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(Written for the MEDICAL DRIEF.]
Some Practical Items.
BY E. R. ELLIS, M, D.,
One of these is on the subject of postparium hemorrhage, or that which swiftly follows the conclusion of labor. The mouth of the womb becomes occluded with clots, and that organ is then filled with blood without the doctor becoming aware of it, unless he is very watchful. Such a case occurred to me a few days after my graduation in 1857, and such cases occur all too frequently in every vicinity, even to this day. The patient will die right under the eye of the doctor, even before he becomes aware of the true situation. He then has to expain that it was “heart failure” or a “mysterious Providence,” in order to let himself out from a blunder.
The case alluded to above was that of a young woman in her first confinement. The labor was concluded in a very natural manner, and I requested the nurse to watch her and report if there was much flow. She reported none and that all was well. Suddenly the patient exclaimed that "aH was dark, that she could not see.” This meant great loss of blood, and sure enough the womb was full of blood and the abdomen distended almost as much as before labor began. I lost no time in clearing the womb of clots and inducing contraction of that organ. The nurse present was a mature woman and had quite a large practice as a midwife. She tried to interrupt my efforts and insisted that "the clotters should never be removed.” Probably a gallon of clots and blood were speedily removed and with hot drinks and stimulants she was restored, but she had become unconscious and had for a time paralysis of the left side and limbs. That experience caused me to lose confidence in midwives. Two women in that vicinity had previously died in that way and I have no doubt that this patient would have been added to the list in five minutes or less had there been that much time neglected.
Probably the most effectual means to prevent such a mishap as this is to secure a firm and permanent contraction of the
uterus immediately after labor. For this purpose I always secure this by distending the thumb and fingers and placing them over the womb, hold it for five to fifteen minutes before placing the bandage in position. When thus contracted there can be no hemorrhage of consequence.
It is important to mention that a woman who has had repeated confinements, at short intervals, is more likely to have undue hemorrhage, or other mishap, than others. If the uterus is thus overworked, it (in a measure) loses its contractile power, becomes more placid, and fails to undergo proper involution, hence the obstetrician should never cease to be watchful.
Again, he should be alert to keep off convulsions. A premonition of this, in the last stages of the labor, is the patient has her eye attracted to an imaginary point in the ceiling, with her finger pointed upwards, and a whistling sound escapes her. Keep your eye on her face and the first sign of this command her, in vigorous tones, “to stop that," and give all her attention and strength to the work before her. In several instances I be. Jieve this has prevented the onset of puerperal convulsions.
Next, as to the bandage, which should never be omitted, as it gives most necessary support to all the internal organs and favors a correct involution of the womb. Occasionally a doctor comes out with denunciation of the bandage, but that is most emphatically wrong. The bandage serves a useful purpose in all relaxed conditions of the abdomen. It was said that during the late civil war soldiers with chronic diarrhea could ban. dage the abdomen firmly and march all day. As proof of this I will relate a case which came under my notice about two months after I began the study of medi. cine. Cholera prevailed in this city and one night my preceptor asked if I would like to see a case. I assented, and he took along with him another doctor for counsel. The patient was a man of about twenty-five years. He lay on the bed, rolling from side to side, groaning with pain, and made the never-forgotten remark, “Oh! if I only had something in me.” The doctors had gone into an ad[Written for the MEDICAL BRIEF.)
BY MARY H. WILLARD, M. D.,
New York City.
oining room for their counsel, and I sat beside the bed. I put my hand on his abdomen, which was so “caved in" that the vertebra could be felt. All that he took came up or went through him. It occurred to me that he could be “filled up" from the outside, and as an exud hard pillow lay upon the bed I placed this across him and pressed it down firmly. In a minute he was easier, turned over with the pillow under him and presently he was asleep. Fourteen years afterwards I moved to Detroit to practice medicine. About my first call was this man, who asked if I “remembered curing aim of the cholera.” The support which that outside pressure gave him was what contributed to his cure and, perhaps, saved his life, and this is what the bandage will do in many cases.
