John Duncan Emmet.

The American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 online

. (page 39 of 79)
Online LibraryJohn Duncan EmmetThe American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 → online text (page 39 of 79)
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servation upholds his. With regard to the

nain point is the carrying out of the die-



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392 Transactions of Societies,

tetic and hygienic treatment, the careful regulation of the surround-
ings of the patient, so as to get a norma
the injection of water and use of baths,
are of the utmost necessity. I have a
for two or three years; she has spent 1
mineral springs, taking exercise, and
show that she is perfectly well. I have
to Hve with the greatest caution and ca

Dr. Davis: I desire to say a word i
of the cases described by Dr. Reynolds,
been continually shown to me in several
toms of ureteral irritation. I desire a
remarkable influence in women exerte
the urine by the use of certain narcot
tea. In studying metabolism in wom<
nant, I have found an obstinate conditic
until the habit of chewing tea leaves w
Again, as to the amount of urea pass<
studying the metabolism of a pregnan
women after labor, there comes a tin
elimination gets less just before labor,
of the wave immediately after parturit
amount of urea in the urine means th
renal insufficiency, and a temporary i
there is thrown in on the excretory or§
an amount of waste material as to cau
that either a deficiency or a temporary
the time being to danger of defective

Dr. Smith: I think this is a very ir
so many women suffer from it. In this
my conviction that ureteritis without inf
genito-urinary tract is very rare. I ac
infection from gonorrhoea, but it is rar
in men. I think that ninety per cent, o
acid or oxalic acid in the urine. It is a
dition of the urine; and I would say, re;
year for the treatment. The disease
genito-urinary tract The bladder is irr
is to try to stop the uric acid or oxalic
chemicals? Urea is perfectly innocent.



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lerican GyncuologiccU Society, 393

is of it, but when there is not enough oxy-
nitrogen stops at uric acid. Less oxygen
;hat is very irritating. The remedy is — ^get
lut off the nitrogen. Give them exercise.
\ pastry and pickles all the time. They are
ind doing very little physical work. Give
IS to eat; pour in two quarts of water a day
at have not been oxidized in the urine. Then
of bicarbonate of soda every day. If you
its you will have no trouble,
losing): I am interested in what Dr. Mann
atment of the ureters, because I had been
impressed with the danger and the proba-
[ler than lessening the inflammation, and
in cases in which there was not pus in the
tie cases due to injury during labor, which
r paper, are extremely interesting. I wish
excess of emphasis which I may have laid
ts. I have seen two or three cases in which
ed to those points, and pursued exactly the
spoken; but there are a large number of
lal points stand out only when one is look-
iich the progress of the affection is limited
decreases above as it increases below, fol-
rse of the urinary passages. I was much
remarks about eating tea, and have learned
>rne Smith's explanation of the effect of
come to me in the clear way in which he
say that I have found the application of
for deficiency of urea in the urine of the
of pregnancy where the urine is abundant
low. I want to conclude my remarks by
that our knowledge of these conditions is
t is rather my expectation that we shall
teritis is usually secondary to disturbance
that event I think we shall find the ureteral
lue in diagnosis.



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terican Gynecological Society, 395

jatient endeavored to leap from the window
*d one of her nurses. She refused food, and
-tube. Prolonged sponging, bathing, and
latives, forced feeding, and stimulants had
ase. She died comatose eleven days after
tem examination, a congenital abnormity
ne in the center of the abdomen was found.

of partially dissolved faeces. The genital
es of infection. These autopsies were made
BFerson Hospital, who has observed in three
le Philadelphia Hospital eighteen cases of

the intestine. Fourteen of these patients
in at some previous time. Two committed
ight into hospital unconscious, dying of
reported the bowels had been thoroughly
i salines. Examination of the blood showed
molecular disintegration of corpuscles. A
te puerperal mania was made, while autopsy
mania, chronic toxaemia from absorption of
from an abnormal loop of the large intes-
Ltion of the intestinal ulcers in Case I was

Discussion.

ik we are all under great obligation to Dr.
before us. In considering the subject and
Der two cases, one particularly that I saw
nember of this Society, delivered with per-
is — a young lady of nineteen, who had al-
1 constipation. After about five days there
)eritonitis. Then the symptoms got better,
jrus any evidence that there had been septic
le uterus to make sure that there was no
ished it out. Another case which I saw out
) had the same history, only that this patient
e of anything in the uterus to explain the
symptoms all disappeared after five or six
of calomel, given one tenth of a grain an
rs, then salines. We finally got the bowels
le caught pneumonia, and for about a week



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396 Transactions of Societies.

