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sngth greatly improved.

|.th — Has been without medicine for three days, and feels a

, which he blames to the damp weather, as it always affects

imilar manner.

:st — Blood examination showed 50 per cent hemoglobin. The

t showed that the blood contained 3,000,000 re^ Corpuscles

millimeter. Physical examination showed the spleen ex-

ily five inches below the costal arch.

[. Quartan form of malaria. E. G. R., aged twenty-five,

ivate. First Illinois Volunteer Infantry. When he arrived



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home from Cuba, September 7th, he was greatly run down, weighing
only one hundred and twelve pounds. Had his first chill in December,
which was eight or nine weeks after arriving in Chicago. For four
weeks the chills came on once a week, then two a week for three
weeks, then every other day for a few weeks, then an intermission of
one week. Following this, they came every day for fourteen days.
Ag;ain eight days without a chill, then every day for nineteen days, then
one week without any. Has noted a temperature as high as 107° F.;
often found it as high as 105.5°. He came to me May ist ; had been
having chills for three days in succession. Physical examination
showed that the spleen extended three inches below the costal arch.
Blood examination revealed hyaline bodies of irregular shape, irregu-
larly pigmented with large, coaise granules. Hematocrit showed that
the blood contained about 3,500,000 red blood corpuscles to the cubic
millimeter, and the hemoglobinometer showed that it contained 50 pet
cent of hemoglobin. Patient claimed that he is unable to satisfy his
desire for water. Borborygmus was a source of great annoyance to
him, and a symptom from which he especially desired to be relieved.
I placed him on guaiacol, five minims three times a day, to be increased
the same as in the other cases just cited.

May 4th — Had a chill on May 2d, and had every indication of one
developing to-day, but it did not mature. Notices his appetite improv-
ing, and has gained five pounds.

May loth — Had a chill on May 6th. Is taking fourteen drops of
guaiacol.

May 15th — Borborygmus entirely relieved ; no chills since May 6th ;
has gained eight pounds in twelve days.

May 22d — Had a chill four days in succession.

May 29th — Has had no chills since last visit ; is gaining in strength
rapidly.

Why the same organism should cause such widely diflFerent results
as is shown by this patient, I am unable to explain.

Case 4. L. W., aged twenty-seven. Company L, First Illinois
Volunteers. I first saw the patient October 8th. He gave a
history of chills and fever, which began two weeks before leaving
Cuba. Had a chill every three days until one week after his arrival
home, when he took an Indian malarial cure, which arrested the chills,
but four days after taking it he became troubled with dysentery, which
reduced him from one hundred and thirty-two to one hundred and five

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458 Tke American Practitioner and News.

pounds. About the same time his chills and fever returned every three
days as before. I gave him quinine in large doses, which checked the
dysentery but failed to control the chills. He continued doctoring
himself from November to April 17th, when he again called to consult
me. He claimed that his chills came on once and sometimes twice a
week. I put him on the guaiacol, as in the other cases, excepting that
he began with ten-drop doses.

April 2ist — Guaiacol disturbed his stomach, and he discontinued its
use. Chills recurred as usual. Without advice he returned to his
quinine, and as before it failed to control the chills and fever.

May i6th — Has continued to paint the guaiacol externally, and thinks
his chills have been lighter in character. With difficulty I persuaded
him to resume the internal administration.

May 22d — Claims the guaiacol disturbs his stomach; chills lighter
m character.

May 31st — Is now taking eleven drops, and for the first time in about
eight months he has been two weeks without a chill, and feels stronger.
I have no doubt that the malaria will be completely controlled when we
get him on the proper dosage.

As a result of my experience with guaiacol, I have arrived at the
conclusion that, though I am unable to state positively that it is a
specific in malarial fever, we possess in guaiacol a therapeutic agent of
great value in many cases which have resisted the ordinary methods
of treatment. In all the cases presented to you this evening, quinine
and other remedies were unable to control the chills and fever ; indeed,
Nos. I and 2 showed marked malarial cachexia, yet the result obtained
by guaiacol was immediate and lasting. Why No. 3 has not been
similarly affected I am unable to say. It may be that we have not
reached a dosage high enough. We will continue increasing until we
come to the stage of complete toleration, as we do with potassium
iodide, 'giving it until we get its effects. It may possibly be due to the
fact that we are dealing with a different micro-organism. I think not,
however, biit that we have not reached a dosage high enough to control
his malaria. He certainly has improved under its administration.
This remedy is deserving of a more extended trial, which I trust it
may receive at the hands of some of my listeners.

