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REPORT OF A CASE OF INTESTINAL omentum was found twisted, having turned comSTASIS AND ITS SURGICAL TREATMENT. pletely over, the left margin being adherent at

the hepatic flexure and the right edge at the BY ROLLA CAMDEN, M.D.,

sigmoid. The binding adhesions were removed, PIRKERSBURG, W. VA.

the raw edges turned in and sutured to prePatient, male, aged 10 at time of operation. vent new adhesions, and the omentum restored Had been in poor health for four years.

to its normal position. The pylorus was conFamily history: Father died, aged 81, of an- tracted by an old scar, and a pyloroplasty was gina pectoris. Tad more or less gastric disturb- done for its relief. Along the ileum were found ance for years, with sick headaches in his earlier several small adhesions and a typical Lane's life. Mother living, aged 78. Sisters and kink; all were removed and the raw surfaces brothers healthy.

turned in and sutured. The cecum was bound History: At the age of 2 or 3 years had some down by adhesions, which were separated, raw abdominal illness thought to be typhoid fever surfaces sutured, and the appendix removed.

an older brother being ill with that disease), Patient left operating table in very good condibut later developments suggested the possibility tion and made an uneventful recovery. Return of an appendicitis. Had usual diseases of child to complete health was slow. At uimes gastric hood, but made good recovery from all. At age disturbance or severe constipation almost deof 9 had a well-defined attack of typhoid fever stroved his hope of attaining a permanent cure. lasting six weeks; good recovery. Always sub. He, however, persisted, using proper diet, exerject to tonsilitis, usually resulting in abscess. cise. mineral oil and laxatives, and graduallly Often had sick stomach as child after eating won back his health, and gained twenty pounds ordinary food, and was subject to headaches in weight. These gradually became less as patient grew At the end of two and a half years he was older, although stomach remained irritable and able to eat almost any food, except acids and headaches appeared after indiscriminate eating strong condiments. He could not take coffee or or drinking. Took alcoholics, usually in modera- alcoholics, but his general health had become tion, at times to extent of intoxication. In the practically normal. main he was a vigorous man, able to endure con- At the end of three and a half years he was siderable physical effort in athletics and in hunt. in good health ; and with bran added to his food, ing. From the age of 13 he had suffered “hun- and one-half ounce of mineral oil night and ger pains," and often felt exhausted when his morning, his constipation disappeared. It is stomach became empty. Food at once relieved now four years after operation, and he is well in this condition. When about 35 he had severe every way and able to eat all kinds of food. peritonsilar abscess, and a few months later a Enough time has elapsed to judge the results heart intermission which caused him to seek of his operation, and both he and I are most enmedical advice. No lesion was found; he was thusiastic regarding the benefit received from told it was due to “autointoxication.” From operation. this time on his health gradually declined. His bowels became constipated, the heart intermis Increase in Number of Women in Industry. sion increased, headaches became more frequent The tremendous increase which has occurred in the and severe, the so-called “bilious headaches' re number of women engaged in industry since the bequired morphia for their relief, hunger pains

ginning of the war is officially stated to amount to

850,000. In industrial occupations in July, 1914, there grew more constant and exhausting, pseudo

were 2,133,000 women; since then 314,000 have been anginal pains, loss of strength and weight, with reported as directly taking the place of men, the perinsomnia. He became depressed and irritable. centage of replacement being 14.7. In commercial and finally gave up his work to seek relief.

occupations in July, 1914, there were 496,000 women;

since then 264,000 women have been substituted for At this time he came under my care. Diagno.

men, a percentage of 53.3. These two groups have sis: Hyperchlorhydria with probable pyloric or evidently absorbed the largest number of women. duodenal ulcer. He was given the customary

But compared with peace-time figures the percentage diet and treatment, but without yreat improve.

of women now doing men's work rules highest in

banking and finance, in transport, and in government ment. I then took him to New York for consul establishments—a section which includes arsenals, tation, first calling on Dr. Wm. Van V. Hayes, dockyards, and national shell-filling and projectile facgastro-enterologist, who, after examination, re- tories, ferred him to Dr. A. J. Quimby for X-ray study Dr. Quimby's report as follows: Pyloric ob

The New Clinic for Women at Christiania. struction, probably due to a scar from an oli