I had to give her the strongest kinds of tonics, and she recovered.

Looking back at that case, with a very

word I would take — and I had abundai

sepsis from the uterus — I can but feel t

tion from ptomaine poison or bacteria ^

tioned as a causation. It brings to oiu"

sity of taking care of our patients befor

look on them now, with our aseptic pre

to get well. Once in a while we lose a

prevented such a result if we had prepai

pare them for any other operation.

Dr. Grandin: This exceedingly inte
me, teaches us a lesson as well as gives
teaches is that it offers us an explanatic
have seemed to us of an exceedingly c
have never made a diagnosis of lesions
as I look back in my experience, I can
autopsy been performed, I question nol
would have been found. There is a dj
with these cases that it is going to caus<
isfied with the diagnosis of possible ptoi
us away from septicaemia. It is sometl
tion of auto-infection, which we all accep
we all reject to-day in the sense in whi
our distinguished Fellow. I have no crit
because the autopsy gives us an adequat
of the symptoms and the fatal result. I
of warning, lest in future we have a cro
The most important lesson is that we ai
after our pregnant patients with that ace
they deserve and which they require. '^
insist on the intestinal tract being thoroi
apt to take the word of the woman that s
tion. She may have had it, but the chai
ficient one. The cases tell us that the
watched carefully from the beginning of
then the pregnant woman is not going
tended gut, and with conditions that lej
intestinal tract and symptoms such as h

Dr. Harris: In a vague and indefin



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The American GymzcologiccU Society,



^'J^P^ression has gone abroad that we have infection in t

tinges on account of the near relation of the gut to t

pax'"ts after operation. I do not believe that Dr. Davi

haAT^ us infer that he will account for all his unaccoui

of septic fever in this way. The gentleman, as he will n

us, is simply giving us one explanation, and he perha

ven-txare to say as yet what proportion of unaccountal

P^l'vic fever are due to this cause. I certainly think tl

v^ry little danger, as the speaker before me said, that it

1^3.rTO in diverting the attention of the profession lro\

good measures which have so successfully driven bot

and morbidity out of the lying-in chamber. I think thi

^"^t: we ought all to remember, and if there are any c

^ho are competent, I think it would be well for us to

these lines.

I^r. Gushing: I wish to call attention to the striki

^* this case, and the cases we have learned to recogniz

.^'^P^rature and serious symptoms after laparotomies^

^s become the rule to take care of the bowels and get

^S'hlv oure^ed beforehand. As we all know, Lawson T

ig cathartics after operation certain

ptoms of peritonitis had already

could be cured if salines could be {

Ligh, the probability being that cas(

trt really cases where putrefactiv(

bowels.

)sing): I wish to thank the gentle
y kind reception of what is a pui
;ory to offer upon the subject. I p
ors in brains and in experience cl:
that Dr. Grandin will not sufficier
ig this paper. This is not a paper i
itioners or of medical students. Ii
len who are experienced, and for 1
pneumonia in his case. I did not
3nditions at all, except to say that
pneumonia was present. I am a
lad not seen a pr,evious case I coul
whatever, and I based the diagn
paratively low temperature with the



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398 Transi

pulse upon the fact that no
things are the work of the p
teaches us our lesson. I ha
purgative of especial value
told by Professor Hare, of
judgment and experience th
ough antiseptic consists of
the bichloride. He advise
Other patients do well with 1
grains and a half) and salin
of bichloride for two or thr<

TREATMENT OF
RETROPERITONI

By William H. Wathi

I

Dr. Gushing: Where th
it comes out very easily; all ;
marks, split the capsule, anc
very easily. The method of
can hardly imagine a conditi
the sac to the abdominal wa

Dr. Harris: I want to
wish I had known enough 1
poses — that is, tying from the
ing the abdomen from abo
began an operation last fall
and, after I had started, I w
to have retreated. I kept t;
I had used thirty-six yards c

Dr. Gordon: As I indie
abdomino-vaginal operation,
easier, and especially in all t
we are to remove the uterus,
the uterine arteries, and the
have done it in hysterecton



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The American Gyncecological Society. 399

cervix is very long and where the tumor does not dip down into

^he cervix. I have frequently divided the vagina from the cervix,

^nd it gives me great relief in the rest of the abdominal operation.

