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relief nearer home. I found the nasal mucous membrane suffused and reddened, and at several points decided hypertrophies. After explaining my treatment, at his request I proceeded to operate.
I cocainized the membrane, removed the hypertrophies, sought out and seared through each offending nerve filament. This accomplished I prescribed a wash and gave him the ointment mentioned above to be used as occasion required.
Instructed him to return to me in one week. He did not however return until the end of the second week. I found the burned points healed and patient entirely free from any symptoms of his malady, and he reported entire relief from date of operation. I followed him through the second season and there was no return of the trouble. This is the third year, but as he has removed to some point in Alabama I have heard nothing further from him up to date.
The other cases presented about the same conditions, and the result of treatment was equally as successful. This year I have treated two cases. One, a very mild case, was relieved by removal of several hypertrophies. The other, a very violent case, in the person of Mr. C. C. T., planter in the Arkansas bottom, aged 35 years, reported to me in the early part of July ; did not look for his attack until Aug. 10th to 15th, but was suffering intensely with a reflected frontal neuralgia which had resisted all the medicine he had taken. I found decided hypertrophies in both sides of the nose--so large as to produce pressure against the septum, and almost occlude the nasal openings. I surmised that the neuralgia was dependent upon this state of affairs, and with the galvano cautery removed the hypertrophies, with entire relief of the neuralgia. As I intended leaving the city in July, I did not attempt to remove the sensitive nerves for relief of his hay fever, but requested him to return in August, about the time his hay fever had set in. Failing to return to the city until late in September, I found him in the midst of an exacerbation, suffering intensely with all the symptoms of the affection. The nose was in such a seusitive state that I advised the postponement of an operation, hoping by palliative means to give him partial relief and place the nose in a better condition for any surgical interfer
ence. Shortly after, the patient continuing to suffer, I anesthetized the Schneiderian membrane and seared through the nerves, which relieved him entirely, with the exception of a catarrhal conjunctivitis which had set in during the course of his attack. This soon succumbed to an application of argenti nitratis grs. v. to aqua zi., painted over the under sides of the lids. The usual after treatment was prescribed, and patient discharged until next summer, when I hope to note the effect of treatment.
I have usually done this work with the galvano cautery, but in its absence it can be done with an acid: nitric or chromic. They are quite effectual but more painful, and the wounds do not heal so readily as where the cautery is used.
As this malady is so common, the general practitioner is often called upon to treat it, or rather to suggest some palliative remedy. By supplying yourselves with a battery of moderate cost, and a little practice, you can treat these cases quite effectively, and save your patients a great deal of suffering and a large amount of money expended in making trips to the mountains.
These few points, thrown together at odd moments, will I hope have proved of sufficient interest to induce you to give the sufferers who call upon you for relief the benefit of the treatment indicated
I am sure you will have no cause to regret it. I hope to hear from some of you in the future and to know the results you obtain.
CLINICAL SOCIETY OF MARYLAND.
WM. T. WATSON, M.D., SECRETARY.
BALTIMORE, December 4, 1891.- The 258th regular meeting was called to order by the President, Dr. Robert Johnson.
Dr. Thomas Opie read a paper on Thirty-two Unselected Abdominal Sections. These cases were operated upon by Dr. Opie at the Baltimore City IIospital in the twelve months ending October 31, 1891. The conditions for which the operations were performed were as follows: Ovarian tumors 6,
chronic ovaritis 7, fibroid tumors 4, pyosalpinx 5, retroflexions with adhesions and dysmenorrhea 3, exploratory incisions 3, extrauterine pregnancy 1, cyst of broad ligament 1, cystic degeneration of ovary 1. The number of deaths was four, as follows: Oophrectomy for double pyosalpinx 1, shock from ovariotomy 1, oophorectomy for acute mania 1, abdominal hysterectomy for fibrocystic tumor 1.
Stitch abscesses occurred nine times, most frequently in cases where the drain tube had been used. Early opening of the abdominal dressings favor their occurrence. When the dressings remained intact for seven days, there seemed to be greatest immunity from the stitch abscess. Dr. Welch says that the staphylococcus epidermis albus is the most common cause of stitch abscesses in wounds treated aseptically and antiseptically. Drainage was used in but three cases. case it retarded convalescence; in another it seemingly did no good, and a small superficial abscess at the entrance of the tube followed its withdrawal ; in the third case an abscess also occurred at the site of entrance. A plentiful supply of fine properly prepared elephant-ear sponges will do away with the necessity for flushing in most cases, and remove the need for drainage. They are efficient helps in keeping the abdomen free from infection. They can be utilized in keeping back the intestines, in occupying the cul-de-sac, in positions below the pedicle, in taking up blood or secretions, in staunching hemorrhage, in separating adhesions, in protecting the intestines while closing the abdomen.