Brandt gives a historical sketch of gynecology at

Christiania, and describes the newly finished women's ulcer in pylorus; mild degree of gastroptosis; clinic

clinic which is on the spacious parklike grounds of adhesions about the distal portion of the iliun the public hospital. Thirty-one full-page illustrations (Lane's kink), chronic appendicitis with ad are given, and a number of floor plans, including the hesions binding down the cecum, an adhesion

handsome residence built nearby, also on the grounds,

for the physician in chief. In connection therewith across the hepatic flexure of the colon and one

Brandt gives a historical outline of the development at the sigmoid. With these findings Dr. Wm. of obstetrics. Until Paré introduced podalic version Seaman Bainbridge was consulted for the proper

in 1550, obstetrics had been left entirely in the hands surgical treatment, it being fully realized and

of women. It was considered beneath the dignity of

a professional man to have anything to do with the explained that the knife only offered a cure. childbirth, and when he was summoned it was merely Dr. Bainbridge operated February 26, 1913; the to prescribe for the mother or do embryotomy. As operation required four and a half hours. His complications calling for these so often proved fatal,

the physician's visit was usually held responsible, and findings verified and amplified those of Dr.

it is easy to understand that the physician was a Quimby. Upon opening the abdomen, the persona non grata at a childbirth,

The Woman's Medical Journal

A Monthly Journal Published in the Interests of Women Physicians

Published by
THE WOMAN'S MEDICAL JOURNAL

3437 Mooney Ave., Hyde Park

Cincinnati, Ohio

PROGRAM FOR ANNUAL MEETING OF

J. W. N. A. IN NEW YORK.
The annual meeting of the Medical National
Association will be held at Hotel McAlpin, New
York City, which is headquarters of the associa-
tion, Tuesday and Wednesday, June 5th and 6th.

Tuesday morning, June 5th, at the New York Lufirmary for Women and Children there will be clinics in each different department for the visiting women physicians.

At 12 o'clock noon Tuesday, June 5th, a coun

SUBSCRIPTIONS:
Domestic-$2.00 per annum in advance.
Foreign- $2.50 per annum in advance.

REMITTANCES should be made by check, draft, registered letter money or express order.

A subscriber should notify the publishers promily of any removal, giving Old and New address, that there may be no break in the service of the Journal.

In order to discontinue a subscription, notice must be sent direct to THE JOURNAL and all arrears paid in full to date.

COPYRIGHT. - Matter appearing in THE WOMAN'S MEDICAL JOURNAL is covered by copyright. but no objection will be made to tbe reproduction in reputable medical journals of anything appearing in the columns of THE JOURNAL if proper credit be given.

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The Editors and publishers are not responsible for the views of

contributors.

NEWS.--Our readers are requested to send us items of news of & medical nature, also marked copies of local newspapers containing matters of interest to women physicians. We shall be glad to know the name of the sender in every instance.

Contributions and books to be reviewed, and all business com munications should be addressed to

MARGARET HACKEDORN ROCKHILL, Managing Editor, Cincinnati,

At 2 p. m., June 5th, an open meeting of the Medical Women's National Association will be held in the auditorium of the Hebrew Technical School for Girls, to which all visiting physicians and friends are invited.

PROGRAM
Address, Bertha Van Hoosen, M.D., President

“Coördination in Organization.”'

While the needs and interests of women physicians are inseparable from those of men, they are by no means identical; and we earnestly hope and believe that in all questions of family life, with sanitary, moral and social problems, they will raise the tone, widen the perception and alter the attitude of the profession in general, so as to make it respond more perfectly to the needs of society, and exert a high power for good in all directions. If this be realized, it will be seen that the work of women is absolutely essential and of ever increasing importance, and the ontlook for this in every respect most helpful.-Dr. William H. Welch.

“Work of Women Physicians and Surgeons

in the European War." Illustrated. Report of Recording Secretary-Treasurer,

Martha Welpton, M.D. Abstract Report of Committees limited to five

minutes (detailed report to be given at coun

cillors' meeting Tuesday afternoon). Editorial.

Election of Officers.

A large attendance is expected at this second annual meeting of the National Association, and

as the New York Medical Women are making MEDICAL WOMEN'S NATIONAL ASSOCIA

great preparations for the entertaining of their TION ACCEPTED AS UNIT BY

guests, we can assure our readers that this occaPRESIDENT WILSON.

sion will be a most profitable and delightful one.