Chicago.



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The American Practitioner and News. 459

2^eports of Societies-



THE LOUISVILLE MEDICO-CHIRURQICAL SOCIETY.*

Stated Meeting, November 3, 1899, the Vice-President, Louis Prank, M. D.,

in the Chair.

Swelling of the Limbs Following Injury to the Hip. Dr. A. M. Vance :
I would like to know the cause of the trouble in the following case :
Four weeks ago I was called to see a Jewish woman, fifty-eight years of
age, who had fallen and injured her right hip. I saw her about an hour
afterward, and thought she had a fracture. I had her removed two
days afterward to the St. Joseph Infirmary. She did very well under
Buck's extension apparatus until the thirteenth day, when I found the
thigh of the injured side enormously swollen, the most exaggerated
distension of the skin that I have ever seen, and only the thigh involved.
I took oflF the plaster and bandage of Buck's apparatus and shortly
afterward the balance of the leg became greatly swollen. This
increased until the thigh was at least eighteen inches in diameter,
pressing the opposite thigh over into abduction. There were no
symptoms, and nothing to account for the trouble ; no pain, and no
evidence of disease. I did not do very much for the patient at this
time — simply gave her supportive treatment — and the thigh soon
diminished in size. Yesterday the healthy thigh began to swell with-
out any particular symptoms other than the swelling, which, as in the
other leg, commenced at the hip and extended downward.

The condition is entirely new to me. An ordinary edema from a
weak heart would become manifest first in the foot, usually; but here
the swelling began first in the hip on both sides. I concluded that
there must be some obstruction to the iliac vein in the first limb, and
thought the bandage around the leg and foot had controlled the swell-
ing there, but when the other leg commenced to swell without any
bandage, commencing also at the hip and going downward, I was some-
what puzzled, never having seen venous obstruction produce swelling
in the upper extremity of the leg, almost always commencing below.

The old lady has no symptoms of Bright's disease, and I never
remember to have seen more than one similar case in acute Bright's
disease, and that was a man (C. C.) who was for a long time in the city
hospital. He had acute Bright's disease, and subsequently became

* stenograph ically reported for this journal by C. C. Mapes. Louisville, Ky.



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The American Practitioner and News.

atous all over, but at first only one leg was swollen for quite a
>er of days.

be case is out of the ordinary, and I would like to have an expres-

af the members of the Society concerning it. The patient has

had any fever or any other symptoms referable to the condition

Qt.

he Advisability of Inducing Premature Labor in a Syphilitic Tviih
pse of the Uterus and Bladder. Dr. T. S. Bullock: At the meet-
f this Society a month ago I reported a case and asked for advice,
patient, a woman twenty-five years of age, had advanced about
months in utero-gestation. The question was whether or not the
tion of premature labor should be done on account of great swell-
id induration of the right labia, a subacute inflammation, a lacera-
f the perineum which was almost complete, with prolapse of the
; cervix and bladder. Doctors Cecil and Bailey, in discussing the
thought it was proper to put the patient to bed and await develop-
>. I intended to do this, but symptoms arose which I deemed
t, so I sent her to Norton Infirmary and introduced a bougie on
ly. She had been unable to stand up without the bladder being
>sed, and without a great deal of the pregnant uterus protruding,
was afraid that sloughing of this acutely-inflamed labia might
)lace, as the tissues looked very low in vitality.
J stated, I introduced a bougie on Sunday afternoon. No uterine
I followed introduction of the bougie, and I removed it after
y-four hours and introduced a still larger one. This I left in from
ay afternoon until Thursday morning, with absolutely no result.
1 withdrew the bougie and inserted another larger one, wrapped
1 little iodoform gauze, which was followed by labor pains within
e hours, and that night I delivered the patient of a fetus probably
le over eight months old — a breech presentation. The cord was
)ed around the neck. Although, after the os uteri had fully dilated,
\xy was prompt, on account of the absence of the pelvic floor, still
lild was dead when bom.

