Reports on Progress. OBSTETRICS. BY WILLIS HALL, M. D., Chief Assistant at the Gynecological Clinic, St. Louis Medical College. The Urethra, Bladder and Ureters During Pregnancy, and the Puerperium. In a discussion of a paper of this title, by W. H. Parrish, M. D., the opinion was uniform that the use of the traction-rod forceps prevented many vesico-vaginal fistulæ. Dr. Daniel Longaker considered the use of the catheter after labor very undesirable, and recommended the increased liberty of the patient as a means preventive of its necessity. He had a series of fifty cases in which he did not once use the catheter.—[The Times and Register, Dec. 5, 1891. The Purse-String Operation for Cystocele. Henry D. Ingraham, M. D., in Medical News, says: As yet no means of mechanical support have been devised that, in a goodly number of cases that come to us for treatment, permanently benefit or even temporarily remedy the displacement with comfort to the patient. Neither has operative treatment accomplished all that was fondly hoped for it. Whenever a cystocele can be supported with comfort by any kind of pessary, with the only inconvenience of an occasional removal of it, and the substitution for a week or so of astringent tampons to allow an erosion to heal, an operation is not necessary, even though the pessary must be worn continuously; nor in the case of a young woman, whose vagina has notbecome over-distended throughout, and where a cure may be expected in a year or two, if the parts be properly supported; nor in an old woman, past the menopause, whose tissues have become relaxed and flabby from age and childbearing, and whose vaginal walls have lost all contractility, so that a cicatrix would be sure to stretch soon after she had left her bed. The operation consists in dissecting off the mucous membrane covering the cystocele, then using No. 7 braided silk with a needle at either end. The first suture is passed nearest the cervix, one-third of an inch from the denuded margin, in and out of the mucous membrane (forward) until the median line is reached, just below the meatus. The same method is employed on the other side. The wound is then cleansed, and with the point of a sound pressed towards the bladder, while the operator crosses and pulls on the ends of the silk, in the same way as a purse is closed, thus bringing the edges closely together. Operation on the perineum is generally necessary at the same time. Five cases have been thus operated upon, but sufficient time has not yet elapsed to determine what the results will be. One important point in this operation is to denude as large a surface, as practicable; the cicatrix is the firmer, and the result more likely to be permanent. The patient should be in the recumbent posture till union is firm. Anaesthetics in Normal Labor. Wm. Scott, M. D., read a paper on this subject before the Southwestern Ohio Medical Society. After reviewing the introduction of anaesthetics in parturition, he cites Channing as having met with four cases of post-partum hemorrhage in seventy-eight deliveries under ether. Fordyce Barker is quoted as having seen but one case of post-partum hemorrhage in several thousand deliveries under anesthesia. Dr. Scott says he has never seen a proper or genuine uterine contraction arrested or suspended by an anaesthetic. From observation and experience he has reached the following conclusions: Ist. In normal labor, all the stages may be facilitated and shortened by the use of an anaesthetic. 2d. The pain of labor may be safely and completely obtunded. 3d. The accidents of labor occur less frequently where an anaesthetic is used. 4th. The occasions for instrumental interference are less frequent. 5th. Hydrate of chloral and morphia are the best, and perhaps the only proper anaesthetics for the first stage; chloroform for the second, withdrawing the anaesthetic altogether as soon as the second stage is ended. Precautions: In normal labor, never give an anaesthetic against the wishes of the patient or her friends. Never produce complete anaesthesia; have the patient in a condition to answer when spoken to sharply. In a person prone to hemorrhage, give ergot and strychnia during the third stage.-[Cin. Med. Jour. The Part the Shoulders Play in Producing Laceration of the Perineum, with Suggestions for its Prevention. — This was the title of a paper read by Dr. W. D. Haggard, in which he made the following suggestions: Ist. The patient should occupy the left lateral decubitus, at least during the second stage of labor. 2nd. Overcome rigidity of the vulvar outlet by the judicious use of chloroform. 3d. The presenting part of the child should be supported, and not the perineum, during the passage of the head and shoulders. 4th. Support the head by pressing it well up under the symphysis pubis, by placing the right thumb in the rectum, and the fingers of the right hand expanded over the occiput. 5th. To retard the exit of the shoulders, pressure should be applied to the trunk and shoulder by placing the index and middle finger of the left hand in the rectum, with the thumb in the vagina to restrain its exit. 6th. Support the head and neck by pressure well over the symphysis pubis.-[The Journal Am. Med. Ass'n., Dec., 5th, '91. Abstracts from Foreign Literature. Treatment of Epispadias BY F. NEUHOFF, M. D., SAINT LOUIS Rosenberger presented to the Congress of Surgery a boy two and a half years of age on whom he had operated for epispadias, with the result that the patient can now pass his urine in a good stream. The operation consisted of first sewing the penis to the anterior abdominal wall, and later on dissecting it loose, taking with it enough of the abdominal skin to close the defect of the penis. The disadvantage of hair growing in the uretha as a result of the operation is not serious, as they will grow outward through the external orifice.