We urge all medical women to make their plans In this time of stress and of devotion to the flag to attend this inspiring gathering of medical -when the thrill of patriotism is felt by every

women coming from all parts of the country, heart—when love of country and love of human

each with greetings and a message from other ity is raising us all above the dead level of com

medical women working in different States, under

different conditions ; each with problems to solve; mercialism, which had almost obliterated the finer each eager to serve and be served, to give of their spirit of Americanism; in these days of plain liv- experience, and benefit by that of another. ing and high thinking-of consecration and sacri- One cannot adequately measure the value of such fice—it will bring to every woman physician a

ana a gathering, the inspiration and encouragement

gained from the meeting together of those of kinglow of pride and joy to know that medical

dred aims, the joy of a fraternal spirit which such women as a whole have offered their services to an association establishes. Do not fail to come their country and have been gratefully recognized to this meeting, and if you are not a member of as patriots by President Wilson.

this great association of the women phvsicians of The Medical Women's National Association in our country, we are confident you will b

you leave. mediately upon the declaration of war offered their services as a unit to the President. Plans

BANQUET FOR VEDICAL WOJEN AT are now being formulated by the War ('ouncil

A. V. A. MEETING. for our work as professional women in this great

The Women's Medical Association of New war for truth and justice. No other class of York City is planning a banquet to be meld af professional workers will be more needed than the Hotel McAlpin, Wednesday evening, June 6, physicians and surgeons, and we can be certain 1917, for the women physicians who will be in that medical women and surgeons will play as

New York City to attend the meeting of the

American Medical Association. Tickets, three great a part as have the noble, self-sacrificing,

dollars each, may be obtained from Dr. Mathilda and devoted medical women of other countries all

K. Wallin, 66 Madison Avenue, New York City. through this awful carnage.

All women physicians are cordially invited.

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CHRONIC INTESTINAL STASIS The object of this clinical number of the WOMAN'S MEDICAL JOURNAL is: 1.—To emphasize the danger to the general

body of permitting the venous and lymph radicals of the gastro-intestinal tract to pick up substances deleterious to the general body in amounts too great for the various

eliminants to remove will promptness. 2.--To present the best known methods, both

medical and surgical, for the prevention of the accumulation of toxins in the digestive

1 canal. In order to make the case records which follow of positive value, it is important at the outset to recall some well-known facts: the digestive canal is a sewer as well as a food channel ; it is provided by nature with gateways and trap-lik: sections, which in health slow the forward moving contents of the canal sufficiently to permit of food absorption, and to provide temporary storage space for waste.

It must be remembered also that the digestive canal in much of its extent is but loosely hung in the abdominal chamber, and is, therefore, largely dependent upon the strength and tonicity of the abdominal wall for the retention of its various sections in normal relation with each other and with neighboring organs.

The ease with which rounded corners (like those at the hepatic and splenic flexures of the colon) become acute angles, and dropped loops of the intestine drag downward until they become veritable “sink holes,” would be incredible were we to forget this important fact: the intestinal canal, modeled on the plan of the quadruped, is, through the assumption of the upright posture of body in man, subjected to the downward pull of gravitation in a manner calculated to make such changes almost inevitable. when through lack of tonicity the abdominal tissues and wall fail to do their work. Recognizing this handicap nature has placed on us, we. as intelligent human beings, should not only accommodate our lives to the condition, but we should also devise medical and surgical methods to relieve the bad results induced thereby.

The influence of respiratory movements upon the contents of the abdominal cavity needs to be more generally understood than it is at present.. Fortunately the X-ray and the Fluoroscope have lighted up the region, and have made available

ble exact and most important data. Realizing its bearing upon health, the Directors of the Ameri

oni can Posture League appointed a committee, a year or more ago, to make a careful radiographic study of the subject, and report. Dr. Nathalie Mankell and Dr. Edward Koenig of Buffalo. consented to undertake the difficult task. Their findings throw such a strong light upon the sub. ject of intestinal stasis. and emphasize so force. fully the importance of developing the musculature of the abdominal wall as a prophylactic measure, that we deem it wise to present their report in epitome as an introduction to the instructive pathological records which follow.

Nearly all cases of chronic intestinal stasis fall into one of the following groups :

1.—Simple enteroptosis due to a weak abdominal wall, bad habits of posture, lowered

nerve force, prolonged constipation with perhaps the frequent use of high enemata, etc., etc.

2.-A “mid group” in which with enteroptosis there are fixed kinks and bands, a mobile cæcum, abnormalities of the omentum or a redundant sigmoid.

