J. M. (James Mitchell) Foster.

The Chicago medical journal and examiner online

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diminishing oxidation of the tissues. It
arrests oxidation of the tissues by render-
ing the haemoglobin less active, and by
abstracting the oxygen from the tissues —
usually stopping the oxidation process at
the stage of fat.

Alcohol is a valuable agent in the treat-
ment of the typhoid state, because it im-
proves digestion, sustains the heart, sup-
plies force, lessens oxidation, and quiets
the restless brain.

Not only when the tongue is dry, but
before the system has been so much de-
pressed, in continued disease, where the
patient is on liquid diet for days, the food
should be seasoned with proper quantity
of salt. This is specialty overlooked when
the patient is on milk diet. Of course,



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EDITORIAL,



277



there is some salt in milk, just as there is
in meat, but not enough, except in normal
mother's milk, where the babe only needs
the salt it contains. However, when cow's
milk is used, either for the babe or for the
«ick, it should be salted, the salt prevent-
ing solid coagulation of the cow's milk by
the gastric juice. Salt has important uses
in digestion and nutrition. It is necessary
for the secretion of the hydrochloric acid,
which in fevers is usually suppressed long
before the peptic secretion. It is also
used in the production of the bile salts,
and that portion which enters the blood,
in some way is necessary to the vital pro-
cesses in producing urea and carbonic
acid.

When the tongue persistently remains
dry, in spite of all these means, the fre-
quent administration in small quantity of
alcohol and peptonized beef, milk, or gruel,
which requires no digestive help from the
crippled salivary and gastric glands, may
be slowly absorbed by the sluggish circu-
lation in the gastric mucous membrane in
limited quantity, but sufficient to furnish a
little nourishment to the starving secreting
cells, which may be manifested by a slight
moistening of the tongue and exfoliation
of the dead coat.

It is not only important to remove, but
equally so to prevent the development of,
a dry tongue, and in attempting to do this
no pains should be spared in using all those
apparently and singly insignificant means
of exciting taste and increased desire for
food. Relishes and aromatics should be
judiciously used in flavoring the food to
suit the peculiar whims of the patient. It
should be remembered that smell and sight,
and the thoughts which they suggest, are
often powerful agents in their action on
the digestive tract, advantage of which
should be taken, preparing the meals so as
to be as inviting and as little repugnant as
possible. Here is a chance for the trained
nurse to show her taste, judgment,and culi-
nary ability. She who, by her tidiness,
taste, and good cooking, caters successfully



to the capricious appetite of the fever-
stricken patient, does as much for the suf-
ferer as the physician.

The conclusion to be reached from the
above is, that in continued fevers, while
medicines can be of unquestionable value,
yet, without the copious use of water and
palatable, nutritious liquid food, at short
and regular intervals, they are of little

value.
168 South Halstbd Stbkbt.



EDITORIAL.



EXERCISE AND FATTY HEART.

Recently there has been quite a revival
of the suggestion, made many years ago by
Professor Stokes of Dublin, of the advan-
tage resulting in fatty heart from system-
atic muscular exercise, as by gymnastics,
mountain climbing, etc.

Doubtless, within certain limits, this ad-
vice may be followed with advantage,
either with or without medication; but
probably the greatest danger attending
such efforts lies in the difficulty of secur-
ing moderation, and progressive increase
in the amount of the exercise, without which
danger to life would be materially aug-
mented. Similar debility of the recti
muscles is frequently found in cases of
asthenopia, and is benefited by systematic
and progressive exercise of those muscles.
Both instances are but illustrations of what
has been so long and so well known of not
only the advantage but the necessity of
proper muscular exertion, confined within
the recuperative power of the muscles
exercised. It seems requisite that old
truths should often be retold, in new ways
and with new illustrations, that sight of
them shall not be lost. At present this is
one of the illustrations, with a useful and
practical object in view. It is to be com-
mended if confined to the limits of safety,
but the dangers, as well as the advantages,
should be fully presented, with reliable
guides to the recognition of impending
danger, and a safe course out of it. With-

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out these there will doubtless be other
victims added to the list of those who have
spasmodically evinced more enthusiasm
than discretion in the matter of physical
exercise, especially in the now popular
athletics.



