Real shortening, or effacement and dilation of the cervix, are no longer supposed to take place normally before labor. The author has seen in some cases of "false labor pains," and cases without any pain, more or less real shortening or effacement and from one to three fingers dilation of the cervix in the premonitory stage of labor, and noted that these did subsequently only partially disappear, but it is a question whether these should be classed as normal as they were really due to the beginning of a premature labor. Formerly real shortening and dilation were thought to occur at the seventh month and many theories of explanation were offered. Of these Bandl's is the most important, because of the facts it contains. the Bandl's theory: In the last two months of pregnancy upper half of the cervical canal dilates from above downwards, becomes the future lower uterine segment which subsequently never disappears and what is called the internal os is not the real internal os, but is simply the lower limit of the dilation at the time of the examination. This theory is based on the following facts: During pregnancy the body of the uterus becomes divided into an upper and lower segment separated by a slightly thickened band, called the retraction ring, or ring of Bandl. Before pregnancy, i.e., in the virgin eturus, the peritoneum is closely attached to the uterine walls as low down as opposite the internal os. Near term and after labor, instead of being attached as low as, what is at this time called, the internal os, it is attached only as low as Bandl's ring. In the nulliparous uterust he cervix and the body are of about equal length (the body being a little shorter) but in the multiparous uterus the body is nearly two-thirds of the whole length of the uterus. The author has seen the lower segment in many miscarriages as well developed as in the uterus at term, and does not believe that dilation occurs before labor, but that the lower segment is always present and pregnancy causes it to stretch and grow, and that the portion of the external surface which was nearly opposite the close attachment of the peritoneum is carried upward by its growth. (The following case seen by the author, seems to favor Bandl's theory, but must be only an unusual retraction of the lower segment: In introducing his hand to remove an adherent placenta after a forceps delivery, he found the cervix funnelshaped from relaxation, the small end of the funnel being at the internal os. Above the internal os could be felt a retracted thick. walled lower segment with a cylindrical canal, just large enough to admit two fingers and about as long as the canal of the cervix. This thick lower segment was pushed into the cervix by an assistant, and then felt like something entirely distinct from the cervix, because of its comparative hardness). The Changes in the Ovaries Tubes and Uterine Appendages. -The ovaries, tubes and uterine appendages increase in size during pregnancy. The ovaries, tubes and broad ligaments lie parallel with and close to the sides of the uterus. The ovaries are at the junction of the upper and middle third of the uterus, and can be felt through the abdominal wall midway on a line between the na vel and the anterior superior spine of the ilium. The round ligaments increase greatly in size, and at the end of gestation feel like a whip cord extending from the side of the uterus to the inguinal canal. Menstrual Suppression. Menstrual suppression has been discussed under the physiology of the reproductive organs. It depends on the excess of nutrition, of blood (congestion), being taken up daily to supply the ovum and the mother's body with the hypernutriment necessary for the continuance of pregnancy. Ovular Suppression. Ovulation is probably stopped, but on this point, however, there are no data of any great value. Other Changes. The other changes are rare or of little importance. THOMAS H. HAWKINS, A.M., M.D., EDITOR AND PUBLISHER. Henry O. Marcy, M.D., Boston. COLLABORATORS: Thaddeus A. Reamy, M.D., Cincinnati. Nicholas Senn, M.D., Chicago. Joseph Price, M, D., Philadelphia. William Oliver Moore, M.D.. New York. Thomas B. Eastman, M.D., Indianapolis, Ind. S. H. Pinkerton, M.D., Salt Lake City Subscriptions, $1.00 per year in advance; Single Copies. 