Primipara, I Ovarian Cyst Complicating Pregnancy. Editor MEDICAL WORLD:-June number just at hand, and on page 262 is an article on "Labor complicated by Ovarian Cyst," by Dr. O. N. Hoyt, with editorial comment. This caught my eye because it is of double interest to me. It is a complication seldom met, but it needs all our brains and skill when we do come face to face with it, as I did on March 3, 1903. Patient 38 years of age. had been in perfect health thru entire pregnancy, with, as she said, at times a feeling of fulness in the left inguinal region, with some pain occasionally but never severe or lasting. Some two weeks prior to confinement I had occasion to make an examination and found the left half of the vaginal tract occluded with a semi-solid cyst which appeared to be about the size of my fist, which would fall back into the pelvic cavity in the recumbent position, but fall down into the base of the pelvis on standing or sitting. I ordered antiseptic astringent suppositories used every four days, followed by free douching, and f. ex. cimicifuga three times a day, and waited results. About 8 p.m., March 3, I was called, as patient was suffering with labor pains, which seemed to increase naturally until about midnight. Upon examination I found head presenting but very high up; os dilating nicely, but the obstacle was still there, and with greater resistance than ever. By this time regular labor pains would have completed the work but for the fact that every time the head began to descend and would press the cyst down into the tract, pains would stop completely until all retracted. I tried to press the cyst aside so as to allow the head to engage in the pelvis, but every time I found it impossible. I then found that I was (so to speak) against the real thing." It being in town I telephoned for Dr. H., who was older if not more experienced than myself. He arrived at 1.30, examined and suggested that we put her on hyoscyamin and codein every hour until therapeutic effect had been reached, and see if by rest and relaxing the system it would not be possible to deliver. Pains soon stopt and patient soon dropt off to sleep, but she awoke about 6 a.m. with renewed and increast pains (altho we had given the medicin every hour up to that time). Our enemy was still there. We tried to apply forceps, but only the right blade could be placed in position, the cyst occluding 66 up the tract so completely that it was impossible to adjust the left blade. Patient by this time was fast losing strength and courage (and ours was not a great ways above normal). Dr. H. suggested version and tried (under chloroform), but could not pass his hand up high enuf to grasp the feet. After trying several times and failing, he askt me to see if I could make it (I had been giving chloroform up to this time). I prepared myself, by anointing my hand and arm up to the elbow with strong carbolized vaseline. Our idea in version was the wedge principle. I passed my hand gradually but firmly past the cyst by pressing the child's head back, thus allowing the cyst to drop back into the left pelvic cavity, and passing on up caught the feet, and with careful hard work gradually completed version. The small end of the wedge filled the vaginal tract and kept the cyst free from engaging. In half an hour we had her delivered of a twelve pound boy, but necessarily lost the child on account of the immense size of its head, but I consider we were fortunate to save the mother. Had we been where we could have secured a specialist, we should have had cesarean section performed and saved both mother and child; but our short line railway is forty miles from the main line, and only one train a day, and that had left the city, so it was too late to do anything but nerve ourselves to the task and do the best we could. This was over one year ago, and the patient is well and hearty with only an occasional tired feeling in the left side. Cyst is only about half the size that it was at confinement, and under treatment that I have her on, have great hope of complete recovery, but have warned her to not become pregnant again, as it will without doubt stimulate development of the cyst again by increast circulation to the parts. This patient was my wife, so brothers you may all imagin my anxiety when Dr. H. failed to perform version; sympathy and fear had to be conquered, as I knew it was life or death; and it must come, regardless of how much it cut me to the heart to do the work. I have related this case in the hope that, tho they are very seldom, it may be the means of helping some unfortunate obstetrician, and perhaps help to save a life. Warsaw, Mo. JOHN RUSSELL SMITH, M.D. Dr. J. A. Parrier, of Forest Lake, Minn., reports a forceps case that was under chloroform nearly twelve hours, recovering with not nausea, fever nor after-pains. To destroy the fetid odor accompanying rhinitis and ozena, insufflate twice daily a powder composed of one part citric acid and four parts sugar of milk. A Five Months