Treatment. First, prevention; second, management; third, after treatment. If the habit of abortion be admitted, its cause must be expected in some degeneration of the placenta whereby it becomes unfitted to carry on respiration and furnish nutrition to the embryo. This condition may be due to syphilis, in which case specific treatment is indicated. In the absence of clues, some obstetricians have alleged an error of hematosis as the cause of repeated abortion, and have recommended the exhibition of potassium chlorate. Prominent authors have expressed doubt as to the foundation of the theory and the efficiency of the treatment. When the symptoms of abortion are imminent uterine sedatives, the horizontal position and strict quiet must be the lines followed if the pregnancy be prolonged to the normal limit and a living child result. Care in the use of narcotics must of course be used, else a habit may be formed that will be little less unfortunate than the loss of the fetus. Ergot may be used to check hemorrhage, but the uterine contractions which it may produce and which usually result from its exhibition, render it more dangerous than valuable. Viburnum prunifolium has acquired some reputation in late years as a uterine sedative, and also as a very nauseous drug. When it has become evident that abortion must take place, the safe conduct of the case calls for careful supervision and discretion. Care to maintain the integrity of the ovum should be exercised, for when it is expelled entire all fear for the future is at an end, and herein lies the safety and the difference between accidental and criminal abortions, as the latter generally have had the membranes punctured and fetus destroyed. Extremists are given to energetic interference in all such cases while timorists trust too long to nature. In such a case the middle course is followed by the judicious. The best practice seems to be not to resort to forcible removal of the remnants of the ovum unless there are particular reasons for so doing. First, signs of sepsis; second, undue continuance of hemorrhage. In the operations and manipulations upon the uterus, during the process of abortion, the greatest care should be exercised to the end that inflammation may be retarded rather than precipitated, and it must be borne in mind that asepsis and antisepsis are not alone sufficient to prevent inflammatory action in this highly sensitive and vascular organ. Pain must be prevented, relaxation promoted, and quiet secured, so that the premature simulation of labor may proceed as nearly along physiological lines as possible. INTESTINAL INDIGESTION.* BY W. H. BENNER, M. D., TIFFIN, OHIO. Synonym. Intesinal dyspepsia. Definition. A derangement in the functions of intestinal digestion, resembling in the more or less complete decomposition of the chyme, caused by defects in the pancreatic, biliary or intestinal secretions, or from deficient peristalsis, one or more of these, singly or combined; characterized by abdominal pain, distention and tympanites developing some hours after meals and nervous perturbation, anemia and emaciation. Causes. Imperfect diet; over-eating; anemia; deficient exercise; worry; immoderate use of tobacco or stimulants; disease of the stomach, intestinal tract, liver or pancreas; malaria. Frequently inherited. Symptoms. Intestinal indigestion may be either acute or chronic, the latter the more common. Acute variety, the result of an irritation in the duodenum, rapidly developed pain, flatulency, slight feverishness, coated tongue, loss of appetite, headache, pain in the limbs, usually terminating in a mild attack of diarrhea. If the attack develops rapidly, the sudden formation of gases causes a paroxysm of colic. Severe attacks as associated with disordered hepatic function, light-colored stools, slight jaundice and high-colored urine. Chronic variety, resulting from a greater or less decomposition of the partly altered food from the stomach. Pain, varying in character, occurring from two to six hours after meals, with slight tenderness and some fullness in the right hypochondrium, epigastrium, or the umbilical region. Tympanites is marked, the result of gaseous accumulations which have developed from the decomposition of the intestinal contents. Dyspnea, the result of pressure against the diaphragm, is of frequent occurrence. Marked nervous phenomena develop, the result of the depressing influence on the nervous system of the absorption of the gases of decomposition or ptomaines; depression of *Read before the Seneca County Medical Society, Tiffin, Ohio, August 17, 1905. spirits, sleeplessness, disturbing dreams, headache, vertigo, buzzing in the ears, deficient mental application, cardiac irritability, numbness and tingling in the extremities and pains throughout the body and in extreme cases, attacks of fainting or epileptiform and cataleptic attacks. The skin is harsh and dry, the bowels are sluggish or constipated and the urine is high colored, of increased density, decidedly acid and on cooling, deposits lithates, uric acid and oxalite of lime crystals. Functional derangement of the liver follows after a time, adding to the general distress. Diagnosis. With our present knowledge it is usually impossible to designate forms of intestinal indigestion, due to defects in the quantity or quality of either pancreatic, biliary, or intestinal secretions. Acute intestinal indigestion differs from gastric indigestion in the time of development of the various phenomena, in the latter the symptoms appearing almost