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in our work as general practitioners we should teach the community at
large that it is not so much of an operation to open the bowel, to make
a little incision and know what is there to a dead certainty, and not go
about with an uncertainty, and when the patient dies not know what
he died of. I believe it is best to call in the surgeon, as Dr. Bailey
said, and throw the responsibility upon him and not risk ourselves.
And as to hurting the science, why, that is nonsense. Quite a number
of patients are saved even in bad cases. And what is the value of a
life? The operation is so innocent when properly and scientifically
done. Let the constitution be pretty fair and every thing be on a level
with what we call healthy, and then if the operation is performed in the
proper way, almost every case would probably get well. It has been
suggested that we should not run the risk in bad cases. Why, let us
run it, and half the cases probably will get well.

Dr. Cherry : I want to mention a case to illustrate what often occurs
in these cases. In the case of a very fat negress with a long hernia
there were symptoms of strangulation. Under anesthesia the hernia
seemed to be completely reduced. The ordinary gurgling was heard.
Several gentlemen present thought that it was all right. A few days



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The American Practitioner and News. 147

later I was passing by and was called in, and the most fearful odor met
my nostrils. I found that the bowels had moved well, and that there
was no tenderness and no vomiting, yet there was sloughing of the
abdominal wall. It speedily caused the death of the patient. I simply
wished to mention the case to show that not all cases, are as simple as
we might expect them to be.

Dr. Aitken, in closing: I agree with Dr. Bullitt in his remarks
about the time and whether we should operate in cases. It is our duty
to let the family know our opinion in regard to the case, and then
propose an .operation and give the patient any chances that may be left.
Dr. Dugan's criticism in regard to the hernia case I think is a justifiable
criticism with reference to the artificial opening. If I had to do the
operation again, I should take the suggestion offered by Dr. Dugan and
make an artificial anus. The reference to the number of operations
made without finding foreign bodies calls to my mind that I have
found three cases in which there were foreign bodies; two of them
were melon seeds, and the third one was that referred to in the paper
in which a chestnut hull was found. As to leaving the gall-bladder
open for drainage, I think that should be done as a rule, but the
obstruction here was so complete from malignant disease that it
seemed to the operator and those about him as well for the patient to
be dead as alive, and the sooner death came the better, owing to the
cancerous condition. If all our practitioners were like Dr. Bailey and
these gentlemen who are each year in attendance upon the meeting of
the Medical Association we would have no trouble getting to operate
upon these cases. The difficulty comes from the practitioners who
stay at home and do not keep abreast of the times.

[TO BE CONTINUED.]



dbstracts an6 Selections.



Thb Importance of Septa and Pockets in the Antrum of High-
more WITH Reference to Operation.— This was a paper by Dr. John
O. Roe, of Rochester. He said that too little consideration bad been paid
to the anatomical details of this cavity. Four features should always be
taken into consideration with reference to operation : the position of the
sinus ; its size, shape, and conformation ; the thickness of its walls, and the
relation to it of the roots of the teeth. He exhibited a series of skulls
which had been prepared to illustrate these points. He also exhibited an



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1 48 The American Practitioner and News.

antrum-searcher, which consisted of a flexible wire spring with probe
point. It ran in a canula, and could be extruded from the latter after it
had been passed into the antrum. In this way it was possible to get a
very accurate idea of the interior of the cavity, even through a very small
opening.— A/<?dfzV«/ Record.

Fetal Chondrodystrophia. — Axel Johannessen {Norsk Mag. Jor
Laegevidensk,, No. 2, 1898) reports very fully the examination of a female
infant, i month old, with hyperplastic chondrodystrophia, or, as it is more
commonly but less correctly called, '* fetal rickets." The infant was
atrophic, and died when about 7 weeks old. The internal organs were
normal. There was spinal kyphosis ; the head was normal, there beings no
premature ossification of the basis cranii; the ribs were normal, but the
clavicles had thickened extremities ; the diaphyses of all the long bones
were short and thin, while all the epiphyses were much enlarged and de-
formed, and the freedom of movement of the joints was much diminished.
The pelvis was much contracted, the conjugata vara measuring only 6 mm.
These points were well demonstrated by means of Roentgen-ray photo-
graphs, and these are reproduced in the paper. — British Medical Journal,

