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be called composite pictures of the disease, but did not describe the particular case. General likenesses were furnished, from which we must expect wide variations. In this latitude, the fever might last five, six, or even eight weeks. The diagnosis would be aided by bearing in mind that the disease must be considered a species of which there were many varieties, embracing wide fluctuations of temperature, excess of nervous symptoms, or unusual tendencies to hemorrhages, or susceptibility to relapses, or troublesome gastric and abdominal symptoms, or disproportionate pulmonary symptoms, or troublesome sequelæ, as neuritis, atrophies, paralyses, etc., or even combinations of these variations. The more common error consisted in considering the disease a malarial disorder, or in confounding it with acute pulmonary tuberculosis, or with tubercular meningitis of children. Long experience was often required to reach a correct judgment. Several visits, with perhaps frequent daily observations of pulse, temperature, and respiration, with the most careful clinical record, might be demanded in clearing up doubtful cases. In all cases of continued fever, where visceral lesions, adequate to account for the disturbance, could be excluded, the suspicion of the existence of typhoid fever should be entertained. The lineal temperature curve of the text-books was seldom seen. Variations were to be expected, and if not found, it was because our observation had not been sufficiently close.

Again, in the opinion of those longest in practice, typhoid fever had undergone marked changes in its manifestations, and in this country it had now become an asthenic disease, though formerly often sthenic in character.

Regarding treatment, we must remember we have to deal with a disturbance which must last weeks, in which incendiary medication might be dangerous, while careful measures were necessary to conserve the patient's strength. Curing the disease must mean caring for it. Greater dependence was to be placed on nursing, air, water, diet, and quiet.

He valued milk as the main food in some form or combination, as it was better borne than any other one article. The whites of from three to twenty eggs a day could be incorporated with it. If the bowels were confined, animal broths might be substituted, on account of their laxative action in disorders where the tendency was to diarrhea.

Digitalis was useful as a heart tonic, while in very asthenic cases strychnine might be given in small doses with a favorable effect.

Regarding stimulants, he advised caution, and, when demanded, would begin with the milder forms, to be gradually displaced by whisky and brandy, if required.

He advocated very little medicine regularly, suggesting onedrop doses of carbolic acid and tincture of iodine thrice daily. Quinine and salicin would often act well in small tonic doses. Diarrhea should be controlled, but not entirely arrested. For intestinal hemorrhage he employed ice upon the abdomen, and ergot and opium internally. Surgical interference, in case of internal per foration, had shown discouraging results, but should hardly be abandoned as yet for that reason.

Temperature beyond 103° over a long period, in his opinion, was exhausting, and rapidly destructive of nervous tissue. Under these circumstances, he advised tepid sponging, or moderate doses of the antipyretics. In some cases alcohol would lower temperature, though its use was experimental.

Competent nursing was of highest importance, and the intelligent and accurate clinical record a good nurse could furnish would be of very material aid. He had found it good policy, contrary to the views entertained by many physicians, to give small quantities of food every hour, or even more frequently, if need be. Unusual frequency of administering nourishment might be rendered necessary by gastric irritability, and should then be resorted to.

Convalescence was often a most trying period, and demanded greatest circumspection, lest improper diet or exercise result disastrously.

DR. B. L. HOVEY, of Rochester, presented a paper on Colles Fracture, in which he reported a series of some thirty-six cases under his care during the past fifteen years. He was convinced of the truth of Dr. Moore's teaching regarding the nature of the injury, the mode of reducing the fracture, and the appropriate dressing.

Of his thirty-six cases, two were double. In eleven cases there was associated with the fracture of the radius, dislocation of the ulna. In all but two, perfect recovery resulted. One of the faulty recoveries was due to the unruliness of the patient-a boy; the other occurred in one of the instances of double fracture.

He then referred to the various dressings employed, and described the application of Dr. Moore's compress, strip of adhesive plaster, and sling, by which all of these cases had been treated. In addition, he made use of pasteboard splints on the dorsal and palmar sides of the arm and hand. The splints extended from the middle of the forearm to the knuckles. They were cut narrow, and so shaped that the hand was deflected toward the ulnar side. He secured them loosely by a few turns of a bandage. His reason for thus employing splints was two-fold; to give better satisfaction to the patient, and to prevent the injured hand from being carried in the other, a matter which seriously jeopardized the result. With this dressing properly applied, after the ulna had been replaced, there could be no shortening of the forearm. Where there was an unreduced dislocation of the ulna, the use of the pistol-shaped splint, so commonly employed, was most illogical. For, in this case, with the hand turned toward the ulnar side, the head of the bone was carried farther away from its articulating surface, while the neighboring ligaments were put upon the stretch, causing severe pain and inflammation, and often resulting in partial anchylosis of the wrist and finger-joints, with atrophy of the tissues. As might be seen, in thirty per cent. of his cases, the fracture was attended by dislocation of the ulna, while, he believed, Dr. Moore claimed it occurred in about fifty per cent., though not in all, as some had supposed. The diagnosis of the complication was all-important. Failure to make proper reduction could be detected by undue shortening of the forearm, by undue separation of the ulna from the radius, and unnatural prominence of the head of the ulna.

[This was one of the most successful meetings the Association ever held. Over 200 members were present, and it served as a fitting observance of the twenty-first anniversary of this flourishing organization.-E. B. A.]

PHILADELPHIA COUNTY MEDICAL SOCIETY.

