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WILLIAM S. PEARSALL, M.D.
Readers of the JOURNAL are cordially requested to send personals, removals, deaths and all items of general news to Dr. William S. Pearsall, 128 West 781h Street, New York City.
Secretaries of societies and institutions are invited to contribute reports of their proceedings, and as it is intended to make this department crisp and newsy reports should be complete but concise.
The Homeopathic Medical Society of the County of New York held its regular monthly meeting in the chapter room, Carnegie Hall, on Thursday evening, October 14, 1897.
There were seventy-eight present when the President, Dr. Geo. G. Shelton, called the meeting to order.
Dr. Margarita A. Stewart, 24 West Fifty-ninth street, and Dr. Harry Zeckhausen, 128 Second avenue, nominated for membership.
The Committee on Obstetrics, Dr. Elizabeth Jarrett, Chairman, presented a paper by Dr. F. W. Hamlin, entitled, “Management of Face Presentations."
Discussion-Dr. Louise Z. Buchholz: Dr. Hamlin, in his paper, speaks of a face presentation as something of a calamity. As my personal experience is limited to four cases, I cannot compare myself with him as a judge, for he has evidently had quite a number. My cases terminated normally without instrumental interence, and in each case with a living child.
Of the causes of face presentation enumerated I have met but one, and that is a posterior position of the child. I am inclined to think this favors face presentation, as the pains, acting on the irregular anterior surface of the child, would tend to extend the head, especially if the occiput catches under the promontory of the sacrum. My last case, which occurred this summer, presented this condition. The child was very large, situated high in the abdomen, and lay with its posterior plane to the back of the mother. The sudden rupture of the sac, with a great gush of water, extended the head, and the face presented. In the case described by Dr. Hamlin we are not told what the cause was. Tire woman had several normal labors before. This was also the case in three of my patients, only one being a primipara.
An early diagnosis is desirable before the rupture of the membranes, and before the face has become engaged. It is not easily made, however, for the presenting part is high, and if a large tense sac (which is the rule) intervenes the diagnostic features cannot be well defined. After rupture of the membranes diagnosis is more easy, but the position cannot then be as well rectified by external manipulation. The very fact that such a presentation is so very uncommon makes us tardy in discovering it.
Why is the labor so slow and tedious? As in every one of my cases the child lay posterior, the chin pointing anterior, I am inclined to think that the same factors which make all posterior position more tedious here operate as well, plus the difficulties met with when the irregular large face presents instead of the small round vertex. In all posterior positions, whether of the head or breech, the first stage, that of dilatation, is very slow. The pains are weak and inefficient, and the progress consequently slow. After complete dilatation labor can be completed in a comparatively short time. That has also been the case with my face presentations. During the first stage, which was in every case very slow, I could be of little assistance, but after complete dilatation, I could press on the abdomen directing the pressure along the posterior plane of the child so as to flex the chin upon the chest, and when low enough in the vagina, I could introduce one finger into the rectum to depress the occiput and with my left hand make pressure on the abdomen so as to get the chin under the pubic arch. Dr. Hamlin seems to regard forceps as necessary in almost every case. Before we have sufficient dilatation we cannot use them, and where there is enough dilatation nature, with our assistance, may do the work. Of course, if the pains cease or are too weak and the mother is exhausted we have no alternative but to use forceps, but if we see that the case is progressing slowly but surely we can afford to wait. Any slow labor may cause asphyxiation, spasm or bloody extravasation in the child, and the awful tumefaction of the face does not seem to be any more dangerous than the compression of the brain following the use of the forceps. That the mento-posterior position is more grave than the mento-anterior is claimed by different authors. I have had no such case as yet, but should think manual interference just as possible as in the other. The smooth back of the child being terior, the pains are likely to be more forcible.
