Page images

vigorously, relaxes so little, that after the expulsion of with disastrous consequences. The belief is the placenta the uterin cavity is almost obliterated, and the amount of the bloody lochia is reduced to the

quite general in the profession that the danger minimum. On the other hand, in multipara, the lies in ignition of the vapor, and the conseuterin muscle being in some degree weakened by

quent burns induced. stretching and perhaps by some destruction of muscle substance that has occurred in previous pregnancies,

It is now known that the danger from chlothe uterus after labor does not contract so firmly and roform is common to not only patient and the relaxations between the contractions are greater in degree and point of duration. Moreover, when

operator, but to any other person who may be the uterin muscle has been over stretcht, as it is in in the room, and that the chances of ignition plural pregnancies or in hydramnios, or when the and explosion are rare and comparativly slight. labor has been exceedingly long or unusually precipitate, very firm contraction does not appear after labor

When the vapor of chloroform comes in conand there are apt to occur other periods of over relaxa- tact with a naked flame there is a resultant tion. This condition, in civilized women, is so very com- decomposition into chlorin and hydrochloric mon that it is necessary to study it under the head of the physiology of the puerperium, and yet the conse- acid. When the chlorin is inhaled there is a quences of a failure of the uterin muscle to contract sense of weight in the head and tingling in the with maximum intensity after labor are always unpleasant and may be disastrous. A relaxation of the

nostrils, and a dry, spasmodic cough develops, uterin muscle fibers implies a loosening of the count- and there is a feeling of distress with each less living ligatures that bind the large vessels of the respiration. This condition may develop in of blood into the uterin cavity. Oozing out gradually patient, attendants, and operator, and it may from the imperfectly closed blood vessels and sinuses, become so severe in the case of the patient as and, finding space in the enlarged uterin cavity to collect, it forms clots often of considerable size, which

to usher in stertorous breathing and failure of act upon the uterus, like any foreign body in it, as an heart and respiration. Cases are on record irritant, exciting it to activ contractions which only

where death of both patient and attendants has cease when the foreign substance is expelled. These activ contractions of the uterus are always painful,

resulted under such conditions. with a pain like that of a cramp in any other muscle. When an operation is imperativ after night, These painful contractions, caused primarily by lack of firm contraction, and immediately by the presence

and cannot be arranged to take place where of clots in the uterus, are called, appropriately enuf, incandescent light can be secured, it is best to after-pains. For the reasons already given, they are choose ether as the anesthetic, and if any not experienced by, primipara unless the uterus has been unduly distended or the labor has been too pro

contra-indication to that be present, to select longed or too precipitate. On the other hand, they are a large room where perfect ventilation is possiconstant phenomena in multipara, and the physician's ble, and complete the operation as rapidly treatment of them constitutes almost always a part of his routine management of the puerperal state in such

as possible. The inhaling masks now on patients. Apparently a trifling matter, it is one of utmost the market, which confine the vapor closely importance. In the first place, the pain is sufficiently distressing to demand relief, but, more important still,

to the face of the patient, are preferable to the these after-pains indicate, to the educated physician,

convenient and less expensiv towel the presence within the uterus of blood clots or

method. Other and newer anesthetics are other putrescible material ; and until they are expelled, and the uterus is induced to remain in a

making strong claims for recognition, but it is state of firm contraction, the woman is not entirely not likely that they will supplantochloroform safe from the dangers of septicemia. Moreover, it is necessary to be familiar enuf with the clinical

for many years to come. All the major operafeatures of after-pains to be able to distinguish them

tions have been performed under cocain anesfrom the pain of peri-uterin inflammation. This thesia, but only those of extended experience should not be difficult. The intermittent character of the after-pains, their cramp-like nature, the fact that

care to use it in the more serious cases. Chlo pressure does not increase the pain, and that the pulse roform will continue to be used, and will conand temperature are unaffected, suffice to distinguish tinue to be used recklessly, but no practician the painful contractions of the uterus after labor from the pain of inflammation.

has any right to add to its dangers those of For treatment, see further quotations from poisoning by extraneous products of decompoauthorities in Quiz Department of this issue.

sition, by its ill-advised use by artificial light.