-[Deut. Med. Woch. New Operations on the Prostate— The idea of relieving prostatic hypertrophy by an operation is in itself natural. It has, however, been opposed because it does not relieve the disturbances which are sequels of the consecutive degeneration of the bladder. Better results may, however, be expected, when we operate before the bad sequels are very far advanced. Removal of the middle lobe frequently brings only temporary relief, because the lateral lobes, also being hypertrophied, compress the urethra from the sides and thus shut off the flow of urine. Kuester was compelled to accept this as an explanation of the reappearance of bad symptoms in a case after the removal of the middle lobe. He has performed prostatectomia lateralis from the perineum in three cases. The chief danger of this operation lies in the profuse hemorrhage which is liable to occur. It is best averted by elevation of the pelvis.-[Deut. Med. Woch. Therapeutic Value of Blood Gherardini has made a series of experiments on the digestibility of blood. Some of them were made on dogs with gastric fistula. The following conclusions were reached: Blood is only digested with difficulty in the stomach. To digest it thoroughly it requires a particularly active gastric juice. The hæmoglobin is changed in the stomach into hæmatin. The hæmatin is not assimilated by the stomach, but goes unchanged into the fæces. The peptonoids which result from the digestion of blood contain but little iron. From these conclusions it follows that blood and its preparations have no therapeutic value, and on account of their difficult digestibility, are to be avoided in the case of persons having a weak digestive apparatus. - [Bollet, delle Scien. Med. -Med. Chir. Rund. 1 Kœnig's 'Method of Restoring a Cranial Defect 1 As the result of a previous fracture of the skull, a patient had a defect in the cranial vault which presented the following bad symptoms: Sensitiveness to pressure of the hat, pulsation, dizziness, and pain on stooping. For relief, a skin periosteal flap containing the superficial layer of the bone was cut from the parietal region and turned so as to cover the cranial defect, from which the scar had been previously cut out. A good result was obtained, and there is no longer any cranial defect.— [Deut. Med. Woch. REPÓRT FROM THE INSTITUTE OR INFECTIOUS DISEASES IN BERLIN. The Action of Tuberculin Upon Experimental Eye-Tuberclosis of the Rabbit. In the early part of the treatment with tuberculin, the tubercular process is hastened, cloudiness of the cornea and pannus developing rapidly, whereas in the eye of the control-animals the process is slower, with, however, early necrotic processes at the seat of puncture and rapid perforation, this necrosis did not occur when tuberbulin in gradually increasing doses was administered. It is immaterial whether the treatment is begun immediately after inoculation or at a time when true tubercle has been formed The administration of the product obtained by Klebs from Koch's tuber. culin was attended with only temporary improvement, the eyes being eventually lost. The same dose of the unmodified tuberculin, continued without increase, also failed to produce good results. The conclusions are: Ist. The tuberculin is a sure curative agent for the experimental tuberulosis of the eye of the rabbit. 2d. Tuberculin shows its curative effect only after true tubercle can be demonstrated. 3d. The first effect of tuberculin is a transient but severe irritation of the eye. 4th. Under the continuous action of tuberculin irritation in the eye subsides 5th. When, before beginning the treatment, deep-reaching destructive processes have not occurred, the cure results in retention of the visual functions of the eye, otherwise atrophy results. 6th. To obtain a cure, it is necessary that tuberculin be given in increasing doses, and the continued maintenance of a not too slight reaction is essential.-[Translated from Deutsche Medicinische Whochenschrift, Nov. 19th, 1891, by Karl von Ruck, M. D., Ashville, N. C. * CLASS-ROOM NOTES. As a tonic in chronic interstitial hepatitis, Dr. Robinson recommended the tincture of muriate of iron in half drachm doses, three timea day, 2 * * One ounce, three times daily, of iodide of potassium, was being given a syphilitic patient presented in Dr. Robinson's clinic at the City Hospital. It was only after this enormous amount was reached that the desired effect was obtained. * * It is a good thing to have doubts on everything in surgery and medicine that is still fairly within the realm of theory, and always to assume the position that, for the time being, that theory is true to which you can offer fewest objections; but yet to deal with such a theory as being absolutely true. Tuholske. X * Dr. H. W. Loeb stated in a recent lecture that the catarrh quack is able to make a living because the average practitioner knows little and cares less about the diseases of the nose and throat; that if medical students, would learn something more about this class of diseases, they could in their early practice take in the shekels which so often go into the charlatan's capacious pocket. * * In septic intoxication we have to deal with a putrefactive process -with the saprophytic micrococcus; in sepatic infection we have to deal with a fermentative process, with members of the class of streptococcus. Pyæmia is a constitutional blood disease depending always on a suppurative focus in the body; in this suppurative focus a thrombo-phlebitis occurs, eventuating in the formation of metastatic abscesses. - Tuholske. * Says Dr. E. H. Gregory: Remember, gentlemen, that it is not the province of the surgeon to mutilate the human form divine, nor to go about with Shylockian mien, seeking an opportunity to remove a pound of flesh. The true surgeon is he who brings into play his acquired, acute, diagnostic and prognostic ability, coupled with innate good judgment in saving life and limb without the use of the knife. |