DENVER MEDICAL TIMES THOMAS H. HAWKINS, M.D., LL.D., EDITOR AND PUBLISHER. COLLABORATORS: Henry O. Marcy, M.D., Boston. S. H. Pinkerton, M.D., Salt Lake City. Subscriptions, $2.00 per Year in Advance; Single Copies, 20 Cents. Address all Communications to Denver Medical Times, 1740 Welton Street, Denver Colo. We will at all times be glad to give space to well written articles or items of interest to the profession. [Entered at the Postoffice of Denver, Colorado, as mail matter of the Second Class.] EDITORIAL DEPARTMENT. Surgical Instantaneous Dr. R. S. Sutton (Medical Record, Feb. 23, 1901) says that by experience. he has learned that under aseptic methods it is perfectly safe to do several operations on the patient at one seance. It has been the custom of Denver physicians for the past fifteen years to follow this course. That is, a patient may have a curettage, a trachelorraphy, a perineorraphy, a divulsion of the sphincter ani muscle, a laparatomy with removal of appendages and anterior fixation of the fundus at one sitting, but we have not yet arrived at such a degree of rapidity as to be able to complete all of these operations within forty-five minutes. Some of the doctors may be able to do a curettage in seven minutes, a trachelorrhaphy in ten, a perineorrhaphy (Tate) in seven, a divulsion of the sphincter in five, a laparotomy with removal of the appendages in fifteen, the anterior fixation of the fundus in five, closing the abdominal wound five, cleaning up of the patient and changing positions ten; time sixty-four minutes. This does not allow for any loss of time in changing or rearranging instruments or sponges or little mishaps that may occur. It does not include applying the abdominal binder nor any possible time that may be necessary for dilating the cervix uteri, etc. Migraine. This functional nervous disease, commonly miscalled neuralgia, gastric headache and nervous headache, is distinguished, writes Patrick (Medicine, January) by the following most prominent features: Heredity, more often on the mother's side; inception generally under 15, nearly always under 20; attacks at first two or three times a year to once a month-later once in two months to twice per week; duration of attack, 6 to 36 hours; freedom from pain in intervals; continuance of affection through many years; pain severe; nausea or vomiting rather frequent; prodromes not infrequent and nearly always the same for each individual; accompaniments of visual, sensory or speech symptoms almost pathogonomic, but not often present; during continuance does not admit of sleep. The pain is usually but not always one-sided. It differs strikingly from typical neuralgia in being steady, though sometimes throbbing. Women not infrequently lose the affliction after the menopause, and men after the age of 60. of 60. Dr. Patrick has yet to hear of the radical cure of a bad case of typical inigraine, but most cases can be materially alleviated. His preference of remedies is for cannabis indica, beginning with three or four drops of a good fluid extract after each meal, and increasing this dose rather rapidly until distinct physiologic effects appear, when the dose is to be diminished just within the limit and held there indefinitely. Mother's Milk. The normal percentage proportions of ingredients, according to Rotch, are fat 4, proteids 1.2, sugar 7, and ash .2. In the poor milk of underfed women, fat, sugar and ash are diminished, but the proteids may be doubled. All the constituents are increased in the very rich milk of a generous diet. In the bad milk of pregnancy and dis ease, the proteids are much augmented, while the remaining solids are greatly diminished. The total daily amount of milk under normal conditions ranges from 254 grams at one week, to 749 at five weeks, 926 at nine weeks, 996 at five months, 1,051 at seven months, 741 at eight months, and 482 grams at nine months. The colostrum of the first week of lactation contains on an average 2.5 to 3.5 per cent. of proteids and 4 to 5 per cent. of salts. These constituents gradually diminish as lactose increases till the eleventh month, when a slight increase is noted. The percentage of iron becomes subnormal after the eighth or ninth month. The last portion of the breast is nearly three times as rich in fat as is the first portion, hence for examination the middle portion should be taken, after the child has nursed one-third of its usual time. Altitude and When a person remains for some time Blood Changes. in the mountains, says Roger, the blood is modified in three ways, namely, increased oxygen capacity, increase in number of red corpuscles, and increase in the iron content. M. Muntz experimented with rabbits of the