There is another matter which all should oppose strenuously. It is that of curetting the uterus in abortion, or when abortion is threatened. All violent means in such cases are unnecessary and dangerous. If but a slight hemorrhage takes place that is sufficient to destroy the life of the fetus, and then if left entirely alone Nature will throw it off in her own time with perfect safety. It will often take a few days for this, but Nature is a good doctor and he will do best who goes least counter to her ways.
Another important item, in this connection, is the manner in which babies are treated in their bathing. Scores of times, in receiving their first wash, have I seen the nurse expose the entire surface of the baby to the air. Many times have I remonstrated vigorously and explained that when a wet surface is exposed to the air, evaporation is greatly increased, and this lowers the temperature; even ice is formed artificially by rapid evaporation, as most persons know. Repeatedly have I know babies to sneeze and snuffle on their first washing from this cause. (Will some microphobist kindly inform whence comes this "specific germ," and how he is enabled to get to work so speedily ?) Only one limb at a time and a small portion of the body, when wet, should be exposed, and then well covered with flannel while other portions are undergoing the same process. 20 Wilcox Street.
“Good diet with wisdom best comforteth nian. "
The Century dictionary informs us that “dietetics is that department of medicine which relates to the regulation of diet." Following this definition, with an extract from Herbert Spencer to the effect that "it must not be supposed the whole of dietetics lies in determining whether or not bread is more nutritive than potatoes," leads us to the conclusion that dietetics cover a far larger field in the world of science than the first definition implies.
The apostle of the “Simple Life” might have taken a step further in his explorations and entered this field of knowledge with vast proits to the people; admitting that the health and morals of the individual depend largely on the quality of the food he eats, and the kind of home he inhabits; does not the prosperity or adversity of the nation take its vice from the health and morals of the individual?
Our lives are short at the best, three score years and ten (shall we quote a well-known authority for only two score years of really capable life?). The world is teeming with glorious possibilities ready to be taken up by the man wcman possessing good mental and physical caliber, and we cannot afford to miss even one day out of our short lives ky eating food which may render us unfit for the world's work; herein lies the great importance of a knowledge of dietetics in health, as well as disease.
Our ancestors—in the good old dayshad to work hard, physically, for their daily food; from the turning up of the soil, to the well-spread table, all preparations were accomplished by hard labor, chiefly in the open air; hence, their appetites were healthy, therefore easily satisfied; their food simple, therefore easily digested; their digestion good, therefore many of the modern diseases were unknown and there was no need for practical dietetics, especial diet lists, etc.
To-day our living is far more artificial. Much of our food is manufactured and brought to our doors ready for the table.
Mental effort has largely taken the place of physical lahor; indoor, the place of out-door life, and overwrought nerves are a force to be reckoned with in every part of our being. Diets have been formulated for all diseases; especially prepared foods are advertised everywhere, and, as in the case of all the best modern improvements are, by some, carried to the extreme, giving rise to the “diet habit."
I visited a home once where every member of the family was taking a different course of diet, and the dinner table daily took on the appearance of a restaurant, each plate surrounded by an array of especial dishes.
So much for the extreme side of the question; on the other hand, we recog. nize fully the inestimable value of the study of dietetics. There are few things, even in this wonderful twentieth century, so necessary to our mental and physical well being.
The fuel value of food has become an important subject, and the many experiments along these lines have demonstrated the value of the proper kind of food to suit various organisms. The terms, “vomb calorimeter," "respiration calorimeter," "oxidation of foods," "measurement of respiration," "heat of body," "application of results to prove true value of food," "effects of preservatives on health and digestion,” etc., etc., ad infin. itum, conveyed no more meaning to our. forefathers than the technicalities of modern electric apparatus are familiar to the student of dietetics and domestic economy.
In a modern cook book we find six recipes for “Hygienic Griddle Cakes;" whereas the word, "hygienic,” was rarely to be found in the vocabulary of our great-grandmothers.
Twenty years ago a well-known writer said that the time was ripe for a system of dietetics and domestic economy which might be applied to the family life; today, we have a well-established method of teaching this branch of science in the public schools and institutions, so that the rising generation may have no excuse for ignorance on the value of food in relation to the health and morals of the community.
