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When labor has occurred, the hemorrhage, the decrease of
vascular tension, slowing of the pulse, and elimination of toxins
cause a regression of these new-formed cells and decrease in the
size of the tumor.

Amaurosis in Pregnancy. — ^Kurt Himmelheber (Miinch, med.
Woch., October 19, 1909) gives the history of a patient aflSicted
with chronic nephritis who became pregnant, and during the
fifth month of pregnancy had an acute attack of nephritis during
which, without warning, her sight failed and in a short time she
was entirely blind. An abortion was immediately produced in
the hope of saving the eye-sight, but this had no effect on the
blindness, which remained permanent and complete. Had
this been the result of nephritis, and albuminuric retinitis, it
would have come on with less suddenness, and recovery must
have occurred. The retinal changes passed away, but the blind-
ness remained. This shows that there was a cause for the blind-
ness behind the retina, in the brain; else optic atrophy would
not have been complete as was the case. In ordinary cases the
retinitis results from increased pressure and edema of the nerve,
just as edema results in the other tissues. Albuminuric neuro-
retinitis comes on slowly with gradual dimness of vision, not sud-
denly. Permanent blindness from uremia is unknown. In-
terruption of the pregnancy brings about a retrogression of all
the symptoms. It is possible that an internal hydrocephalus
may have caused pressure on the optic chiasma sufficient to pro-
duce optic nerve atrophy.

Hyperemesis Gravidarum and Adrenalin Therapy. — Stephan
Rebaudi (Zent. /. Gyn., October 30, 1909^ refers to the cases of
severe vomiting in pregnancy in which relief is not brought about
by any form of treatment, and the life of the woman is en-
dangered. The author thinks that vasomotor disturbances
of neighboring spinal centers may be the cause of this trouble,
and that on this depends the good effects obtained by the use of
certain forms of medication. One of these is adrenalin, which
has the property of regulating vasomotor conditions and af-
fecting the vomiting center. Freund has applied adrenalin to
the nasal mucous membrane in vomiting of pregnancy with very
good results. The author has used this method in the Woman's
Hospital at Genoa in a case of which he gives the history, and
in other cases of nausea, vomiting, and ptyalism of pregnancy.
Various hypotheses are given to explain the benefit of the drug;
the tonic action on the neuro-muscular mechanism and the
metabolic effects of adrenalin are cited. In the author's case
the adrenalin was administered at first by rectum, later by
mouth. In a few days it stopped the vomiting which had been
going on for two months, and was so extreme that the patient
was weak and emaciated, and her death seemed imminent. The
mother received no injury, neither did the fetus of which she
was delivered normally at term. Either the metabolism is

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improved so that toxins are no longer produced, or the nervous
centers and muscular apparatus are toned up by the medication.

Pathology of Eclampsia and Toxemia of Pregnancy. — J. £.
Welch (Jour. Amer. Med, Assn,, 1909, liii, 1358) states that the
liver lesions in eclampsia are not uniform. Pregnant or post-
partum women dying from convulsions may have hemorrhages,
central necrosis, general autolysis, or cloudy swelling in the liver.
The liver lesions in toxemia of pregnancy are not uniform. They
may be either hemorrhagic or central necroses, both of which
are found in eclampsia. The hemorrhagic lesions are produced
by liver and placental cell emboli, thrombi formed from blood
plates and fused red blood cells, and by a solution of vascular
endothelium. Heightened blood pressure increases the extent
of the hemorrhages. The agent producing the hemolysis and
general cell destruction is probably an enzyme.

Psychoses Occurring During Pregnancy and the Puerperium. —
In a series of 457 insane women who had bom children, E. P.
Ballantine {N. F. State Jour. Med., 1909, Ix, 460) found that
in 141, or 30 per cent., the onset of the psychosis occurred during
either gestation, the puerperium, or lactation. Study of these
cases seems to show that the majority of the psychoses asso-
ciated with child-bearing fall easily into three well-known groups
of insanities, (i) The deteriorating insanities, the strain of
child-bearing evidently only precipitating a psychosis that was
bound to follow any severe physical or mental strain or shock.
2. The recurrent insanities of the maniac-depressive type; child-
bearing is merely an incident connected with one or more of the
recurrent attacks. 3. The infectious-exhaustive group, in
which the insanity is caused by infection or precipitated by
exhaustion. In a small percentage of the cases the incident of
child-birth brings to the front symptoms of insanities that may
have existed for one or more years.