Query. The Actual Source of Danger in Administer- Are you paying any advance fees to collection agening Anesthetics by Artificial Light. cies now? Are you signing any contract-notes" for

collection agencies, to be caught up on, a few months As students, all practicians have had imprest later? Didn't THE WORLD stop all that funny busiupon them the danger incident to the use of ness? Is there in all this country a doctor who is fool anesthetics by artificial light, but generally the

enuf to get caught on that game now? If there is, he

has only himself to blame. What say you? How conception is somewhat hazy regarding wherein many thousands of dollars do you suppose is thus saved the actual danger exists. H. C. Wood calls

to the medical profession per year? Did any other attention to the fact that the vapor of ether,

medical journal ever render such service to the pro

fession? being heavier than air, sinks to the floor

; ;

Twenty grains of alum to the ounce of water makes therefore, in giving ether at night the light

an efficient application to apply in tonsillitis and ordishould be placed high above patient and nary sore throat by means of a swab or throat brush. operator. Even with this precaution, the vapor

It exerts a destructiv action on the teeth, and its appli

cation should therefore be followed by rinsing the has passed eight feet to a flame and exploded mouth well with clear water.






ORIGINAL COMMUNICATIONS organs be relieved too quickly; fainting or

even death may follow the setting of the blood Short articles of practical help to the profession are solicited for

to the surface caused by anemia of the internal this department.

organs. To stimulate the lungs and heart, and Articles accepted must be contributed to this journal only. The retain part of the circulation in the internal editors are not responsible for views expressed by contributors.

organs, nothing surpasses a cup of hot tea. Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline

Frost-bite : The sensation of cold is folresponsibility for the safety of unused manuscript. It can lowed by tingling and aching of the part usually be returned if request and postage for return are received with manuscript ; but we cannot agree to always do so.

affected. Numbness and a sense of weight is Certainly it is excellent discipline for an author to feel that he must

noted, and then all sensation is lost. On say all he has to say in the fewest possible words, or his reador is sure to skip them; and in the plainest possible words, or his

examination the part is white, stiff, and frozen. reader will certainly misunderstand them. Generally, also, a So insidious is the inroad of cold that a part downrighe fact may be told in a plain way, and we want downright facts at present more than anything else.-RUSKIN. may be frozen for hours and the individual

have not the slightest knowledge of cold, pain

or discomfort. The action of frost is first by The Process of Freezing to Death.-Frost- direct injury to the tissues, and second and bite.-Chilblains.

more noteworthy, the injury to the nerves that Editor MEDICAL WORLD:—The early effect

control the local circulation of the frosted area. of intense cold on the system is noted as soon

Rapid restoration to the normal temperature is as the individual passes from the warm room

followed by inflammation, sluf and gangrene. into the cold atmosphere. First there is a An individual with a frozen finger, toe, or sensation of obstructed breathing, as if the extremity, should first be taken into a room passages of the nose were narrowed ; simultan- that is scarcely above the freezing point; after eous also is a slight rawness and fulness of bundling with clothing sufficient to keep the the chest. Reaction in the nose soon follows, body warm, the frozen part should be rubbed and a watery discharge is very common as a with snow, or immerst in ice water, and gently result of the hyperemia of the mucous mem- rubbed while the frost is coming out. Gentle brane. Slight cough and expectoration are friction is necessary as the circulation returns, noted in some. The breathing then becomes lest engorgement follow. For a short time after free, and remains so during the exposure to the frost is out the rubbing should continue. the cold. Parts exposed to the cold at first

After this first step the patient may be put to tingle and show a lack of blood; the setting of bed in a cool room. The frosted member should the blood inward congests the brain, and frontal be elevated so that the arterial circulation is headache follows; with the reaction and return retarded, and the venous circulation assisted of blood to the parts the headache subsides, from the part by gravity. The limb should be and a sense of faintness and nausea is often left in an elevated position for several days, felt, which again rapidly subsides as the circu- open to the air with neither cover, nor dresslation becomes full and strong under the stimu- ings. The room must be kept cool (40 or 50 lating influence of the cold. For a time all of degrees F.) Allow the patient plenty of the natural powers combine to combat the bedding that the room need not be kept warm. inroads of cold, and the individual is alert to If the frost-bite has been superficial, cold every pain and pang from without and within ; compresses of lead-water and laudanum will be there may even be anxiety. Finally the head- soothing, and assist in preventing inflammation. ache is again felt, there are chilly spells, one If the deeper structures have suffered from the part after another tingles from cold, then the cold, the lead-water and laudanum should not tingling lessens, and numbness and weight of be used; but at intervals of two or three hours the limbs follow. The mind is prone to reverie