Child which Lived Twentyeight Hours. Editor MEDICAL WORLD:-Here is a little item that might interest some of the brothers. My wife was about five months pregnant, when she got a very severe fall from a defectiv sidewalk on May 1st, and on the 14th the child came. It weighed one and three-quarter pounds, eleven inches in length, perfect in every way except that the eyes were not open and didn't seem to be quite developt. It was very strong; cried, kidneys and bowels moved, took water and a little milk. Wrapt it in old linen soakt in oliv oil, then wrapt in cotton with hot water bottles around it, and it lived 28 hours. Cord was full size. Placenta, which came 5 minutes after child was born and before the cord was tied, was about half the size of a normal placenta. Wife was in more pain at its birth than with our little boy, who is now 22 years of age. The sex of this child was female. No abnormal hemorrhage. There was a little hair on the head, and it did not appear to have any outer skin. It did not evince any pain, and slept most of the time. The "stuff" inclosed, together with a box containing eight of the tablets, received by my brother. A gentleman that is teaching music here also got a "lot." Big success to THE CHAS. COLLINS, M.D. WORLD. Maquoketa, Iowa. ST. LOUIS, U. S. A., May 13, 1904. MR. COLLINS :-We are pleased to enclose a sample of Antikamnia Tablets. A sample of something good is a "good thing" to keep about the house or for convenience, in your pocket. Antikamnia Tablets" will relieve all headaches, neuralgias, la grippe, insomnia and especially men's aches and worries. The enclosed booklet tells when and how many, and druggists everywhere sell them in any quantity or in our regular "Vest-PocketBoxes" as below. Sincerely yours, THE ANTIKAMNIA CHEMICAL COMPANY. C. F. TAYLOR, M.D., Dear Doctor:-This is just one more vote in your favor on the "Brief" and antikamnia fight. Go ahead! Somehow the antikamnia people got their goods on the Indian office drug estimate lists a few years ago. This list carries only standard drugs-no pharmaceuticals, "eth" or otherwise. Then it was knockt out, and "acetanilid compound" tablets (good ones) substituted, and we have them now. Well, the "howl" the antikamnia folks put up was a good one. They sent us bundles of literature about "unstable," "unreliable," and "indefinit" compounds, and incidentally handed each of us a neat little medicin case-I suppose to pay for our specifying antikamnia on the next annual estimate. Pardon the suggestion, but wouldn't a short list of names of symptoms, etc., with definition, be interesting, such as Cheyne Stokes respiration," "McBurney's point," "Hutchinson's teeth"? C. W. DRIESBACH, Agency Physician. Cheyenne River Agency, So. Dak. [Doctor, all terms such as you mention are defined in the standard medical dictionaries. For example, McBurney's point and Hutchinson's teeth are defined and illustrated by drawings, in a late medical dictionary before me. The antikamnia people want to keep everybody, even the medical profession, mystified as to the composition of antikamnia. It is a well known fact that it is an acetanilid mixture, but they want to keep that fact quiet; also the proper price that should be paid for an acetanilid mixture, based of course on the cost of acetanilid-about 30 cents per pound. Any medical journal that publishes these facts, which the medical profession should have a right to know, will get the ill will of the antikamnia people; and if the antikamnia advertisement has ever in the past been carried by said journal, the antikamnia people are verv likely, as in our case, to try to use that fact to throttle said journal forever. The other analgesics with fanciful names are also acetanilid mixtures, but the antikamnia people are the only ones who have complained to us about our publishing the facts concerning acetanilid mixtures. Hence our replies are chiefly concerning antikamnia. Incidentally it has come out that they are circularizing and sampling the laity extensivly. The profession regards acetanilid as a dangerous drug; and advice to the laity to use an acetanilid mixture freely, cannot be regarded with favor. Prepared foods, cod-liver oil and its preparations, simple laxativs like syrup of figs (which, however, is simply a preparation of senna, and used as a substitute for castor oil, which many, particularly ladies and children, dislike), and such harmless preparations may be used with safety by the laity, but not so a dangerous drug like acetanilid, and mixtures of the same. -ED.] MY DEAR DOCTOR TAYLOR:-Thousands of doctors thank you today for your position relativ to "antikamnia" and such like drugs. That is one of the kinds of work that makes THE MEDICAL WORLD popular with the profession. Please keep right at it. Munice, Ind. W. A. SPURGEON. The Placenta in Cases of Twins. Editor MEDICAL WORLD:-In an article in the June WORLD, page 251, by Dr. George MacMurphy of Ortonville, Minn., on Twins, he seems to doubt the possibility of