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and properly attending to them and keeping them always in a normal condition. A knowl. e dye of the diseased conditions, the foundation of which is laid in the neglect of regularity and temperance in eating, drinking, sleeping, working, studying and exercising; in the neglect to give proper attention to the functions of the bowels, kidneys, skin, and even of the lungs, by the practice of regular deep breathing; in a disregard of any abnormality of the menstrual functions; or in a neglect of the proper care of the nose, mouth and teeth.
Thorough and special instruction should be given to young girls in regard to the long train of evils, chronic diseases and life long misery caused by undue exposure to cold, or wet, or by becoming chilled or having wet feet, during the menstrual period; that a "cold” taken during that time is not likely to affect the nose and throat, where it could easily be cured, but that it is more likely to affect the already physiologically congested ovaries, tubes and uterus, where a cure is not likely to be ever effected. It will not do to trust to the mother's fee ble authority in this matter. Nothing but a clear knowledge of the serious and often embarrassing consequences of indiscretion will serve to caution most young girls to prudence.
A knowledge of contagious diseases, the means of their contagion and the necessity and difficulty of efficient isolation, quarantine and disinfection should be imparted to all. Wh.n this subject is properly understood by the people, a well-meaning but ignorant Auntie, going from a diphtheria or scarletina infected family to another family of healthy children would be regarded much as a venomous serpent would coming in their midst. Then a person would not feel justified in going right out from a contagious sick-room into the crowded cars or public gatherings to spread the disease broad. cast. Then the people might finally become convinced of the importance of raising children to maturity without allowing them to run the gauntlet of whooping cough, measles, scarlet fever, chicken pox, small-pox, diphtheria,
sml-pox. diphtheria which annually slay many and leave the mark of chronic impairment upon many more. Then might we hope that contagious diseases would
be finally stamped out and disappear entirely from civilized society.
A thorough knowledge should be imparted of the physical evils of even slight indulgence in stimulants, tobacco and narcotics.
A fair and impartial statement should be given of the worthlessness of patent medicines, the dangers of some of them, and the base swindle of them all.
In the physical training department the pupils should be instructed and trained in the best methods of avoiding accidents of various kinds and how to treat injuries that arise from those that unavoidably occur. In this depart: ment should be given instruction in regard to fire-arms and explosives; how to prevent fires and to escape from burning buildings; railroad, steamboat and driving accidents; alighting from and boarding vehicles in motion; to prevent and treat accidents from drowning, suffocation, &c.
This may be taken as a mere skeleton outline of a practical course of instruction in this most important branch of educational training. There are many who have had large experience and given much thought to the subject, who could easily take it up and complete it. The state should at least take as much interest in teaching its youth how to become and remain healthy as in giving them the training which will help them to become wealthy.
Let us, then, have in our public school system, thorough, systematic instruction and training in the all-important subject of the preservation of life and health.
Bichloride of Gold for Cobra Bite. We learn from the Indian Medical Recori that Dr. Calmettes, of Saigan, Cochin China, has demonstrated that the subcutaneous injec. tion of bichloride of gold, made before apoplectic symptoms have occurred, is a certain antidote to the venom of the cobra di capilla. Tuis suggests its utility in poisoning by other venomous reptiles and inse ts.
Doctor, if you are satisfied that The MEDICAL World can h lp you in your practice and enhance the interests of the profession we S! should like you to join our large family of readers and contributors. We will give you the advantage of a trial trip the remainder of 1892, including the June (Cholera Infantum) number, for only fifty cents.
Manuscript cannot be returned.
P82 m2 st say all he has to say in the fou'est possible words, or
zords, or his reader will certainly misunderstand them.
Original Communications. -he should quickly and at some distance
(20— 40 feet) be able to locate the direction
whence the brightness comes. Short articles on the treatment of diseases, and experience
with new remedies, are solicited from the profession for Again, comparing the density of the cataract this department, also difficult cases for diagnosis and
with the power of light perception, the treatment.
difference between the two may be so striking Articles accepted must be contributed to this journal only.
