Page images

furnish me

with any data which are several, and which one is rewill make the record complete for sponsible for this patient's trouble this year is urged to do so. This we are unable to say. I have seen will save the secretary a little of the this operation performed a few double burden which this second times with cocaine anæsthesia ; but, editing of the annual volume will judging from the amount of noise impose. The burden of the secre- the patient makes when so operated tary's work for the year is the upon, if I were to be operated upon editing of this volume. This sec- I should insist upon having comond editing if complete, will be plete anæsthesia. This is what we greater than the first. This will de- intend to do today. lay the volume at least ninety days' The patient has been prepared for more. Please give these requests anæsthesia in the usual manner,

and prompt attention.

as soon as she is completely under FINLEY ELLINGWOOD, M. D., the influence of the chloroform we

Secretary. bring her forward until her head

hangs over the end of the operat

ing table. This is for the purpose Clinical Department

of keeping the blood from running EDITED BY Mrs. J. M. Covert, M. D. down the throat, as these operations

are always attended with a great SPECIAL CLINIC.

deal of hemorrhage. Service of Dr. Trowbridge.

We first make an incision from This patient, aged eighteen, of before backward with a pair of cutJewish parentage, came to the office ting forceps made for the purpose ten days ago and we found that she and with another pair of forceps we was suffering with a deviated sep- make first an incision downward tum and enlarged tonsils. Think- and then upward, thus making a ing it better not to perform both crucial incision in the septum. We operations at the same time, we de- now pass this nasal forceps into the cided to remove the tonsils in the of- nostrils so that the septum shall be fice and then refer her to this clinic. between its two prongs, and by

We find on examination that the pressing the handle together we can septum deviates to the left to quite squeeze the septum straight. It is

. a degree. This has produced hy- advisable to push the septum a litpertrophicd turbinated bodies, which tle farther over than we want it, interfere a good deal with breath- for it is quite likely that it will ing, and the patient complains that spring back a little towards its old she does not breathe through her position. We now have two nasal nose while sleeping.

splints carefully sterilized, The causes of deviated septum slightly larger than the other. We


at apex.

will put the larger one in the left was such that we decided she was nostril, which pushes the septum a too weak to be operated upon. The little to the right. The smaller abdomen was distended and very splint we will place in the right tender, the recti muscles firmly connostril. This holds the septum tracted; respirations irregular, rangfirmly between the two, a little to ing all the way from twenty to sixthe right of the median line.

ty in an hour's time, due to fixation In three days these splints should of diaphragm to protect the inbe removed, cleansed and put back flamed organs within the abdomen; into the nostrils again. After that no cough; lungs clear; heart gives a they should be cleaned at least ev- soft, blowing, hemic murmur, heard ery other day. The splints should be worn about four weeks, by which November ist, abdomen flat; gentime the septum will have grown to- eral condition greatly improved ; gether again sufficiently strong to pulse 90 to 100, temperature 99 to keep the position in which it has IOI, respirations 20 to 40, lungs been held while healing.

clear, urinalysis negative; bimanual You will notice that the splints examination revealed enlarged tubes are hollow and perforated at various and ovaries. points in contact with the mucous Diagnosis.-Salpingitis, ovaritis, membrane.

adhesive pelvic peritonitis and pos

sible appendicitis. SURGICAL Clinic.

Operation.-Incision was made Service of Dr. Billig.

down the median line below the umPatient, a single woman, aged bilicus, through the rectus muscle twenty, always robust and healthy and fascia, especial care being takprevious to recent illness.

en in incising the peritoneum, the History: admitted to hospital Oc

omentum and intestines being adtober 23d. General condition very herent on account of the peritonitis. poor; pulse one hundred and twen- Since some of the signs pointed ty, weak and thready; temperature to appendicitis, the appendix vermi103, respirations irregular, facial ex

formis was sought and found adpression one of great distress; pain herent to the right tube and ovary, over right ileac region intense; and inflamed from contact. It was slight leucorrhea, reddish brown, deemed expedient to remove it. and very offensive. Microscopic The peritoneal covering examination revealed gonococci, peeled back to the corium and the staphlococci and streptococci. appendix ligated on either side of

On October 25th the pain in the the proposed section. After section right ileac region developed more the stump was cauterized with 95 markedly and the general condition per cent carbolic acid, followed by


and ovary.

alcohol. The peritoneal cuff was

lesser time. The ovaries were endrawn up over it and surrounded larged, inflamed and cystic. The with a purse string including the serous and lymphoid coats of the apserous coat of corium.

pendix were inflamed and distended, Next the left fallopian tube was more so where adherent to the tube located and found to be inflamed and swollen; also its ovary. After carefully ligating the ovarian and

MEDICAL CLINIC. uterine arteries, the tube was ex

Service af Dr. Thornton. cised as near to the fundus of the

This woman before you suffers uterus as possible. After cauteriz- with the malady with which twentying the raw surfaces with carbolic, five per cent of all the people in the stumps were drawn together England are afflicted. What is it? that no raw surfaces might be left. No, not "pneumonia" in that land The broad ligament was thus short- of smoke and damp breezes. Yes, ened and the uterus held in normal "rheumatism." Rheumatism is one position.

of our common, everyday diseases ; The right side was then explored, yet I am always fearful of the conthe right tube and ovary brought to sequences when I have rheumatism view and found to be more con- to treat. Only a little rheumatism, gested and swollen than the left. the knee perhaps, but who can foreThe same process of removal was see what the outcome may be ? I observed as before.

want to impress upon you the imThe abdominal cavity was portance of treating this as a serithoroughly sponged out and, since ous disease. Cheadle is authority the omentum is liable to form ad- for the statement that ninety-five hesions with the uterus and cause per cent of all organic heart lesions trouble, the inflamed portions of it are caused by it. were ligated and removed.

