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J. A. (Joel Asaph) Allen.

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changes that result in the death of the patient, unless relieved by
appropriate means. Sometimes before the menopause, without
any apparent reason, or the result of any treatment, these growths
undergo involution, shrink, and completely disappear, except a
cicatricial tissue, and cause no further disturbance. Softening
may result from various causes, the most frequent one being preg-
nancy, due to the exaggerated nutrition of the uterus, which
occurs at this time. Fatty degeneration also occurs, although
rarely, and most frequently after pregnancy. Calcification,
although an unusual change, does occur. It is now a well-
established fact thM malignant degeneration of these growths
occurs, although formerly it was denied that this change ever
took place.

It is not, however, so much the changes that take place in the
fibroids themselves as the changes that occur in the adjacent
organs as the result of the pressure of these growths. And here
let me again state that the small tumor is just as likely to cause
complications as the large one. If the tumor be small and nodu-
lar, the complications come on early, due to the irregular pressure
upon the surrounding organs ; but if it be symmetrical, the compli-
cations do not appear until the tumor has attained much greater
dimensions.

The former class seems to be much more sensitive and intoler-
ant of interference than the latter, and any form of palliative
treatment may, at any time, light up symptoms not only urgent but
dangerous. The pain, due to pressure upon the bladder or other
surrounding organs, may be suflScient to render the life of the poor
sufferer unbearable, even though there be no organic change in
the structure of these organs. Pressure and irritation often cause
peritonitis, and, although it does not usually terminate fatally, it
renders the patient an invalid for life, and seriously complicates



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IN6BAHAM : UTfiBINE FIBROIDS. 77

any operative procedure. Tubal disease, in some one of its vari-
ous forms, is a frequent complication of fibroids, and this condi-
tion should be borne in mind when treatment is considered.
Organic disease of the heart is quite frequently a complication of
these growths, and although this is an indication for operative
interference, yet the fact of its existence tends to render the
operation more dangerous.

The most important question is, What shall be done for the
relief of this class of patients ? The use of ergot, to cause the
shrinkage of the growths, which was so popular a few years ago,
is rarely resorted to at present. The use of galvanism, which was
prominently brought to the notice of the profession by Apostoli,
and which was thoroughly tried by many faithful followers, has
been abandoned by nearly every one. At one time I used it quite
extensively ; in some cases causing a shrinkage of the tumor ; in
others, relieving many of the unpleasant symptoms, especially the
hemorrhage. Yet it is doubtful if the patients were relieved
more than they would have been by other means, such as tonics,
ergot, and the use of the curette. I had the opportunity, three
years ago, of observing its effects as used by Apostoli himself, and
the most that he did, or claimed for it, was the relief of the
symptoms, and this was done only in a portion of the cases, as
any one can readily appreciate when the complications are under-
stood.

Operative measures for the relief of fibroids have not generally
been resorted to, because of the great mortality resulting from the
attempt to remove the tumors ; and the results obtained by the
removal of the tubes and ovaries have not been as satisfactory as
could be wished. Yet, for the past two years, the mortality with
several operators has been small, and, no doubt, the time is not
far distant when a uterine fibroid can be removed as safely, by a
competent operator, as an ovarian cyst. I am well aware that it
is a much more difficult operation, but, with our improved tech-
nique, the removal is perfectly justifiable and the results satisfac-
tory. This may seem an exaggerated statement to many ; it cer-
tainly will to that class of physicians who advise patients that it
is unnecessary and too dangerous to have tubes removed that are
an inch or more in diameter and, probably, filled with pus.

At present, several methods for the removal of fibroids are
being used, but the ones that are attracting the most attention
are total extirpation, as practised and chiefiy brought to the



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78 BARTLETT I HOW SHALL WB TREAT SCARLET FEVER ?