FiBRO-LiPOMA OF THE BASE OF THE ToNGUE. — This was a report of
a case by Dr. E. Fletcher Ingals, of Chicago. His patient was a farmer,
aged twenty-eight years, who for three or four years previous had suffered
from difiiculty in speaking, swallowing, and breathing. Some time previous
to his coming under observation, the cautery along with scissors and snare
had been applied with some relief. For the last two months all the
symptoms had been aggravated, especially dyspnea on lying down. On
examination a smooth tumor with congested surface could be seen situated
in the laryngo-pharynx, apparently attached to the right two thirds of the
tongue and the right pharyngeal wall. It seemed to be of a fibrous nature.
Removal with the cold wire (No. 5) snare was attempted, but the wire broke
three times. A uterine ^erasure carrying a No. 8 wire, properly bent,
proved to be the ideal instrument. One large mass measuring from one inch
to an inch and a quarter in its various diameters was removed at the first
sitting, and later other smaller masses were removed. Some were fibrous,
some fatty, and others were of the mixed type. Attachment was found to
be to the right side of the epiglottis, the right pharyngo-epiglottidean fold,
the right side of the pharynx, and possibly the base of the tongue. The
patient had been seen that very day, and it was noted that there was an
adhesion between the epiglottis and the right side of the pharynx and the
base of the tongue. This would prevent the epiglottis from shutting down
over the larynx during deglutition, but there was no difiiculty in swal-
lowing.

Dr. Woolen said he had seen a similar case. The wire had been slipped
over the growth several times, as he had shown the case to students to
demonstrate the mode of removal. When operation was finally attempted,



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The American Practitioner and News. 149

the patient suddenly ceased to breath. After resuscitation the attempt
was again made, and just as the wire was tightened cessation of breathing
again occurred, and this time resulted fatally. No anesthetic, local or
general, had been used. If such had been the case and death had ensued,
it would have been attributed in all probability to the anesthetic. — Medi-
cal Record.

PROTARGOiy IN GoNORRHKA. — Colombiui, of Barduzzi's Instituto Der-
mosifilopatico in the University of Siena, speaks well of the effect of pro-
targol in gonorrhea (reprint from Atti delta R, Accademia del Fisiocritici,
Serie iv, vol. x, 1898). He keeps at hand a lo-per-cent solution which he
prepares by pouring 5 c.cm. of neutral glycerine into a small mortar, and
adding to it 10 grams of protargol, stirring up the mixture with a glass rod
till a thoroughly homogeneous moist paste is produced. This is next
diluted with 95 c.cm. of cold sterilized water, and shaken up till a perfect
solution is produced; this solution is kept in a colored bottle in a dark
place. As required, a 0.25-per-cent solution is made by mixing 2]/^ c.cm.
of the standardized solution with 97 >^ c.cm. of sterilized water; a 0.50-per-
cent solution by mixing 5 c.cm. with 95 c.cm. of water; a i per cent by
mixing 10 c.cm., and a 2 per cent by mixing 20 c.cm. of the standardized
solution with 90 and 80 c.cm. respectively of sterilized water. These
solutions he uses as urethral injections according to the stage of the
disease. In the acute stage he uses the 0.25-per-cent solution. After
making the patient pass water, and washing the glans and prepuce
with some antiseptic solution, he first injects a syringeful of protargol
in such a way that sufficient room is left for the outflow of the injection ;
then refilling the syringe (which is made to hold 6 c.cm.) to two thirds
of its capacity, he injects the solution very slowly, blocking the meatus
completely so that it may not run out again. The syringe is carefully
removed, the patient being directed to keep the meatus closed with
his fingers for fifteen minutes, and not to pass water for an hour. As
the inflammation subsides, the strength is gradually increased up to 2 per
cent. The solution is injected at the temperature of the air. The first
day one injection is given, the next one in the morning, and another
in the evening; the third and following days one in the middle of
the day as well. The injections are continued for twenty days after the
cessation of the discharge, the daily number being gradually diminished to
one. Colombini gives details of 21 cases, and sums up that the results
were excellent in every respect. The gonococcus quickly disappeared, the
subjective phenomena speedily ceased, the discharge was rapidl]^ dimin-
ished and modified, and complete recovery occurred without any complica-
tion. According to him, it realizes the ideal of a remedy for gonorrhea,
curing the disease rapidly and effectually, without the least irritation or
undesirable after-effect on the mucous membrane. — British Medical
JournaL



