Memphis Medical Monthly

[FORMERLY MISSISSIPPI VALLEY MEDICAL MONTHLY.]

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F. L. SIM, M.D., EDITOR,
Memphis, Tennessee.

THE TREATMENT OF ENDOMETRITIS.-At recent meetings of New York and Philadelphia Medical Societies, papers were read on the treatment of chronic endometritis. One author advocated treatment by drainage with gauze-packing even in the presence of salpingitis or other forms of perimetritis, and the other writer made use of intrauterine injections. These papers are interesting, and especially so when coupled with the fact that for some time there has been a growing tendency among some of the most prominent gynecologists to abandon altogether intrauterine treatment above the internal os. They have condemned it as inefficient, unnecessary and dangerous. Among the early ones to withdraw their allegiance from this treatment were two of our most distinguished gynecologists and teachers. From their late utterances, the one in a new edition of his work just published, and the other before the New York Academy of Medicine in December last, it is seen that they maintain the same views. Their warning of several years ago was, then, eminently timely, and prevented much harm being done. Then little was known of pelvic inflammations. All honor to Emmet and Thomas; their names are imperishable and their work will ever remain a rich heritage to the glory of American gynecology. But in the light of recent advances in diagnosis and antiseptic methods, can we not venture a little farther in the treatment of the interior of the uterus?

In the consideration of this subject, we eliminate those forms of endometritis due to various constitutional causes, VOL. XII-18

with the correction of which the discharge ceases. The question that concerns us in the therapeutic study is, whether the disease is, or is not, complicated. When serious disease of the tubes and ovaries can be clearly excluded, the treatment by dilatation, the curette and drainage with gauze, will yield good results and prevent the extension of disease to sound appendages. The treatment, too, is safe in careful hands when every precaution has been taken to have clean hands, clean instruments, clean vagina and clean cervical canal. What danger there is lies in sepsis, not traumatism. On the other hand, in the free advocacy of such treatment in the presence of diseased adnexa, it occurs to us that dangerous ground is being trodden upon. There is danger of producing a fresh attack of pelvic peritonitis and of rupture. Leaving out the bad effects that may ensue, the treatment in many cases is illogical and could not result in benefit. While it is undoubtedly true that an endometritis is in most cases the primary trouble, still it is equally true that, in time, the outlying inflammation may become the main factor in keeping up the disease of the lining of the uterus and the discharge. In old cases of periuterine inflammation, there is a thickening of all the parametric tissues and contraction of the ligaments which bring down the uterus to a different plane from that which it occupies in the normal state. With this condition there is a doubling of capillaries and veins upon themselves with a passive congestion as the result. This congestion seeks its own remedy by exosmosis in the direction of the uterine cavity. In such cases how futile seems intrauterine treatment. Again, this treatment is recommended, "whether we know the tube. to be open or not." In a pyosalpinx, with obstruction of the uterine end of the tube, we fail to see how drainage of the uterus would be of benefit, save in some cases, with a possible diminution of the surrounding infiltration, but which would not compensate for the risks of the method. The drainage of one abscess cavity in close proximity, but unconnected with another, will not lessen the amount of pus in the second cavity. Where the appendages are so permanently diseased, as in the two classes of cases mentioned, would it not be the wiser course to first remove them, and, if necessary, afterward

treat what endometritis may remain? However, we admit that local treatment may be justifiable, in the most careful hands, in those cases of pyosalpinx where the uterine end of the tube is open and the damming back is from the internal os. With the dangers before us we cannot imagine cases requiring greater care and gentleness, and this mode of treatment, under these conditions, should be left entirely to the experienced gynecologist.

In reference to intrauterine injections in the non-puerperal uterus, we would state that they are deemed unsafe, and the physician who makes frequent use of them will, in time, have his patient seized with uterine colic and shock, and possibly peritonitis. The application of the medicament by means of the cotton-wrapped applicator is safe and sufficiently efficient, and when supplemented by curetting and gauze-drainage everything has been accomplished that can be done in the way of local treatment. W. W. TAYLOR, M.D.

METHYLINE-BLUE IN MALARIAL FEVERS.-Since noticing the experience of Guttmann and Ehrlich, published in German literature early last year, the profession has been somewhat hopeful that a new and more direct remedial agent for the developmental arrest and destruction of malarial organisms in the blood had been discovered. The systematic use of the remedy in Prof. Osler's wards of the Johns Hopkins Hospital, as reported by the Bulletin, however, gives no encouragement to the hope that methyline-blue will ever supersede quinine as such an agent. Seven cases were treated, and W. S. Thayer, who reports the results, reaches the following summary :

Thus out of seven cases, in two, Cases 1 and 6, one of tertian and one of quartan fever, a definite cure seems to have been effected. In two more, Cases 3 and 4, one a chronic case without fever but with symptoms of vertigo, and one a quotidian fever, a definite cure may have been obtained. In the former, however, it is highly probable that a more thorough examination would have revealed an occasional crescent, as the disappearance of this variety of organism is not usually so rapidly effected even with quinine; and in the second the examinations of the blood, as already noted, were not so thorough but that the rapid relapse might give rise to suspicion

that organisms were still present in the blood on discharge. Of the three other cases, in two, Nos. 2 and 5, which were chronic cases with hyaline bodies and crescents in the blood, an immediate temporary benefit was noted, followed later by an increase in the organisms and a return of the fever, which, in the end, yielded rapidly to quinine. In the other, Case 7, a quotidian, the chills disappeared rapidly and the temperature remained absolutely normal for twenty-two days, but the organisms never entirely disappeared and at the end of this time the typical tertian ague appeared again.

All of these cases were of such a nature that one might have safely expected no secondary rise of temperature after the administration of quinine, and though in the two cases in which the hyaline bodies and crescents were present the organisms might not have entirely disappeared even in one or two months, we might have been relatively certain of a speedy and entire cure in Case 7. From these observations I think the following conclusions are justified :

1. Methyline-blue has a definite action against malarial fever, accomplishing its end by destroying the specific organism; but it is materially less efficacious than quinine, failing to accomplish its purpose in many cases where quinine acts satisfactorily.

2. The action appears to be rapid, the chills disappearing, or the temperature, in the remittent cases, falling to normal during the first four or five days; but later, however, if a sufficient number of organisms have resisted the drug, they appear to develop again directly under its influence, causing a return of the symptoms.

3. Methyline-blue seems to have no advantages over qui'nine which would warrant its further use.

THE Tri-State Medical Society of Alabama, Georgia and Tennessee will hold its fourth annual meeting in Chattanooga, beginning Tuesday, October 25, 1892. The meeting will last three days. That it will be a success is assured by the fact that Dr. W. E. B. Davis is President of this young and vigorous society, and he is working like a Turk for the next meeting. We do not know exactly how a Turk works, but that is the way it is generally put, so it must be the correct thing. The membership includes many from States other than those included in the title. Papers have been promised by the following: Drs. W. E. B. Davis, Rome, Ga.; I. N.