The editors are not responsible for views expressed by as to indicate serious internal difficulty to the contributors.
thoughtful surgeon. Still again, the pupil may Copy must be received on or before the twelfth of the be very inactive, and not readily respond to month for publication in the next month. Caused
the stimulus of light, thus demonstrating a
weak perceptive power. All these conditions Certainly it is ercellent discipline for an author to feel that he
-marked limitations of the field, feeble prohis reader is sure to skip them, and in the plainest possible
jecting ability, a great disproportion between Generally, also, a downright fact may be told in a plain the opacity of the lens and the perception of way; and ze want dorenrighi facis at present more than
light, a sluggish or inactive pupil-all these
point to some serious internal lesion, disease of READ. REFLECT. COMPARE. RECORD. the retina and optic nerve, atrophy of the
choroid, turbid vitreous, etc. Under these Cataract.- Question and Reply. circumstances, the prognosis may be so doubt| EDITOR MEDICAL WORLD:-Dr. Brown, of
ful as to warrant the experienced oculist in reMilwaukee, Wis., gives us a very interesting
fusing an operation. dissertation on the differential diagnosis be
(6) The tension of the eye-ball (its softness tween glaucoma and cataract. I would be
to touch) may be so far below normal as to pleased to have an article from him on catar
justify the diagnosis of detached retina, a conact. I recently examined two very interesting dition precluding a successful operation. cases in the same family. One aged fourteen (c) A surgeon may not be willing to risk years, the other seven years. Both had catar- his reputation by operating on a case which, act from birth, and bɔth cases were pronounced in his opinion, is likely to result disastrously incurable by prominent oculists. The lenses to his patient and himself. We have often are pearly white, but vision is not entirely de- heard that liberal minded oculist, Dr. Carrow, stroyed in either case—that is, they can dis. of the University of Mich., say to his students, cover a lighted lamp in the room. Nɔw, if -"A surgeon has no right to refuse an operathey are not curable I would like to know why. ti yn when everything is to be gained and nothThe optic nerve seems to be perfectly healthy, ing lost.” If the condition of things is careor why should they discern light? Why wait fully explained beforehand, and well underfor a cataract to ripen ? and what is the philo. stood by patient and friends, an operation sophy of a cataract ripening?
urder these circumstances would redound Dr. Brown's article appears in March rather to the credit than the disadvantage of WORLD, page 92.
the conscientous surgeon. . Linwood, Kan. J.D. WARFORD, M.D. 2. What is the philosophy (pathology) of a
- ripening cataract ? EDITOR MEDICAL WORLD:-Complying with The crystalline lens is made up of long the request of Dr. Warford, Linwood, Kansas, fibers, or rather very elongated cells arranged for an article on cataract, I will confine myself in a peculiar manner. The central fibers are to the points mentioned by him, the general known as the “nucleus”.-the external cells, subject being too broad for one sitting.
as the "cortex." I speak now of senile 1. Why should an oculist refuse an opera cataract, to which reference is apparently tion on a congenital cataract as useless, when made. As age advances the lens gradually there is a perception of light on the part of the hardens. This is a normal condition. This patient ?
hardening begins in the nucleus. Between the . He may do so for one or more of the follow nucleus of a normal senile len; and a senile ing reasons :
cataractous lens, there is little difference in (a) In his judgment, the perception of light transparency. Sometimes, however, the nucleus may not be sufficient to warrant an operation of a senile lens hardens in an irregular manner, To discern light is not always enough to justify that is, differently from the usual and natural operative measures. The whole field must be way. This irregularity in hardening is suptaken into consideration. A pa:ient should posed to make such an alteration in the external not only see light immediately in front of the fibers or cortex as to cause them to become eye, but also when the illumination comes swollen, granular, disintegrated and divided from positions to the right, left, above, below, by fissures, the result of which is a loss of
transparency, and, in time, a dense opacity-a cataract. Between the cells are found particles of coagulated matter, which also help to destroy the clearness of the lens.
3. Why should we wait for a cataract to ripen ?
In mature cataract, the lens is sclerosed, and consequently somewhat shrunken. This shrinking causes the lens to be more or less loose in its capsule, and detaches from it every part of the cortex. Being now smaller than normal, and completely separated from its en veloping capsule, it is easily removed, leaving no lens substance behind to awake inflammation and destroy the effect of the operation. On the other hand, if the cataract be removed before it is ripe, some particles of the cortex which adheres to the capsule remain behind, and, being transparent, are not observed at the time of the operation. Sooner or later these fibers become opaque ; appear in the pupillary space, ruining vision, causing unpleasant in flammatory reaction, and oftentimes destroying the eye itself.
