The explanation suggested in Gerhardt's first men- not suffer with feruncles, but one of his assistants had tioned patient was that there was a stenosis probably from atheroms at the origin of both the left carotid and left subclavian arteries, since the pulse in the left car otid was likewise less frequent and smaller than on the right side. The patient left the hospital. A similar symptom is recorded by O. Huebner in a woman aged 42; the right pulse was sometimes smaller and less fre quent than the left pulse, at the necropsy a thrombus was found nearly closing the channel of the right sub clavian artery. SURGERY. to struggle with operative boils continually, and in this task the gloves were found of great value. Finally, the usefulness of the boiled gloves was illustrated most strikingly when wounded persons requiring immediate aid were brought in, and five minutes spent in disinfecting the hands meant a serious loss of time. The first plugging of a wound involving the internal mammary artery, he remarks, may be done with the gloves on, and thus time be gained for careful disinfection. The same is true in regard to various severe abdominal wounds. At present he uses the gloves in operations on septic subjects; in operations on clean wounds the treatment of which does not admit of postponement, provided he has had to deal with anything septic; in case he has any wound, furuncle, or the like, on his hand; and in sudden emergencies. By operations that can not be postponed he does not understand merely kelotomy, tracheotomy, etc., short operations that in themselves con not be defered; there are often extraneous circumstances that demand the performance of an operation at a certain time, just the time when the surgeon has on his hands, for example, a lesion that does not admit of its disinfec tion. The "Boiled Hand" in Surgery.-Dr. W. Zoege von Manteuffel, of Dorpat (Cent. f. Chir.; N. Y. Med. Jour.) argues in favor of the use of the rubber gloves in surgical work. The disinfection of the sur geon's hands, he says is still an unsolved problem, in spite of all the practical results of the surgery of the present day which would seem to show the contrary. We are not yet in a position to disinfect our hands to such an extent that the disinfection will bear close critcal tests under all circumstances. This we may learn In all such cases as he has mentioned it is, in the aufrom Kummell's, Furbringer's Sanger's and Reineck's thor's opinion, not always-he would rather say neverexperiments, from von Bergmann's demonstrations at possible to disinfect the hands adequately One may the last International Congress but one, and from the console himself, in the case of a person brought in with recent investigations of Lauenstein and others. We an injury just received, that of two evils he is choosing may secure a relative, but not an absolute, freedom from germs, and we must always take into account the varia. ble degree to which the vital properties of the tissues of the person operated on are called upon to correct the faulty disinfection of our hands; however slight the faultiness may be. In general, therefore, we accomplish the desired result, but we do not secure absolute freedom of the hands from germs when we have touched infectious materials or dipped the hands in fecal matter or pus. the lesser, that above all else the immediate danger must be met; but after the operation, done with an infected or diseased hand, one will have the memory on his con. science either of something no worse than a suppurating fistula or of general septic infection. Of course, says Dr. von Manteuffel, it is somewhat awkward to operate with gloves on. In septic cases this is not of very great consequence, for in them there are generally no technical difficulties It is different, however, when we cover the infected or wounded hand, insusceptible of disinfection, with the rubber glove and undertake an aseptic operation. If the glove fits close, the hand becomes anemic and is soon fatigued. The gloves in the market have another defect; there is no expansion for the ball of the thumb, so that it is difficult to abduct that digit. Moreover, if the fingers are too long, they impede the nimble handling of instruments, especially those having the form of scissors. But even with well fitting gloves, to some extent furnished to measure, the operation will probably be somewhat prolonged. But what is this, asks the author, compared to the absolute reliability of the "boiled hand"? Finally, so far as rapidity is concerned, even major operations, he says, may