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The American Practitioner and News.

'*NEC TBNUI PENnA."

Vol. 28. AUGUST 18, 1899. No. 4.

H. A. COTTELL, M. D., M. P. COOMBS, A. M., M. D., Editors.

A Journal of Medicine and Sui^ery, published on the first and fifteenth of each
month. Price, $a per year, postage paid.

This Journal is devoted solely to the advancement of medical science and the promotion of the
interests of the whole profession. P.ssays, reports of cases, and correspondence upon subjects of pro-
fessional interest are solicited. The Editors are not responsible for the* views of contributors.

Books for reviews, and all communications relating to the columns of the journal, should be
addressed to the Editors of The Ambrican Practitioner and News, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the
undersigned, to whom remittances may be sent by postal money order, bank check, or registered
letter. Address JOHN P. MORTON A COMPANY, Louisville, Ky.

ANESTHESIA.



There is no more important matter to be considered than anesthesia.
Every practitioner should thoroughly familiarize himself with the
technique of this most important part of the art.

First of all, the condition of the heart should be investigated ; then
the lungs and general condition. The kidneys should not be over-
looked, and the condition of the urine should be carefully noted.
Chronic catarrhal conditions of the lungs and larger bronchial tubes
contra-indicate the use of ether. The recumbent position is an absolute
necessity to safety. This rule should never be varied if there is any
possible chance of maintaining it, because it is always desirable to
keep the brain well supplied with blood, and this can not be done in
the sitting posture or the semi-recumbent position.

The stomach should always be empty. Not less than four hours
should intervene between the time of administering the anesthetic and
the last meal, and eight hours would be better. It is well not to let
the patient know just when the operation is to take place ; then the
mental effect upon digestion is avoided. We have seen a child under
seven years of age with its stomach full of undigested food eight hours
after the meal as the result of its anxiety concerning an operation which
was to be performed on its eyes.



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The American Practitioner and News. 151

The flannel-covered wire cup is probably the most convenient device
for administering an anesthetic ; but a towel, paper cone with a napkin
secured inside it, or a tumbler with a napkin stuffed into it, will serve
the purpose.

From four to ten minutes is sufficient time to anesthetize any person
with chloroform ; ether requires almost double the length of time. One
drachm of chloroform is quite enough to place on the inhaler at one
time. Frequent renewals in small quantities are preferable to saturating
the inhaler; that is, the napkin or towel, if these articles are used.
Plenty of fresh air should be admitted, but the windows of the room
should, as a rule, be closed.

The anesthetist should never forget that he is r-esponsible for the
good or bad results that may follow his work, so far as the anesthesia
is concerned. His whole attention should be given to the patient. He
should not for one moment allow himself to become interested in the
operation, or any thing but his work and the patient. He should see
for himself that all clothing is loose about the chest, abdomen, and
neck. The clothing should be so arranged that he can at any time see
the movements of the chest and abdomen. With one hand the tem-
poral artery can always be felt, and any change in the heart-beat can
be noted from this. The circulation in the skin of the face, ears, and
lips should be closely watched. Pallor of any of these structures
demands an investigation into its cause or causes, and the circulation
should be restored before proceeding. Sudden cessation of respiration
demands prompt action in the withdrawal of the anesthetic, admission
of fresh air, artificial respiration, stimulants, elevation of the feet to
give gravity a chance to send blood to the brain, ammonia to the nos-
trils, strychnia, and nitro-glycerine hypodermatically ; all these things
should be done when demanded.