While our clinicians are examinThe peritoneum was closed by ing this patient, let me ask you the continuous suture with chromicized nature of rheumatism. Six years catgut, and the superficial opening ago in this place I gave it as my closed with deep interrupted sutures opinion that rheumatism was of of silkworm gut.

germ origin. Some, then, felt inExamination of the excised por- clined to dispute me but have since tions showed, in addition to the accepted the germ theory. For sevhigh degree of inflammation, a con- eral years now two Englishmen, siderable amount of pus in the right Poynton and Payne, have been tube and a lesser amount in the left working to isolate the germ and estube, in which the inflammatory tablish its identity. They do not process had been operating for a agree with the Italian scientist Ac

[ocr errors]

halme, that it is a bacillus but place There were rings jest where yo:1 it among the cocci, calling it the placed your stethoscope. What is diplococcus rheumaticus. With this the meaning of that? “Oedema.” germ they have been able to repro- The history sheet says, "trace of duce the various manifestations of albumen, a little sugar, hyaline rheumatism in the human body. casts"-indicative of nephritis, the

Other germs produce conditions most common form of which in which simulate rheumatism. The these cases is parenchy.natous. joints seem to be particularly fitting What shall our treatment be? places for them to make disurbance Rest, from the very start, is imperaand set up an arthritis. If you as- tive. In acute articular rheumapirate some of the fluid, you may not tism, immobilize the part. A splint find the diplococcus rheumaticus, cr plaster of paris cast would secure but the pneumoccoccus or the gon- absolute rest in arthritis, but the Ococcus.

laity ordinarily will not submit to It is now generally believed that this treatment. I tried it on a pathe germ finds entrance through the tient not very long ago, and now the tonsils. Tonsillitis may be the se- other fellow is taking care of the quel of the invasion but, as far as case! The theory is all right, but our observation goes, rheumatic at- it seems to be impracticable. tacks are preceded more

or less

Dressings,—What shall we use? closely by a tonsillitis.

Sometimes I blow hot and someWhat complications will we find times I blow cold. Scmetimes hot growing out of rheumatism? "Heart applications afford most relief; then lesions" most assuredly — and again cold is most grateful. Some greatly to be feared when seasons it is hot, other seasons it is patient is a child. Tíie heart fibres cold. As cur Prof. Whitford says are two tender and unresisting. we must use the "epidemic remedy."

Our clinicians diagnose the heart In the culture of the diplococcus lesion in this patient as mitral re- rheumaticus lactic and formic acids gurgitation. They find the apex im- are formed. This suggests alkalies, pulse too far to the left. This indi- such as potassium or sodium salts.

. cates what? “Dilatation of the left Sodium salicylate is very generally ventricle."

used. In England they give twenWhat did you hear with yolir ty-five grains every two hours to a stethoscope? What did you hear child and forty grains to an adult. with you fingers ? Train your fin- To prevent the cyanosis and other gers to get the impulse of the heart untoward results they give strychover the apex.

You will learn to nia. A very good form in which to detect more than you ca! possibly use it is the U. S. P. Elix. Salicylate get with the stethoscope.

Comp.; or you may give ten grains


of sodium salicylate in spirit of ni- nothing of so much importance as trous ether; or combine it with ten some nice form of aromatic chewgrains of sodium bicarbonate; or ing-gum, which relieves the thirst you may combine it with citrate of and dry mouth, improves the appepotassa to get stimulation of the tite and digestion, and restrains kidneys, as well as alkaline reaction nausea, if any. Hence some of the of urine.

most disagreeable accompaniments Pain in the muscles on motion of the disease are mitigated. I begives us the indication for macrotys, lieve also that it materially aids while pain in the joints indicates the absorption of the medicine when bryonia. What as to the diet of our the alimentary tract is so impaired patient? You say exclude meat. by the incessant fever. Many say give skimmed milk. I go I do not claim originality in this further and give them skimined treatment, although I have never water. In other words shut off found any reference to anything of all food—the “absolute diet” of hos- the kind. However, it may have pital regime until the system has been regarded as too simple to need rid itself of the toxins and is ready mention; still it is, in my estimation, to take care of food.

quite important in any continued

fever. CHEWING-GUM IN FEVERS. The necessity of a stimulant to THE COMPANION AS A CHRISTMAS Gift. the salivary glands is often appar- Can you think of a gift more cerent to the physician in severe fe- tain to be acceptable than a year's

subscription to The Youth's ComThe salivary glands play quite PANION ? Is there any one, young quite an important part in contin- or old, who, having once had the ued fevers, yet they are not consid- paper in his hands and looked ered in the treatment of the case. through it, did not wish to possess One of the first and most important it for his very own? It is a gift restrictions in the patient's dietary which, far from losing its freshness is to drop all solid food from the as Christmas recedes into the past, list at the physician's first request, grows more delightful, more necesand just then the salivary glandssary to one's enjoyment week by begin to lapse into torpid condition week. which very often results in an in- The boy likes it, for it reflects in flammation and, finally, suppuration, its pages every boyish taste and and that disagreeable dryness to every fine boyish aspiration. The the tongue and fauces so uncom- father likes it, not only for its fiction fortable to the patient. For the re- but for its fund of information of lief of this trouble I have found the practical sort. The girl likes


« PreviousContinue »