notice of the profession at large by Dr. Martin, of Berlin, and, in
this country, by Dr. Polk, of New York, and the n^ethod of ligating
the ovarian and uterine arteries, and amputating the cervix and
leaving a small part of it. The latter operation was first brought
to the notice of the profession by Dr. Baer, of Philadelphia, and
is known in this country as his operation. It is claimed
for this method that it is easier to perform than total extir-
pation, and that it leaves the vagina in better condition, as
it does not take away any portion of it, and the support is much
stronger than when total extirpation is done. Either one of these
methods gives much better results, at the present time, than any
other manner of operating. Which one, if either, will finally be
generally adopted by operators, trial alone will determine. At
the present time I incline to the Baer method, although my
results with it have not been as good as with total extirpation. I
have done only two operations by this method, and both my
patients died; but I do not think it the fault of the method. Dr.
Baer has done this operation thirty times, with only two deaths,
both the result of other causes, and not due to the method of
operating. Prof. Winckel, of Munich, is reported to have done
this operation fifty-one times, with only one death. The method
of total extirpation, in the hands of Drs. Martin and Polk, and
some others, has given about the same results as those obtained
by Dr. Baer. Enough has been done to demonstrate that, in the
hands of competent operators, the removal of uterine fibroids, that
render the patient an invalid, is perfectly justifiable, and that the
mortality should not be above six or seven per cent. Some put it
even lower.



HOW SHALL WE TREAT SCARLET FEVER ?^

Bt FREDERIC W. BARTLETT, M. D., Buflfalo, N. Y.

The interrogatory is rather an unusual way to introduce individ-
ual opinions regarding practical proceedings in the treatment of
disease, and it signifies, in this case, that the essayist relates, with
timidity, his method and results, more with expectation of obtain-
ing information than a conviction that he has a more excellent
way than his fellow co-workers. It is, furthermore, not intended ^
in the brief time allotted to papers, to make any reference to the

1. Read at the annual meeting of the Medical Association of Central New York, June
16, 1803.



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BABTLKTT : HOW SHALL WE TREAT SCARLET FEVER ? 79

etiology or pathology of the disease. Newmarket imports no
coals. Briefly, then, I present my plan of dealing with ordinary
cases of scarlatina, more especially as regards disinfection, general
and local.

Given a case of scarlet fever, the treatment may be defined
under the following program :

1. Preparation of the apartment to be occupied by the patient.
This should be as isolated from the family as possible, preference
being given to an apartment upon upper or attic floor, not com-
municating with another. Carpets and all other movables, window
curtains, mattresses, etc., if the value is to be considered, removed,
and plain, wood chairs, old worn sheets, blankets, quilts, etc., substi-
tuted. If in the country, oat straw may be used for making the
mattress ; and in the city, in humble homes, planing mill shav-
ings answer very well. These should be sprinkled with turpen-
tine, solution of carbolic acid, ol. of menth. pip., and spirits of
camphor. The bedstead may also be sponged with glycerine, in
which some aromatic oil has been dissolved, which will, by its
affinity for moisture, always retain any infectious germs. The
patient's apparel should be selected from articles whose destruction
will be least noticed ; and, these preliminaries settled, he should
be placed upon the bed which, if he survives, will be his home
for two or three weeks. If the rash is perceptible, the first treat-
ment will be friction with the best pulvis sinapis, and this should
be repeated every fourth hour, removing excess after each appli-
cation with a napkin, moistened with a solution of bichloride
hydrarg., 1-8000 grains. If excess of temperature occur, it should
be met by antipyretics. If the throat, on inspection, is found to-
be inflamed, gargles of boric acid, two teaspoonf uls to the pint of
water, may be employed, or the same solution sprayed at frequent
intervals over the pharynx. Water may be allowed ad libitum.
For the protection of the cervical glands, an ointment composed
of hydrarg. bin iodide, grains, iii.; lanolin, Sii*9 should be applied
from mastoid to mastoid, including the trachea down to the
sternum, three or four times daily. The hair, if long, must be
shortened, and boys should be as closely clipped as possible, and
the head sponged once daily with a 1-8000 solution of hydrarg.
bichloride. Milk forms the preferable diet, but fruit, broths, etc.,.
may be substituted. The mustard frictions are to be used for
three or four days, or until the rash subsides, the object being to
invite the blood, with its contained septic material, to the cutane-



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€0 BA.BTLETT : HOW SHALL WE TREAT SCARLET FEVER V

ous surface, and thus lessen the amount in the viscera and glandu-
lar system. These means cooperate with Nature^s efforts, and all
experience shows that patients with well-developed eruption are
far less afflicted with dangerous sequelae. When the mustard
frictions are suspended, the patient is to be sponged morning and
■evening with warm carbonate soda solution, a half ounce to the
•quart of water, the applications to be followed by inunctions of
olive oil. This is the toilet for ten days or more. After that,
sponging once daily with soap suds, particular attention being
given to the axillae, groins, and interstices between the fingers and
toes.