alcohol should be applied to the part, using and a sense of security ; the cold is noted, but gentle friction to stimulate the circulation. the desire to ward it off is gone, and there is a For two or three days the appearance may be strong desire to sit or recline, and allow the quite normal, and then without apparent cause mind to continue its thoughts. Drowsiness suddenly the part inflames, becomes swoolen, and an almost irresistible desire comes to blackens, and gangrene sets in. If sluf or sleep, and at the same time the sensation in the gangrene should develop, the injured locality limbs is lost. The individual may know that should be covered with a light dressing for a he is freezing, but the will is too weak to rouse few days until the line of demarkation is estabthe body to action. Unless aid soon comes to lisht between the part that is going to recover, such a one, death is imminent. Nature has and the part that is hopelessly injured. The exhausted her vital power, the heart slows, and nerves are slow to recover after being frosted, so does the respiration.

and for this reason do not control the capillary On entering a warm place care must be blood vessels, allowing of local congestion and observed lest the congestion of the internal distention. Above the injury the normal veins are not sufficient to carry away the excess of blood with fluid, and stimulate the heart and blood; thus thru the weakened walls exudation lungs. easily follows, with distention and inflamma- 7. No material is as warm as soft grass for tion, and restoration is retarded, finally ceases, the hands and feet, used under the outer and gangrene ensues. The line of demarka- clothing.

J. H. ROMIG, M.D. tion in superficial injuries is back of that in the Bethel, Alaska. deeper structures, making the stump of healthy

[The above was written last winter, but as it tissue convex; but where the injury has been did not reach us till spring—too late to be deep and of some hours' duration the reverse appropriate to the season-we have kept it to of this condition is to be found, and the stump present this winter.—ED.] is concave. The bone least of all the tissues regains its vitality. Operations to remove frozen fingers, toes, or

Shall the Country Doctor Move to a City ? extremities must be performed well back of the

Editor MEDICAL WORLD:-In answer to W. line of demarkation (especially is this true of Va., who wants advice in regard to country the bone) lest a second operation be necessary physicians or village doctors moving to town before the desired result is obtained. Frosted or city, I will give my advice. While at the tissues are low in vitality, and healing may be Pan-American Exposition at Buffalo, I made retarded. Primary union cannot be expected the acquaintance of a doctor from near the as often as in operations on more healthy capital of N. Y. He had repeatedly thought structures.

of moving to Albany to practise his profession, Chilblains : Parts that have been frosted or but he finally decided, as I have, that he exposed to cold for some time and then rapidly "would rather be big dog in a little place warmed behave in a peculiar manner, and thus than little dog in a big place." Charge for claim separate consideration. Hyperesthesia what you do and stay with your practise, and of the affected area is the prominent feature of you will be just as well off. After 22 years of the trouble. The injury is more of the nerves experience, I find that it pays to become one than of the tissues. Rapid rise of temperature in of the fixitys of a place. C. A. RIFE, M.D. the part, with or without previous exposure to

Kyger, Ó. cold, gives rise to very annoying symptoms : burning and itching with reddening and more Editor MEDICAL WORLD :-I would be or less swelling. Moist heat (the bath), heavy pleased to give at greater length than your clothing, and sudden changes in the atmos- columns would admit, my experience regardphere are all exciting causes. The treatment ing the advisability of changing from a counof such cases should be first directed to the try to a city practise. I believe that the prevention of rapid changes of temperature of statement of facts as they exist to-day in the the part affected. When local irritation is great teaching centers—with the present syspresent, the itching and pain may be arrested tem of mis-government and the multiplicahv the application of cold compresses wet with tion of eleemosynary institutions, and their

sad-water and laudanum, or by painting the effect upon the practise of medicin, if truthpart with fl. ext. of belladonna, directing the fully placed before a man, and more especially treatment to the injured nerves. Massage and if he has children who would be compelled to the use of astringent liniments are of value be- make the streets their playground, on account tween the times of irritation.

of the stealing of money which should have All parts that have been frozen are sensitiv been used for the purchase of parks—would to cold for some time, and should be given prevent his coming to the city. It is only the massage to restore the functional activity of man who has gone thru it that is in a position the vessels and tissues of the part.

to give an opinion. Experience teaches fools. Points of interest :

In addition to all the risks to the family, a 1. To combat cold the system uses up her man must be prepared to make an outlay of energy very rapidly.

three to five thousand dollars a year, for at 2. A sense of security and drowsiness are least five years, and possibly longer, before he the danger signals of cold.

establishes himself, I care not how well up he 3. The restoration of a frozen part must be is. There are hundreds of men here fully gradual.

qualified, waiting for something to “turn up. 4. Heat is the enemy to recovery.