In artificial respiration care should be taken not to put your patient
through the maneuver more than eighteen or twenty times per minute,
as otherwise the very object that you wish to accomplish will be
defeated. There must be time for the air to pass in and out, and some
time for interchange of gases in the lungs. The possibility of the
tongue's falling back into the pharynx and blockading the respiratory
tract should not be overlooked. In holding the tongue out, care should
be taken not to depress the lower jaw, which will very materially inter-
fere with breathing. In cases where the patient is apparently dead,
artificial respiration should be kept up for at least an hour.



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152 The American Practitioner and News.



TUBERCULOUS DAIRY CATTLE.



The Chicago Board of Health recently applied the tuberculin test
to a herd of sixty cattle, and twenty-five of that number showed a rise
in temperature, which is indicative of the presence of tuberculosis.
This test was confirmed by post-mortem examination of the cattle.

It is admitted that fully ten per cent of all the dairy cattle in the
country are tubercular, but this shows that fully forty per cent of that
particular herd was infected. The milk of any given dairy is usually
mixed before sending it to the consumers, and the result of it is that
all the milk from dairies is tuberculous to a degree. It is certain that
tuberculosis will not decrease in cattle as long as the boards of health
are as careless as they are at present. There is a great howl sent up if
a dairyman is caught watering his milk or putting a little innocent
coloring-matter into it, and he is hauled up before the City Court and
fined ; but he can keep diseased cattle in his dairy continually and sell
as much tubercular milk as he pleases, and go unmolested. Why is
this so? Because the authorities do not do their duty.

The action of the city of Baltimore concerning tuberculous cattle
could be profitably imitated by other cities. The health board of that
city had every dairy cow registered, and if its owner wished to move a
cow from one side of the street to the other he was obliged to get a
permit from the Board of Health. This is essential in order to carry
out the proper workings of the board. Baltimore controlled her dairies
and milkmen, and made the dairymen sell milk from healthy cows, and
there is no reason why it should not be accomplished in this and every
city in the world, for that matter. It will work hardship on some, and
will cost the State and city some money, but it must be done.

The law concerning tubercular cattle is quite suflScient for all prac-
tical purposes if the inspector of dairy cattle will only do his duty and
test each cow with the tuberculin. If we are to lessen the number of
deaths from tuberculosis we must begin by cutting oflF the sources of
infection, and it is now a settled fact that milk carries the tubercle
bacilli in great numbers, and of course some of the many millions of
these germs find a suitable soil in the human body and there begin
their work of destruction. Aside from heredity and the direct inhala-
tion of the germ from infected persons by sleeping with them, and by
inhaling it from dust, it is most likely that milk aflFords the greatest



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The American Practitioner and News. 153

opportunity for the propagation of this disease, hence the necessity of
having this great food-supply free from contamination. It is estimated
that about one seventh of the human race die annually from tubercu-
losis, which to a degree is preventable.

If smallpox, cholera, or yellow fever were in our midst, causing as
many deaths each week as consumption does, we would all be up in
arms fighting it day and night ; and yet we pay no attention to this
hideous monster that is sapping the very life of our nation. The reason
for this apathy is probably due to the insidiousness of the disease and
its long, lingering course lending hope to its victims. It is in reality
" death on a white horse,*' and the horse never sleeps ; he is going day
and night, and never fails to make time. Although it is occasionally
slow time, he gets there.

Let the dairy cattle be tested, and let a competent bacteriologist
sample and inspect each dairyman's product once each month, for in
that way only can we have pure milk.



THRBB-YBAR MEDICAL 5CH00LS.



When the Kentucky State Board of Health recently issued a ruling
refusing to recognize in any sense the diplomas of medical colleges that
graduate any student who has attended less than four full courses of
lectures in four separate years, we did not suppose that any college
would be bold enough to question the propriety, the justice or authority
for such a ruling. We are therefore not a little surprised to learn that
the schools requiring attendance upon but three courses of lectures are
not only very much disturbed about this ruling of the Board, but have
even become oflfensive in threats oi legal prosecution and other dreadful
things to compel the State to recognize the diplomas of their schools.

