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interferes with the development of the exposed fibula and the outer toe or
toes of the exposed foot. Lack of space determines the bend of the grow-
ing tibia ; the adhesion which produces the so-called scar is a result of con-
tact of the most salient point of the tibia with the enveloping wall. Early
pressure and disuse produce deficient vessels and nerves, and so lead to the
lack of growth of the whole limb. Where there is a rudiment of the fibula
of some size, but situated higher up than normal, an operation aiming to
slide this down and fix it to the tibia as an external malleolus might be
worth considering. Amputation is to be thought of only in cases utterly
unsuitable for other treatment. — British Medical JournaL

A Hemorrhagic Micro-Organism. — C. Klein {Centralblatt Jiir Bak-
teriologie und Parasitenkunde ^ xxii, 4; Centralblatt fur inner e Medicin,
November 5, 1898), after alluding to the bestowal by the laity of a common
name on various diseases of sheep, speaks of one of those diseases as being
manifested by hemorrhagic edematous swelling of the groins and of the
abdominal wall, proceeding from the vulva, in sheep that have recently
dropped lambs, proving fatal in from twenty-four to ninety-eight hours.
In the skinning of these animals three persons acquired a vesicular affec-
tion of the skin which seemed to have many points of similarity to the
carbuncular manifestations of anthrax. The fluid contained in the ves-
icles had a bloody color. Besides the vesicles there were observed in the
human subject only erythema, swelling of the axillary glands, and local
itching and irritation, but without any elevation of temperature. From
the contents of the vesicles the author obtained by cultivation a staphylo-
coccus-like micro-organism into the behavior of which on various media,
together with its staining reactions, he goes largely, particularly as to the
points that distinguish it from the micrococcus fotmd by Noccard in cases
of the gangrenous mastitis of sheep.



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The American Practitioner and News. 157

Clinically the two organisms are chiefly distinguished from each other
in their effects by the fact that Noccard's micrococcus gives rise only to
transitory boils, while the micro-organism found by the author always
occasions extensive hemorrhagic edema of the subcutaneous tissue and
of the muscles. In several instances, also, hemorrhagic enteritis and,
especially after intra-peritoneal injection, hemorrhagic peritonitis have
been observed. The small size of the liver is striking. The infection is
almost always fatal. Immunization is possible by the employment of pre-
liminary inoculations with highly attenuated culture products, but the
immunization is not perfect, for the subsequent inoculation of large quanti-
ties of the unattenuated product still gives rise to the disease, although its
development is postponed.

In two instances Klein has inoculated sheep with his micro-organism.
One of the animals died, and the other recovered after having for a long
time shown severe illness with a temperature of 106° F. From the sheep
that died there was obtained a micro-organism that displayed the greatest
virulence when inoculated into guinea-pigs. — New York Medical Journal.

Salophenr. — M. Cresle {Gazette hebdomadaire de medecine et de chi-
rurgiej December 18, 1898), in a thesis before the faculty of Toulouse,
considers salophene as now definitely settled in the therapeutic domain.
It exerts, he says, an incontestable action upon acute and sub-acute
rheumatism, but its effects are less constant than those of salicylate of
sodium. In chronic and blennorrhagic rheumatism it has not shown itself
superior to other drugs. Salophene possesses a powerful analgetic action,
which is exercised even in those cases where this drug can not be looked
for to effect a cure. It has given good results in migraine, in various neu-
ralgias, and in sciatica. Salophene employed in a medium dose produces
no phenomena of intolerance, nor does it occasion headache, buzzing in the
ears, or troubles of visions, but tolerance appears to be rapidly induced.
In certain cutaneous affections salophene appears to have some efficacy,
but it is necessary to wait for further experience. The medium dose of
salophene is sixty grains daily, more or less, according to the gravity of the
complaint. — Ibid,

Calculus of the Uvula. — In the Boston Medical and Surgical Journal
of Dec. 8th, Dr. J. L. Goodall has published the following case which he
claims as unique: A colored female infant, aged two months, suffered
since birth from dyspnea. In the upright position respiration was per-
formed normally through the nose, but in the recumbent position there was
considerable obstruction to nasal breathing. On the anterior aspect of the
uvula, midway between the tip and the junction with the soft palate, was a
white globular mass about four millimeters in diameter, lying apparently
immediately beneath the epithelium. The probe showed it to be of bony
hardness. It was readily enucleated by a cutting forceps. Under a press-