The evacuations should be received in glazed vessels, and, per-
haps, bichloride solution, 1-4000, sufficient to cover the solid
deposits, is preferable to any other. A tablespoonful is sufficient
for urinary or liquid motions. These may at once be deposited
in flushing water-closets, but otherwise they should be retained
longer, and buried far away from the dwelling, or source of water
supply. For general disinfection and prophylaxis, sulphur fumi-
gation is, probably, preferable to any other agent. It is best
■effected by enclosing the powder in a small bag, made from cheese
cloth, and shaken in small amount over a hot stove cover, carried
through the house on a lifter. In this way it is thoroughly
<iiffused, and the fine dust is promptly ignited.

In place of rags or old linen, the supply of which is often soon
exhausted, tissue or closet paper, which has been sprinkled with
weak bichloride solution and then dried, may be substituted.
This destroys the disease germs, and is readily consumed. The
attendant should wear a close-fitting cap, so as to exclude germs,
and should occasionally wash the head with boric acid or other
disinfecting solution.

As a covering to the floor, roofing-felt, cheap and easy of
application, forms the best material. Siding paper will do. An
•excellent and effective germicide is flame, and this can be utilized
by laying strips of old newspapers in a large disused basin, through
which a stout wire has been thrust and bent at an angle. Holding
the paper in position by some sort of weight, and, by raising and
lowering the basin, the flame will consume all floating particles.
The care of the patient should be entrusted to not more than two
persons, and the garments worn by them, preferably cotton or
linen, should occasionally be thoroughly fumigated. Inter-
course of the patient with other members of the family should not



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BABTLETT I HOW SHALL WB TREAT SCARLET FEVER ? 81

be permitted before tbe end of tbe tbird week, and tbe apparel
should be thoroughly aseptic.

Among the most useful possibilities of the future, ozonized air
may be mentioned. I have had abundant proof, in many years'
experience, of its ejffect upon vegetable forms of life, to which, by
common consent, pernicious microbes are restricted.

In addition to antiseptic precautions heretofore described, I
cause to be attached, by safety pins to the clothing, over upper
sternum, a pad, three by three inches, composed of two or three
layers of flannel, and moistened several times daily with a liquid,
the formula for which is :

R.— 01. Terebinth § s.

01. Eucalyptus 5 s.

01. Menth. Pip C 5 s.

Tr. Iodine 3 ii.

Chloroform 5 8.

Spirits Camphor 5 s.

Acid Carbolic gr. x.

01. Olivae q. s. fr.

M. § iv. S. — Add 40 to 60 drops, three or four times daily.

These pads to be worn by all the members of the family. It
is specially intended for the children thus far exempted, so as
partially, at least, to protect the fauces from the lodgment of
infecting germs ; and, worn under the outer dress, I find this plan
a good one in diphtheria and whooping cough.

Enteroclysis. — The great success attending enteroclysis, or
flashing the colon, in dysentery, typhoid fever, and diarrhea, has
encouraged me to test the same treatment in diphtheria, measles,
and scarlet fever. There can be no doubt that the ptomaines and
bacilli may find refuge in the convolutions of the intestines, par-
ticularly in the colon, and if the special virus may be active for
months in clothing, furniture, etc., why not in these fructifying
localities, where temperature and culture fluids are so favorable to
constant development? There can be no question as to the trans-
mission of the disease by the evacuations, and this not only in
the acute stage, but many days after it has passed, and cutaneous
desquemation has, apparently, ceased. I adopt the same policy in
one condition as the other, and thoroughly irrigate the colon. The
patient is placed upon the right side, so as to gain advantage from
gravitation in tbe transverse colon. For a child, from two to ten



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82 BARTLETT : HOW SHALL WE TREAT SCARLET FEVER ?

years old, two to three pints of the solation, according to the fol-
lowing formula, is employed :

R. — Hydrarg. bichlo grs. ii.

Aq. Fontana , O. ii.

