Report of a Case of Malignant Growth in the Pelvis of a Child Two and ELASTIC STOCKINGS. DIRECTIONS FOR MEASUREMENT. Follow the directions carefully. Goods made to order at Give the exact measurement taken loosely. We allow for expansion. c. Silk $2.00, cotton $1.50. For a Garter Stocking-Circumference at A, B, C, D, E,F-Length from For a Garter Legging-Circumference at C, D, E, F-Length from C to F. For a Knee Cap Circumference at E, F, G, H. Silk $2.00, cotton $1.50. For a Knee Stocking-Circumference at A, B, C, D, E, F, G, H-Length from sole of foot to H. Silk, 6.50, cotton $5.00. to H. For a Knee Legging-Circumference at C, D. E, F, G, H-Length from c D... For a Thigh Stocking - Circumference at A, B, C, D, E, F, G, H, I, K- C. For a Thigh Legging Circumference at C, D, E, F, G, H, I, K.-Length For a Thigh Piece-Circumference at G, H, I, K-Length from H to K. We use only an Imported Rubber of Extra Superior quality. Umbilical Belts, Abdominal Belts, Wristlets, etc., at equally reasonable Measure Cards furnished on Application. In a paper read before the forty-first annual meeting of the American Medical Association, the author cites several cases to show the lack of protection afforded gynecologists in New York, and urges the necessity of measures being adopted whereby conscientious surgeons may perform abdominal operations without the fear that through the agency or influence of some unscrupulous and disreputable lawyer the family will bring suit for malpractice if the patient lives or for malpractice and manslaughter if the patient dies. He quotes several passages from the laws of New York to show the various ways in which they may be misconstrued causing a distinguished lawyer to once remark that however well prepared he might be, yet he would not dare to practice medicine as the law now stands. He also cited a case in which the attendant was tried by one court and found guilty, but the higher court overruled it and so ended the case. The history was as follows: The surgeon was called upon to see an abdominal tumor and upon examination finds the patient is 36 years old, married 20 years and no children. The tumor has been growing 8 months. Patient has never menstruated regularly, often not flowing for 5 or 6 months. She has vomited and been constipated at intervals, has felt no quickening and does not believe herself pregnant. VAGINAL EXAMINATION.-A cervix high up, somewhat enlarged, os uteri not palutous or particularly enlarged, unable to 'make out body of uterus. [1] Upon abdominal examination, a distinct fluctuatery tumor is made out located centrally and evidently from the physical signs contains fluid within a cyst. The diagnosis of ovarian cyst is made and an operation is proceeded with. Upon opening the abdomen the tumor appears. The walls are thin and not of unusual appearance, the trocar is introduced and six quarts of fluid withdrawn after which the operator finds he has tapped a pregnant uterus. He completes the operation by caesarian section and in five days. the woman dies of septicaemia. The surgeon is indicted for manslaughter, the indictment avering that he, through gross ignorance by gross negligence, by rashness or want of proper caution, caused the death of his patient. The prosecution was based upon the fact that amenorrhoea, vomiting and the presence of a tumor was sufficient evidence of pregnancy to require a most searching examination before pregnancy could be excluded and that the defendant was negligent and unskilled in his examination. It is shown that he did not examine the breasts for the changes that occur in pregnancy and that he did not inspect the vagina for the change of color, he did not seek to elicit ballottment. The defendant showed by competent witnesses that he had exercised the average care and skill in examining the patient and had not acted with undue haste or rashness and that he was honorable in his belief of its being an ovarian cyst. Another case is given to illustrate the presence of concealed pregnancy in which a fibroid of 20 years standing was operated upon and on the operator opening the uterus a buxam fœtus. popped out much to the surprise of all present. He gives as his summary the following: I. That we should exercise the greatest care in the examination of our cases of doubtful diagnosis. 2. That when in doubt we should lay great stress upon the necessity of an exploratory incision and make a very proper explanation of what this means to the patient and friends. 3. That in cases thus far brought to trial we have reason to believe that the judges in their rulings have treated our profession with great fairness, the strong points being that the public good is not subserved by undue and wilful persecution of the surgeon who has shown the proper amount of intelligence in his profession. 