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158 The American Practitioner and News.

ure of 3 lbs. it broke into yellowish-white fragments. Microscopically they
consisted of amorphous particles, fat crystals, fat drops, and degenerated
epithelium. A week after removal the wound had healed and respiration
was freer. Probably the mass originated in a mucous gland, and the
weight in the recumbent position occluded the naso-pharynx. Though no
case of calculus of the uvula has been recorded, three cases of calculus
of the soft palate have. A boy, aged sixteen years, had dysphagia and
dyspnea. Two masses were found on the soft palate, one on either side of
the uvula, and of about the size of a hazel-nut, which on probing through
the dilated mouths of the palatine glands were found to be calcareous. A
tampon saturated in dilute sulphuric acid dissipated them. Mr. C. A. Park-
er, at a meeting of the Laryngological Society of London on Dec. 13,
i893» reported the case of a young man, aged twenty-nine years, who com-
plained of great soreness in the throat for six or eight months. A calcu-
lus was situated in the substance of the soft palate just to the right of the
base of the uvula, a portion lying free and resembling a sloughing ulcer.
It was removed from what was apparently a cul-de-sac between the muscu-
lar layers, and when dry it weighed 54 grains. It was composed of epithe-
lial debris, spores and mycelium of gladothrix, and earthy salts. — Lancet,

Conviction of a Christian Scientist.— We learn from the Cleve-
land Journal of Medicine for January that Harriet O. Evans, a ** Christian
Scientist " of Cincinnati, complacently allowed Thomas McDowell to die of
typhoid fever without any treatment except the much-vaunted prayer of
these peculiar people. Under the energetic initiative of Dr. Charles A. L.
Reed, of Cincinnati, who is a member of the State Board, she was prose-
cuted for practicing medicine without a license. The police-court jury is
reported to have employed just twenty minutes in deciding that she was
guilty as charged. The case has been appealed, of course, but it is a most
excellent beginning. The thanks of the medical profession of the State,
says the Cleveland Journal, are due to Dr. Reed for having shown in this
and many other cases what a sincere and energetic member of the board
can accomplish. — New York Medical JoumaL

An Undescribed Form of Osteopathy of the Lower Extremities.
— At the meeting of the Soci6t6 M6dicale des Hdpitaux on Nov. 18, 1898,
Dr. E. Hirtz presented a man, aged thirty-seven years, who at the end of
1893 had shooting pains in the legs and knees, of greatest enteusity in the
left ankle. There was also a little periarticular swelling but no deformity.
The feet also became affected. He was treated in hospital during six
weeks for rheumatism, and was cured and resumed his occupation of sales-
man, which obliged him to constantly stand. In January, 1894, the swell-
ing reappeared in the same places. In March deformity first became evi-
dent; it consisted at first of enlargement of the internal part of the left
ankle-joint with weakening of the plantar arch. After a month the right



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The American Practitioner and News. 1 59

foot was similarly affected. The pain was great, and in June he again
entered the hospital. Under treatment the enlargement subsided some-
what, and he was able to resume his occupation. But the pains and de-
formity increased. Pressure corns formed on the soles, terminating in per-
forating ulcers. He entered the hospital a third time. In October the left
lower limb was much magnified, the thigh was enlarged in its lower third,
the leg and foot were still more enlarged, and the internal malleolus was
enormous. Palpation showed that the enlargement was principally osseous ;
it involved the lower half of the femur, the tibia in an increasing degree
from above down, and the fibula, which was double its normal dimensions.
The foot was converted into a veritable block of bone in which individual
bones could not be distinguished. The right lower limb was affected in a
much less degree than the left. No other bones were involved ; the signs
of Paget's disease and of acromegaly were absent. The case resembled
one brought before the society in 1892 by Marie under the name of ** system-
atized osteopathy of a type not described." But the latter differed from
Dr. Hirtz*s case in that the radii and inferior maxilla were affected. There
were no signs of syphilis or of locomotor ataxia. — Lancet,

Glycerinated Lymph. — The following minute has been issued by Mr.
Henry Chaplin, President of the Local Government Board, London:

Local Government Board, Nov. i6, 1898.
I desire to place on record an expression of the value which I attach
to the labors and researches of Dr. Sydney Monckton Copeman in connec-
tion with the preparation, by the aid of an aqueous solution of glycerine,
of a vaccine lymph which is free from harmful organisms. An indication
of the value which is attached to Dr. Copeman's researches is to be found
in the fact that Parliament has decided by Statute that this form of lymph
shall for the future be used in this country. Henry Chaplin.