be done without noteworthy loss of time. Besides septic operations, he has used the gloves in a radical operation for inguinal hernia in the female, and in a resection of the elbow joint by means of a radical The author says that he soon came to recognize an incision. Perhaps, he says, these operations lasted from additional advantage of the gloves. He himself does five to ten minutes longer than usual, but he is not yet In consequence of the very varigated material that he has had to deal with in the Dorpat City Hospital, and the necessity of operating promiscuously upon uninfect ed and septic patients, of opening abscesses and then dressing wounds, Dr. von Manteuffel has come to the practice of protecting his hands against infection by the use of boiled rubber gloves. One can get along wel! enough without this device, he says, if he has a great number of trained assistants, but even after repeated washings—nay, on the following day, too, in the case of an operation on a very septic person-he can not rid himself of the uncomfortable feeling that his hands are not quite right, although at present he can soon do away with the unpleasant odor which formerly, when the use of alcohol as a disinfectant was not yet under. stood, clung to the hands for an extraordinary length of time. thoroughly accustomed to the gloves and has none that then killed the micro-organism developed rapidly, with fit well. abundant formation of gas in all organs. Of course, he adds, he considers it incumbent on him to disinfect his hands first, so as the circumstances of the case may permit of it, so that in the event of the gloves being ricked, at least no wholly disinfected skin shall be exposed; this, indeed, is required for the mere drawing on of the gloves, although a sterilized glove may be used for that purpose. He has the sleeve of his operating gown close about the wrist, or at least reaching down as far as that, and the arm disinfected to the elbow. Thus far, he has used gloves somewhat longer than those employed by chemists, reaching up so as to inclose the wristband. OBSTETRICS AND GYNECOLOGY. Dr. Dobbin argues that in this case the bacilli were introduced by the nurse; that they found in the dead fetus, as in the dead rabbit, a suitable nidus, and filled the uterine cavity with putrid gas; and that the mother died not from infection by the bacilli, but poisoned by the toxins produced by them, her own macerated vaginal tissues, moreover, acting as a seat of germ development. The Rapid Death After Labor from Infectious Meningitis from the Pneumococcus.-Crouzat (Rev. Obstet. Internat.) communicates a case of death occurring soon after labor from an unusual cause. Recently he had used the rubber glove, or at least a patient, says the British Medical Journal, had presented rubber finger stall, in examinations per annum, provided no abnormal symptoms in pregnancy; her confinement no fine details had to be made out, and it is astonishing, (the twelfth) and the first day of the puerperium were he says, how little it interfears with palpation if it fits also physiological. Without any premonitory symptoms snug. On the whole, he recommends boiled rubber she passed suddenly into a state of coma, and in less gloves as a very useful article for the operating room. than twenty-four hours she was dead. The urine examMoreover, he says, they must be particularly useful in amined at the time of labor was free from albumen. country practice, carried about in a glass receptacle, for The following was the history: Two days after her disinfection of the hands in a farmhouse is almost al confinement she complained of pain in the head, and ways defective. after a few slight convulsive movements became comatose. The urine now contained a small quantity of albumen, but this soon afterwards disappeared again. The head was turned backwards, she kept grinding her teeth and biting her tongue, and the limbs showed some degree of contracture. The lower extremities showed "Gas Bacilli" and Putrescence in Utero. diminished sensibility on the left side, but hyperesthe-Dr. G. W. Dobbin reports, in the Johns Hopkins sia on the right. A purgative was ordered; inhalations Hospital Bulletin, a case of puerperal sepsis due mainly of oxygen, ice to the head, and injections of caffeine to the bacillus aerogenes capsulatus. The patient, a and ether were given. The diagnosis rested between multipara with a generally contracted pelvis, had been meningeal hemorrhage and slowly progressing tubercuin labor two days with a child of large size, and was lous meningitis. There was