double placentas in twins, claiming that in seventeen cases of twins there were only single placentas (italics his own). In another part of his paper, still more to emphasize his remarks, he says, "I have yet to see a case where there were two placentas. For the benefit of the Doctor, I would state that a double placenta, that is one for each child in twin pregnancy, while not very common, may occur. In January 20, 1883, number of the Medical and Surgical Reporter, I reported a case of placenta praevia in twin pregnancy; the case was Dr. Polk's, of this city, who had called me in consultation; the first placenta presented praevia at the os, while the second was at the upper right fundus. Since then I have delivered two other cases of twins, each with its own placenta. (Obstetrics in Private Practice for the past Decade, read before the Phila. County Medical Society, February 24, 1892.) What is the cause of this condition? It depends entirely on the impregnation of one ovum or two ova; if from a single ovum we would undoubtedly have but one placenta; if Editor MEDICAL WORLD:-On Wednesday, May 25th, I was called to wait on a lady in confinement. She was a multipara about 22 years of age. When I arrived she was having very poor pains about eight or ten minutes apart. I examined her and found everything O. K., and the soft parts fully dilated. I decided to try to increase the force of the pains by rupturing the membranes; with about the fourth pain thereafter came baby. I hurriedly tied the cord, and on examination found a foot presenting. In a few moments came baby No. 2. Noticing very little diminution in the mother's size, I suspected a third, and made haste to tie cord No. 2, and had to work with him to resuscitate him. On examination I found a third one, sure enuf, which was born in a few minutes. Now the peculiar part was, the last one was born with membranes intact, and so tough were they that I couldn't tear them, but had to cut them with my scissors. They were all boys, weighing seven pounds exactly, each, and are perfectly developt. Mother and babes are doing nicely. There were two placentas, but they had grown together. First baby born 12.05 a. m., last one 12.55 a. m. I my brother M.D.'s that I am "dreaming, only dreaming." In a single family consisting of five members, four are drinkers of sweet milk, the father and three children; the mother is the only one who is a non-user of the lacteal fluid, and strange to say her tongue is habitually clean, and the others are the reverse. find others who drink milk, sweet milk only I allude to, are also carrying the white flag of malaria on their tongues. If my observations are correct, can any brother give a tangible reason therefor? I've learned never to claim originality in anything I may do or say concerning a medical subject; but I have heard nothing on this subject. I am in the pine hills whereon the circular saw sings, and the needle leafed monarchs of the forest are being laid low; ever since malaria has been rampant among us. So long as the mighty pine holds his head above the hills and vales, malaria has no resting place among them; but when the tops are left to decay, sickness becomes more common than ever before, and generally it is of a malarial or typho-malarial type or form. McKenzie, Ala. A. I. HALL, M.D. Tuberculous Patients in the Rural Districts. Editor MEDICAL WORLD:-In reply to your query, on page 194 of the May issue of THE WORLD, "what do our rural friends do for their tuberculous patients? Are they neglected and allowed to die?" I want to say that in the first place, no class of physicians on earth gives their patients more care and attention than country doctors. Why? Because they are not over crowded with work, and have time to study each individual case, and can put more time in on a case than the busy city practician. Then, again, the doctor practising in the country knows his patients' habits and mode of living, as he mixes with them; the physician of the city cannot do this. As a rule the patients in the country are a better class of patients for the doctor than the city people. When a patient comes to me for treatment I have a pretty good idea that he is going to take my advice and medicin until he gives it a fair trial. In the city I have seen patients go to one doctor then to another, and probably change physicians as often as every month. No one can give his patients rational treatment under such circumstances. again, in the country we have no over crowded tenements and flats and streets with smoke and dust from factories. We have plenty of room and fresh air, and no necessity of people breathing the same air over and over again. I think if we had some way of finding out where the mortality is the greatest from this class of patients, we would find it is from the city, as a Then very small percent of the deaths of the country doctor are due to tuberculosis. Before I give you my mode of treatment I want to first give the conditions existing in our county. We are 