We are glad to be able to offer our congratulations as well to Dr. Cope-
man with regard to his arduous researches into the question of glycerinated
lymph, though of course the idea of using glycerine as a vehicle did not
originate with him. But we think it is fair to say that he has raised what
was formerly a mere hypothesis in this country into the region of ascer-
tained fact. By the use of properly prepared and standardized glycerinated
lymph the last shred of objection which any objector other than a pig-
headed fanatic can possibly put forward to vaccination has been done away
with, and we can only hope that the ** tremendous experiment " upon which
the Government has entered may not be attended with disaster. If an
epidemic of smallpox should come, it will fall hardest upon innocent chil-
dren, who will owe disfigurement and possibly death to the mistaken action
of those whose first duty it should have been to guard them against such
misfortunes. — IHd.



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Special ZTotices.



A Vbry Gravb Error.— The experience of many of the best men of the profes-
sion, not only of the United States but abroad, has established the clinical value of
antikamnia. Among those who have paid high tributes to its value and who occupy
positions of great eminence, may be mentioned Dr. J. Acheson Wilkin and Dr. R. J.
Blackham, practitioners of London. They have found it of value in the neuralgias
and nervous headaches, resulting from over work and prolonged mental strain, par-
oxysmal attacks of sciatica, brow-ague, painful menstruation, lagrippe and allied con-
ditions. Indeed, the practitioner who has such cases as the latter come under his ob-
servation, who attempts their relief by opiates and stronger drugs, when so efficient
an agent can be used, which is much less harmful, commits a grave error.

Experience goes to prove that ten-grain doses of antikamnia in an ounce of
sherry wine, taken every two to four hours, will carry the patient through these pain-
ful periods with great satisfaction— ^^^tVa/ Reprints^ London^ England.

Geo. W. Samubi*, M. D., Nashville, Tenn., says: I had a case of a man who had
been drinking heavily for several days. I prescribed Celerina in tablespoonful doses,
every three hours, and in a short time he was in good shape again. I also used it in a
case of neuralgia, in the following formula :

K Celerina, 8 ounces.

Quinia Sulph, 60 grains.

M. Sig. Teaspoonful every four hours.
It acted like a charm. In a case of impotency, I used calomel in connection with
Celerina, and the patient reports every thing standing all right.

Sanmbtto in Gbnerai^ Naso-Pharyngeal and Bronchiai« Catarrh Compli-
cated WITH Gastro-Intbstinal Catarrh— Ai^o IN Hypbrtrophv of Prostate,
Dysuria, and Painfui* Micturition. — I have used Sanmetto in my own case, that is,
general naso-pharyngeal and bronchial catarrh with the invariable complication in all
such cases, gastro-intestinal catarrh, with the very best results, and I frequently pre-
scribe it in such cases with the most satisfactory results. I use it in all cases of
hypertrophy of the prostate, dysuria, difficult and painful micturition, and such as
need to have the genital tract braced up, with the very best results.

Bedford, Ind. J. B. Duncan. M. D.

W. Irving Hysi^op, M. D., 4408 Chestnut Street, West Philadelphia, Pa., says : I
have used Celerina quite largely both in private and hospital practice, and with grat-
ifying results. It is void of repugnant taste, and is readily retained by the stomach
My experience with Celerina has been confined chiefly to its use in nervous diseases,
particularly loss of nerve power, and the opium habit, in which conditions it has
served me well, and I shall continue to prescribe it both in private and hospital
practice.