•Sb/netimes, with a very long cervix — which I always intend to re-

:ases — it is a little protracted for you to do it

yet in the majority of cases I am able to do

n that I make, which is the continuous suture.

and I never cut it from the time I begin my

h it, of course having a separate one for each

acing a Spencer- Wells forceps under the tube

Dmmence my continuous suture below that, cut

V, closing the broad ligament as I go along

mor out until I get down to the point of the

2n divide the peritonaeum in front of the uterus

5, dissect it down, and keep up the continuous

seems to me that if we attempt to enucleate
tely we will get into very vascular and dan-
I see no reason why we can not continue this
* flap, which we all make in removing a fibroid
teral flap, and let some of the dangerous adhe-
l the tumor down laterally slip off to one side
)ped down in front by the anterior flap, and
jordon has said, by whipping over with a con-
1 that way not get into this desperate and dan-
n by attempting to enucleate all the way down
\ uterine artery to tie it. But in those cases

dare do that I think the combined operation
imes would be the most perfect and successful
ne arteries from below and shut off the tre-
[laemorrhage which might come from attempt-
these adhesions, and to thoroughly enucleate
ire, in the same line as was suggested by the

talking of the paper read by our distinguished
: your kind of operation to the particular kind
ve to deal with, instead of being bound by any
you may make for yourself.

I would Uke to detain the Society for a mo-
the various methods of controlling this vascu-
le doctor speaks. There is no doubt in the



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400 Transactions of Societies,

minds of men who are indulging in much of this work that the stress

laid by Dr. Gordon on the combined method is aptly put just now.

At the same time, when working from above we are oftentimes

enabled to reach this area in a manner which at first sig^ht might

seem extending the operative field too k

especially in passing in review those ca

all, of large intraligamentous growths, v

gion is exposed to us in such a manner

the haemorrhage can be readily reached

of these vessels at a point much nearer 1

employed. If you recollect the position

growths, you will readily convince yoi

apart the layers of the broad ligament ;

the uterine arteries, and the vesical arteri(

carrying you up to the bifurcation of the

by securing the anterior trunk of that ve

contain the vessel in question, the obturat

all of these structures are exposed, and s

in the Trendelenburg posture, and my e

it is a comparatively easy matter to con

the last year I have succeeded in ligatinf

of any opening up of the broad ligament

by simply drawing aside the layers of th<

words, following out the technique of th

all of us for aneurism of the posterior

artery. The steps of the operation by v

are quite familiar to you. Following ou

ure, you find comparatively little diffic

Trendelenburg posture, in reaching these

there in situ; and that having been done,

ease you can complete your operation.

you cut off so large an area from its blooc

note what are the results. Here we gai

reference to the ligation of the internal

stand perfectly that that operation has

frequency to show that none of these ne

dreaded in the ligation of some vessels j

anastomosis exists, on the one hand, bei

posterior trunk of the internal iliac thrc

the branches of the deep profunda, wh



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The American Gyruecoiogtcal Society, 401

amount of vascular supply to the lower genital organs to nourish
thtm against any damage. But, apart from this, you will find that
t/ie anastomosis which occurs between the branches of the epigas-
tric and the obturator are of vast importance in this connection;
and you will find that the middle haemorrhoidal plays a more impor-.
tant part than has been assigned it. This vessel, coming off from
the prolongation of the anterior trunk, sends its branches not merely
to the rectum, but to the whole posterior vaginal area, and sends its
shoots up the posterior wall of the uterus. So that you see that we
have here an unusual area of anastomosis which insures this re-
S^ion against any damage which might come from the ligation of
apparently so important a system at its origin. I would therefore
nierely suggest that, in connection with the class of cases alluded
to by Dr, Wathen, and emphasized by Dr. Gushing as well as by
7^- Gordon, you take into consideration the propriety of cut-
t^n§^ off your blood supply as close to its origin as it is possible to
o without inflicting undue damage upon structures that extend
. ^yond ; and this means that it is hardly necessary to ligate your
Internal iliac — that ligation of the anterior trunk will quite suffice
^^ doing this work.