THE NEED OF A MEDICAL REFER.
ENCE LIBRARY.

At the present time there is consider-
able attention concentrated upon the New-
berry Library, which is being organized
here, and an effort is being made to secure
the establishment of a medical department
in it. It is understood that this is to be
strictly a reference library. The endow-
ment is ample to make it complete in all
departments of science and art, if the
money be properly expended.

There are two things that are essential
to any important library — books and a capa-
ble librarian. For the Newberry Library
such a librarian has been secured, and if too
much money be not expended in monu-
mental buildings, as has too often happened,
so that the essentials have ever afterward
suffered, the Newberry Library may be
made of inestimable value for reference.
It is very desirable that such a mistake be
not repeated here, as making the building
of first importance and its contents a
secondary consideration.

Chicago has become an important medi-
cal centre, with several medical colleges,
and the medical men resident here need the
advantages which a large medical library of
carefully selected books of reference would
afford. Physicians from other points, es-
pecially in the interior of our country,
would also find it of great assistance to
them in their literary work. The library
of the Surgeon-General's office of the army
in Washington affords such facilities, es-
pecially for Eastern physicians, but it is
almost inaccessible, because of its remote-
ness, for physicians residing in the interior.
The present occasion affords an opportunity
of supplying this need, and the trustees of



the Newberry Library should recognize the
fact and provide for a medical department^
to be in keeping with what it is proposed
to make the other departments. It would
be incomplete without a medical depart-
ment thus equipped. Access to such a
medical library would not only be a great
convenience, but the advantage to medical
science would be incalculable.

The State has appropriated money for
moderate libraries in some of its charitable
institutions, but political and other con-
siderations led to the locating of these
institutions in various parts of the State,
and the libraries are not available except
to a very limited number. Chicago has
never made a successful effort to build up
a medical library, and there is now no col-
lection of medical books in the city suffi-
ciently complete for reference. In the
Chicago Public Library there is a limited
medical department, containing books ob-
tained from various sources, but it is with-
out a special librarian devoted to its care
and prosperity alone. With the co-opRa-
tion of the profession, and the library
officials, this incomplete collection of books
could be made a servicable hbrary in
time, but probably not such a reference
library as is needed. A librarian devoted
especially to the interests of the medical
department is a requisite. The profession
should support the administration in its
efforts to increase the usefulness of this
department, and aid in contributing to it,,
even more than it has already done. The
library should contain the current Ameri-
can and foreign serials in medicine and
biology in different languages. These
journals should always be accessible.

Complete files of the same serials, run-
ning back as far as possible, would be a
desirable acquisition, and a librarian de-
voted to this department alone could da
much to secure them and other matter of
various kinds that would materially increase
the value of the present medical depart-
ment for the use of the medical profes-
sion.



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SOCIETY REPORTS.



279



OBITUARY.
Professor Elkanah Williams, M. D., of
Cincinnati, died at Hazelwood, Pennsyl-
vania, October 5, 1888. He was born in Bed-
ford, Indiana, December 19, 1822. He
graduated in medicine in Louisville, Ken-
tucky, and located in Cincinnati. Soon
after Professor Helmholtz made known
the ophthalmoscope and its revelations. Dr.
Williams visited Europe and devoted him-
self to the study of diseases of the eye, espe-
cially in Germany and France, for nearly
three years. In 1855 he returned to Cin-
cinnati, and was soon elected Professor of
Ophthalmology in a medical college. The
honor has been accorded him of being the
first scientific ophthalmologist established
in the United States. For more than
thirty years he was a successful practi-
tioner in his favorite branch, as well as a
teacher and writer of recognized ability.
His professional attainments and his per-
sonal worth inspired confidence in all who
came in contact with him, and his social
qualities made friends of all who knew
him'^ well. He was a man among men.
Two years ago, whilst he was engaged
as president-elect in the work of organiz-
ing the section of ophthalmology in the
Washington International Medical Con-
gress, it was discovered that his health,
previously impaired, was rapidly failing,
and, on consultation with his medical ad-
visers, it was decided that he should aban-
don for an indefinite time all work and
anxiety. After that decision, in writing to
a colleague and expressing his regret at this
enforced abandonment of his work in con-
nection with the Congress, in which he
took great interest, he said: **Much as I
would like to serve the Congress, when I
know that it is prejudicial to my health, I
feel it my duty to resign; health is pre-
cious above all considerations."