marked inequality of the under the care of a midwife. On approaching the bed pupils, and the tache meningitique of Trousseau was a sweetish, offensive odor was perceptible, and the ma- very apparent. Death followed in a few hours; and at ternal genitals emitted a bubbling, crackling sound, the necropsy the kidneys were found to be normal, but whilst the vaginal discharge contained may gas bubbles. the meningeal vessels were greatly congested, and alDelivery was accomplished with the Tarnier basiotribe, though there were no hemorrhages, all the cerebral vesunder chloroform. Immediately after it there was an sels beneath the pia mater and at the base of the brain explosive escape of sickening fetid gas from the uterine were marked out by tracks of pus. There was no trace cavity. There was as yet no tissue emphysema. Next of tubercle. There were old adhesions between the left morning "gas bacilli" were found in the tissues of the lung and the pleura. The pus contained the pneumofetus and in the placenta, and the same evening the coccus of Talamon-Fraenkel and no other micro-organmother died. A few hours later the body was enorm- ism. The subcutaneous inoculation of a rabbit with ously swollen and emphysematous. The fetus and the pus caused death by septicemia in forty-eight hours. placenta were likewise infiltrated with gas, which burnt The author can give no explanation of the source of the with a flame when ignited, and were infested every pneumococcus. where by the "gas bacilli" along with staphylococci and streptococci. The placental blood vessels contained gas cysts surrounded by a zone of these bacilli, cultures of which were made. A pigeon and rabbit were inoculated and rapidly developed an edematous emphysema. These observations are in accord with those of Welch and Nuttal, who attributed many cases of supposed entrance of air into the uterine sinuses to this parasite. They also found that this bacillus when inoculated into rabbits was not usually fatal, but that if the animal was Appendicitis Complicating Pregnancy. It is not long since Munde first recorded a case of ap pendecitis complicating pregnancy, and now R. Abrahams (Am. Jour. Obst.) is able to review 15 examples of the occurrence, including 4 under his own observation. He points out the extra danger met with in such cases when the uterus forms one of the walls of the abscess cavity, and regards the habitual constipation of pregnancy as a predisposing etiological factor. The conditions which require to be differentiated from ap pendicitis in pregnancy are chiefly right-sided gestation, salpingitis or oophoritis, and typhoid fever. In 10 sup purative cases, all of which but one was operated upon, there was a maternal mortality of 7, 70 per cent; on the other hand, all the instances of catarrhal appendicitis recovered, so that the total mortality was a little over 46 per cent. The infantile mortality was over 85 per The treatment in early operation-laparotomy— in acute perforative appendicitis, a pulse of 116 to 120 being an indication. The same rule nolds for recurrent old appendicitis in pregnancy, even should the attack be mild. cent. BOOK REVIEWS Books reviewed in this column may be obtained, post-paid, by addressing the publisher of this journal, and remitting the quoted price. New Volume of Hare's System of Practical Therapeutics. A SYSTEM OF PRACTICAL THERA PEUTICS. By Eminent Authors. Edited by HOBART AMORY HARE, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Volume IV. Octavo, 1065 pages, with illustrations. Regular price, Cloth, $6; Leather, $7; Half Russia, $8. Price of Vol. IV. to subscribers to the System, Cloth, $5; Leather, $6; Half Russia, $7. Price of the System complete in four volumes of about 4500 pages, with about 550 engravings, Cloth, $20; Leather $24; Half Russia, $28. Philadelphia and New York: Lea Brothers & Co. 1897. This volume supplements most admirably the previ ous three volumes in containing information regarding the real improvements in the practice of medicine during the last five years. A characteristic and much ap preciated feature of Dr. Hare's work is its rigid adher. ence to the plan of presenting only actual treatment with such explanatory information as will ensure its adaptation to the various stages and complications of disease. The names of the twenty-eight contributors alone furnish a guarantee of the excellence of the work, whose editor has most successfully accomplished his object in bringing to each reader the personal methods of its various contributors rather than discuss every plan of treatment