Our ideas, in regard to diet in disease, have undergone even more marvelous changes in the last few years. We no longer "feed a cold and starve a fever," irrespective of the condition of the patient, but are learning the importance of sterilization of food, predigested albumin, medicated food, vegetable diet, relative values of mutton, chicken and beef, and a host of other important topics.
The knowledge of dietetics is, as yet, in its infancy, and few of our home-mothers know whether a basin of broth, a glass of milk, or a mould of wine jelly contain the most nourishment for the individual case under her care.
Sir Henry Thompson, the well-known English authority on dietetics, declares that “more than half the disease, which embitters the middle and latter half of life, is due to avoidable errors in diet." One has only to visit a children's ward in any of our large hospitals to feel assured that this applies to the care of our little ones. The regular tenement-house breakfast, for the whole family-not excepting the two-year-old baby-consists of strong coffee and hot rolls.
It is impossible, in a short sketch, to do more than skim over the surface of such an extensive subject as dietetics. When it is realized that the peoples of the world are groaning under a burden of suffering, which, in the large majority of cases, may be traced to indiscretions in the form of diet; over-feeding the system with highly. seasoned viands; starving it with unnutritious food; planting in it germs of disease, which bear fruit a hundredfold; or, through ignorance, neglecting the kind of diet to create a wholesome body; we see clearly demonstrated the true importance of the science of dietetics.
[Written for the MEDICAL BRIEF.) Static Electricity in Appendicitis.
BY 0. HOUTS, M. D.,
In the past two years I have treated fourteen cases of appendicitis with the static machine; but little medicine was given. Some of the cases had run six weeks, some one-half day. Some were
hauled in from the country on cots. The mode of procedure was as follows:
First, the patient, either sitting on a chair or reclining on cot, placed on the static platform, was given ten minutes brisk static insulation (positive), then the long-handled sponge electrode was met in warm water connected up with the negative side of machine, with a cord. The machine is started with the prime conductors closed after the machine is going at good speed; draw out the prime conductors until the limit of tolerance of the patient is reached. The positive side of machine is grounded. Continue treatment ten or fifteen minutes longer; peat in twenty-four hours, if needed. Follow up with a saline laxative every two hours, and with injections of one part glycerine, seven of water, high up in the bowels. No relapses have followed. One case that had run seven weeks, with right leg drawn up to body; almost impossible to get him to the office. The induration as large as his head.
Treatment.—The negative electrode from galvanic battery, No. 3, was placed over appendix. Positive over lumbar region, size 6 to 8 current, gradually increased for fifteen minutes, up to thirtyfive milliamperes. He was then placed on static platform and given the regular treatment with sponge electrode. He took seven treatments, when he could stand on both feet. Gave treatments every third day.
I will continue to treat all my appendicitis cases as above.
She returned to bed and in fifteen min. utes had a very severe chill, which was soon followed by fever. A physician was sent for, and after an examination said she had taken cold, and that inflammation had set in about the womb and ovaries.
He ordered poultices on the abdomen and gave medicines internally, for the chill, fever, and pain.
This attack kept her in bed two months. In May a swelling was first noticed to the left side of the abdomen.
Since the above attack she has had chills and fever continually, there being also more or less nausea. The urine contained no casts or albumen. She was put upon a good, nutritious diet, tonics, etc.
My diagnosis was a suppurating tumor, either in the left fallopian tube, ovary, or broad ligament.
A month later I opened the abdomen and found a tumor the size of three billiard balls, extending up to the umbilicus. Following it down into the pelvis, I found that it was the left ovary, with firm adhesions to the uterus, broad ligament, small intestine and surrounding parts. The fallopian tube was drawn up over the tumor.
While gently manipulating in separating the adhesions the sac wall, being so thin in the pelvic cavity, gave way, and its contents of offensive pus poured out. The tumor was separated, a pedicle formed, a ligature applied, and the tumor removed.
The abdomen was thoroughly washed out with an abundant supply of warm water. The excess water was sponged out, leaving a moderate amount still in the cavity. Monsell's solution of iron was applied to the oozing from the separated adhesions.