ivaited for the ordinary time, and there was no uterine action. I
d for an hour, and then tried to express the placenta by Crede's
3d, but every time I made pressure on the fundus the uterus and
er would prolapse. I then had the woman anesthetized and intro-
l my hand to remove the adherent placenta. In this manipulation I



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The American Practitioner and News. 461

discovered the explanation of the apparent insensitiveness of the uterus ; *
that I had to deal with a bicornate uterus, the implantation of the pla-
centa being in the right compartment. I suppose the explanation of
my failure to excite labor pains in the first, second, and third attempts
with the bougie was that the instrument entered the Unimpreg^ated
horn of the uterus. The bicornate uterus was easily demonstrated, the
impregnated compartment extending up in the right side, and the non-
impregnated compartment being to the left.

I neglected to state that at the time I withdrew the bougie from the
second introducton (on Monday) the right labia spontaneously ruptured,
and quite a large quantity of pus was discharged. I was very much
concerned for fear there might be an infection from this source, and
during the progress of the labor I had the right labia covered with
gauze wrung out of bichloride solution. The necessity of introduc-
tion of the hand and peeling oflF the placenta was that it was completely
adherent. The procedure was quite difficult, and I know was not
thoroughly accomplished, but was the best that could be done under
the circumstances. I remembered the view taken by Dr. Turner
Anderson, that it is better to leave some little portions of the placenta
than run the risk of doing too much damage to the uterine wall by too
persistent eflForts. After removing all the placenta I could, I gave her
an intra-uterine douche of bichloride solution, followed by plain water.
The woman went along and recovered, much to my surprise and grat-
ification, without an untoward symptom. A little fever developed on
the third or fourth day, I suppose due to the appearance of milk in the
mammary glands. The breasts were treated by means of the ordinary '
belladonna ointment and firm pressure, and she had no further trouble.
I have kept the woman in bed for quite awhile, and intend later to do
some plastic work, and probably a ventro-fixation or something else to
keep the uterus up and to deal with the chronic labial inflammation.

Dr. Windell, under whose care this patient formerly was for specific
disease, told me that she had had numberless vulvo-vaginal abscesses,
so much so that when I first saw her the whole right labia was chron-
ically inflamed and enlarged. She had a child several years ago, since
which time she has had a number of miscarriages.

The question I desire to ask is, What probably caused the death of
the fetus in the present instance? The woman was syphilitic, but the
fetus showed no evidence of the disease.



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The American Practitioner and News.

'ussion. Dr. Turner Anderson : The explanation given by Dr.
; as to the apparent insensitiveness of the uterus is probably
viz : that the bougie was introduced in the compartment which
mpregnated. Death of the fetus was, in all probability, due to
1 being passed around the neck in a 4ouble turn. I am sure
he cause of so-called stillbirths in quite a large percentage of
It is a condition which we can not recognize in advance. The
ly be passed around the neck and then carried up around the
1 such manner as to interfere with circulation. Of course, a
ognized by all obstetricians is as soon as the head is out to pass
er up around the neck of the child to ascertain whether or not
I encircles the neck ; the progress of labor is then watched care-
id matters expedited if it seems necessary,
have all encountered cases of bicornate uteri. I had a case
me ago in which I suspected, from the irregular contractions of
•us, that there was a condition of this kind by the manner in
he fundus behaved at the termination of labor, where the pla-
as expressed in the ordinary way, but where there was not the
rical feel that we would ordinarily expect to find. I induced
ire labor in a woman who had an uncontrollable albuminuria
I occasions several years ago, and the last time, when she was
nths pregnant, she suflFered from intense albuminuria ; she was
blind, she had chronic Bright's disease, and labor was induced
tne difficulty. It was found that she had a bicornate uterus ;
e was pregnant normally in one compartment, and that there
dns in the other. It was necessary to introduce the hand and

the placenta from the compartment in which the double
lation had occurred. The placenta from the other side came
ithout trouble. That was an interesting case. The woman
Drtly afterward from chronic Bright's disease, and, unfortunately,
not have an opportunity of securing a post-mortem examination.