. ^i". Wathen (in closing) said: If you understood my paper you

'■^member that I referred to the ligation of the uterine artery

^^^g'tnaw, especially in those cases where the tumor is very tightly

. ^S"ec3 in the pelvis, and suggested that the same method, if pre-

j ^^> might be practiced in the removal of other myomatous

. P'^'s, and that the ligation should be near the region of the

g^-l?"*^^ artery beyond the vaginal. Our worthy President, going

j^j *^rther, ligates the artery from which the uterine artery arises.

3 ^3^ of you have had cases that rose but little out of the pelvis,

^ ^t^st you could not pull with great force, where you could find

jj^ ^^stige of the broad ligament except at the top of the pelvis.

{asln^* in these cases you are compelled to enucleate after the same

• ^^, ^^^xi for a considerable time, and often enucleation is very diffi-

^ ^* l>efore you can reach the uterine arteries. In just such cases

. ^*i^ve that the previous ligation per vaginam will be of great

. ^» and very soon you can pull your uterus and tumor higher

^^ abdomen. If you have ligated the arteries from below, and

^^^^ted the vagina and the tissues some distance up, it is certainly

^^sy matter to ligate your ovarian arteries and hurriedly sepa-

"^^tie broad ligament and haul out your tumor from below. I



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402 Abstracts,



have never seen, and I do not know that I have ever read of any
case where in these growths the tumor goes below the uterine
artery. It seems to be invariably below the tumor, so that it can
be reached. As to the flaps suggei " ' -^ -^ . - - -
this case we can not make any flap
extraperitoneal. You may remove a
the capsule, and let it fall in the pe
abdominal method. As to the adhes
of by Dr. Johnson; we do not hav(
nothing. It is the unfolding of the
dissect it, not between the peritonaei
the peritonaeum and the tumor or t
A recess was taken until 3 p. m.



STATUS OF GYN^C(

GERMA^

Treatmcfit of Peh

Dr. EiCHHOLZ, in the Frauenarz
Kreuznach his experience in the
Considerable progress has been mac
dition by the means at our comma
presses, tampons, irrigation, and ma
been noted since the introduction
the process of absorption is a very s
of patients and physician is exhaus
apparent. Again, there are many c
employed with advantage.

When we consider the effect o
pelvic organs, and realize that the p;
for work, we can appreciate the imp
disease.

Thus far all of the researches o
failed to provide a remedy for this
must turn to some therapeutical m

In order to promote absorption



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tm of Gynacoiogy Abroad, 4^3

we can not depend merely upon local thera-
i into consideration the general circulation
:o-physically active factors of the blood cur-
circulation must play a most important part
idates; for, obviously, the freer the circulation
;^an the greater facility is offered to the lym-

extravasated serum to the blood current,
ion of tissues there is always a venous stasis,
imilar to that observed in structural disease
ective action of the central organ causes in-
5 venous system, and finally transudation of

Massage by direct pressure aids the flow of
:he important researches of Oertel more sci-
een employed for the relief of this condition,
irches the treatment was limited to stimulat-
by certain drugs. Oertel met this indication
leart muscles by systematic exercise; the re-
nt to the flow of blood he accomplished by a
ed the fact that an unlimited introduction of
I must favor the disturbance of the hydro-
icreasing the pressure in the venous system,
larger amount of work on the heart. The
s system of exercise, mountain climbing, and
, and the correctness of his views are to-day
s method the blood is diminished quantita-
lalitatively by the concentration. If the body
minimum amount of fluid, and profuse per-

condition is reached when the fluids of the
) the veins by their aspiratory action. The
aturally give up its excess of fluid with the

*ral principles, and are, of course, modified
^s regards dry diet, the author believes that

No animal will drink more than he actually
its in his food creates an artificial thirst, and

pleasure experienced by drinking is alone
antity of fluids consumed, and the sensation
lenced by habit. We can prescribe without
t in every case of exudative disease. The



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404 Abstracts

amount of fluids should be gradually
tained at the minimum quantity, wt
the uric acid and its salts in solution,
clear the fluids may be diminished, j.
to the reduction of the amount of flui(
fluid may be encouraged chiefly by h
by baths, packs, mountain climbing,
author advises because it causes proi
tates deep inspirations and strengther

If the exercise is impossible or in;
then a system of gymnastics and m(
should be adopted. Generally, in a f
proved so much that her capacity for <
The author thinks that the prescript!
is frequently given when it should be
lute rest can not be employed for an}
bodily detriment. Specialists are incl
eral health of the patient, and deprive

The author has pursued this plan
years, and with exceedingly satisfac
was always the combined one — name
cise, baths, etc. — and so it would be (
the most important. The records c
those of former years. In many cas
with such astonishing rapidity, and
conditions improved so surprisingly,
have been convinced. In fact, negati
neglect on the part of the patient to
great deal of energy and self-comman
lent habits and force the body into ac
of thirst is not at first easy, but it
amount of water will satisfy the bodib

FRANCE.