same brood, keeping some on the plain and some on the heights of Pic du Midi. At the end of seven years the blood analysis of the descendants of these two classes showed the following differences: Oxygen absorbed in 100 grammes of blood in the plain, 9.56 c.c.; on the heights, 17.28 c.c.; iron contained in 100 grammes of blood, 40.5 mgm. and 70.2 mgm. Viault found the number of corpuscles contained in each cubic mm. of blood to range from 4,000,000 to 5,000,000 on the plain, and from 6,000,000 to 7,000,000 on the heights. Pleural According to Widal (International Clinics) Effusions. the examination of serous fluid from the pleural cavity is to be made after the removal of the fibrin either before or after coagulation. The effusion of "idiopathic" pleurisy, or pleurisy from cold, has been shown by Landouzy to be really tubercular in origin, and is marked by a number of small lymphocytes tending markedly to run together, and often also red blood cells. Pleurisies in frankly tubercular subjects are characterized by very few cells, namely, red blood corpuscles, small lymphocytes and old deformed polynuclear or mononuclear leucocytes, and amorphous anuclear agglomerations. Mechanical pleurisies, due to cancer, cardiac or renal disease or irritation of neighboring parts, are distinguished by the presence of large endothelial cells, often grouped by twos or threes or even in sheets. In serofibrinous pleurisy of streptococcic origin the picture is scarcely characteristic, consisting of polynuclear neutrophiles with deformed nuclei. The vigorous tissue reaction of pneumococcic pleurisy is manifested by red cells, some lymphoctes and especially an abundance of polynuclear leucocytes. Pathognomic, however, are the large mononucleated cells, mostly endothelial, some of which englobe even the polynuclear cells in their protoplasm. Pleural effusions during typhoid are frequently hemorrhagic and may contain a majority of eosinophiles. Leucorrhea. Speaking broadly, says John Cook Hirst (Therapeutic Gazette, Oct. 15, 1900) the discharge can have its origin in one of three places: the vagina, cervix or endometrium. Vaginal leucorrhea, unless it is of gonorrheal origin, is nearly always thin and serous. Cervical leucorrhea is very thick and abundant and rarely streaked with blood. Corporeal leucorrhea is thinner, often offensive and excoriating and quite commonly streaked with blood. Leucorrhea is very common in cases of lowered health from any cause. For the vaginal form the writer recommends astringent douches of alum and zinc sulphate, and the occasional use of a solution of silver nitrate, gr. x-xx to the fluid ounce, filling a cylindric speculum with the solution and gradually withdrawing the instrument. This latter treatment, combined with douches of corrosive sublimate, 1:4000, has given perfect results in gonnorrhea. Corporal leucorrhea, depending on septic endometritis, requires thorough curettement to remove hypertrophied masses, followed by tonics and the intrauterine application of protargol bougies. Curettage of the whole uterus is also often required for cervical leucorrhea. In the way of non-operative measures for this form of the discharge the writer uses hot astringent douches and boroglyceride tampons thrice weekly, and paints the vaginal vault with Churchill's tincture of iodine. In inveterate cases protargol bougies are curative. Tonics should always be prescribed for these patients on general principles. Iron must be avoided in cases where there is a tendency to uterine hemorrhage. The Treatment Winfield Ayers, M. D., New York City, of Syphilis. (Philadelphia Medical Journal, Novem 10, 1900.) The writer states that when his attention was called to mercurol as an antiseptic of special value in the treatment of gonorrhea, it occurred to him that it would be a first-class preparation for the treatment of syphilis. Some time was necessarily spent in determining the proper dosage. At first one-eighth of a grain was given three times daily, and this dose was gradually increased until it was found that three grains was the average quantity required to control the malady. The highest amount given was seven grains and the lowest amount that exerted a controlling influence upon the disease was one-half grain. In starting a patient on a course of mercurol the author advises beginning with the halfgrain or grain doses. Salivation has been produced by two grains, and yet as much as six grains has been taken with no disagreeable symptoms. The objections to the use of unguentum hydrargyri as a remedy in secondary syhilis are referred to; and while the popularity of mercuric protiodide is conceded, the irregularity of its action and its tendency to cause |