gauze laid loose about the patient's nose and mouth, kept moderately sprayed with either, will keep the patient under with greater chances for air than any other method. This spraying is accomplished by perforating an ether can in the center of the top with the point only of a common brass pin, and directing it downward toward the gauze, the heat of the hand in holding the can forcing out the tiny stream. With this method it is a common practice to keep a laparotomy case under for one hour, using only 100 grains. So it is to be decried, the routine practice of saturating a large bunch of gauze stuffed into a big brass drum or rubber inhaler, where for the same operation and same time 500 to 1,000 grains are used. And this latter amount of anesthetic is what has caused the profession to state as a fact that ether causes pneumonia, nausea, and nephritis, and the many doctors that believe these disadvantages of ether will give two drachms of Hoffman's anodyne and get no less ether into the human economy for elimination than will be given on the open gauze method and using the 100 grains. Careful administration of a minimum amount of ether, with the anesthesist in full charge to do as he thinks best, yet preserving (both he and the surgeon) a consideration for one another in their respective occupations, makes surgery and anesthesia the best of friends instead of too often experiencing friction. International Medical Congress. The committee in charge of the International Medical Congress, which will be held in Lisbon from April 19 to 26, 1906, has written asking for the contribution of papers on the following medico-legal subjects, and saying that as yet no titles of communication touching on any of these subjects have been received from this country: The signs of virginity and of defloration in madico-legal relations Hand-marks and finger-prints; their medico-legal importance. The medico-legal importance of the carunculæ myrtiformes. The mechanism of death by hanging. The value of bacteriologic examination of vulvo-vaginal discharges in the determination of venereal contagion. The signs of death by drowning. Eschymoses in legal medicine. Spontaneous and criminal abortions from a medico-legal point of view. The relations between the seat of cerebral contusions and the point of application of the agent which produced them. Epilepsy in legal medicine. The induction of abortion; when is it permissible? The value of legal medicine in the study of criminal law. The best legislation for the protection of the "medical secret" (the obligation imposed upon physicians to treat as inviolable all information concerning patients obtained while in the discharge of their professional duties). The effects of the civil and penal law towards the new-born living infant. brane. Criminal vulvar copulation. Organization of medico-legal services. If any of the readers of this communication intend to take part in the discussions of this section of the Congress, or to prepare papers for it on any of the subjects mentioned, or on any other subject in medicine or surgery, he should inform the Secretary of the American Committee. RAMON GUITERAS, Secretary American National Committee, 75 West 55th Street, New York. Recent Progress in Medical Science. GENERAL MEDICINE. IN CHARGE OF JOHN J. MOREN, M. D., Professor Nervous and Mental Diseases, Hospital College of Medicine. GYNECOLOGY. IN CHARGE OF C. W. HIBBITT, M. D., Associate Professor of Gynecology, Medical Department, Kentucky University. GENERAL MEDICINE. Transillumination of the Stomach.-(Brooklyn Medical Journal), H. H. Lincoln. Fluorescein was first used by Kamp. It is a napthlin product, a deep-red powder, and gives a green-yellow color in mild solution. It is made of phthalic anhydrid 5 parts, resorcin 7 parts, heated to 200 c., is soluble in alcohol and alkaline solution, but not in hydrochloric acid. Is harmless in stomach or circulation. The mixture used is % gr. fluorescein, 40 grs. bicarbonate of soda, 1-2 drachms of glycerine, and water to make 1 pint. The glycerine is used to increase the fluorescence. This is placed in stomach, and the lamp is introduced. The illumination is much better and can outline the stomach better than water, lime, etc. After several tests, he located the stomach lower than most writers, and concludes that gastroptosis per se is not so serious, and that artificial support is not needed as often as is applied for these various ptoses. Case of Gastric Ulcer after Gastroenterotomy.-(Medical News). Kaufman reports a case in which gastroenterotomy was performed for ulcer. The patient did nicely for three months; gained twenty-seven pounds. Soon he developed distress after taking food, and pain one hour afterward. He had several courses of treatment for ulcer, but showed no improvement. Fecal vomiting appeared, and the pain was so severe that a second operation was approved. They found a gastrocolic and jejuno-colic fistulæ. The button was used in this case, and at post-mortem they found necrosis at attachment. Kaufman concludes his article as follows: "We ought to bear in mind the possibility of peptic ulcer whenever gastric disturbances recur after gastroenterotomy." He warns against too early and free feeding. "The further surgical treatment of peptic ulcer following gastroenterotomy has given very poor results. Complete recovery is rare, fatal issues frequent. A careful consideration of all these facts should tend to restrict the indication for gastroenterotomy, which otherwise gives such excellent results in certain benign gastric diseases." The Tests for Occult Blood in the Feces and Their Clinical Significance.-(Pennsylvania Medical Journal). Steeles made 265 tests in 48 cases. His results agree with those given by the German observers. 1. In cancer of the stomach or intestines, the test has shown blood in almost every stool passed. 2. In ulcer of the stomach, blood is not, as a rule, found in every stool, but is irregularly present. Sometimes it may miss one or more stools. Under this division of intermittent occult bleeding comes also duodenal ulcer, benign pyloric stenosis and spastic pyloric stenosis. 3. Occult blood is never found in gastritis acida, anacida, or subacida, hyperacidity, hypersecretion (without ulcer), benign dilatation, or neuroses. GYNECOLOGY. Sterility in Women.