Unfortunately, oflScers high up and conspicuous in the Southern Col-
lege Association have been the most persistent in the denunciation of
this laudable eflfort of our State to uphold a higher standard of medical
education. This does not speak well for the Association, after what
occurred at the meeting of the Association of American Colleges in
Columbus, Ohio, in June of this year, where the representatives of the
Southern Association expressed not only a willingness but a determina-
tion to do every thing possible to encourage students to attend four
courses of lectures before offering for graduation, and to induce the
schools of the South to adopt the four years' graded course.

12



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154 The American Practitioner and News.

They were especially emphatic in asserting that any contract with
medical students who had previously matriculated in a school (** that
they may apply for graduation after attendance upon but three courses
of lectures '') could not apply to any students save those previously
matriculated in that particular school. The advertisements in the med-
ical catalogues and in the medical press from these schools for the next
session do not indicate good faith in this particular in any sense, for
the fact is made conspicuous that students who matriculated prior to
the session of 1899 and 1900 may apply for graduation after attendance
upon but three courses of lectures. If a college had no desire to
extend this privilege to other students than its own former matricu-
lates, why the necessity of this eflFort to procure students of other col-
leges? And why not mention the fact that the privilege must apply
only to the students of the college issuing the advertisement?

There are no palliating circumstances to justify any school in the
United States in graduating medical students who have not attended
as many as four courses of lectures, and we congratulate the medical
profession, State boards of health, State examining boards, and local
and national associations in the interest of higher medical education
upon the determined stand they have taken to compel medical colleges
to conform to their requirements.

Such medical colleges as require attendance upon but three
courses of lectures, with few exceptions, have poor equipments in
clinical and laboratory facilities, and no one knows better than the
teachers in such schools the indefensible position they have assumed ;
and medical students should take timely warning and not be induced
to graduate except from schools that conform to the nearly universal
demand of the profession of the entire country. The student who does
otherwise will find himself subjected to humiliating criticisms and
must suflFer in conscience and in purse.



THE SOUTHERN MEDICAL COLLEGE ASSOCIATION.



The fact that colleges of this Association find it necessary to allow
students to graduate after attendance upon but three courses of lectures,
and admit students to advanced standing within three months after the
completion of a previous course of lectures in another school, is an open
confession that these schools are either badly equipped for scientific
and successful work, or that they are badly conducted.



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The American Practitioner and News, 155

If the students of the South go to Kentucky or further north to at-
tend medical lectures, it is because they feel that they are oflFered better
facilities — otherwise they would not incur this greatly increased ex-
penditure of money.

It is to be greatly regretted that under the rules of this Association
a student may matriculate in advanced standing within three months
after completing the work of a previous course of lectures; and the
evil of this rule is especially emphasized by the fact that there are two
flourishing spring and summer schools in Louisville, the sessions of
which close July ist — just three months before the schools of the Asso-
ciation begin in the fall. The students of these two schools may get
credit for one course of lectures, and then get credit for half of another
course within one year, a misfortune to be deplored by every member
of the medical profession who has any appreciation of the benefits of a
higher standard of attainments in medical education ; and this must
not and will not be permitted to continue.

Some of the three-year schools of the Southern Association admitted
the students of the spring and summer schools to advanced standing
during the session of 1898-9; and several of these students had no
credentials to show that they were entitled to credit for lectures that
would admit them to advanced standing, having nothing but a matricu-
lation ticket and laboratory tickets, which were issued to them when
they entered the school the previous session, and did not indicate that
they had attended any part of a course of lectures.



Hotes axib Slueries*

The twenty-fifth annual meeting of the Mississippi Valley Medical
Association will be held in Chicago, October 3-6, 1899. An excellent
program has been arranged, and the meeting promises to be one of the
best in the history of the Association.



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 72 of 109)