3.—Cases in which resection, a “Developmental Reconstruction” or other major operation, perhaps several, must be performed to bring about a

Surgeons tell us that 90 percent of the patients classified under “group 2" would never have needed an operation had a correct diagnosis been made, and proper treatment instituted, while they still belonged to the first group. This throws a great responsibility upon the general practitioner, which should be more generally felt than it is at present.

“Mid group” cases, as Dr. William Seaman Bainbridge, of New York, has so often demonstrated, are amenable to proper surgical treatment, and no patient in this day of radiology should be permitted to suffer for a lifetime from abdominal stasis due to these causes.

That the third group cases still have a chance for restoration to health is proven by the remarkable operative results recorded in some of the histories which follow.

Space will not permit a detailed analysis of the case histories given in this number; however, we think some points should be emphasized. The importance of giving much more attention than has been common in the past to strengthening the abdominal wall, not alone in children, but in adult life, can scarcely be over estimated. Most especially would we urge that after childbirth women shall remain under the observation of their attending physician until the tonicity of the over-stretched wall is restored or a mechanical support applied if eneteroptosis in any degree is found. Dr. Mosher's method of replacing and sunnorting the abdominal viscera js so simple and so successful in first oroun cases, that we do not hesitate to commend it to the nrofession. Diet and medicine usuallv aid the work, and with the organs in normal place recovery should be prompt and complete.

The charcoal test used by Dr. Stevens is cer. tainly a valuable means of ascertaining the rate of movement within the digestive canal.

The relation of the internal secretions to the gastro-intestinal process must be left sub iudicc.

as Tater we shall expect the newly formed “Internal Secretion Society" to give the profession important facts bearing upon this subject. important la

Angulation at the duodeno-jejunal junction is of great importance, especially in its relation to duodenal ulcers, as also are gall stones. The cases of Dr. Dow, Dr. Berglia, and others throw light on this important subject.

Congenita: malformations, especially of the colon, are se common that no child suffering from long continued indigestion and constipation should be passed by without careful ab. dominal investigation, by means of radiography, if possible. Reversion to the animal type, in which the colon is much more loosely fastened to the body wall than in human beings, has been found to be of much more frequent occurrence than we have supposed. Dr. Hazen's girl of nine,

with the wonderful results of his operation, is a Intestinal Stasis. Many more histories, with the classic upon this subject.

results of treatment, must be collected and comAlmost every case history in this symposium pared, and greater skill in diagnosis must be mentions changes in the skin and nervous system, acquired before we shall be able wisely to use with marked improvement as a result of the cure the "ounce of prevention and the “pound of of stasis by medical or surgical treatment or both.

cure." We regret that we were obliged to omit cases in which epilepsy and insanity were coincident with mechanical obstruction causing profound

OFFICIAL NOTICE FROM THE A. N. A. OF intestinal stasis. There is, however, much reason

(LINICAL SESSIONS, to believe that such a relation exists in a large Clinical Sessions will be held in New York City percentage of patients thus affected.

June 4th and 5th in connection with the annual Sir Arbuthnot Lane told us long ago that meeting of the American Medical Association, lumps in the outer quadrant of the breasts in You will find herewith the section of the Cliniwomen suffering from chronie intestinal stasis cal Sessions program which covers women physiare very common, and we have ourselves ofte cians. observed them, but a colored discharge from the Mathilda E. Wallin, (hairman Marie L. (hard. Secretary nipple in addition, with a prompt and complete S, Josephine Baker

Lillian K. P. Farrar cure following the incising of kinks and bands Annie S. Daniel

Ethel D. Brown

Elsie S. L'Esperance

Anna W. Williams within the abdomen is something of a revelation. With a diagnosis of cancer and removal of the

MONDAY AFTERNOON, JUNE 4th.

2:00 10 3:00. Cornell University Medical College. breast advised, the discovery of stasis certainly

Lantern slide demonstrations; gross and misaved this patient from useless mutilation, and

(roscopie hange in gynecology.-Drs. E. S.

L'Esperance, L. K. . larrar.

2:{xt to 1:00 Health Department Headquarters tion in all breast cases not malignant.

.1. Diagnostic examinations for cliphtheria, tuber.