S3rphilis and Pregnancy. — ^J. P^nard and A. Girauld {Gaz. des
Hdp., Oct. 9, 1909) state that pregnancy exaggerates the severity
of syphilis and causes a recrudescence of general symptoms and
local lesions. The chancre lasts longer and tends to ulcerate;
mucous patches are exuberant, form vegetating hypertrophies,
and cicatrize slowly. Syphilis is the most important cause of
death of the ovum and infant. The origin of the syphilis and
the length of time from infection affect the action of the
syphilitic virus. In paternal syphilis, when the mother, not
being infected, yet produces an infected fetus, the method of
transmission is obscure. The ovum is infected directly by the
spermatozoon; this is a syphilis of fecundation. The mother
is secondarily infected by the fetus. There is no visible primary
lesion, and secondary symptoms appear toward the third month
of pregnancy. The mother may present no symptoms of
syphilis, the infection being latent only. The mortality in
paternal syphilis is less than in maternal syphilis, but abortions
are more frequent because the virus has its action at the begin-

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ning of conception. Maternal syphilis has different effects
according as infection occurs before or at the time of conception;
if the mother is infected during the last months of pregnancy,
as a rule the fetus is not infected during pregnancy, but may
be after birth if nursed by his mother. Such children should
not be nursed by their mothers, nor should they be wet-nursed,
since it is impossible to tell absolutely whether they will infect
the nurse. During the first half of pregnancy infection of the
mother is very likely to be fatal to the fetus; from the sixth to
the seventh month there is an interval of uncertainty, and later
than that the infant may escape. Infection of the infant in
utero by its mother occurs only after a period of fifty days.
Anteconceptional syphilis is most frequent; infection passes by
the placenta through the umbilical vein to the liver; it is an
infection by the blood and occurs during the •period of active
exchange between the circulation of the mother and of the
fetus; it is later than paternal syphilis, but it is also more
serious, for the fetus receives a vitiated nutrition from an in-
fected mother. Mortality is about 60 per cent. When both
parents are infected, infection of the fetus by the blood is still
more severe and more fatal, the mortality reaching 92 per cent.
The influence of time is attenuating to the virus. Early preg-
nancies end in abortion, later ones in premature labor, still
later in living children with syphilitic lesions, and finally healthy
children are born. In maternal syphilis, mortality of the fetus
is greatest at the beginning, while secondary symptoms are present ,
and much less after the third year. Time still more attenuates
paternal syphilis. In the second generation it is frequent,
dystrophies occurring, and sometimes even virulent syphilitic
lesions. The destructive influence is almost as great in the
second generation as in the first. A reinfection of a hereditary
syphilitic is possible even when he has had the hereditary lesions
in his youth. In some cases syphilis skips one generation and
attacks the next. The effect of syphilis is indefinite, following
some families until it causes their extinction. Hydramnios is
one of the effects of syphilis, especially in old syphilis, due to
circulatory difficulties and portal hypertension, with hepatic and
splenic cirrhosis. Death of the fetus occurs generally after it
is viable, expulsion does not occur immediately, but generally
after more than two weeks, and the fetus is macerated. The
diagnosis is facilitated by the Wassermann reaction and finding
of the treponema in the tissues of the fetus, or the lesions in
life. In the living child the organism may be found in the
blood, in a cutaneous or mucous lesion, or in the placenta. In
macerated fetuses it is almost always present. Wassermann's
reaction occurs in the blood, milk, urine, and cerebrospinal
fluid. A negative reaction is not of positive value against the
diagnosis of syphilis. It is generally absent in late syphilis.
Practised on mother and child at the same time it does not
always give the same results. The good effects of mercurial

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treatment during pregnancy are undoubted. Every syphilitic
woman who becomes pregnant should take a course of mercurial