For more than a year it has been mani-
fest that his most serious affection was or-
ganic disease of the brain, and that was
the immediate cause of the death by which
America lost her Nestor among scientific



ophthalmologists, and within a few months
of the demise of his friend and confrere,
Professor C. R. Agnew, than whom no two
men in the United States did more to se-
cure recognition and respect for scientific
specialism in the medical profession. All
will concede that in the death of these two
great and good men the medical profession
and our country have sustained a serious
loss.



SOCIETY REPORTS.



TRANSACTIONS OF THE AMER-
ICAN ASSOCIATION OF OBSTET-
RICIANS AND GYNECOLOGISTS.
The first annual meeting was held at
Washington, September 18, 19, 20, 1888.
First Day — Morning Session.
The President, Dr. W. H. Taylor, of
Cincinnati, called the meeting to order and
delivered his annual address, in which he
said : On the assembling of this association
for the first time, it may be proper to de-
mand a reason for its existence. The daily
round of professional experience impresses
the practitioner of medicine with the in-
completeness of his knowledge, and to the
man who sees in his avocation something
more than a mere source of pecuniary
profit there must arise the desire to know
the yet unknown. No argument is needed
to prove the assertion that the united ef-
fort of many is more fruitful than the in-
harmonious working of individuals ; hence
the propriety of co-operative organization.
It may be admitted that the motive of our
association is, first, our own advancement,
yet it cannot be considered undue self-
adulation if we believe that from such
combined effort good must come to the
profession at large, and necessarily through
the profession to those who, above all oth-
ers, are interested in the perfection of our
knowledge and skill — our clients.

The activity of the past decade has given
us so many important facts that it would
scarcely be hyperbole to say that a new
practice of obstetrics and gynaecology has

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been created in that time. But the very
fact that there has been such progress, and
that so much that but a few years ago was
impracticable or even unknown is now
feasible and well known, only stimulates us
to better work and further advance; and,
with the vast range of study and diversity
of subjects now comprehended by the sci-
ence of medicine, it is clear, beyond con-
troversy, that advance can be made only
by men directing their efforts to a limited
field of work. Such, gentlemen, I believe,
are sufl&cient reasons for our presence here
to-day as the American Association of Ob-
stetricians and Gynaecologists.
. An opinion has large credence among
the laity, and is indorsed by some members
of our profession, that intentional abortion
is a common crime, while statisticians and
social scientists see in the decreasing fe-
cundity of American women clear evidence
of the truth of this charge. That some
women are guilty admits of no doubt, but
that it is so universal an evil as sensational
literature, especially of non-professional
origin, would indicate, I do not believe.
Permit me to direct your attention to a,
more demonstrable cause for diminishing
fertility. I need but remind you of the
deleterious influence of social habits and
circumstances over the functions and phy-
sique of women, and, consequently, how
many fashionably-educated girls are inca-
pable of completing the process of mater-
nity. Those who are fond of charging
American women with the crime referred
to, cite to us the rich, the educated, the re-
fined, as guilty, while their sisters who are
less favored financially, and are humbler
socially, bear their due proportion of chil-
dren. Now, the first class are the phys-
ically feeble, the enervated, and therefore
incapable of carrying the process of repro-
duction to its ultimate perfection. A lack
of fecundity on the part of a woman is of-
ten due to endometritis, and is overcome
by the cure of the diseased condition.
Many cases of sterility after the birth of
one child are due to inflammatory pro-



cesses of the genitalia. Accept these state-
ments as true, and a rational explanation
of the asserted evil is found, which at once
transfers it from the domain of ethics and
morals to within the pale of our profes-
sional care, and at the same time vindi-
cates those whom we look upon as the
purest and best from the indiscriminate
charge of the murder of their unborn chil-
dren.