This is modified sometimes for children to half strength, and
is usually employed after the eighth day — sooner if there is diar-
rhea. In all the cas^s treated, I have never observed a baleful
ejffect from the mercurial, and the good results have been so
apparent that I can conscientiously recommend it. Of course,
boric acid, tannin, and other agents may be used and found
^fficifnt, but when one has been so fortunate as to lose no cases
in many years, treated by this special solution, he can well afford
to congratulate those who discover a plan, exempt from any possi-
ble ill-effect from the germicide used in solution.

A very important precaution in the treatment of scarlet fever
is the detection of kidney insufficiency. I provide for this pur-
pose a dropper, a small vial of nitric acid, and a test-tube. Every
^ay for four weeks I direct a test to be made, and if the urine
is permanently cloudy, or deposits albumen, I am promptly
warned. Generally, if this condition is early detected, it will be
iound amenable to treatment. If neglected, the probabilities of a
temporary or permanent cure are greatly lessened. Among the
more efficient means to be employed, is the moist hot pack, in the
manner here described.

Prepare the bed by covering the mattress with a rubber
blanket ; over this a padded quilt or woolen blanket, and fill four
to six pint or quart bottles with hot water, tying in the corks
with twine beyond the possibility of becoming loosened. Wring
a blanket from hot water and wrap the child in it, and place upon
the prepared bed. Then pack the bottles two or three on each
side of the patient, covering each well, and locating opposite
shoulders, hips, and knees. Cover all with a warm, dry blanket or
spread, and envelop the head in a napkin which has been dipped
in cold water, and which must be frequently renewed. Keep the
patient thus perspiring for twelve or more hours, and give water
freely. Avoid diuretics, such as digitalis, acet. potash, etc.,
and give, preferably, calomelas and jalap in appropriate and
repeated doses. I recommend, also, when obtainable, poultices
over the abdomen, made hj bruising the common chickweed, the
virtues of which, used in this manner, I accidentally discovered.



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BARTLKTT I HOW 8HA.LL WE TREAT SCARLET FEVER ? 88

I have seen a duld with distended scrotum and general anasarca
completely relieved m a few hours by this simple remedy. As
regards the hot pack, if perspiration is not induced, or, if induced,
the patient declines drinks of any kiad^ it should not be too long
contiiiued, nor if the temperature rises. Since I have adopted the
disinfecting plan, as heretofore described, I have been quite indif-
ferent as to internal medication. Regulating temperature and
diet, and otherwise promoting the comfort of the patient, has
seemed to meet all wants.

By pursuing the plan represented in this essay, I have rarely
had more than one case in a family, even where there was from
eight to twelve children. When the excellent hygienic directions
given by the State Board of Health of Michigan, which may be
obtained at any time from its secretary, Dr. Henry B. Baker, of
Lansing, are faithfully followed, or those lately issued by Dr.
Ernest Wende, Health Commissioner of Buffalo, there will be
slight risk of the transmission of the disease. When we consider
the great direct mortality from scarlet fever, the many sequelsB,
such as chronic otitis, with impaired or total loss of hearing, the
inauguration, not unfrequently, of acute and fatal nephritis, or its
ultimate development in the chronic forms, and other scarcely
less important pathological effects, we cannot fail to be impressed
with the great responsibility assumed when treating the disease.
Indifference or neglect are inexcusable. To be reminded in after
years that any of these misfortunes was due to lack of knowledge
of the best treatment, medical and hygienical, is a contingency we
should strive industriously to avoid.

I desire to briefly summarize the suggestions made in this
essay.

1. The hygienic directions in preparing the sick-room.

2. The local cutaneous treatment by dry mustard frictions,
followed by bichloride sponging, later by sodii carb. bath and
oil inunctions.

3. The breast pad, medicated as described.

4. Enteroclysis, with solutions hydrarg. bichloride 1 to 8,000
or 16,000, varying with the age of the patient.

5. The hygienic essentials as formulated by Drs. Baker and
Wende, and boards of health generally.

6. The moral obligations imposed upon the physician, far too
frequently ignored, to be faithful to his trust in every detail, upon
the intelligent discharge of which such important interests depend.



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84 BARTLBTT ! HOW SHALL WB TREAT SCARLET FEVER ?