Dr. E. E. Hagler, University of Michigan, recently reported to me such a case. A patient had been operated upon for cataract by an eye. surgeon. Shortly after the operaticn the pupil was found filled with opaque matter. A second operation was performed at the University clinic, and the mass removed proved to be a collection of lens fibers, which had escaped removal at the hands of the first operator. Fair vision, however, resulted. On the other hand, Dr. Flemming Carrow informs me in a private communication, that during the past winter he has removed in his clinic several cataracts, where he could perceive a distinct red reflex through the lens, and that the results were good, and the operations not difficult. It may be that the experience of such bold though careful and conscientious operators, may in time modify the classic opinion as to the necessity of perfect ripeness before operating on a case of cataract. The revived practice of syringing out the capsule and anterior chamber with a mild antiseptic solution after operation, and the desirable results claimed from it, may also aid in bringing about some modification of the present practice, a change very agreeable to those patients, who, after blindness occurs, are obliged to wait a long and tedious time for their cataracts to mature.
Finally, the following simple tests for determining the ripeness of a cataractous lens may be found useful by the general practitioner :
1. The edge of the iris rests upon the crystalline lense throughout its entire margin. There is nothing between the two, ex.ept the very thin lens capsule. Bearing this in mind, throw an oblique focal light of medium strength
upon the eye, in a dark room. !f the external or cortical part of the lens be opaque or ripe, no shadow will be thrown by the edge of the iris, because it rests upon an opaque surface, the hardened lens. If the outer part of the lens be still transparent, the edge of the iris will th. ow a shadow upon the hard centre of the lens, which shadow will correspond in width wich the thickness of the cortical lens substance, which still remains transparent. With a little patience, this test will be satisfactory.
2. Dilare the pupil, and expose the whole lens. Examine carefully. If the striæ or lines of hardening upon the surface of the lens are fine and opaque looking, the cataract is mature. If the lines are broad and glittering, of various shades, some like mother of pearl, the lens is likely not mature. In a few weeks the difference in hue and appearance between the striæ will be seen to be less, and finally to disappear. The cataract is now ripe.
3. Dilate the pupil. With an ophthalmoscopic mirror, throw a good reflected light upon the lens. A mature cataract should not permit the slightest red reflex from the fundus.
4. A test for favorable prognosis: In a dark room throw a faint light, reflected from a hand mirror, upon the eye at a distance of from two to four feet. In a promising case, the patient should distinctly recognize the illumination and also the directions whence it comes. Any slowness of perception in these particulars is suspicious, and points to a more or less unfavorable result. I trust that these tests may be useful to some one.
Often do I see patients who have come from a great distance to have a cataract removed long before it is ready for an operation. Such could be saved much expense and trouble, did their family physician. use a little more care in making his diagnosis. All of the above “reasons” and “tests” can easily be under. stood by any intelligent practitioner, and if they shall be helpful to any such of my brethren, the trouble of writing them out will be amply compensated for.
BELNO ADDISON BROWN, M. D. 201 Grand Avenue, Milwaukee, Wis.
Monstrosities and Maternal Impressions.
EDITOR MEDICAL WORLD:-On the 22nd day of April, '92, I was summoned to attend Mrs. W., in this city, who was then in severe labor. When I reached her bedside I found, upon examination, slight dilatation and the head presenting, though the tense waterbag prevented accuracy of diagnosis. Wishing to allow every advantage of dilatation, I did not interfere for some time with the amniotic membranes.
The patient was enormously large and I'ap. prehended twins. She was like the teutonic gentleman, whose abdomen was so gross that he was obliged to ask the boot black if his shoes needed polishing, not being able to see over his ponderous belly.
Several hours having elapsed and the pains becoming almost incessant, I ruptured the water bag and was surprised at the great flow of amniotic fluid. The patient said, “I am wet up to my shoulders.” There must have been two or three times the normal quantity Now the abdomen became unusually small and she was enabled to see her feet; also the fear of twins vanished.
Further digital examination revealed a strange presentation indeed. There was a large, soft tumor pushed down on the right
discharging a large mass of dark clots, evidently blood.
for the reader to form a correct idea how the monstrosity looked I refer him to Fig. No. 1.