which has been introduced. A large number of illustrative prescriptions are included in the text. The work is one of rare excellence and will be greatly appreciated by practitioners, teachers and stu. dents. The print is large and clear and the entire mechanical work in the make-up of the volume is in harmony with its great literary merits. The Diseases of the Stomach. By DR. C. A. EWALD, Extraordinary Professor of Medicine at the University of Berlin, etc. Translated and edited, with numerous additions, from the Third German Edition by MORRIS MANGES, A.M., M.D., Assistant Visiting Physician to Mount Sinai Hospital, Lecturer on General Medicine at the New York Polyclinic, etc. Second Revised Edition. New York: D. Apple ton & Company. 1897. Since the appearance of the first edition of this work in 1892 much progress has been made in the knowledge of the diseases of the stomach. The work before us is based upon the last (third) German edition which, pub. lished in 1893, was a complete revision of the earlier work. The great popularity of the work is evidenced by the fact that within a short period three editions have appeared and translations published in England, France, Italy, Spain and the United States. In the American editions the author's text has been followed by the translator with few exceptions. The current opinions have been appended, attention being at the same time called to the change. Much new matter has been incorporated into the text and new illustrations have been added. The work, based upon lectures which were delivered before practitioners and which were subsequently en larged, is intended for general practitioners and stu dents; every part has been considered from this stand. point and represents an extensive practical experience. The work is comprehensive, practical and thorough and will be found of invaluable service by every practitioner, teacher and student. For the outward appearance of the work, the paper and binding and the large and clear type, the publish ers deserve much credit. NOTES: AND ITEMS North Missouri Medical Association.—The North Missouri Medical Association held its annual session at Moberly, Mo., June 17 and 18. City Hospital Medical Society. - The City Hospital Medical Society of this city, whose meetings are of the most profitable of all local medical societies, adjourned June 18. Society of German Physicians. — At the last meeting of the Society of German Physicians Dr. Gerling read a paper on "Myasthenia of the Stomach.” The Society has adjourned for the summer. Death of Dr. Yost.-Dr. E. Brank Yost died at his home in Grantfork, Ill., last week. He came to St. Louis from Greenville, Ky., 1887, and soon achieved success in his profession. He was a nephew of the late Rev. Dr. Brank, of the Central Presbyterian Church. The Doctor's health failed him several years since, caus ing him to remove to the illinois town wherein he died. His remains will be interred in the family cemetery at Greenville, Ky. Death of William Thompson Lusk.-Dr. William T. Lusk, of New York, died June 12, at the age of 59 years, from cerebral hemorrhage. Death of Dr. J. Lewis Smith.-Dr. J. Lewis Smith, of New York, died June 9. He had reached the age of nearly 70 years. A Castration Bill has been introduced into the Michigan Legislature providing for the castration of all inmates of the Michigan Home for the Feeble Minded and Epileptic before their discharge; also for that of all persons convicted of a felony for the third time, and of those convicted of rape. Bacteriuria as a Cause of Diurnal Enu resis.-L. Nicolaysen (Norsk. Mag. f. Laegevidensk; Brit. Med. Jour.) reports 8 cases of diurnal incontinence of urine in children varying from 5 to 13 years of age. In 4 of these there was bacteriuria, the urine carefully removed giving rise to cultures of the bacillus coli; but whether the bacteriuria was due to an affection of the bladder, or was the expression of a slight irritation of the pelvis of the kidney from a concretion, was not clearly to be ascertained. The treatment recommended is the washing out of the bladder with a solution of nitrate of silver and the internal administration of salol or other antiseptic; but the bacteriuria may be very per sistent. The Curette in Uterine Fibroids. - Olerin (Monats. f. Geburtsh. u. Gynaek.; Br. Med. Jour.) speaks in favor of scraping the uterine cavity in cases of myoma. In two instances where this was done thor oughly not only did the hemorrhage cease, but the growth diminished in size. Pregnancy Lasting Eleven Months.