STATED MEETING, NOVEMBER 14, 1888.

PROF. FORBES in the chair.

DR. JOSEPH PRICE read a paper entitled: "A Consideration of some Recent Work in Abdominal Surgery." (See original communication in December number, p. 220.)

DISCUSSION.

DR. THEOPHILUS PARVIN: My remarks will be chiefly in reference to the treatment of extra-uterine gestation. Quite agreeing with the writer that the certain diagnosis of this condition in the early weeks is impossible, and that the great majority of cases are recognized only after the rupture of the gestation cyst, I must think that those instances in which early recognition was asserted were altogether exceptional, and the recognition only a conclusion of probability, or a fortunate guess.

But an extra-uterine gestation being known, the question of treatment immediately presents itself. Different answers to this question are given. What may be called the American method, because more employed in this country than in any other, owes its origin to Dr. J. G. Allen, of this city, who successfully employed the faradic current for the purpose of destroying the life of the fetus. One of the criticisms made upon this method is that the proof of the extrauterine gestation fails, in that no product of conception is revealed, the corpus delicti cannot be found; there may be as many as two or three exceptions-that is, some time after fetal life has been destroyed, an abscess has communicated with the exterior, and parts of the fetus been discharged. Nevertheless, the question has been asked, whether, in the long list of cases in which electricity was employed with such unusual success, there were some in which the fact of pregnancy was not conclusively proved.

In regard to those few cases of asserted interstitial pregnancy in which the fetus entered the uterus, obedient to the electric stimulus, and then was expelled through the natural passages, I must confess to the least scepticism as to the correctness of the diagnosis in all; for such a uniformity of successful results, the fetus in all cases behaving so well, seems extraordinary. Is it not, at least, probable that, in some instances, the rupture of the cyst would be into the abdominal, instead of, invariably, into the uterine cavity?

The injection of morphia into the fruit-sac, for the purpose of destroying the life of the fetus, is a method regarded with favor by some eminent German authorities. Even if always successful and devoid of danger, the same theoretical objection, which has been made to the treatment by electricity, applies to it. There are still other objections to both methods.

Others

There remains the treatment by abdominal section. Now, this is applicable to cases of ectopic gestation, whether rupture has occurred or not, though in the former, it seems to me, it is imperative. beside Mr. Tait have had valuable experience in the surgical treatment of this affection, though none, probably, a tithe of his; thus Worth has operated seven times, with six recoveries, and so firmly convinced is he of the importance of abdominal section that he declares an extra-uterine gestation ought to be treated as a malignant tumor-that is, extirpated at the earliest moment.

At the Philadelphia Hospital, quite recently, the abdomen of a woman was opened on account of rupture of a gestation cyst; a large

amount of clotted blood was found in the abdominal cavity, but no bleeding points discovered, and, therefore, no ligation of vessels was done, or extirpation of the fragments of the cyst; the woman's chances for recovery were vastly increased by the thorough cleansing of the abdominal cavity.

After having witnessed several operations for extra-uterine pregnancy performed with great skill, and the results being uniformly favorable, I am more and more convinced that this is the method of treatment for all cases, the only exceptions being an abdominal pregnancy so far advanced that there would be hope of extracting a living child at term (when the operation might be deferred until near the close of pregnancy), and an unruptured interstitial pregnancy.

A word as to tubal collections of pus in puerperal septicemia. I cannot believe this is frequent, either from the few post mortems of women dying of puerperal fever which I have seen, or from my reading; in the last edition of Schroeder's Obstetrics, 1888, for example, it is stated that occasionally, or sometimes, such collections are found. I cannot, therefore, hope that any great diminution of the mortality of puerperal fever will come through removal of pus-filled tubes.

The brilliant results obtained by Mr. Tait, and many operators in this city whom I might name—the almost total exemption from mortality which their statistics show-must not mislead us, for there are dangers in abdominal sections, and patients may die shortly after a so-called successful operation. Thus, a little more than two months ago, in conversation with Dr. Lombe Atthill, of Dublin, he told me of a lady operated upon by a distinguished surgeon, and she perished from hemorrhage a few hours after.

The treatment of pelvic abscesses by abdominal section is, of course, a valuable addition to therapeutic means. But are all intrapelvic inflammations with suppuration amenable to this means? Given a case of inflammation adjacent to the uterus, the parts matted together making a resisting mass as large as the two fists, or larger, the patient suffering from peritonitis, and having fever, can the offending pus be safely reached through the opened abdomen?

Then, too, are there not other limits to the employment of abdominal section in diseases of women? I do not object to the removal of the tubes in cases of pyosalpinx, on the false ground that the woman is thus rendered sterile, for a tube so diseased can never have its functions restored-it is, hopelessly, remedilessly ruined. But what of the removal of the ovaries for pain, or for certain nervous disorders? Does such removal cure or even palliate in the majority of cases? Here is a question that demands careful and large investigation. Doubtless, some cases of so-called menstrual epilepsy are benefited by the operation, but it is doubtful whether many absolute cures result. It may be questioned, too, whether pain in the ovaries, the organs being otherwise normal-the so-called ovaralgia-demands their extirpation. I have seen a woman whose ovaries had been removed on account of pain; the suffering returned as severely as ever, and then the stump of each pedicle was taken away, but not the slightest benefit followed-a year after the last operation she was as bad as before the first. I have myself removed the coccyx for well-marked coccygody

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