I believe the influence of the genitalia
over the general system, especially in its
nervous manifestations, has been exagger-
ated ; that entirely too much attention has
been paid to the genital organs in connec-
tion with the neuroses.

A subject of practical importance, ur-
gently demanding attention from the ob-
stetrical section of our association, is the
constantly-increasing inability of women,
who should be *' nursing mothers," to fur-
nish milk for their infants. Many women
who have borne children are incapable of
nourishing them; probably about 40 per
cent, with us, and, according to Escherich
and others, in Bavaria, 59 per cent, of
mothers become incapable from physical
causes of nursing their children within two
months after delivery. In a large degree
this is the result of habits tending to im-
pair the integrity of the mammary glands.

Another topic well worthy of our most
careful thought is. What can be done to
mitigate the pains of labor .> My impres-
sion is that, with the great majority of ob-
stetricians, but little is done to lessen pain
during a large part of the process of deliv-
ery. With the abundant therapeutic re-
sources of the present day, we ought surely
to divest this ordeal of the intensity of its
pain. I trust by another meeting to report
upon some experiments I am now making.

It has been said, as civilization pro-
gresses the tendencies of all human dis-
eases has been to assume the neurotic
type, and also that diseases become more
complex in their manifestation. On the
other hand, the recent advances in antisep-
sis allow the hope that some day we may



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281



eradicate the septic diseases of child-birth,
and that our grand advances in surgery
shall qualify us to cope successfully with
what, a few years ago, would have been
considered a helpless and hopeless condi-
tion. Science knows no sentiment, and we
can cherish the achievements of the past
only so far as they aid us for the future.
Science almost every day brings a new
surprise, so we may confidently anticipate
advances and successes which shall as far
surpass our present attainment as these do
those of the past generation, and happy
may we count- ourselves that this associa-
tion shall contribute to these beneficent
attainments.

Dr. A. CoRDBS, of Geneva, Switzerland,
sent two memoirs, which were read by the
secretary. The first paper was on the
" Treatment of Puerperal Eclampsia,*' and
contained a report of four cases treated by
the injection of bromide of potassium and
chloral hydrate, with abstraction of blood
over the mastoid processes by leeches. He
advocated this treatment in preference to
general bleeding, chloroforqi, and arterial
sedatives. He also deprecated any inter-
ference with the genitalia, such as digital
examination, passing the catheter, etc.,
which he thinks are liable to provoke con-
vulsions.

The second paper was " The Treatment
of Endometritis *' by injections of pure ni-
tric acid, and was illustrated by three cases
in which this method was employed. The
writer preferred this method of treatment
to that by the curette, in cases where there
were fungosities or other irregularities of
the intra-uterine surfaces.

Dr. A. Lapthorn Smith, of Montreal :
I would like to be permitted to say a few
words on this very important subject. I
think we should lay down three principles
to guide us in these cases. Puerperal con-
vulsions are due to mechanical pressure on
the renal veins. If that remains too long
it will bring on uraemia. Uraemia con-
tinued long enough produces perma-
nent damage to the brain. We should



empty the uterus and take the pressure off
the renal veins at the earliest moment we
are sure such a condition is in existence.
I have acted myself for two or three years
on that plan, and have had no cause to re-
gret it. The only regret I have is that dur-
ing five or six years I adopted the method
of waiting. Although none of the patients
died, all of the children did, and one of the
patients was in an asylum several years. I
think if premature delivery is brought on
under antiseptic precautions, we will in all
cases save the woman, preserve her brain
intact, and occasionally save the child.
But the child is, however, a secondary
consideration.

Dr. BvRON Stanton, of Cincinnati : I
would like to ask if bringing on labor is
not adding fuel to the flame; if it is not
better to defer as long as possible the in-
duction of labor, and treat the renal con-
dition ; place the patient in better condi-
tion for delivery. We know that convul-
sions do not always cease at delivery.

Dr. A. Lapthorn Smith : I do not
think you should wait until the woman has
convulsions. If you know that the urine
is loaded with albumen, bring on labor
without delay. Every moment of delay
you increase the danger.