In conclusion I would say that if you will re5. Spirituous liquors are never of use in a fer to me all inquirers who are thinking of cold climate during exposure, for with their coming to this city, and if I cannot give them reaction there is the greatest danger of freez- information regarding the uncertainties of meding

ical life here to prevent them adding one more 6. Hot tea is the best drink to supply the to the already too long list of sufferers, then I

am woefully mistaken. My first attempt at re- tending from a little above the trochanter to plying to the query would, I am sure, make four inches below the foot, and bind that on interesting reading for the inquirer, but I with a dry roller. You can apply extension know where, on account of its length, it if you wish. I never have. Before the star, would go. I would be pleased to write the gets dry there is not much tendency to condoctor fully, if he wishes more information traction, and what there is is counteracted by regarding this city.

the straight splint. After it is dry, I remove F. MARSH SOPER, M.D. the straight splint, cut out a strip an inch Pinkney Court, W. 140th st., N. Y. City.

wide from the toes to the top, then apply

straps, two to the foot and one every six The Starch Bandage.

inches the whole length of the leg. You can Editor MEDICAL WORLD:—The article in tighten or loosen these or any one of them, as the Sept. WORLD (page 394) by Dr. Bardwell occasion requires. There is no danger of on the use of the silicate of soda bandage as a shortening after the bandage is dry, for you permanent dressing for fractures, prompts me have a perfect mould of the leg, and there is to give you my experience with the starch no chance for the muscles to contract. In all bandage, to further show the folly of spending the cases I have treated I never have had any money for a big stock of patent splints for shortening. The results were perfect. The such work, and nine times out of ten you do patient can usually get up in a week and go not get as good results out of them as you do around on crutches. out of the silicate, starch or plaster-of-paris There is always a little stiffness of the bandage when properly applied. I have been ankle and knee after you remove the bandage, in the business for forty years and never but that soon limbers up and need cause no owned a set of splints. I don't claim I have anxiety. I know in modern surgery passiv had a thousand cases, but have had a goodly motion of the joints is advocated, but in these number. I have treated all my fractures of cases of starch bandage I think it is uncalled the leg and thigh with the starch bandage, for, and might be injurious to the union that and all my arm fractures with common board is taking place, and give the muscles a chance splints properly shaped and padded, and I to contract. have never had a bad result; in fact the very In compound comminuted fractures I cut a best results. I graduated at Bellevue in 1865, trap just large enuf to treat the wound. The and in one of Frank H. Hamilton's clinics, toes being left out, you can tell when the where he had applied a plaster bandage, he bandage is too tight and interfering with the remarkt that any butcher could cut a leg off, circulation. As long as there is no blueness of but it took a surgeon to save one ; also that nails, it is all right. there were three requisits to make a surgeon: I have gone into details for the benefit of a perfect knowledge of anatomy, a natural the young physicians, for the modern works of mechanical skill, and a good degree of com- surgery don't tell you how it is done. I have mon sense. I thought I had a little of all known physicians to make mistakes both with three. I was sure I had the mechanical skill, starch and plaster in fractures of the femur, and as for the anatomy, I could brush up on applying from the hip to the knee only. Of that before an operation, but the common course they could not have a good result, and sense I have often thought since, at times, that consequently they condemn the apparatus, I was short on, especially when a fellow would when in truth the fault was in their ignorance. come whining around and I would give him a I am not writing this to condemn other apdiscount off his bill.

pliances or to claim extraordinary advantages Now there is one thing in the use of the over them. I am only telling you what I starch bandage I do different from modern have done and how, and the results I have teaching, and that is, I apply the bandage at got out of it. The great advantage with this first-do not wait for swelling. If the band- is, the material is always at hand and costs age is properly applied, the evaporation of the you nothing. The ladies will make starch and starch in drying acts as a poultice and prevents starch the bandages for you when you show much swelling. I cover the leg evenly with them how. Assistants will hold the leg while cotton from the toes to the hip, then run a you are putting them on. After you have all dry roller bandage the full length, then smear your starch rollers on and the dry roller over it over with thick starch, and apply the starch all, pull the leg straight and have it in line rollers, five to six layers, smoothing each layer just as it was before fracture ; then have the down with a little additional starch, then a assistants hold it exactly there while you apply dry roller over all. When complete, I put on a the straight splint. See that the leg lies straight splint about four inches wide at the smooth and nice in the bed with a little packtop and about three inches at the bottom, ex- ing of some kind on each side to hold it