3,000 feet above sea level on what is known as the plains of Texas. The atmosphere is dry and the nights are cool in summer. Our winters are not severe as some would think, nothing to compare with the winters of Kansas or Colorado. I have been practising medicin here in the same place since April 1896, and have yet to see the first case of tuberculosis develop here. I have had several patients come here with well developt cases of tuberculosis that are now apparently as well as any one, and I believe the atmosphere here is as near inimical to the life of the tubercular bacilli as can be found anywhere. Now as to my mode of treatment: I do not treat the tuberculosis per se, but try as best I can to meet the symptoms of each individual case. I give them plenty of fresh air without exposure to colds and draughts, a good airy room to sleep in, moderate exercise, and feed them and let them get well. H. D. BARNES, M.D. Light in the Treatment of Tuberculosis.— Treatment of Goiter by Cataphoresis. Editor MEDICAL WORLD :-You askt in the May WORLD: "What do our rural friends do for their tuberculous patients?" I will tell you what I do for mine. In pulmonary tuberculosis there is a deficient power in the lung tissue to prevent the invasion of disease, or in other words, the incroachment of the bacillus tuberculosis. It is taken for granted that all are more or less exposed to the contagion of disease, and that one's vital-resisting power measures his immunity from it. Now if we can find something that will increase the power and strength of pulmonary tissue and at the same time inhibit the multiplication and growth of the germs that are causing the mischief, we have a double-acting remedy which will work both ways. Nothing will do this any better to my knowledge than light and heat. Nothing is more invigorating to vegetable and higher life than the warm rays of the sun shining in a proper amount directly upon the individual, or upon a particular part. At the same time this light and heat is sure death to some of the lower forms of life that pervade the system when diseased. Works on bacteriology tell us that direct sunlight or a strong electric light will destroy many of the germs that infest the human body in disease; among these are the germs of consumption. Explaining this to an intelligent farmer from a neighboring town, he remarkt: "We have a worm in our section that will sometimes destroy whole fields of grass by eating the roots; but if you lay the worm on top of the ground, even on loose dirt, in the sunshine, it will die in a short time before it can bury itself beneath the surface." At the same time the same bright sunshine which destroyed the worm would, other things being favorable, make the grass on which the worm fed grow vigorous and flourish to its fullest extent. Let us apply this simple fact of nature so well understood, to the treatment of tuberculosis. I have my office equipt with incandescent lamps from one candle power up to 300 c. p. The various uses to which the smaller lamps are put I will not stop to explain. When a case of pulmonary tuberculosis presents itself I have the patient strip to the waist line, and recline on a properly arranged couch. I then bring a 300 c. p. incandescent light to shine directly on the front, sides and back of chest, keeping the patient under the light from ten minutes to two hours, according to the effect. The light is shielded by proper reflectors to direct the rays to the desired parts and to protect the eyes of the operator. The eyes of the patient can be protected by a black handkerchief. This ray penetrates more freely than the X-ray thru the bones of the chest, as can be demonstrated by holding a five c. p. light in the closed hand. If the surface becomes uncomfortably warm, a blast of air from a condenser, or rapid sponging with water in which there is an antiseptic, will give relief. The effect on the skin is to increase the capillary circulation, the surface becoming red as tho a mustard plaster had been applied. The effect on the system generally is of a soothing nature; patient frequently feeling like dropping to sleep during treatment. Metab. olism is increast and the vital processes thruout the body are quickened. Almost invariably before the light has been applied five minutes the patient will involuntarily take a full and deep inspiration. It seems to give them the desire and power to do so, and this condition continues. As one patient exprest it the second time he was in, "I feel as tho I could breathe down a foot deeper than I could before I received the treatment yesterday." patient usually feels stronger and better from the first; the appetite and digestion improve, and the general condition is more satisfactory. The cough and expectoration disappear pari passu with the improved condition. The This treatment combined with pure air, out door life and nutritious food with hygienic living in every respect, will restore a large percent of the cases. In reply to "Indiana," in June