-Wig odsky (Medicinsk. Obosrenie; Brit. Med. Jour.) observed protracted gestation in a 3-para, aged 28. The last pe. riod was on September 7, the fetal movements were first felt at the end of January, and labor occurred on August 13. Pregnancy otherwise ran a natural course. Delivery was delayed by the great breadth of the shoul ders, and the forceps was applied. The fetus was a liv. ing anencephalus. The Hodgen Medical Association, compris ing the Counties of Bates, Cass and Vernon, will meet in regular session in Harrisonville, Mo., Thursday, July 1, 1897. Many scientific papers will be read and dis cussed, among which are the following: "Cholera In fantum," by Dr. Overholser, of Harrisonville; "Dysentery," by Dr. Truax, of Rich Hill; "Surgical Dressing," by Dr. Allen, of Rich Hill. Papers by Dr. Gilmore, of Adrian, Dr. Priest, of Nevada, Dr. Renick, of Garden City, whose subjects are unannounced. An interesting clinic is promised for this meeting and it is hoped that a large number of the members will be present. All clinics will be held in the forenoon. Volunteer papers solicited from other members. It is expected that all members will be present, as important matters will be presented. T. C. BOULWARE, M.D., O. F. RENICK, M.D., Secretary. President. The Anemia of Malignant Disease. -Mori (Atti dell' Acad. Med. Chir. di Perugia) gives the result. of his experiments on this subject. Having prepared a sterile extract of cancer-taken from a case of rectal epithelioma and from one of mammary cancer-he injected 2 to 4 c.cm. daily into rabbits. At first the rab. bit (a young one) increased in weight, but afterwards steadily lost. The red corpuscles, except in the later stages, were unchanged. The leucocytes augmented in number immediately after injection (from 1 in 400 to 1 in 100). The hemoglobin co-efficient rank from 70 to 50. After two months the animal was killed, and except for enlarged glands about the site of injection, the organs were healthy. Other rabbits similarly treated exhibited similar effects. In another set of experiments the author tried the effect of intermittent injections, with the result that the animal (if young) recovered when the injections were interrupted. This was tried over a period of two years in some cases, and always with the result that stoppage of the injections was followed by return to the normal condition. The author does not discuss the nature of the toxic principles contained in his extract, but considers that the anemia of malignant disease is probably closely associated if not due to some toxic product of the neoplasm.-British Med. Journal. The Dietary Properties of Fish. -Sir Henry Thompson brought out in a recent article the nourishing qualities of fish (Dietetic and Hygienic Gazette). He holds, and very reasonably too, that the sedentary man, whatever his calling in life, whose engagements permit him only to take just that moderate amount of muscular exercise which is in all circumstances essential to health; for a great proportion of women whose habits mostly are not, and often can not be, active, the nutritive elements afforded by fish admirably apply an important part of the wants of the body. The moderate amount of flesh forming material present in fish, and in a form which entails little labor on the digestive organs (for most persons certainly eat less than meat), and the facility with which fish may be associated with other elements (some fatty matters, with cereals and vegeta. bles, as well as fruits) place it in the first rank of foods in that mixed dietary which is suitable to those who lead more or less the kind of life referred to. He does not say that it should supersede the use of meat altogether, although it may do so sometimes without advan tage-a point only to be determined in each individual the demand paramount. We feel that this demand has instance after some observation and experiment. For been satisfied by the introduction of Elixir Maltopepin all cases it is to be remembered that no man who has sine (Tilden). Everywhere leading medical men of the habitually eaten meat two or three times daily can at day who are desirous of using the most efficient theraonce exchange it for fish and cereals and vegetables peutic agent obtainable, are prescribing Elixir Maltowithout some discomfort, to say the least. All radical pepsine (Tilden) in all ailments arising from faulty dichanges in diet, even in the right direction, require to gestion. This is far in advance of all other preparabe gradually made; the stomach conforms slowly, when tions in the treatment of cholera infantum, and all long accustomed to deal with highly nitrogenized ani forms of summer complaints with children. It is very mal food, to the task of deriving from unaccustomed palatable, and acts in all conditions of the stomach. materials the support necessary to the body. Given time for such modification of function, and it is remark. able-at least it appears so to those who have not prac tically studied the subject—that a diet which, if adopted suddenly, might be equivalent to semi-starvation, may by degrees become the most healthful and nutritious which the individual can adopt. PUBLISHER'S DEPARTMENT. It Has No Rival.