2. This can be prevented by prohibiting the use of every kind of food and cathartics by mouth, and by employing gastric lavage in every case in which there are remnants of food in the stomach or in the intestines above the ileo-cecal valve, as indicated by the presence of nausea, vomiting, or meteorism. 3. The patient can be supported by the use of concentrated predigested food administered as enemata not oftener than once in four hours, and not in larger quantities than four ounces at a time. 4. This form of treatment,when instituted early, will change the most violent and dangerous form of acute perforative or gangrenous appendicitis into a comparatively mild and harmless form. 5. Cases of perforative or gangrenous appendicitis with beginning general peritonitis can usually be carried through the acute attack safely with this method. 6. In all cases of this class gastric lavage should be practiced in order to prevent the absorption of decomposing material from the alimentary canal. 7. In cases of doubtful diagnosis this form of treatment should always be employed. 8. This treatment will prevent a large proportion of the most troublesome complications and sequelæ of appendicitis, such as ventral hernia, fecal fistulæ, extensive adhesions, etc. 9. The patient should be permitted to recover fully from his acute attack before an operation is performed, except in cases encountered within the first thirty-six hours after the beginning of an attack or in case of the formation of a superficial circumscribed abscess. 10. It often requires but a small amount of any kind of food to change a harmless circumscribed into a dangerous diffuse peritonitis. 11. The treatment does not protect the patient against a subsequent attack. 12. It does not contraindicate the removal of a diseased appendix before the septic material has extended beyond this organ. 13. It is indicated in all intra-abdominal conditions in which it is desirable to prevent the distribution of septic material by means of peristaltic motion. 14. The laity should be taught to stop feeding and giving cathartics to patients suffering from intra-abdominal diseases. GYNECOLOGY AND OBSTETRICS. UNDER CHARGE OF T. J. CROFFORD, M.D. Professor of Gynecology, Memphis Hospital Medical College, AND W. D. HAGGARD, M.D. NASHVILLE, TENN. Professor of Gynecology and Abdominal Surgery in University of the South (Sewanee); Gynecologist to the Nashville City Hospital; Professor of Gynecology, Tubal Pregnancy. University of Tennessee. J. Goodrich (St. Paul Med. Jour., vol. 4, no. 2) says that if surgical intervention were withheld in all cases of aberrant pregnancies about 5 per cent. would ultimately recover, while the remaining 95 per cent. would succumb to hemorrhage or sepsis. In the hands of a skilled surgeon the mortality is less than 1 per cent. Operative procedure for relief of the various forms of extrauterine pregnancy must vary according to the conditions present and may be briefly summarized as follows: 1. Hematoceles, whether intra- ligamentous or peritubal which point in the cul-de-sac of Douglas are often best relieved by a posterior colpotomy with drainage. 2. Hematoceles which point in the vagina anterior to the cervix may be relieved by an anterior colpotomy with drainage. This is true whether intra-ligamentous or peritubal. 3. According to J. W. Taylor all cases of rupture accompanied by diffuse hemorrhage should be subjected to laparotomy. 4. Cases of unruptured tubal pregnancy seen before the third month may likewise be relieved by a posterior colpotomy. 5. Hematoceles which extend high in the abdominal cavity should be treated by celiotomy and, if necessary, vaginal drainage. 6. In cases of tubo-abdominal or ovarian pregnancy beyond the third or fourth month an abdominal section is advisable. 7. Cases of infected hematocele which are accessible by either the anterior or posterior portion of the vaginal vault should be relieved by a kolpoceliotomy unless there be evidences of active hemorrhage when the combined method would probably be more expedient. 8. Unruptured ectopic sacs which have become infected are more safely dealt with through the vaginal route if the pregnancy has not advanced beyond the fourth month, in which case the combined method will probably give the more gratifying results. Tuberculosis of Peritoneum. W. Webb (Amer. Surg. & Gyne., vol. 15, no. 4) says: 1. Tubercular peritonitis is a surgical disease, and should be treated surgically, and not medically, for the simple reason that when treated medically patients die, but when treated surgically a cure is effected in a large proportion of cases, and a marked improvement follows in all. 2. The proper treatment is abdominal section rapidly and carefully performed. 3. Danger from operation is very slight, the mortality being less than 3 per cent. 4. Of the many theories advanced to account for the cure in these cases, the antitoxin theory of Gatti seems to be the most rational. It is not unlikely, however, that the good results attained are due to a combination of several of the various causes assigned. 