needed work — is ever pleading for the recognition of the
necessity for quick surgery in cases where surgery at some time in
the history of the malady becomes necessary.

No one at this time would think of advising a woman to wait
until the growth was so large or her physical condition such that
she could not walk a mile, before having the tumor removed, as
was done a few years ago by a great writer. This would be dan-
gerous conservatism.

It is as absurd to call the removal of a sequestrated Fallopian
tube and ovary a mutilation as it is to call an amputation of a
hopelessly injured leg a mutilation. These operations are per-
formed to fulfil strictly surgical indications — saving life and
relieving suffering. It is a daily occurrence to see reported that a
case diagnosticated as appendicitis has recovered. That this is true
no one will doubt. Many cases reported as recovered have since died
from recurrence of the disease, and many an appendix, supposed
by the medical attendant to be dangling healthfully in the peri-
toneum of his patient, is saturated with Muhler's fluid or alcohol^
in a specimen jar, while the patient has long since died from a per-
foration, or has been saved by good, timely surgery. No opera-
tion in surgery has a higher mortality than that of the delayed
operations for the removal of a diseased vermiform appendix, but
if done early, the procedure has an almost nil mortality. A late
writer reports twelve cases treated on the expectant plan with two
deaths (16 per cent, mortality) and two cases with recurrent attacks
(16 per cent, of recurrences). The writer says of the two wha
died that they were almost in articulo mortis when first seen by
him. He does not tell uh whether he put on a fresh poultice and
hid from view the big abscess bulging in the right iliac fossa, or
gave the patient an extra dose of opium to relieve the pain of the
patient and obtund the senses of the doctor. These cases should
have been seen by a good surgeon, who would have stopped all
opiates and let out the pus, applying the same surgical principles
to this locality as to other parts of the body. " When you find
pus, let it out." Appendicitis is a surgical disease, and the sur-
geon should see the case with the physician as soon as the diag-



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INTBA-PELVIC AND ABDOlflNAL DISEASES. 731

nosis of appendicitis is made. Let the physician and the surgeon
watch the case together.

The modern application of the principles of surgery as applied
to diseased Fallopian tabes is the same that has been practised for
ages as applied to the surface of the body. A felon is lanced — the
earlier the better. The good surgeon does not advise delay and,
while waiting, paint the finger with Churchill or apply hot irriga-
tion. As soon as evidences are present that pus is forming, he
lets it out.

How thankful the abdominal surgeon would be could he lift
up a pus-filled Fallopian tube without entering the peritoneum,
" rip it up the back" (as suggested by a late writer), scrape it out,
destroy all the remaining epithelium, and by redressing it restore
its caliber so that the spermatozoa may throng its canal and preg-
nancy take place, just as though this culture tube had not been a
hotbed for gonococci and other pathogenic bacteria for months
previous.

All cases of salpingitis are not operable cases, but the majority
of cases seen by the specialist are old purulent cases with tubes
filled with pus and caseous debris strictured in one or more places,
uterine and abdominal ostii closed. Here it is conservatism to re-
move these dangerous sequestrse.

Hardly a week passes without seeing one or more cases of far-
advanced cancer of the cervix uteri extending into the broad liga-
ments, bladder or rectum. These are inoperable cases when so far
advanced. Again, I see cases where a diagnosis of a cauliflower
growth has been made, which proves to be a badly lacerated cervix,
with the resulting local mischief attending an unhealed tear in this
locality. Surgical diseases should be attended by the surgeon in
conjunction with the regular medical attendant. The time to
operate, if necessary at all, could then be arrived at muttuilly and
timely.

When the masses are educated in every sense, when gonorrhea
is stamped from the face of the globe, when the perniciousness of
criminally induced abortions and the dangers of the indiscriminate
use of the sound are understood, then there will be less necessity
for the practitioner to hurl at the specialist his "bucket or barrel
of ovaries" (?) ; then the specialist will cease his cry against need-
less tinkering and dangerous procrastination; then our women
will have their babies at full term, in the good old way. Until
this goal is reached, the use of the knife will be found necessary in



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732 SELECTIONS.

properly selected cases to relieve the suffering and save the lives
of these unfortunate women with diseases the result of the above
mentioned causes.