WORLD, page 262, I would give him the following treatment, which has. in substance, been publisht before by me. Iodin is the remedy to be used, but instead of merely painting it on the outside of the tumor or taking it into the stomach, it should be used cataphorically; that is, iodin should be carried into the tumor on an electric current. It is a principle of electro-physics that all substances have an electro-affinity peculiar to themselves. That is, all substances are either attracted or repelled by the poles of a battery. Any substance that is repelled by one pole of a battery is invariably attracted by the other, and vice versa. All acids are attracted to the positiv pole, all bases to the negativ. The iodin group is attracted to the positiv pole. This is beautifully illustrated by taking a perfectly white blotting paper, and making a blot on it with Lugol's solution of iodin. Then take the metallic electrodes of a galvanic battery, place the negativ electrode on the iodin blot, and the positiv electrode some little distance away from the blot on the white portion of the blotter; turn on a current of ten or twelve milliamperes or more. In a few minutes the blotting paper will become white around the negativ electrode, and a dark stain of iodin will appear around the positiv electrode, without any stain whatever between the original blot and that appearing around the latter electrode. This shows conclusivly that the iodin has been driven away or repelled by the negativ pole, and drawn towards the positiv pole. apply this principle to the treatment of goiter. Saturate a piece of lintine or absorbent cotton with Lugol's solution of iodin (this is preferable to the tincture) and apply it to the goiter; over this apply a sponge electrode from the negativ side of the battery and the positiv placed indifferently, but better on the back of the neck. Turn on five or ten milliamperes of current, continuing from five to fifteen minutes. Treatment should be repeated as often as the patient can bear it, say every two or three days at first. After a few applications the skin will become very sensitiv to the current; then wait awhile. By this method the iodin is carried directly into the tumor and it becomes saturated with it. At the same time the electrical current per se will relieve the vaso-dilatation which is always present. The tumor will appear smaller after each treatment, and usually remains so. I had a new case come in only yesterday. The dress-binding around the neck which was quite tight before treatment was very loose afterwards; so much so that the patient called her husband's attention to it. I have treated several cases in this way, and in every Now X-ray in Goiter.-Reflex Irritation. Editor MEDICAL WORLD:-On page 262, June WORLD, "Indiana" asks for treatment of goiter. Having had some experience in this disease, can say there is no reliance to be placed in drugs. Had a very difficult case a few years ago. I used everything known in medicin, electricity, massage, etc., and in desperation concluded to try the x-ray, which soon gave satisfactory results. I have used it in a number of cases since with uniformly good results. Some mild cases entirely disappeared after five or six exposures; very large and fibrous ones required twenty or more treatments, averaging 10 minute exposures. The doctor will be surprised to see how fast they melt away. Dr. Vilal, page 264, should examin the lower orifices of the body for irritated or impinged sympathetic nerves; and if present, remove impingements and he will improve the circulation of his patients. Also to apply faradic electricity (secondary current), and the superheated air, as suggested by Editor, and his patient will get well. Don't forget to use positiv suggestion, along with the treatment, as he has become discouraged, no doubt. Dr. Krebs, page 265, should examin the prostatic urethra, vesiculae seminales, anus and sigmoid in his asthma case. If he understands the pathology of these organs thoroly, he will be able to cure his case. During the paroxysm, if he will try dilatation of anus, or pass a good sized sound, and note the effect on the breathing, he will have his cue, if his patient is relieved temporarily by this procedure. Dr. Higdon, same page, will benefit his case by a few doses of sulfur, 200x or higher, given about once a week, and have her observe the "life essentials." EUGENE HUBbell. St. Paul, Minn. The Power of Suggestion. Editor MEDICAL WORLD:-When I perused the article on "Soda Bicarbonate in Diabetes Mellitus" in the March WORLD, from the pen of Dr. D. C. Summers, of Elm Springs, Ark., page 112, I was shockt to read that when a patient informed him that she was using "Warner's Diabetic Cure" with apparent benefit, he made answer, "and just about the time you get well, you'll die." That remark was heartless and cruel. Does Dr. S. not realize or understand the power of suggestion? It was incontestably demonstrated to the medical profession of the whole world about 1860. In |