Drainage is doing more harm than good, and ought to be abandoned by the abdominal surgeon. The oft-repeated removal of dressings of the patulous drainage tube must of necessity be a very great danger; surely it favors decomposition and invites germs. After an anesthetic restlessness and jactitations are not wholly restrainable, and it is easy to see how physical injury may occur to the patient during this time from these smooth, but not at all innocent, glass tubes. When the laboratory physician says that bruised tissue is a paragon field for the cultivation of germs, let us heed the warning and cast aside the drainage tube.
Dr. Parkes says as to drainage : “ Views and practices con
cerning drainage have materially changed even since the antiseptic era began. Our predecessors drained to permit the escape of pus, which they knew would form. Until lately we have drained in order to prevent its formation. We seem now to be on the eve of an era when we need to drain but little or not at all. We resort to drainage now only of necessity in septic or infected cases. In other cases we drain mostly from habit or from fear. Indeed, when we start afresh, as it were, without previous infection, the practice of drainage is a confession of fear or of weakness, both of which are alike unscientific and unfortunate. It even seems to me that in many cases where all other aseptic requirements have been met, we do much more harm than good by the use of drains.”
Dr. W. S. Thayer spoke of The Treatment of Five Cases of Malarial Fever at the Johns Hopkins Hospital, with methylene blue.
Immediately after the appearance of the article in the Berliner Klinische Wochenschrift for September, 1891, in which Gulmannn and Ehrlich described the successful treatment of two cases of malarial fever with methylene blue, this treatment was begun with the cases of malarial fever entering the hospital. So far only five cases have been treated.
One case of tertian ague yielded immediately to methylene blue, 0.1 five times a day. No rise of temperature after beginping of treatment. No organisms in the blood after the third day.
A severe case of quotidian ague had one chill twenty-six hours after the beginning of the treatment (methylene blue 0.1 every four hours), and a lesser rise of temperature without chill on the two successive days. After this the temperature was normal. No plasmodia seen after ninth day.
In a case of chronic malaria, with pigmented crescents and small intracellular hyaline bodies in the blood, no organisms were seen after the ninth day under methylene blue 0.2 four times a day.
In two cases of severe chronic malarial remittent, the temperature fell to normal in a few days, but there were occasional returns of slight fever, and the organisms — hyaline bodies and pigmented crescents—had not entirely disappeared
in forty-one and twenty-three days respectively. (In the former case, after eleven days' treatment with quinine, a moderate number of organisms was still present.)
In all the cases the drug was given as a powder in capsules. Slight burning sensations with micturition were usually present after taking the drug, and were relieved by small quantities (1-5 of a teaspoonful) of powdered nutmeg several times a day. The urine, under treatment, was of a deep blue color. The fæces when passed were not colored, but on exposure to air turned rapidly blue. The sweat and saliva were not colored.
The number of cases yet treated is of course too small to give a sufficient basis for any definite opinion as to the relative value of this drug and quinine. The experience is sufficient to show that methylene blue has a definite curative influence on malarial fever, and to warrant its further trial.
Dr. J. E. Atkinson said that the discouragement which one nearly always finds in treating malarial diseases with other remedies than the derivatives of cinchona bark, is due to the extreme usefulness of cinchona bark itself, for it is so promptly antidotal in its effects in these disorders that we are apt to be discouraged, and not persist in the treatment by other agents. The testimony given to us by Dr. Thayer seems to show that in methylene blue we have another agent in the treatment of these disorders. The effects of the use of quite dissimilar drugs in these diseases is remarkable. Of course we all know the value of arsenic as an anti-malarial remedy, and we know that iodine possesses properties in this direction, properties inferior to quinine, but still pronounced. Some years ago, prompted by some papers published by a physician connected with the English army in India, who claimed that iodine had properties equal to cinchona bark, Drs. Atkinson and Hiram Woods made some observations on the treatment of malarial intoxication with quinine. The results of these investigations showed that while iodine has undoubted antimalarial properties, yet in a large proportion of cases it will fail absolutely. There is a wide range of remedies that possess this antimalarial property, and which would be valuable if we did not have cinchona bark to use.