(ulosis, malaria, typhoid (blood and urine) Whether abnormal mobility of the cacum is of

syphilis, gonorrhea. Dr. David Poor. congenital origin or is an acquired condition, we

2. Milk inspection.-Dr. H. Hatfield.

3:00 believe is an open question. When present, it is

N. Y. Medical College and Hospital for Women.

1. Children. - Dr. Grace M. Kahre. one of the more certain causes of stasis and,

2. Electro-therapeutics, -Dr. Elizabeth W. Wright. eventually, of intestinal obstruction.

2:00 to 4:00 N. Y. Polyclinic Medical School and Hospital. In one.

Demonstration X-ray work.- Dr. Gertrude W third of the cases here reported a mobile cæcum

welton. was found, and with it the usual kink of the MONDAY AND TUESDAY AFTERNOONS, JUNE 4th and 5th.

MONI ileum, and in several instances a so-called Jack

2:00 to 4:00 Baby Health Stations, Bureau of Child Hygiene,

Department of Health, son's membrane. It is not always necessary to

Dr. S. Josephine Baker. resort to radiography to demonstrate a wandering

MANHATTAN cæcum ; it can easily be moved from its place 172 East 3d Street

348 East 74th Street and outlined by auscultatory percussion, the pa

512 East 11th Street

2017 East 98th Street 306 Avenue A

209 Stanton Street tient lying on the left side.

+43 First Avenue

120 East 116th Street 2. Fast 107th Street

210Fifth Avenue We are glad so many surgeons have in their 2+1 East 10th Street

108 Cherry Street reports sounded a note of warning regarding

174 Eldridge Street

122 Mulberry Street Vanderbilt Clinic

27 Suffolk Street small incisions for appendectomy. The need for

326 last 11th Street

73 ('annon Street 114 Thompson Street

96 Clinton Street secondary operations not only weakens the con 315 East 112th Street

206 Madison Avenue 24+ Mulberry Street

231 Monroe Street fidence of the public in surgical procedures, but 10S West 47th Street

289 Tenth Avenue brings discredit upon the profession of surgery

78 Ninth Avenue

95 Forsyth Avenue itself.

BROOKLYN 208 South 20 Street

631 Manhattan Avenue The sigmoid, pelvic colon, and rectum are the

621 Fourth Avenue

185 Bedford Avenue 208 Hoyt Street

296 Bushwick Avenue most abused portions of the digestive tract, 14 Navy Street

994 Flushing Avenue 2:46 Pacific Street

17.) Nassau Street partly because they lie at the end of the line and

18 Fourth Avenue

129 Osborn Street are most easily reached. The habit of constipa

359 Manhattan Avenue

098 Henry Street 19 Carrell Street

3:24 Sutter Avenue tion is reported in nearly every case we have 76 Johnson Avenue

107 Hopkins Street 23 Suvdam Street

1992 Park i venne given, and the accumulation of hard material in 323 Osborn Street

239 Graham Avenue the trap-like bends of this part of the canal is

1:27 Dupont Street

19 Amtoy Street

TIIE BRONX quite sufficient to elongate its more dependent

311 East 119th St. 13.34 Webster Ave. 2380 Huglies dve. portions. Dr. Rose's patient with redundant sig.

QUEEN'S moid tells a story which we often hear in our 114 Fulton Ave. Astoria

2 Misbeth Ave., Maspeth offices, and without operation these cases are

72: Onderdonk Jre.Ridgewood

RICHMOND among the most hopeless we meet with.

689 Bay Street. Stapleton, Staten Island Chronic arthritis has so lorig evaded the search

Stations and clinics will be open for visitors on June 11. at hours indicated. Doctors and nurses will be on hand (luiring liours stateal to explain working of the statious and clinics There are no restrictions upon the number that may attend,

and no (ards of admission needled. heroic operative work. If it were possible to ac complish so much at the late stage which the

DENTAL (LINICS disease had reached in this patient, with what

Monday and Tuesday Mornings. June 4th and 5th. hope may we not undertake the cure of earlier

9:00 to 12:30 The Bronx. Public School No. 27. 18th Street

and St. Ann's Avenue. cases by means of abdominal surgery?

9:00 to 12:30 Brooklyn -

Public School No. S. Hicks and Poplar St, Dr. Camden's case, the last of our series, show's

Public School No. 126, Meserole and Lorimer

Streets. what can be done by a skilled operator even in

l'ublic School No. 108, Thronp Ave. and Bart

lett Streets. extreme cases of intestinal obstruction.

Public School No. 175. Blake and ilopkinson

Avenues. The last word has not been said on Chronic

re

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