not see how Dr. Bullock could have managed his case any better,
we have a case of uncontrollable albuminuria, where we have
ervous disturbances presenting themselves, I believe it is our
relieve the patient of her burden. We ought not to hesitate
he matter. If the patient has passed the seventh month of
^station, we should induce labor with much less hesitancy than
arlier months of pregnancy. There are cases of chronic Bright's
complicated by pregnancy in which the induction of premature



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The American Practitioner and News. 463

labor oflFers the only hope of relief. I think Dr. Bullock was perfectly
justified in the course pursued in his case.

Dr. A. M. Vance : I remember in one case I had to take a catheter
out of the uterus of a patient. The catheter had been introduced for
the induction of premature labor because of the existence of a pelvic
tumor. The Catheter, at the time I saw the patient, had been in situ
three days. Sometimes a catheter may be introduced into the uterus
and may remain there a long time without exciting labor. In the case
referred to, labor was finally induced after several introductions of the
bougie. I believe Dr. McMurtry subsequently removed a uterine
fibroma.

Dr. J. G. Cecil: It is more than probable that the explanation of the
in sensitiveness of the uterus mentioned by Dr. Bullock is correct ; still, as
stated by Dr. Vance, pregnant uteri are often extremely tolerant of foreign
bodies like cathjeters, bougies, etc. The general practitioner often sees
such cases after attempts at criminal abortion. I remember a girl who
was brought to the city hospital during my term of service there as interne.
She had used the spindle from an old-fashioned spinning-wheel in an
effort to induce an abortion. She had introduced it into the vagina,
and had made at least twenty or 'thirty punctures about the vaginal
walls, cervix, etc. The entire cervix had the appearance of having
been filled with a load of buckshot, and it was in a suppurative condi-
tion. She was then seven or eight months advanced in utero-gesta-
tion, and, of course, we all thought labor would be promptly induced
as a result of the patient's own acts. This, however, proved not to be
the case. Under simple warm water injections and the use of antisep-
tics the wounds healed, and the patient progressed to full term, and was
delivered of a living child without difficulty.

The general practitioner also often sees cases where attempts at
abortion have been made by the introduction of catheters or probes,
which have remained in situ for several days, and yet labor has not
been induced. An explanation of this may often be found in the diffi-
culty encountered in introducing a rubber instrument like a catheter or a
probe, in that it doubles upon itself, not entering the uterine cavity, and
therefore no uterine action is produced ; whereas if the catheter or probe
passed up along the uterine wall, separating the membranes, it is much
more likely to induce labor pains. It should also be remembered, in Dr.
Bullock's case, that there was an extremely elongated cervix, and pos-
sibly he introduced the probe the ordinary length or depth that is



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464 The American Practitioner and Neuts.

usually necessary, and yet it did not extend as high as was necessary
to reach the uterine cavity. Again, possibly the prolapsed condition,
the soddened, thickened, prolapsed neck rendered it less sensitive to a
foreign body. All of these are simply points which might, in a measure,
explain why it was so hard to induce labor.

Dr. T. S. Bullock : The point mentioned by Drs. Vance and Cecil
is one that I have noticed repeatedly, that the uterus is sometimes
extremely insensitive. It will be remembered that 'Dr. Anderson
reported a case to this Society recently, where he operated for a vesico-
vaginal fistula, in which he not only repaired the damage done but in-
troduced a sound several times into the uterus; still the woman, who
was pregnant at the time, went on and was delivered at full term in
spite of the handling and manipulation of the operator, it not being
suspected at the time that she was pregnant. I have noticed on one
or two occasions an extreme insensitiveness of the utei;us to the intro-
duction of a bougie, where I know it was properly inserted, because it
was withdrawn and reinserted to see if it had curled up at the first in-
troduction. I remember a case of atresia observed at the University
clinic in which it was deemed advisable to induce labor in the early part
of the eighth month. We introduced a large bougie, which was allowed
to remain for forty-eight hours before any uterine action was apparent

In the case reported, when I found that the woman had a bicomate
uterus, I naturally supposed I had introduced the catheter into the un-
developed horn. It did not curl up, because it was withdrawn and
reintroduced to be sure that it had properly entered.