-J. Riddle Goffe, M. D. (New York Medical Journal, August 26, 1905), says he considers under three heads the various pathological conditions that obstruct the passage of the ovum into the uterus: (1) Those that relate exclusively to the ovary; (2) those that relate exclusively to the tube, and (3) those in which both ovary and tube are involved. The ovary may be absent, devoid of Graafian follicles, or incapable of developing them. The most common affections are those that result from inflammation, such as atrophy, cirrhosis, and cystic degeneration. The most frequent pathological conditions that are the cause of sterility in the tube are catarrhal, gonorrheal, and septic salpingitis pyosalpinx, hydrosalpinx, and hematosalpinx, which contorts the tube, producing a tortuous course, and it finally becomes constricted. A common cause is where the fimbria become agglutinated and the potency of the tube absolutely destroyed. Atrophy of the ovary is beyond surgical interference; hypertrophy and cystic ovaries are to be relieved only by surgical interference. In cases of tubal trouble, operative procedures seem to be more efficient. When the fimbrise are inverted and adherent, he contends that it is a simple matter, under a saline douche, to massage the tubes, rotate them between the fingers, gradually to unfold the fimbriæ and to restore the ampulla to its normal condition. This is far better than amputating the tube. In cases of acute or chronic salpingitis and the long-standing destructive effects, now quiescent, of inflammatory invasion no longer producing symptoms or palpable by the examining finger, the peritoneal cavity is invaded for the deliberate purpose of relieving the condition of sterility and rendering the patient fruitful. Just what the scope and limitation of conservative work upon the tube may be in the presence of retained pus is still awaiting the decision of further experience. He protests against indiscriminate sacrifice of tubes that are the seat of ectopic gestation. Rupture of the tube and hemorrhage in these cases is not always produced by distension of the tube, but the biological process inherent in the growth of the ovum and placenta erodes the epithelium and eats its way or grows through the wall of the tube and its peritoneal covering. Such cases are peculiarly adapted to such conservative work as opening the tube, evacuating its contents, and stitching up the incision. Some Gynecologic Superstitions.-S. Waite, M. D. (American Medicine, September 2, 1905), says that gynecology has been burdened with numerous dogmatic theories, and they are accepted by the profession without question. Speaking especially of backache and constipation as symptoms to be caused by posterior displacements of the uterus, she shows by statistics that both of these conditions are present in a large percentage of antipositions and absent in a fair per cent. of retropositions. Waite believes that the statistics, relative to the clinical significance of retroposition of the uterus. bears directly on the amount of unnecessary operating being done under the false impression that the symptoms complained of are due to the position of the uterus, and the complications which are really responsible for the symptoms are overlooked. Practical Gynecology.-W. A. B. Sellman, M. D. (Inter. Journal of Surgery, April, 1905), says observations prove that women not exposed to degenerating influences can compete in strength and endurance with men of their own race. He says there are two periods in woman's life in which she is susceptible to morbid influences, and not being removed will produce either structural or functional disease, viz: Puberty and the menopause. Anemia and chlorosis are the most frequent constitutional maladies which produce amenorrhea in young and unmarried women. Tubal Tuberculosis. Dr. C. H. Mayo (Inter. Journal of Surgery, July, 1905), says many cases of tubal tuberculosis will be found in chronic and subacute appendicitis. It is advisable in women to always gain an idea of the pelvic conditions, if possible, when the abdomen is open and the diagnosis is questionable; especially is this true if free fluid is found without sufficient active condition of the appendix to account for its production. Stenosis of the Cervix.-Augustin H. Goelet, New York, in the International Journal of Surgery, October, 1905, says stenosis may be due either to a diseased condition of the mucous membrane lining the canal or its glands, or of the underlying structure, and not necessarily to contraction of the muscular fibers. Another and common cause, he says, is mechanical obstruction caused by indurated, hypertrophied granulations at the internal os, which interferes with free drainage from the cavity of the uterus. He contends that, on the introduction of a sound between periods, nothing is noted, but the increased congestion preceding and attending meustruation couses tumefaction and consequently more or less complete closure of the canal. Stenosis of the external os is seldom sufficient to produce dysmenorrhea, if we except that due to cicatricial contraction from injury. Dilatation per se will accomplish very little, and it should never be carried to the extent of divulsion or rupture of imaginary constricting bands. He says dilatation should be only sufficient to permit the easy accomplishment of the work to follow, whether it be a curettage, irrigation of the cavity, the introduction of gauze, or the uterine stem. Forcible dilatation serves only to expand the caliber temporarily, and retraction is certain to follow sooner or later. He further states that results obtained with negative electrolysis is more permanent if employed properly, as it stimulates an altered circulation and nutrition, softens indurated tissue, and effects drainage of the cervical glands, as well as drainage from the uterine cavity. The sharp curette must be used after the dilatation for the removal of granulations at the internal os, and pure carbolic acid applied to that location only, and not into the cavity of the uterus. After a week applications of negative electrolysis are made to the canal by means of the conical electrodes, using size that may be inserted without force. makes these applications every second or third day, with graduallyincreasing intervals, until the cervical structure is softened and the canal remains normally patulous. Never more than a 10 m. current is used for more than three minutes. He The intrauterine stem is limited to those cases of stenosis due to or associated with hyperplasia and induration of the cervical structure and for flexions. It should never be kept in the uterus for a longer period than a week. |