-At the meeting of American Medical Association, held at Washington, D. C., Dr. J. H. McIntyre reported "Ten Selected Cases of Laparotomy, with Remarks." from this paper, published in the Journal of the American Medical Association, we quote as follows: "I use but little opium or morphia, for the reason that these drugs, by locking up the secretions, limit the power of elimination, and therefore favor sep. ticemia. For over a year past, in cases of laparotomy, where pain and rise of temperature were present, I have used antikamnia in 10 grain doses, with the happiest effects." A further objection to opium and its derivitives is referred to in an article by Dr. Herman D. Marcus, resident physician, Philadelphia Hospital (Brockley), pub. lished in Gaillard's Medical Journal, from which we quote: "There is probably no group of diseases in which pain is such a prominent and persistent symptom as uterine or ovarian disorders, and in no class of cases have I been more convinced of the value of anti kamnia than in the treatment of such affections. An obstacle in the use of morphia is the reluctance with which some patients take this drug, fearing subsequent habit. Antikamnia causes no habit, and I have never found a patient refuse to take it." Digestion and Digestive Ferments.-To the casual observer and thinker it may seem that the subject of digestion and digestive ferments, both nat ural and artificial, has been thoroughly exhausted, and that with our present knowledge and perfection in both and that the best possible results are now being ob tained. Yet, if the question was put to-day: "What is the great decideratum"? doubtles the reply: "A better and more general corrective and digestive," would be A. L. Scott, M.D., Ph.G., of Birmingham, Ala., writes as follows to the Resinol Chemical Company, of Baltimore, Md.: "I wish to say a few words of highly deserved praise in reference to your wonderful preparation-Unguentum Resinol. I have had the most flattering success with it in my practice in the treatment of pruritus ani, itching piles, and also in allaying the intense itching and burning of eczema. I have found it superior to any preparation of its kind that I have ever used, and I think it stands without a peer as an an tipuritic and sedative. I could relate many interesting cases in which I have used the remedy. I trust that all my professional brethren will use this valuable preparation whenever it is indicated." All the Way From the Missouri River to Buffalo. the Wabash Railroad Operates Trains Over Its Own Tracks.-Having leased the tracks of the Grand Trunk Railway between Detroit and Suspension Bridge, and those of the Erie R. R. from Suspension Bridge to Buffalo, the WABASH R. R. will run its own trains from Kansas City, Omaha, Des Moines, St. Louis, Quincy, Hannibal, Keokuk and Chicago to Buffalo, being the only road from Missouri and Mississippi points having its own line and trains running into Buffalo. Through cars from Kansas City. St. Louis and Chicago to Buffalo without change. A New Lake and New Trout.-Rear Admiral Beardslee of the Pacific Coast Squadron U. S. N., about a year ago brought to the attention of tourists and anglers a beautiful lake in Northwestern Washington, that contains new varieties of monstrous trout. President Jordan of Stanford University, California, an authority on fishes, pronounced them entirely new to science. They are very large, weighing from 10 to 13 pounds and ranging from 10 to 30 inches in length. They are caught by trolling, at a distance of 30 feet or more below the lake's surface, and are the gamiest sort of trout, full of fight. Already anglers have gone from the far East to Lake Crescent to enjoy the rare sport found there. A long chapter on this beautiful lake and its finny inhabitauts, located in the heart of the Olympic Mountains, is found in the Northern Pacific New Tourist Book, Wonderland '97. Send 6 cents for it to Chas. S. Fee, General Passenger Agent, St. Paul, Minn. |