The case mentioned by Dr. Anderson, where the woman was preg-
nant with twins in one compartment of the uterus and had a normal
pregnancy in the other, was extremely interesting. The woman was
pregnant at four months ; she had a single cervix, and the uterus not
being very large, it was exceedingly difl5cult to tell exactly what we
were dealing with.

In the case I have reported I could not have made the diagnosis of
bicornate uterus unless I had introduced my hand to remove the
placenta. Previous to that time I had attributed the position of the
uterus to an ordinary lateral obliquity of .the uterus.

The essay of the evening, " Hygiene of the Nose,^' was read by
William Cheatham, M. D. [See page 441.]



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The American Practitioner and News. 465

Discussion, Dr. Turner Anderson : The paper causes us to think
seriously upon a very important subject. I remember a number of
years ago, before we had so many specialists in this department, that
it was popular to treat cases of ozena, for instance, with a machine
called Thudicum's Nasal Douche. At that time a patient of mine, a
beautiful young lady, was kept out of society on account of an exceed-
ingly oflFensive discharge from the nose. There was no specialist at
that time to consult, and I attempted treatment of the case by pur-
chasing one of these machines and using a decoction of rhatany and
chloride of lime. She had no trouble from its use, nor did any of the
fluid get into the eustachian tubes. I taught the patient to use it her-
self, and she completely recovered. She had suffered for a long time
from this purulent discharge from the nose, probably the result of ulcer-
ation of the turbinate bones. She was under treatment perhaps six
months. The trouble never returned. After the fortunate result in
this case I began to think there was not much danger from this method
of treatment.

Dr. T. C. Evans : I believe it is a very common error to presume
that children frequently suffer from diseases of the nose. The great
majority of cases of apparent nasal disease, or so-called filling of the
nose in childhood, is due to a deflected septum or adenoids in the naso-
pharynx. In most cases of children we are unable to cleanse the nose
properly. I do not believe that disease of the nose proper is common
in children, and there are few cases where a spray can be used with
much benefit in the earlier years of life. It may be used with much
more benefit in adults than in children. I have found very few cases
of hypertrophic rhinitis or other disease of the nasal cavity proper in
children ; they are nearly all diseases of the naso-pharynx or deflec-
tions of the cartilaginous septum.

In regard to the post-nasal douche, I have had little experience with
it. Some way my patients will not tolerate this method of treatment.
It seems to be a very disagreeable thing ; at least my patients have
always thought so, and for cleansing purposes I prefer to put in a little
more time using the spray. However, I am not much of an advocate
of the spray, except in such cases that we do not know what else to do
for them. We relieve more cases by operative intervention than by
use of the spray, with either aqueous or oily solutions.

It would be of great benefit for the laity to read such a paper as Dr.
Cheatham has written, that they might recognize the importance of
matters of this kind.



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466 The American Practitioner and News.

Dr. S. G. Dabney : The title of Dr. Cheatham's paper scarcely indi-
cates its contents ; it sounds more like a paper on the results of nasal
obstruction. He has reviewed the subject pretty thoroughly, and it is
one that we hear a great deal about just now. I agree with Dr. Evans
that sprays do not accomplish much in children. The great majority
of nasal symptoms we see in children are due to some form of obstruc-
tion from adenoid growths. There is one notable exception in the so-
called purulent rhinitis which occurs in little children from four to
eight years of age, where there is a disagreeable, purulent, malodorous
discharge from the nose. In these cases cleansing agents are of great
value, and have to be used freely and frequently. I believe I have
seen some of them cured by the persistent use of cleansing agents, the
treatment extending over a long time. However, the majority of cases
of nasal discharge in little children, in my judgment, come from the
post-nasal space rather than from the nose itself. The symptoms due
to post-nasal obstruction are just those Dr. Cheatham has described,
the most important of all being those referred to the ear. Sight is not
often affected by nasal lesions. A great many people believe that
ocular diseases are due to some reflex disturbance from the nose. The



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 106 of 109)