Checking the Secretion of the Lactating Breast. — H. J.
Storrs {Surg, Gyn. Ohsi., Oct., 1909) reports that the follow-
ing method has been employed as a matter of routine in all
cases in the obstetrical department of the Johns Hopkins
Hospital whenever it was desired to dry up the breasts.
When the child is born dead, or suckling contraindicated for
any reason, the breasts are left absolutely alone for the days
immediately following labor. Ordinarily they become consid-
erably engorged about the third day, and occasionally quite
painful; the patient, however, is told that the swelling and pain
will promptly disappear and that no treatment is necessary.
Within the course of twenty-four or thirty-six hours, the swelling
begins to subside, after which the secretion gradually diminishes
in amount, to disappear entirely before the end of the week.
When the breasts are large and pendulous, a loosely fitting
bandage is applied to keep them from sagging, but not to exert
pressure, and probably onoe in twenty cases a single hypodermic
of morphia or codia may be necessary to relieve pain during the
period of active engorgement. During the past four years the
use of the breast-pump, belladonna plasters, and tight breast
bandages has been entirely abandoned. In 171 cases the secre-
tion was checked in the manner described and in no instance did a
mammary abscess develop.


The Beginning of Menstruation in the Japanese, with Obser-
vations of the Monthly Periods among the Chinese, Ritikiu and
Aino Women of Japan. — M. Yamasaki (Zent. f. Gyn., September
II, 1909) has made careful observations as to the time of the
beginning of menstruation in the Japanese and other races in-
habiting Japan and Formosa, and the influence of tropical
climate on the period of its first occurrence. There are five
distinct races inhabiting Japan — Japanese, Ainos, Korean,
Chinese, and natives of the country in Formosa. The observa-
tions of Japanese women included 4,861 women, the average
age of beginning of menstruation being fourteen years and ten
months. The earliest menstruation occurred at nine years and
seven months, the latest at twenty-one years and ten months.
From collected observations of fourteen authors, numbering
26,082 women, the average was fifteen years and eighteen days.
The Chinese women observed were all residents of Formosa
who had emigrated from China long ago. There were 135 cases,
the earliest menstruation being eleven years, the average seven-
teen years. Although the climate of Formosa is warmer than
that of Japan the first menstruation occurred later than in
Japan. Of the Riukiu women there were 184. Among them

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the average was seventeen years. Here the beginning of pu-
berty is still later than among the Japanese, although the climate
is warmer than that where the Japanese races live, and colder
than that of Formosa. Among the Ainos there were eighty-
four women examined. The average here is fifteen years. The
results with reference to climate are the opposite of those gener-
ally given. The general opinion seems to be that race and
manner of life has a greater influence on puberty than climate.
The four races show very little difference, although their mode
of life varies greatly. The Chinese women live entirely in the
house, and the Ainos hunt and work in the fields.

Appendicitis and Maladies of the Adnexa. — ^Paul Segond (Ann.
de gyn. et d*obsi., October, 1909) says that appendicitis is fre-
quently coexistent with phlegmasias and tumors of the adnexa,
and with pregnancy and^ the puerperal state. Aside from those
instancy in which the coexistence of the lesions is a coincidence,
there are many cases in which there is a relation of cause and
effect between them. All these organs may be inclosed in a
single mass of suppuration and inflammation in acute cases;
in chronic cases all degrees of lesions are seen from simple fi-
brous bands connecting them to masses of sclerosis including
appendix, adnexa, and uterus in a block of adhesions. Appen-
diculo-adnexitis may complicate normal or extrauterine preg-
nancy. The first reason for these conditions is in the close rela-
tions of position of these organs. The communication occurs
through the peritoneum itself. False membranes are formed
extending from the adnexa, which capture the appendix, inclose
it, and produce a peri-appendicitis first, and then a typical ap-
pendicitis. On the other hand, the condition may begin with
the appendix, and the same false membranes may grasp the
adnexa and cause a perisalpingitis. The differential diagnosis
is here very difficult. In acute conditions an error is partic-
ularly grave because it may result in operation on an acutely
suppurating salpingitis which should have been allowed to wait
until the inflammation had subsided ; or it may cause delay of
operation in a toxi-infectious appendicitis until it is too late to
save the patient. Our best guide is palpation. FrankeFs
sign consists in taking the uterus between two fingers and moving
it from side to side. If now there is pain in the region of the ad-
nexa there is an involvement of these organs. If there is no
pain there is probably an appendicitis. We must study the
locationjof the pain, its irradiations, and its effect on menstrua-
tion, the intensity of the gastrointestinal symptoms, the degree
of temperature, and the expression of the face. Pain high up is
in favor of involvement of the appendix; low down, of the ad-
nexa. A question of importance in such cases is whether to
make a median or a lateral incision.