Dr. Joseph Price, of Philadelphia : The
gentleman that has just taken his seat ex-
presses a great deal of wisdom in his re-
marks. Mr. Tait calls attention to the fre-
quency of such troubles in elderly primi-
parae. It is claimed that it is exceedingly
common in that class of patients.

** The Indications for Drainage in Ab-
dominal Surgery " was the subject, of a
paper by Dr. Joseph Price, of Philadel-
phia. He said the object of his paper was
to point out the indications for drainage in
abdominal surgery. At the present time,
there is the greatest variance in the opin-
ions and practice of surgeons upon this
point, and some fixed rules, such as are
laid down in other departments of opera-
tive surgery, are needed.

First : Is there danger from the reten-



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tion of fluids in the peritoneal cavity?
Second ! Is the drainage-tube a safe means
of obviating this danger ? Third : If the
tube involves danger, what are the compar-
ative risks from its employment or omission ?
That the peritoneum will relieve itself of
exuded fluids is well known ; and it is also
an established fact that the free use of
saline cathartics will often arrest acute per-
itonitis. Experience has also shown that
these resources often fail, and it is necessary
to re-open the abdomen, irrigate the perito-
neum, and insert a tube ; this, too, in cases
where no pus is found. It is a fallacy to
believe that extensive adhesions are alone
an essential indication for drainage, since
free exudation can arise from severing slight
adhesions and extensive bleeding follow
slight ooz ing after the patient reacts. This
latter fact was illustrated in a recent case
in which bloody exudation, which seemed
almost nothing at the close of the opera-
tion, flowed freely through the tube for
ten days afterward. A great difficulty is
presented in deciding a case to be simple,
particularly in cases of inflammation of the
tubes and ovaries. Indeed, no one can de-
cide during an operation whether the in-
flammation is simple, purulent, or specific.
Herein is an additional indication for the
cautery used by Keith. Drainage removes
the pabulum of infection. In case of very
extensive adhesions and positive haemor-
rhage, the value of the tube cannot be ques-
tioned.

The danger involved in inserting a simple
glass tube in the abdomen is very small.
The involvement of the peritoneum in the
perforations of the Bantock tube has been
urged as an objection to its frequent use.
This danger may be entirely obviated by
carefully packing the tube lightly with ab-
sorbent cotton, which also, by capiliarity,
facilitates drainage. The tube should be
rotated occasionally and slightly elevated.
When kept clean, by frequently changing
the cotton, with careful attention to that
part of the incision through which it is in-
troduced, there is no appreciable danger of



infection. I have reached this conclusion
after using it in extreme cases of pelvic ad-
hesions, extra-uterine pregnancy, hysterec-
tomy, pus tubes, and so-called simple opera-
tions. I have never had a single fatal
result which could be attributed to the use
of the drainage-tube, and in numerous cases
I have seen serious trouble relieved by its
introduction.

Irrigation is an important adjunct to
drainage in abdominal work. It is of the
utmost value in removing debris, clots, and
shreds. Pouring water through the incision
is not so efficacious as its introduction by a
syringe, which makes an uninterrupted cur-
rent. I place the nozzle of the syringe
through the lower angle of the incision,
and with two fingers retract the intestines,
thus giving free exit to the current In
this way the entire abdominal cavity can
be thoroughly washed out. I can not see
any advantage in Professor Martin's method
of drainage through the vagina. To close
the ventral incision to make one in the va-
gina seems to me unnecessary and illogical.
If drainage be decided upon, the site of the
incision offiers every requisite.

All chemical solutions are unnecessary
and positively harmful. Such agents intro-
duced into the peritoneum have done much
mischief. The intestinal pain so often fol-
lowing operations in which solutions were
applied is, in many cases, due to the adhe-
sions formed in consequence of their use.

In deciding the important question. When
shall the tube be removed ? we should look
to the character and quantity of the dis-
charge. When this is clear and sweet and
scant, the tube should be removed. It has
been urged that the tube delays union and
thereby increases the danger of ventral



Online LibraryJ. M. (James Mitchell) FosterThe Chicago medical journal and examiner → online text (page 45 of 63)