A glass drainage tube was inserted, and the wound closed with Chinese-silk sutures. The right ovary, being diseased, was removed. The patient reacted well from the operation, Chloroform was the anesthetic given.
The morning of the fourth day, her temperature being 9912° F., pulse one hun. dred and six, respiration twenty, and no fluid being drawn from the tube, it was withdrawn. T'he patient made an excellent recovery.
(Written for the MEDICAL BRIEF. A Case of True Abscess of the Ovary.
BY S. O. MISH, M, D.,
San Francisco, Cal.
Mrs. H. W. S., age twenty-four, menstruated at fifteen, and married at seventeen. Her first child was born in 1901. Breech presentation. On the twelfth day, feeling well, she went downstairs.
In March, 1903, her second child was born. On the fourth day after labor, hearing a noise in the house, she jumped out of bed and went about the halls for some
The case is of interest in several re- tendance and graduation at two regular spects.
medical colleges. Take, for instance, the The pathological reports show the tu- one who manifests an aggravated form of mor to be a true abscess of the ovary. hysteria at the mention of medical adver
We are aware of there being a distinct tising, and who insists that one must posdifference between this condition and ab- sess numerous literary degrees before bescess of the fallopian tube and the pelvic ing permitted to enter a medical college, cellular tissues in and around the broad and he will tell you that typhoid fever, ligaments.
pneumonia, and almost every known disThe extensive use of Monsell's solution ease, is self-limited, and should be treated of iron to arrest the copious oozing from on the expectant (?) plan. This means, the separated adhesions and its success is write a few Latin prescriptions in which a point of interest.
you have no confidence, and wait. While Some surgeons are opposed to washing you are waiting organize a county society out, and are in favor of sponging out the on the reorganized plan, and try to get a abdominal cavity. In abdominal opera- bill through the Legislature which will tions where there is much oozing of blood, permit you to bleed the real physician which forms into clots among the convo- who believes in medicine, and the English lutions of the bowels, or along the spinal language, and which will enable you to column, or under the diaphragm, or liver. live in luxurious idleness with your skepor behind the stomach or spleen, or deep ticism. This is modern education, accord. down in the pelvis, it is almost impossibl3 ing to the medico-political dictator, who to cleanse these cavities thoroughly by at present controls and exploits the regu. sponging. Moreover, lengthy sponging de- lar profession, and is trying to include the lays the operation and produces a great manufacturers of proprietaries in the amount of unnecessary irritation of the bleeding process. It would seem he has abdominal and pelvic viscera, thus en- struck more than he can handle at this hancing the danger of shock.
game, as the proprietary interests emSome surgeons also dispute the efficacy brace an immense capital, as well as of the drainage tube in abdominal opera- brains, and a desire to run their own busitions. Drainage through the abdominal incision, when properly done, is not Now then, brethren, if this close corpor
ation of medico-political dictators should against gravity, as usually implied. I re. | N fer to those cases only where drainage is meet with the rebuke and defeat they denecessary, for the tube, if used, is the serve by this unjust attempt to appropriopening through which we can draw off
ate private property, do not permit them the fluid as it gravitates there.
to lay the whole thing on the rank and Parrott Building.
file of the profession, as they are almost
sure to do, for remember they have al(Writtea for the MEDICAL BRIEF.]
ready appropriated everything we have; Education.
our liberty, which includes our standing
with the State and the public-at-large, is BY JOHN A. WELSCI, M. D.,
subject entirely to their individual whims, Farber, Mo.
without recourse under the law. A dean
of a certain medical college has been laThis is the war cry of the medical poli- menting the fact that the increased retician. And when you come to analyze quirements (?) may cause a deficiency in one of them there are few men in or out the production of physicians to the extent of the profession who actually possess less of making the supply not equal to the of it than the stickler for higher require. demand. He bases his opinion on the ments (?). Plain tincture of aconite has decreased number of matriculates in the been just as effective in my practice as medical colleges at present. But the organ tinctura aconitum. And so with all rem- of the medical trust hastens to assure him edies which I have used during my fifteen that there is no decrease in first-year years' experience as a student and prac- students at the really high-class (?) medtitioner of medicine, which includes at. ical colleges.