A lateral incision is found to be too small if it becomes neces-
sary to remove the adnexa, while a median incision is unneces-
sarily large for removal of an appendix alone. But both of these

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conditions may coexist. Appendicitis of adnexal origin has a
slow course; a gonorrheal infection has begun the trouble;
there is a plastic or suppurative pelviperitonitis situated low
down in the pelvis, involving Douglas' culdesac; menstruation
is painful; there is leukorrhea; signs of appendicial and adnexal
troubles are combined. Retrodeviation of the uterus may be
caused by adhesions left from an appendicitis, or a pelviperi-
tonitis. Sterility may be caused by closure of the tube by
adhesions left after appendicitis. We should not allow our-
selves to be so hypnotized by McBumey's point as to do an
appendectomy when we have only a typhlo-colitis, nephro-
ptosis, or a simple appendix phobia. When an acute toxi-infec-
tious appendicitis occurs in the course of pregnancy, extra-
uterine pregnancy, or with fibroma uteri or ovarian cyst, the
diagnosis is especially obscure; but with grave symptoms, opera-
tion is indicated in all these conditions, and the diagnosis may
be made after the abdomen has been opened. With fibromata
the involvement of the appendix will contraindicate a vaginal
hysterectomy. In all cases of suppuration the indication is to
evacuate the pus. Every appendix should be carefully ex-
amined when it is encountered in the course of a laparotomy
for whatever cause, and removed when involved.

Final Results of Conservative Ovarian Surgery. — ^In examining
his records of 300 cases of ovarian resection, J. O. Polak (Jour.
Amer. Med. Assn., 1909, liii, 1382) found 163 with patho-
logical reports. In ninety cases the diseased structures belonged
to the class of multiple cystic ovaries, presenting numberless
small cysts throughout the ovarian structure. In fifty-five
of these cases one ovary was ablated, leaving one good ovary,
while thirty-five were resected. But five complete cures are
recorded; twenty-one patients returned for further surgery. It
would seem that multiple cystic degeneration was least favorable
to conservative procedures, while ovaries containing retention
cysts, cysts of the corpora lutea, large monolocular cysts, fibroids
and dermoids may be conserved by resection with considerable
hope for the patient's continued well-being.

Epilepsy in Relation to Menstrual Periods. — ^A. Gordon (AT. Y.
Med. Jour.y 1909, xc, 733) has collected twenty-three cases of
epilepsy in whom the seizures coincided with the periods of men-
struation. They were totally free from attacks and enjoyed good
health in the intervals between the menses; of these, only five
presented dysmenorrheic symptoms, but without apparent disease
of the ovaries. A course of gynecological treatment improved the
condition, but did not totally remove it. As the epilepsy con-
tinued in spite of the improvement, the presumption was in
favor of the view that the irregularity and abnormality of
menstruation have not much to do with the seizures. If we
take into consideration the fact that the remaining eighteen
patients did not present dysmenorrheic symptoms, it is evident
that disturbed menstruation has no bearing upon the causation

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of epilepsy. The usual bromide treatment kept up continuously
succeeded in some of the cases in arresting the attacks for
one or two months, but the latter eventually returned with the
same regularity as before. Every one of the twenty-three
patients was placed upon thyroid. The dry extract was given
at first in gr. iii doses, three times a day, and at the end of two
weeks gr. v three times a day. During the entire month or for
a period of three weeks, according to the case, between the
menstrual flows thyroid extract was given, but about three or
five days before the onset of the menses it was discontinued and
the bromide given instead. As soon as the flow ceased, the
thyroid treatment was resumed. The result was very satisfac-
tory. All the patients benefited considerably, some more than
others. The best results were obtained in the fourteen cases in
which the convulsions occurred a day or two before the menstrual