Wii^WAM R. Warner & Co.'s salesroom, offices, and storerooms at No. 1228 Mar-
ket Street, Philadelphia, were entirely destroyed by fire on the night of February
i6th, but they announce to the trade that their laboratories are running day and
night, and all orders will be filled with as little delay as possible from the laboratories,
Broad and Wallace Streets. Their Chicago branch, however, has a large stock on
hand, and are prepared to fill all orders promptly that may be sent them.

MAI.NUTRIT10N. — " I am sure the Imperial Granum Food was an efficient agent
in restoring the health of a baby boy recently under my care. He was suffering from
malnutrition with a most persistent diarrhea. Many foods were tried and discarded,
and I was beginning to lose heart, when I happened to think of the Imperial Granum.
Its use proved it to be very easily assimilated, and I think it saved the baby's life."

, M. D.



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American Practitioner and News.



'NEC TENUI PENNA.'



Vol. XXVII. Louisville, Ky., March i, 1899. No. 5

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the
fewest possible words, or his reader is sure to skip them ; and in the plainest possible words, or his
reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain
way ; and we want downright facts at present more than any thing else.— Ruskin.



0riginal Clrticles.



SOME POST-OPERATIVE EFFECTS OF ABDOMINAL SURGERY
VIEWED FROM A MEDICAL STANDPOINT.*

BY THOMAS HUNT STUCKY, A. M., M. D.

My desire in discussing the above subject is to cast no reflection
upon the brilliancy of the work in this especial field, nor to decide the
character, condition, or circumstances requiring surgical interferences,
but to mention some of the after-effects observed in my own practice,
after the patient has passed from surgical observation as cured.

The results as observed may be divided as follows :



Mechanical.. { ^^^^^t^.
Nervous.... {N - »,^„t^-



' Digestive.
Respiratory.
Mental.
Manifestations.



I regret exceedingly I am unable at this time to find a better name
for the first division, being forced to believe in the vast majority of
cases when the peritoneum in its normal relation is disturbed adhesions
result, the degree or extent of the adhesions not depending on the
amount of surgical interference.

In nine cases operated upon five years ago (the operation being one
ovary in four and both in five), four have died since. Upon three,
autopsies were held.

Case i. Mrs. L., aged twenty-eight. Operated upon January 3,
1893. Both ovaries and tubes removed ; passed from surgeon's obser-
vation after two months cured. Remained improved several months.

*Read before the Louisville Medico-Chirurgical Society, February lo, 1899. For discussion see p. 178.

18



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i62 The American Practzttoner and News.

Pains in abdomen, first transient, then more continuous, growing more
severe and continuous ; constipation persistent, digestion poor, loss of
flesh, evidences of strangulation. Surgeon recalled ; advised re-open-
ing abdomen, which was done July 6, 1894. Adhesions everywhere,
with bands binding so tightly portion of small intestine as to produce
gangrenous spots. Patient died July 8, 1898.

Case. 2. Mrs. T., aged forty-five. Both ovaries removed for some
cystic trouble. Had prior to operation always been cheerful and happy
in disposition. Fond of family and home. Digestion good. An ideal
case from which an excellent result was to be expected. One year after
operation depression of spirits, moroseness, fault-finding, generally dis-
agreeable, digestion becoming impaired ; bowels constipated, constipa-
tion increasing; pain at seat of ovaries. Notwithstanding treatment,
the patient died four years afterward with symptoms of strangulation.
Operation advised but refused.

Autopsy revealed constriction of sigmoid flexure. The autopsy on
the third case revealed similar condition of bands of adhesion, death
undoubtedly taking place from exhaustion.

Of the living cases operated upon during that year, three are mark-
edly neurasthenic, with digestive disturbances; one manifesting at
the time of the period hysteria, lasting for three days. This patient,
aged thirty-eight, both ovaries removed, has missed the past three hys-
terical attacks, due, I believe, to the administration of ovarian extract.

Another has an attack of asthma, not having missed but one since
the operation in October, 1893, and, notwithstanding treatment, con-
tinues to have the attacks.

In the past four years there appears to be a lessening of the intes-
tinal symptoms, due perhaps to the increased skill in manipulation and
less handling of abdominal contents, preventing thereby local injury to
parts.

Whether the nervous symptoms found differ radically from those
produced in any condition of slow poisoning is most difficult to
determine. Or whether the neurasthenic conditions produced from
prematurely induced menopause differs materially from operations on
bladder or prostate in the male, if we accept the comparisons made by
Dr. Moyer, in the Journal of October 10, 1898, there is no difference.