Version, recommended by Dr. Hamlin, is not so difficult in a transverse presentation, but when we must push up a large tuimefied head into the abdominal cavity to get the feet down it becomes a very difficult matter. I had a case recently where the head and both feet presented at the same time. I had to either push up the head and get down the feet, or push up the feet and get down the head. Every time I'introduced my hand the patient would bear down so that the parts were jammed close together. After great difficulty I succeeded in pushing up the feet far enough to allow the head to engage. The little limbs were so mangled that large blisters formed, and the child died in spasms about fourteen hours later
. It was a twin; the other child presented by the vertex, and is still alive. To perform version successfully in a face presentation it requires a roomy pelvis or a small child. Dr. Penrose's method of applying one blade of the forceps to the posterior cheek of the child
seems a good one. I have tried it in vertex presentation with success, and it is worth a trial in a face presentation.
Dr. L. L. Danforth: Face presentations, while usually more tedious, are often terminated without great difficulty. With chin anterior, good pains, etc, everything should go on normally. Placing blade of the forceps against posterior cheek works well, the principle is a good one, as it gives something to resist against. The mento-posterior presentations are almost formidable. We cannot here apply forceps so easily, and the more we pull the greater the mass becomes impacted. The obstetrician must watch carefully the condition of both mother and child, and if all goes well, it is best to let matters go on. Mento-posterior position may be delivered in an excellent way by anterior rotation of chin from right mentoposterior to right mento-anterior by one hand in pelvis and the other on abdomen. A correct diagnosis is the all important thing in mal-presentations.
The committee on Clinical Medicine, Dr. B. G. Carleton, Chairman, presented two papers. “A Case of Phthisis, showing possible Result," by Dr. J. W. Dowling.
Discussion—Dr. T. C. Williams: The whole secret of resistance to tuberculosis lies in the temperament, diathesis, susceptibility, whatever it may be called. Every one who takes in tubercular bacillus is not afflicted with tuberculosis unless the soil is favorable. The treatment must be directed to lessening the susceptibility either by change of climate or the use of remedies and hygienic measures.
Dr. L. H. Danforth cited a case of undoubted phthisis, who was determined to recover, and went alone to the Riviera, and stayed all winter and was cured, cough gone, temperature gone; in fact, all unpleasant symptoms.
Dr. P. J. B. Wait: I recall six or seven cases which, when removed to a dry climate, resulted in cure, even when heredity pointed to death from tuberculosis. The question I thought of is how is the way of determining whether patient is to go to cold dry or warm dry climate?
Dr. G. S. Harrington: I remember a point given by Dr. T. F. Allen was to consider the remedy indicated for the case in deciding this point. For instance, a dry, hacking cough, with thirst, fever and sweat, rather of the aconite type, should seek a moist climate, and a hoarse cough, with low fever, etc., the reverse.
Dr. Geo. T. Stewart: I have lived in Arizona, Mexico, Colorado and California, and have seen cases again and again recover. Cough left the patient very quickly in certain parts of Colorado, because the air was charged with iodine. I gave iodine in all cases with excellent results. I also let them chew young eucalyptus leaves. I have seen lungs with cavities heal. Some of our nine hundred cases at the Metropolitan Hospital improve, but most of them come to us in last stages. Phthisis can be cured.
Dr. Charles Deady: In San Antonio the population was onefourth Mexican, one-fourth German, and one-half consumptives. Sleeping on the ground there hot nights was common, where the temperature runs 106° in rooms. The safety in outside sleeping does not seem to me to depend upon the dryness simply, because I have gotten up soaked with dew and yet no cold resulted.
Dr. J. W. Dowling: As to cold dry climate or warın dry climate, it depends upon the patient's vitality. The robust can stand a cola dry climate, but the delicate subject has to go to a dry mild climate
“Asthenic Bulbar Paralysis” was the title of a paper by Dr. J. T. O'Connor.
Discussion-Dr. Wm. H. Van Den Berg: It seems that Dr. O'Connor has so thoroughly exhausted the subject that it leaves little to be said by others.