Note. — Having been, so far as I can discover, the originator
of the treatment of dysentery, typhoid fever, etc., by intestinal
flushing with germicide solutions, notably and usually hydrarg.
bichloride, my published reports dating back to 1883, and being
interrogated often as to the method employed, I herewith define
it fully :

Place the patient upon the right side, and so that the back is
turned outwardly. Use suitable protectives for mattress.

Use, preferably, an Alpha syringe, or one in which exit tubes
are inserted, not fitted by screw attachments.

Dissolve the bichloride in a glazed vessel, never in a metallic
one. A half -gallon fruit jar is very good.

Make connection for the rectal tube by cutting off the small
bone finish from an ordinary number ten catheter (American) and
in an Alpha, push the cut end well back in exit end of syringe.
This makes a perfect connection.

Oiling the catheter, insert, at first, partially and gently, and
inject fluid slowly. Then, by careful manipulation, the catheter
may gradually be introduced its full length. In adults, insist on
using and retaining the full quantity, two quarts. With children,
permit the outflow. In very irritable children I often induce
partial chloroform anesthesia. As soon as the one or two quarts
used has been introduced, place the patient upon the slop jar,
rather than usual vessel, so as to accommodate the ejected fluids.
I have known serious annoyance from limited capacity. On
returning the patient to the bed, place on the left side, to obtain
gravitation of the contents of the transverse colon.

Treat all cases of colitis, from whatever zymotic cause, in this
way, and, if my results are realized, you will hereafter so treat
all such cases, even in young children,. Many cases of enterio
colitis are cured by one enema.

523 Delaware Avenue.



There are at the present moment 131 ladies registered as students
at the seven French medical faculties. Of this number, ninety-five
are Russians, twenty-five French, four Roumanians, two Bulgari-
ans, two Servians, one German, one Turk, and only one English.
No one who has studied in Paris can avoid remarking the prepon -
derance of the Muscovite element among these fair aspirants for
medical honors. — Lancet



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DAGGETT: CONCERNING POSTURE. 85

CONCERNING POSTURE.*

By B. H. DAGGETT, M. D., Buffalo.

T. Laudkb Bbunton contribates to the November number of the
Papular Science Monthly ^ an interesting article concerning pos-
tare and its indications, in which he discusses the varying attitudes
and common postures one meets with daily ; illustrates these
postures in schematic outline, and inquires why they are
assumed.

The variable attitudes of the body are attributed to trade,
habit, mutable mental states, physiological activity, and patholo-
gical conditions.

Gravity in the upright posture is undoubtedly a contributing
factor to engorgement of the pelvic viscera, rectal, uterine, and
vaginal prolapse, varicose veins, hernia, and as we grow older to
sagging of the bladder, and bagging of the rectum.

Our progenitors, moving about upon all fours, escaped, we pre-
sume, these direful calamities, and in due progress of evolution
acquired the upright posture ; eliminated the caudal appendage ;
consigned the appendix vermiformis to waste and final oblitera-
tion ; and will, in due course, reinforce veinous valvular construc-
tion and develop complete support for the pelvic organs.

In the meantime we are called upon to alleviate conditions
which confront and study theories which perplex.

It is proposed to consider, herein, some of the objective rela-
tions of this subject so far as they concern posturing for examina-
tion, treatment, and operation.

The varying attitudes of the body, the movements of the
extremities, functional activity of the internal organs, and patho-
logical conditions, modify in a greater or less degree the environ-
ment of the viscera, which should be taken into account in exami-
nation and operation.

Posture changes the site of the impulse of the normal heart,
yet the text-books scarcely make reference to it.

Paul says that the patient may sit, stand upright, or recline
for examination of the heart, as is most convenient.

Guttman alleges that the cardiac sounds are the loudest in the
upright posture.

Dr. Azoulay, of Paris, claims that he has devised a means of
intensifying the cardiac sounds by placing his patient upon the back,
elevating the arms, flexing the lower extremities, and rising the

1. Copyrighted.



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86 DAOGBTT : CONCERNING POSTURE.

head, which reinforces the heart sounds and slows its action. Drs.
Azoulay and Jules Simon have employed this method in the Child-
ren's Hospital, in Paris, and state that they have been able to
localize extra- and intra-cardiac bruits, as the slowing of the heart's
action and the augmentation of its sounds aided in clearing up
their vagueness and complicated character.

It is said that dyspnea and arythmia without slowing of the



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 9 of 78)