4. That we should seek still further to have the law so made in our favor as to eliminate the cases of wilful prosecution. 5. That in the careful study of these cases we have presented the lamentable condition of expert testimony. Men absolutely ignorant upon the subject, men who have never done an operation of any merit in surgery, being allowed to come upon the witness stand and testify as experts. ACUTE TONSILITIS. This is the subject of an article by Dr. E. H. Bidwell, of Vineland, N. J., appearing in the Medical Record, which is somewhat in the nature of a criticism upon an article by Dr. Hudson, of Stockton, Col., advocating the use of veratrum viride in this malady. He urges against the tendency of modern times to rush and scramble after the new remedies wholly regardless of the value of some of the older ones which are ultimately forgotten. He reviews somewhat extensively the literature of modern authors upon the subject, and quotes from Morell Mackenzie his treatment by Guaiac which he considers really specific in the superficial, and also believes that it frequently aborts an attack of the parenchymatous variety. The author himself is highly in favor of the method of treatment pursued by Mackenzie, and has employed it with the most excellent results, and in fact the results have been so uniformly gratifying that he has resorted to none other. Locally he uses poultices on the outside of the throat, preferably a slice of fat pork, though flaxseed is used where patients are prejudiced against the vulgar pork, and in severe cases inhalations of steam. As a gargle he employs the following: R. Tr. guaiaci ammon . Tr. Cinchona comp. Honey strained. Sat. sol. chlorate of potash .aa jounce. jii. ounces. xvj. ounces. M. Sig. Gargle and swallow a teaspoonful every two hours, hour, or half-hour. And in young children where gargling is impossible he directs them to swallow the remedy without attempting to gargle, which proves almost as efficient. He frequently adds aconite to this mixture, but says hereafter in view of Dr. Hudson's recommendation he shall substitute veratrum viride. He does not consider much reliance to be placed in the history of rheumatism in the differential diagnosis of rheumatic tonsillitis, but thinks that these cases are characterized by an amount of pain, fever, and dysphagia disproportionate to the objective symptoms. He uses in these cases the salycilate of soda in free and frequent doses and considers in as efficient as the guaiac in the more common form which he thinks there are good reasons for believing a specific infectious disease not of rheumatic origin. THE NECESSARY PER-OXIDE OF HYDROGEN.* Stop suppuration! That is the duty that is imposed upon us when we fail to prevent suppuration. As the ferret hunts the rat, so does peroxide of hydrogen follow pus to its narrowest hiding place and the pyogenic and other micro-organisms are as dead as the rat that the ferret catches when the peroxide is through with them. Peroxide of hydrogen, H. O in the strong 15-volume solution is almost as harmless as water, and yet, according to the testimony of Gifford, it kills anthrax spores in a few minutes. For preventing suppuration, we have bichloride of mercury, hydronapthol, carbolic acid, and many other antiseptics, but for stopping it abruptly and for sterilizing a suppurating wound, we have only one antiseptic that is generally efficient, so far as I know and that is the strong peroxide of hydrogen. Therefore I have qualified it, not as "good," not as "useful," but as "necessary." In abscess of the brain, where we can not thoroughly wash the pus out of tortuous canals without injuring the tissues, the HO2, injected at a superficial point, will follow the pus, and throw it out, too, in a foaming mixture. It is best to inject a small quantity, wait until foaming ceases, and repeat injections until the last one fails to bubble. Then we know that the pus cavity is chemically clean, as far as live microbes are concerned. In appendicitis, we can open the abscess, inject peroxide of hydrogen, and so thoroughly sterilize the pus cavity that we need not fear infection of the general peritoneal cavity if we wish to separate intestinal adhesions and remove the appendix vermiformis. Many a patient, who is now dead, could have been saved if peroxide of hydrogen had been thus used when he had appendicitis. Read in the Section of Surgery and Anatomy at the Forty-first Annual Meeting of the American Medical Association, held at Nashville, Tenn., May, 1890. |