Quoting from his paper: "The first question which naturally pre-
sents itself is this : Is there any difference between operations upon the
pelvic organs of women and operations in general ? If you examine



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The American Practitioner and News. 163

the statistics you will be at once struck with the number of cases which
are operated upon for pelvic disease, which show insanity, neurasthenia,
and other nervous troubles following operation and probably resulting
from it. Some writers have come to the conclusion that these opera-
tions are peculiarly liable to be followed by such phenomena ; but if
you come to analyze the cases more closely you will find that operations
are performed upon persons whose general health is greatly impaired.

** The great majority of them are very much reduced by a long
history of illness prior to the operation. The operations in themselves
are many times prolonged, and a by no means infrequent condition is
the one of infection, a slow poisoning of the system for which the oper-
ation was undertaken. Those necessarily are apart from the operation
itself, and they furnish a fruitful soil upon which nervous troubles and
insanity are built. In order to get some sort of basis for comparison, I
have taken fifty cases of operations upon the prostate and bladder. I
have thought there might be some comparable relation between the
pelvic organs in the male and in the female. The operation was on
the same part of the body, and frequently accompanied by ill-health,
and often in the male by infection. I compared fifty cases, excluding
all those in which there was marked disease of the kidney, and I found
that the mental and nervous effects following operations which might
be attributed to the operation per se were much greater in the male
than in the female. Taking all factors into consideration, operations
upon the female pelvic organs are not attended with more nervous dis-
turbance, such as neurasthenia or insanity, than are the operations in
general surgery.

"The character of the mental disturbance which may follow opera-
tions is substantially the same, whether the operations are done upon
the pelvic organs or upon other parts of the body. The great bulk of
them fall within the class of neurasthenia, or that condition which is
described by alienists as primary confusional insanity. These two con-
ditions seem to be the great predominating mental and nervous states
which follow operations.

" In conclusion, therefore, I would simply say that I have arrived at
the opinion that there are no radical diffierences in the primary effects
of operations upon the pelvic organs in men differing from the effects
of similar operations in women, or indeed of operations in general sur-
gery, and that there is a distinct and peculiar effect from the removal
of the ovaries or tubes, or both, by which the menopause is established,



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164 The American Practitioner and News.

but that does not differ in its nervous phenomena from the menopause
occurring normally at the ordinary time of life. As to the possibility
of a peculiar physiologic effect following extirpation of the ovary, not
attributable to the menopause, I have absolutely no conclusion to offer.'*

Dr. Joseph Price writes regarding nervous phenomena following
operations, " I am perfectly willing to admit that we have had too
many post-operative sequelae and too many local lesions following our
operations; the materials were badly chosen, and are yet in many
cases."

Dr. Price seems to attribute much of the ill-success to carelessness
upon the part of the operator, the operations being done with badly
prepared materials, and as a result all sorts of local pain and nervous
disturbances are going to result. If this be true, and it seems to be
supported by our leading gynecologists, then much of the evil rests
upon the surgeon himself. Then may it not be in the anxiety of the
operator to impress upon his patient the fact no further treatment is
necessary, that the successfulness of the operation is an assurance of
recovery ?

Failing, as has been my observation, to consider the great moral
shock in breaking the chain of performance of function, that the digestive
and eliminative systems have been interfered with, if not arrested.
There is a necessity for moral support as well as physical. Competi-
tion is always brisk, and especially so among the knights of the seal-
pel.

I do not wish to be understood as meaning there are no cures from
removal of diseased organs ; far from it. Most strenuously have I advo-
cated the removal of all pathological conditions of the pelvis when
admissible, but I do believe many post-operative evil effects we now
meet are due to removal of parts physiological, negligence on the part
of the operator as to material, cleanliness, and selection of patients.
The practitioner meets these cases in their little ailments, whether they
be neurotic or lithemic, and it is he to toy with their moods and dis-
comforts. Deducting from a limited experience of seventy-six of whom
I have a record :

First: There are nervous cases which seem to originate reflexly
from pelvic affections which are not relieved by removing the uterus



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 19 of 109)