10 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 CARDIOVASCULAR WEAKNESS OF FEVERS. Stengel concludes that the pathology of this condition is connected largely with vasomotor depression, as the older writers held, and less with mechanical factors in the heart and vessels. In the management of heart weakness during infectious diseases, he employs strychnine with alcohol (not to exceed six or eight ounces of good whiskey or brandy in 24 hours). When the circulation requires additional support, particularly when nervous symptoms are prominent, he has found camphorated oil (one grain of camphor in fifteen minims of sterile olive oil) by hypodermic injection most valuable. He frequently gives a grain or two of camphor in this way every second or third hour for several days in succession. He has come to use adrenalin solution in these cases (30 minims in a half pint or pint of normal salt solution subcutaneously or intravenously) only when an acute emergency, such as collapse from hemorrhage or perforation in typhoid fever, has been the indication for prompt support. Digitalis and strophanthus are far less satisfactory in the relief of the cardiac weakness of fever than in the treatment of valvular disease. The cold bath and its substitutes act chiefly as therapeutic agents in reducing the tendency to excessive weakness and in mitigating the nervous symptoms of fever. Generally speaking, the principal indications for cardiac stimulation in infectious diseases are alterations in the apex beat (more diffuse and wavy) the change in the character of the first heart sound (more valvular; sometimes blowing at base) and the depression of the systolic pressure at the wrist. Time and care alone can effect a complete restitution of the heart muscle and other tissues. For this reason, it is best, whenever possible, to forbid an individual just recovering from an infectious disease from resuming his occupation for a considerable period of time. When, despite our efforts, myocardial weakness is developing during convalescence, thermal baths, massage, and the use of arsenic, strychnine and phosphorus are advantageous. AIR. The atmosphere is a boundless source of life and a medium of death. Fresh air and plenty of it is absolutely essential to the maintenance of health. Historic examples of the effects of insufficient air are the "Black Hole" of Calcutta, in which 123 out of 146 British prisoners perished in a single night; and the 300 captured Germans, who after the battle of Austerlitz were crowded into a small prison with the result that 140 of them died that day and night. It is said that 61 societies in the boroughs of Bronx and Manhattan are interested in fresh air and summer outings for the poor. Vitiation of the air is noticed by the sense of smell when the carbon dioxid from respiration reaches .6 pro mille, and this limit should never be exceeded. To meet such sanitary requirements an adult individual at rest should be supplied with 3000 cubic feet of fresh air per hour. The air in a living room can hardly be changed throughout with comfort more than three times in an hour; hence each adult person ought to have at least 1000 cubic feet of room space. Account must also be taken of the products of combustion, a 16-candle power kerosene light giving off five times, and the same intensity of burning gas three times, as much carbon dioxid in an hour as is exhaled in the same time by a man. The most dangerous vitiation of the respired air, except specific germs, is from the decomposition of organic matter, namely: ammonia, amins, sulphur compounds, ptomains and leucomains. Chronic poisoning by these and by excess of carbon dioxid, through deficient ventilation, is marked by morning drowsiness and headache, nausea, malnutrition, anemia and debility. Subjects of this common form of poisoning are particularly suscepti. ble to infection. The long continued inhalation of drain and sewer air produces gradual loss of health, anemia, fever, lassitude, headache, sore throat, vomiting and diarrhea. Acute mephitic poisoning from open, foul drains and cesspools is marked by sudden, severe vomiting and purging, headache, prostration and sometimes partial asphyxia. Up till 1846 the mortality of the British army, crowded in ill-ventilated barracks, was 11.9 per thousand. As more space was allowed to each man, this mortality fell to 2.3 per thousand in 1870, and still lower since that time. The relative death rate from consumption in prison is said to have been formerly about four times that among the free population. The regular practice of deep and full respiration in the erect posture is a highly important factor in the prevention of pulmonary disease. The chest may be further strengthened by daily ablutions with cold salt water or the shower bath, always taking care on drying to rub with the towel until reaction takes place. SUNSHINE. Photographic comparisons prove that the light on a bright day is 18,000 times stronger at the seashore, and 5,000 times as strong on the sunny side of a street as in the ordinary shaded and curtained rooms of a city home. Sunlight is as essential to human beings as it is to plants. Both grow pale and weakly for want of it The chlorophyl of grass and leaves and the hemoglobin of the blood are increased by exposure to the sun's rays. Sunlight is actively germicidal. According to Rosenau, objects infected with the bacillus pestis may be sufficiently disinfected on the surface by exposing them all day to a bright sun, providing the temperature is above 30°. Tubercle bacilli are destroyed by direct sunshine in three or four hours. The virus of smallpox is quite resistant to the solar rays. |