This represents the exact manner that it came into the world. A face presentation, changed to this by the blades of the forceps and manipulation from the presentation previously described. The appearance was most hideous when it came into view, as the reader can appreciate by examination of the accompanying cuts. I carefully guarded the monstrosity that the mother should not see it, and had the husband carry it out of the room wrapped in a towel. I never allowed her to see it, though she much desired to do so. Careful examination revealed that there were
side of the vagina, appearing to the touch like no perfect vertebræ, no parietal bones, no frontal the placenta. I carefully explored and found bone, except a narrow portion in the forehead; that the growth was attached to the back of no occipital, except a rudimentary portion at the neck. I now examined further and found the base of the skull; very small portion of that my finger passed into the mouth on the temporal; rudimentary ears (pinnæ and audi. left side of the soft parts directly opposite the tory canal); No perceptible brain matter; no tumor. I could find no sutures or fontanelles, membranes of the brain; open spinal canal and having outlined the gums and felt the down to the last lumbar vertebra, this vertebra tongue, I explained to the family, aside from being the only one that could be detected, and the patient, that I feared a deformity or mon- that with no processes. This vertebra was not strosity, and that I should advise the applica. covered with integument; the ribs and chest tion of forceps, as there seemed no progress in bones were all pushed into a heap, and the the labor. I had no difficulty in applying the sternum and upper chest wall was continuous forceps, but was obliged to labor long and with the inferior maxilla, throwing the face patiently before the fetus could be forced upward; the eyes were not formed, i. e., the down low enough to unlock the forceps. Fear. globes, not the lids, only two sockets, covered ing rupture of the perineum, I did this, and by thin membranes. See Fig. I. three or four powerful pains brought the "imp" Before I had the photograph taken I stuffed away, the large sack previously rupturing, and the spina bifida sack with cotton, but could not make it appear as large as it should have done, owing to the walls of the tumor being so frail. By examining Fig. 2 you will discover a talipes of the left foot, also, non develop ment of the soft tissues of the left leg. The absence of the spine is shown in Fig. 2; also the concavity covered by the membranous sack.
From a careful estimate of the time, I conclude that the mother carried this "imp" for at least ten months and a half.
I was engaged to attend her by the husband at least two months prior to the time she was confined, and he told me the time would be up in two weeks. Thus the mother's calculation, dating from the time her menstrua ceased,
born and she saw the tumor she exclaimed, "Oh! the intestines of the goat ?" The tu. mor was an encephalocele.
Dr. W. E. Ground, of Wisconsin, further corroborates my position by the following statement in the Medical Standard: He says, “There was a large amount of amniotic fluid, but no other item of special importance in the case of labor." The Doctor's case was like mine in this particu'ar. His "imp weighed about five pounds,” about the weight of the one above described. "The meninges and a small amount of brain matter occupied the cavity of the cranium."
"The monster was temporarily placed in the
must have been three hundred and fifteen days. consulting room in full view of any one, and I learned from the mother of the lady con. the Doctor having been suddenly called away, fined that her husband took home an artifici. 1 a pregnant patient called and strayed into the rubber snake about two months after she be room where the imp stared her in the face. came pregnant, and playfully sprang the rep- She became fascinated and stood motionless, tile in her face, frightening her nearly into gazing for some moments. She then started convulsions. I believe that this was the cause to leave, and nearly fell owing to the shock of the malformation. They had been married she received: The imp remained constantly seven years, and this was the only time she had in her mind, asleep or awake, till she miscarbecome pregnant. The sex of the fetus was ried some six weeks thereafter, with a mon. female.
strosity more hideous than the one which Maternal impressions are, no doubt, well frightened her." proven. Dr. Spitzka strongly maintains this view; he says: “There is a potency to produce aberrant development.” A case is recorded in point in the May number of the Medical Standard by Dr. S. R. Thompson : “The mother, when five months pregnant, saw her husband dive his knife into the abdomen of a goat, which had been slaughtered, and the sight of the suddenly protruding visceral mass so shocked her, that she fell back, clutching the nape of her neck. The impression haunted The ancients must have had some informaher for some time, and when the child was tion relative to maternal impressions, else