A Case Like that of Perplext" Arrested and Acquitted THE MEDICAL WORLD

straight till it gets dry, and to avoid accidents when she woke up the baby was dead. In two while the patient sleeps.

days, when I called, it was buried, and they Now I have not told you anything new. It were preparing to move to another state, so I is something old. And I here tell you I am let it go, but I have reasons to suspect that the not going to give up an old friend for a new child was killed by its mother. one. The starch bandage is good enuf for About one year after the birth of this child, me-materials always at hand, and I never she gave birth to another one under similar have to worry as to results.

circumstances, followed similarly by death of W. H. MARTIN, A.M., M.D. the child. No physician was present at the time Lamont, Okla.

of the birth of this child. The people had the

child exhumed and a post mortem made. The A Case Like that of - PerplextArrested verdict was that it died from strangulation, and and Acquitted.

the young woman was arrested, tried and acEditor MEDICAL World:--I have been read- quitted, there being no direct evidence to coning your valuable journal for several years, and vict her; yet it was the opinion of the people I conclude that it is the only journal that in general that she was guilty. reaches the country practician in the way of Now did I do right in this case or not? rendering real help. I have profited by its We hear so much these days about small many words of advice. With great interest I families, race suicide, etc., that I want to read the articles on “Perplext." Very few touch on this question. President Roosevelt practicians have not had one or more cases is a wise and great man; he wants to see large along the same line. And I have come to the families; so do I, and many other people. conclusion that we who must earn our bread Some writers lay the blame directly on the and the necessaries of life, would better keep parents for small families, or no children at quiet, for if we report these cases, the law is so all. I do not take this view of the question. lax that justice often miscarries, and we be- It is true I find more miscarriages than at any come the butt of ridicule, and we get a host of time previous in a 20 year practise, but who is enemies by doing what we think is right in to blame? I find many in my practise who the sight of God and man. Silence is often are anxious for children, and I do not think the best policy. I do not uphold any wrongs they try to evade conception in the least. in this direction, and I believe in 'standing Many women who conceive will miscarry in upon the principles of right and justice; but spite of our best efforts; and for those who we must know on which side our bread is never conceive, it is a question as to why they buttered. I wish to relate one case in particu- do not.

do not. Are they steril and beyond help? or lar. About five years ago the writer was is the male steril? There is but little said called to attend Miss in confinement. The about the male being steril in our books, yet family were about half smart taken all to- I am of the opinion that there are in this land gether, and the young lady was no exception about as many steril males as females. I want to rest of the family.

to hear from the brothers who read THE WORLD The father of the young lady said his daugh- what they think of this question. Again, it is ter had cramp colic and was very sick. I had admitted that our foreign population is much heard it reported that the young lady was in more fruitful than the American. Why this is the family way, but did not know only from I cannot understand. Why does not some reports. When I arrived at the house her specialist get to work among the nativ Amergeneral condition indicated that she was in icans and see what is wrong? Here is cerlabor. I called for some warm water and tainly a good field for some of us. proceeded to make an examination. This she

RACE PERPETUATION. positivly forbad, and her mother also went against me, and said I should not examin the Consumption and the Opium Habit. daughter, but give her something for the colic. Editor MEDICAL WORLD:-It is rather surThis I refused to do. While we were arguing prising that any one could for a moment beabout the examination, the child was born. lieve that the habitual use of opium could Then she allowed me to attend to her. I inhibit the progress of consumption or prevent found the child to be a strong, healthy young. its contraction. All the nutritiv functions are ster to all appearances. I gave her all the lowered in the opium user. The appetite is attention needed. When I was about to leave lessened, the power of digestion is lessshe said she did not want any baby, and had ened, and secretions and excretions are lessa notion to wring its head off. I told her to be ened. There can be no question that the recareful what she said and did, or I would see sisting force of the individual is lessened under if anything happened the baby. That night such conditions. Every successful phthisiothe child died; said she went to sleep, and therapist makes the increase of physiologic

« PreviousContinue »