In some particulars the cases quoted suggested the possibili ty of peripheral disease rather than a central lesion or, as suggeste d by Gowers, a degeneration in the motor tract is identical with th at of muscular atrophy. These cases are very interesting, and I think much is yet to be learned in regard to their exact pathology. I was glad to hear of the apparent benefit of veratrum, but would a dd a word of caution to that spoken by Dr. O'Connor about expecting too much from drugs in these cases, as it is a well-known fact that many cases remain at a standstill or apparently, improve under no medication at all. Yet Dr. O'Connor's experience adds considerably to the therapeutics of these cases.
Dr. G. F. Laidlaw: I agree with Dr. O'Connor in his opinion that the so-called asthenic or functional bulbar paralysis is really the early stage or a mild form of the organic disease. I have recently treated a case of bulbar paralysis that illustrates this point. A woman aged seventy years had suffered from partial and variable paralysis of the tongue and pharynx; but from the sudden disappearance and return of the paralytic symptoms, I was inclined to regard the condition as a hysterical or functional paralysis rather than an organic lesion. At one time she had regained full power of chewing and swallowing, when suddenly this power disappeared as rapidly as it had come, and she died in five days with symptoms of respiratory paralysis.
The Committee on Diseases of the Eye and Ear, Dr. M. Ruth Worrall, Chairman, presented two papers. “A Case of Retro-bulbar Neuritis,” by F. G. Ritchie, M.D.
Dr. Chas. Deady: This paper has a special value for ophthalmologists in the fact that it is one of the very few cases of acute retro-bulbar neuritis, in which careful scientific tests of the visual acuity and of the visual field, both for white and for colors, has been made. In fact, I do not now recollect any case in which this work has been so thoroughly done. It is only within a few years that the disease known as retro-bulbar neuritis, and especially its acute form, has been well differentiated from other affections of the optic nerve; and while we find in our text-books fairly good descriptions of the
chronic form of the disease, there is much room for study of the acute variety.
Some five or six years ago Dr. Knapp published in the "Archives of Ophthalmology" an article on this disease, in which he gave as the symptoms of the acute form, among others, headache, orbital pain, and general diminution of color perception. In the present case, there is no history of preceding headache, pressure upon the eyeball reveals no special pain, and the history of the color fields is essentially different. Nevertheless there can be little doubt of the diagnosis, for although similar symptoms might occur in two other forms of optic nerve affection, either of these varieties should have a history leading up to it which the careful investigations of Dr. Ritchie have proven to be absent in this case. The present limitation of time forbids the extended discussion which the case is entitled to.
Dr. O'Connor: I would like to ask Dr. Ritchie if he was able to determine the location of the lesion in his case.
Dr. Ritchie: I am afraid I will be unable to answer Dr. O'Conner as satisfactorily as I would like, as pathologists have not been able to locate the changes in any specific portion of the nerve. As I was seated here the idea presented itself of asking Dr. O'Connor if he could reconcile the peculiar shape that the central scotoma assumed, with the distribution of the nerve fibres as they enter the eyeball
“Operative Treatment of Chronic Suppuration of the Middle Ear,” by Dr. Geo. W. McDowell. This interesting paper was not discussed, owing to the lateness of the hour.
After adjournment the society partook of light refreshments at the invitation of the Executive Committee.
H. WORTHINGTON PAIGE, M.D., Secretary.
Homeopathic Medical Society of the County of Kings.—The 322d regular meeting of the Homeopathic Medical Society of the County of Kings was held in the Franklin Literary Society rooms on Tuesday evening, October 12, 1897, the President, Dr. E. W. Avery being in the chair.
Report of the Bureau of Diseases of the Chest, H. L. Carr, M.D., Chairman. “Trismus Neonatorum” was the title of the first paper and was read by Dr. Edmund Devol.
Discussion-Dr. Avery: I should like to ask the doctor whether the physician who treated those seven cases was allopathic or homceopathic at that time?
Dr. Devol: Allopathic.
Dr. Baylies: I remember of treating two cases of tetanus, both recovering under the use of angustura. One case where chamomilla cured.
Another case cured by calcarea. This was interesting from the fact that the child had had a calcarea indigestion. Within twenty