A CASE OF EXTIRPATION OF THE RECTUM BY THE
KRASKE METHOD.

Bt dr. X. O. WERDER, Pittsburg.

I WISH to present to you a brief report of an extirpation of the
rectum by the sacral method, or Eraske operation. The patient,
John C, 43 years old, was perfectly healthy until about eight
months ago, when he was seized with a very profuse hemorrhage
from his bowels. A month or so later he had considerable strain-
ing at stool, with bloody discharges, returning at short intervals.
These attacks were treated as dysentery. Between these paroxysms
of tenesmus, accompanied by mucous and bloody discharges, he had
normal evacuations.

When I saw him in consultation, January 11th of this year, I
found on the interior wall of the rectum a mass, beginning about
one and one-half inches above the external sphincter, of oval shape,
and involving about half of the lumen of the rectum ; its upper
margin could hardly be reached by the examining finger. The
examination was not particularly painful and did not cause much
bleeding. There could be no doubt as to the nature of the
neoplasm, and extirpation of the rectum by Kraske's method was
advised.

The operation was performed January 16, 1894, in Mercy Hospi-
tal. The patient was placed upon his left side, in Sims's position.
An incision from the point near the anus was carried to the middle of
the sacrum, the soft parts detached from the left side of the bone.
The sacro-sciatic ligament divided, and then the coccyx completely
enucleated, and a section of the fifth, fourth and third sacral verte-
brae removed with bone forceps. The whole rectum was now fully
exposed and the organ separated from its attachments. As these
were exceedingly firm, at least over the anterior wall, in which the
neoplasm was situated, the enucleation was tedious and very diffi-
cult, and accompanied by considerable bleeding. After all adhe-
sions around the rectum had been broken up, a ligature was placed
around it above the cancerous growth, and the whole organ
removed, including the external sphincter. The artificial anus was
attached to the upper angle of the wound, immediately under the



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HEMATOMA OF THE OVARY. 738

remaining portion of the sftcrum, by sutures. The wound over
the sacrum and coccyx united by sutures, and the pelvis cavity
firmly packed with iodoform gauze, the ends allowed to protrude
at the lower angle of the wound where the anus had been removed.
The patient stood the operation well and rallied nicely from the
shock. His recovery was uninterrupted. He never suffered much
pain, and the highest temperature was 101^^. His bowels were
allowed to move on the seventh day. He was able to leave his bed
at the end of the third week, and left the hospital five weeks after
the operation. He is feeling perfectly well. The only inconveni-
ence he experiences is the fact of not having control of his bowels.
He is wearing an apparatus similar to a truss worn for an umbilical
hernia, which closes the artificial anus temporarily. Unfortun-
ately I was ignorant at the time of the operation of Gursuny's
device of twisting the end of the bowels, which is said to give a
sphincter-action to the artificial anus, thereby obviating the un-
pleasant result of such operation, %. ^., loss of control over the
action of the bowels. — Pittsburg Medical Heview,



HEMATOMA OF THE OVARY.'

Bt GEORGE H. ROH^, M. D., CatonsvUle, Md.

Abdominal surgeons not infrequently find, in extirpated ovaries,
small blood-clots, varying in size from a pea to a hazel nut. The
nature of these clots seems not very clearly understood. In most
cases they are believed to be due to excessive hemorrhage into the
Graafian follicle after rupture, and the escape of the ovule. This
view seems to me not tenable, because in not a few instances no
rupture of the follicle has occurred. Besides, the corpus luteum,
the successor of the ovule in the occupancy of the Graafian follicle^
frequently contains no blood. Indeed, the view seems not irra-
tional that hematoma of the ovary, no matter how small it may be,
should always be regarded as a pathological formation, having no
essentia] connection with the physiological process of ovulation.
In such a specimen as that here shown, in which the blood-clot in
the fresh state of the specimen was as large as a small chestnut^
we have to deal with a pathological condition. The specimen is
from a case of hystero-epilepsy of over eight years' duration, in
which both ovaries and tubes were removed by abdominal section
in 1891. The patient recovered, and has had no recurrence of the



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 73 of 78)