immediately after meals, while in the former not appearing until from two to six hours afterwards. Chronic intestinal indigestion may mislead the physician, if the various nervous phenomena are of marked character and a careful history of the case is not developed. Prognosis. Favorable if proper and early treatment be inaugurated unless the result of an organic lesion. Treatment. Acute variety, the result of indigested food, is best treated by opium in some form, to relieve the acute suffering, warmth to the abdomen and a prompt cathartic to cause rapid expulsion, or six or eight calomel powders (1⁄2 gr. calomel, 2 grs. soda), followed next morning by a saline or good big dose of castor oil. Chronic variety. Of the first importance is to the diet, which should be restricted in amount and confined almost entirely to articles which are readily digested in the stomach, such as beef, eggs, and milk. The hepatic, pancreatic and intestinal secretions should be stimulated by a course of alkalies, one of the most efficient being sodii phosphate and as an aid to intestinal digestion use extract of Nux 1-3 gr. every four hours or extract of pancreatis from 2 to 6 grains, with soda bicarbonate 5 to 10 grains, two or three hours after meals, will be found useful. In severer forms, if there is much distress in the region of the stomach, vomiting should be promoted by warm salt-water or other simple emetics. A favorite prescription of mine, which I have had most excellent results with in intestinal indigestion is, rhubarb compound with golden seal and pancreatin. Old Ladies' Home Building. THE COLUMBUS MEDICAL JOURNAL. A MONTHLY MAGAZINE OF MEDICINE AND SURGERY. EDITORS. JAMES U. BARNHILL, A. M., Ph. D., M. D., 248 E. State Street. COLLABORATORS. W. D. INGLIS, B. S., M. D. ERNEST SCOTT. B. Sc. M. D. Communications relating to the editorial department should be addressed to Dr. J. U. Barnhill 248 East State Street; those relating to business management should be addressed to Dr. W. J. Means, 715 North High Street. Per annum, in advance, subscription price, including postage ........15 cents. Bound volumes... $1 00 2.00 Original articles, scientific and clinical memoranda, correspondence and news items are cordially solicited from the profession. SEPTEMBER, 1905. Editorial. MEDICAL EDUCATION IN THE UNITED STATES. The "Educational Number" of the Journal of the American Medical Association for the current year furnishes valuable information in reference to medical education and medical colleges in the United States for the year ending June 30, 1905. This Journal has, for several years past, collected statistics on this subject, the data being collated principally from college authorities, annual announcements, and reports from state examining boards. It is stated editorially in this issue that "there has been a distinct gain in the entrance requirements during the past two or three years." This change for the better is due, in part, "to a few individual colleges, but largely it is the result of concerted action on the part of several organizations which have it in their power to promulgate and enforce rules and regulations for the government of colleges. The state examining boards, in particular, have exercised a most wholesome influence by raising the requirements and by taking an active part in the regulation of preliminary or preparatory education." The total number of graduates for the current year was 5000, a decrease of 141 below that of the preceding year. The decrease in the number of graduates from the regular colleges was 64, from the homeopathic 95. The total number of matriculated medical students was 26,147, this being 1995 below the year 1904; of these 24,119 attended the regular schools, 1104 the homeopathic, 578 the eclectic, 114 the physiomedical, and 232 unclassified schools; the attendance at the regular schools showing an increase of 457 over that of last year, while in the homeopathic schools there is a decrease of 205 below the attendance of the previous year. Of the total number of medical students for the year 1073 were women. According to this report there are, at the present time, 157 medical colleges in the United States, or 9 less than there were for the preceding year. Of the total number 126 are regular, 18 homeopathic, 9 eclectic, 3 physiomedical, and 1 unclassified. "During the year 2 homeopathic colleges united, and one eclectic college changed its faith and is now teaching regular medicine. Six of the regular colleges listed did not confer degrees, teaching only the first and second years of the medical course. Three colleges (two regular and one homeopathic) are clusively for women; 63 for men; 91 are coeducational. There are five schools to which only colored students are admitted, two less than last year, one having become extinct and the other now admitting both white and colored students. Three schools operate under the continuous course system, the year being divided into quarters, and the student being allowed to attend only a specified number of quarters or semesters in each calendar year. These three schools are located in Chicago. Sixty-eight regular colleges, 4 homeopathic and 1 eclectic college have a university or literary college connection or affiliation. Only two colleges (located in Chicago) impart instruction exclusively in the evening, and three colleges have both day and evening classes." "Seventy regular colleges are members of the Association of American Medical Colleges; 14 belong to the Southern Medical College Association." * * |