Mental Alienation in Women and Abdomino -pelvic Disease. —
W. P. Manton (Jour. Amer, Med. Assn.y Oct. 2, 1909) refers to the
fact that it has always been a popular notion, fostered no doubt
by indiscreet and thoughtless observations on the part of the
profession, that insanity in women is most frequently the direct
result of a diseased condition or perverted function of the organs
of generation, and hence it has been believed that the restoration
of these parts to a normal state, either by repair of defects or the
removal of pathologic structures, would lead to renewed mental
health. To those who have had the largest opportunity to study
these questions, however, experience has shown that this is not
altogether true. But whether a cure of the insanity is effected or
not, it is certain that improvement in the mental condition is
likely to supervene from the removal of the focus of irritation ;
the subject is rendered more comfortable and therefore becomes
more tractable, and through this is often changed from an un-
tidy, refractory patient to a clean, industrious, and orderly

Irrigation and Drainage in Obstetrical and Gjrnecological
Operations. — ^H. G. Wetherill {Jour. Amer. Med. Assn., Oct. 2,
1909) say that the majority of the best surgeons limit the use
of intraabdominal irrigation and drainage to few and to certain
specific indications, chief of which are rupture or leakage from
some hollow viscus or localized abscess which has poured into
the abdominal cavity food, urine, pus or blood in considerable
quantities. Glass drains are now rarely used even in the abdo-
men, and by only a very few operators. Gauze, always an in-
different drain, is more often employed for packing and walling
off infected areas, arresting oozing of blood which may otherwise
be difficult to control and for guarding against fecal and urinary
infiltration into the tissues, and leaks into the cavities of the
body when the hollow viscera have been injured or sutured.
When intraperitoneal drainage is necessary it is preferable to
make it downward through the vagina. Routine irrigations in

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obstetrics and gynecology are condemned, especially after un-
complicated normal labors. Drainage of the uterus and bladder
under certain conditions may be indispensable. When irrigation
of these cavities is necessary it should be made with nonpoisonous
solutions, and in the main with a view to their mechanical effect in
flushing the cavity as in contradistinction to their chemical and
antiseptic effect. Low hydrostatic pressure should be employed
and ample provision must be made for the return flow of the
flushing fluid. The writer calls attention to his rubber tube for
irrigation and drainage.

Inflammatory Tuberculosis, Dysmenorrhea of Tuberculous
Origin. — Gaston Cotte {Gaz. des H6p., Oct. 12, 1909) states that
tuberculosis as a cause of dysmenorrhea has been left out of
consideration. An aggravation of pulmonary lesions has been
noted at the time of the periods; the facility with which tubercu-
losis develops at puberty has been noted by others, while many
cases of tuberculosis have coincident menstrual troubles. Dis-
turbances of regularity and character of menstruation are ob-
served in tuberculous subjects. Of seventy women treated for
tuberculosis, all of whom had dysmenorrhea, forty were entirely
cured of their dysmenorrhea by tuberculin. Most of these
patients had begun to have dysmenorrhea when the tuberculous
disease began. These symptoms, together with anemic vertigo,
palpitation, pain in the stomach, and anorexia seem to be mani-
festations of the tuberculous toxemia. Their beginning coincides
with the beginning of their general troubles. When the toxins
are eliminated recovery from the uterine symptoms occurs.

Malignity of Benign Tumors of the Breast. — ^Lop (Gaz, des
HdpitauXf Oct. 18, 1909) records six observations of supposedly
benign tumors of the breast which were not operated upon
when they were first found, but which underwent malignant
degeneration and necessitated extirpation of the gland, and
resulted fatally. The adeno-fibromata and adenomata of the
breast have lost their reputation for benignity. After they
have shown malignancy it is too late for a successful operation.
The tumors shown by the author's cases were insidious in their
beginning, and only slight traumata of the pectoral region caused
them to be noticed. Their mobility was perfect; there were
transient enlargement and pain at menstruation. Secondary
involvement of the glands was not seen, and there was no deform-
ity or retraction of the breast. Had these cases been operated
upon at once they might have recovered. All neoplasms of the
breast should be freely excised as soon as seen.

The Sacroiliac Joint. — ^According to F. H. Albee (Jour. Amer.
Med. Assn.f Oct. 16, 1909), the sacroiliac articulation has all the
elements of,«a joint and therefore has a similar pathology. It has
motion and plays an important r61e in labor. Its variation,
according to individual, age, or sex, is very slight. Its anatomy

Online Libraryof Rhodes. Spurious works AndronicusThe American journal of obstetrics and diseases of women and children → online text (page 54 of 109)