Vaginal Q

Dr. TuRGARD (Sentaine gynecologiq\
cases: First, a nullipara, thirty-six yej
a prolapsus. On examination, a tum
was found presenting between the lab



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Status of Gynacology Abroad. 405

niovable that it gave the sensation of a hernia, but its true nature
>\'as determined by rectal and vaginal exploration. With cocaine
^he cyst was excised.

The second case occurred in a woman twenty-eight years old.
-Had two children, and during her second confinement her physician
<iiscovered the tumor. This was the size of a hazelnut, and was
^*^3.ched to the posterior vaginal wall. This was excised. Its con-
tents were thick and of coffee color, probably of haematic origin.

The origin of these cysts is obscure. Huguier attributes to them
^ glandular origin; but there are no glands in the vaginal walls.
-According to others, these cysts are accidental hygromas produced
f^y abuse of coitus or confinement; but the most probable theory
's that they are of Wolffian origin.

. The third case presents a tumor of the vulva. The labia of the left

icle are distended with a dull fluctuating mass. Before marriage pa-

^^^ had an abscess of the vulvo-vaginal gland; during pregnancy

. ^ '^^ss appeared as described, but disappeared after confinement.

^^^^ sitting down suddenly with force the present tumor appeared.

^ ^s Was treated by incision and irrigation. It was considered a

.-^ ^^^^>^ vaginal cyst, ruptured by the fall, and produced a hsema-

Metrorrhagia in Aged Wotnen.

"^ - ^x*. Masse {Semaine gyn(fcologique, April 7, 1896) gives tlie

.^it: to Dr. Monod of having first called the attention of gynae-

^^S'ists to this subject. In 1892 he cited three cases occurring in

^^^n from sixty to seventy years old. These were cured with

^^"^iti and hot borax injections. In by far the majority of cases

^^^c^xrhagia at this time of life indicates malignant disease of the

. ^^^^^sa, or is dependent upon a fibroid. Still, there are cases where

. . ^^^r of these conditions can be found. Haemorrhagic endome-

., ^ Tnay arise suddenly in old women seven or eight years after

^"^^^enopause. In the ten cases recently published by Monod the

1 ^ interesting point noted was that the patients were nearly

?5^>^s very large and fleshy.

•^J/^^^s obesity, which is very frequent after the menopause, cause

P ^Edification in the mucosa of the senile uterus? Hermann and

i^^^-*"^eux, while studying this subject, found the muscular tissue

.1^ ^-^d pliable, and the vessels atheromatous. Delert has proved

^l^sence of the glands of the mucosa, and this tissue is very vas-



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4o6 Abstracts,



cular in women who have had endometritis. This senile degenera-
tion of the mucosa probably predisposes to the uterine haemor-
rhages; the aetiology, however, is still verv obscure. It is evident
that they may occur without the pres
or fibroid, as shown by the case related
In regard to treatment, in some cai
are sufficient, while in others it is necesj
medication. All kinds of caustics have
cess. The author proposes the applica



The Treatment of Perito

Dr. R. PiCHEViN (Semaine gynecolo^
that surgeons and gynaecologists diffe
of a case when pus has entered the
operation. Some, following Martin, c
the cavity freely with sterilized water,
but wipe with gauze the soiled area an
or drain through the vagina. The exp
excellent results. Which is the better
termined. In France, flushing the abd
to now so frequently as formerly.

When symptoms of infection occur^
ment?

Long ago the injection of serum b)
ous routes has been discussed at the S
has investigated the intravenous met]
results. The subcutaneous method is f
that, unless the intravenous method i:
rior, it should be tried.

When septic infection occurs, it n
be better to open the abdomen again, a
with a borated solution and a norma
obtained such a satisfactory result in c
he is disposed to further test the meth

Bouilly is in the habit of draining
he anticipates a post-operative compli
signs of infection appear, he injects ase



Online LibraryJohn Duncan EmmetThe American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 → online text (page 39 of 79)