5. Sepsis is not apt to occur on account of the pathological changes that have taken place in the peritoneum. 6. Tuberculous infection of the wound does not occur. 7. Antiseptics are useless, and drainage should not be employed if it can be avoided, as it is apt to leave a permanent fistula. Most of the deaths after the operation have been due to a general tuberculosis or tuberculosis of some other organ. 9. The successful treatment of this disease depends upon. the diagnostic ability, good judgment, technic and skill of the man behind the knife. Memphis Medical Monthly Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880 Memphis Lancet, established 1898. LYCEUM BUILDING, MEMPHIS, TENN. Subscription Per Annum, One Dollar in Advance. Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR. W. B. ROGERS, M.D. DEPARTMENT EDITORS. A. G. SINCLAIR, M.D. T. J. CROFFORD, M.D. W. D. HAGGARD, M.D., Nashville. B. F. TURNER, M.D. THE MEMPHIS MEETING OF THE MEDICAL SOCIETY OF THE STATE OF TENNESSEE. THE sixty-ninth annual meeting of the State Medical Society, which will be held in Memphis on April 8, 9 and 10, promises to be the most important meeting that this organization has held in a number of years. It has been several years since Memphis has entertained the State Society, and we look to considerable interest being manifested in this meeting by local physicians and members of the profession throughout the Western Division of the State. On this occasion the following amendments to the constitution will come up for final action: 1. "The State Society to be known as the home or parent society, with three branch societies, to be designated the East, Middle and West Tennessee branches of the State Medical Society. "The parent society to meet annually in Nashville on the second Tuesday in April. "The branch societies annually in September, October or November at such places as may be elected. The membership fee and annual dues to be $3, $2 of which shall belong to the parent society and $1 to the branch society. (See Transactions, pp. 22, 23 and 24.) 2. "To establish a journal to be known as Tennessee Medical Journal, which shall be published monthly in the city of Nashville, the proceedings and all papers of the branch societies as well as the parent society to be published in the Journal. Publication of the Transactions in book form to be suspended." Considering the proposed amendments, each for its own claims for adoption, we regard the scheme to organize the society into a parent society, with three branch societies, as a plan that has many theoretical and practical advantages, but it would almost necessarily require that several existing district organizations, for instance, the West Tennessee Medical and Surgical Association, be discontinued, for it would hardly be reasonable to expect the physicians of the various sections to lend sufficient aid and recognition to maintain more than one organization with practically the same scope. Such organizations as the one mentioned have usually found a warm spot in the hearts of their various members, and serve a useful purpose, and we believe that they would not surrender their identity without first making a strong effort to maintain their organization and individuality. The second clause of the first amendment has always been warmly advocated by us, for we think that a State Medical Society should hold its annual meetings at the State capital. The expediency of this is emphasized in the fact that the meetings at the State capitals are invariably the best attended and most interesting that are held. Still, a strong fight will be made against the adoption of this clause of the amendment. To take up the second amendment, we would first like to go on record as stating that in this matter we have absolutely no ax to grind, for the MONTHLY has never depended upon the State Society to any considerable extent for contributions to its original pages, nor would its subscription list be materially decreased were it to lose every subscriber thereon who is a member of the State Society, but to us it seems that this proposition to establish a medical journal, to be known as the Tennessee Medical Journal, is the most absurd scheme. that it has ever been proposed to perpetrate upon the society. In the first place, no medical journal can be a really successful venture without it is enabled to secure a certain amount of advertising matter. This will be found very difficult to do with such a journal, for the subscription list will unquestionably be almost wholly confined to members of the society, since the journal will be of entirely too local a nature to extend its circulation very much beyond the confines of the State. Further, we are very familiar with the cost of running a medical journal, and unless printing is obtained much more cheaply in Nashville than in MemVOL. XXII-12 |