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The patient was enormously large and I'ap. discharging a large mass of dark clots, eviprehended twins. She was like the teutonic dently blood. gentleman, whose abdomen was so gross that For the reader to form a correct idea how he was obliged to ask the boot black if his shoes the monstrosity looked I refer him to Fig. needed polishing, not being able to see over
No. 1. his ponderous belly.
This represents the exact manner that it Several hours having elapsed and the pains came into the world. A face presentation, becoming almost incessant, I ruptured the changed to this by the blades of the forceps water bag and was surprised at the great flow and manipulation from the presentation preof amniotic fluid. The patient said, “I am viously described. The appearance was most wet up to my shoulders." There must have hideous when it came into view, as the reader been two or three times the normal quantity. can appreciate by examination of the accomNow the abdomen became unusually small and panying cuts. I carefully guarded the monshe was enabled to see her feet; also the fear strosity that the mother should not see it, and of twins vanished.
had the husband carry it out of the room Further digital examination revealed a wrapped in a towel. I never allowed her to strange presentation indeed,
There was a
see it, though she much desired to do so. large, soft tumor pushed down on the right 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 (pinna 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. 1. 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 development 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 nalf.
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. I 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.
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
Jacob was a genius of no mean order, as it is An Interesting Case of Laparotomy. said of him in the Book of Genesis, xxx chapter, EDITOR MEDICAL WORLD:-On the 18th of beginning at the 37th verse, "And Jacob took February, 1892, I was called to see a patient him rods of green poplar, and of the hazel and with Dr. A. S. Reever, of Belleville. The chestnut tree, and pilled white strakes in them, patient had applied to Dr. R. on the 15th comand made the white appear which was in the plaining of belly ache. Dr. R. gave him an rods.
opiate for immediate relief of his pain. This "And he set the rods which he had pilled was vomited up, as were also medicines given before the flocks in the gutters in the watering to move his bowels; and the only relief obtroughs when the flocks came to drink, that tained was from the hypodermic use of morthey should conceive when they came to drink. phine. This plan of treatment with enemata And the flocks conceived when they came to was pursued for several days; at first there was drink before the rods, and brought fourth cattle little or no constitutional disturbance, but ringstraked, speckled and spotted."
each day the bowels became more and more It would seem that if animals which are tender and swollen, with a more and more fremuch duller than the human being could be quent pulse, and corresponding rise in teminfluenced by such influences as above detailed, perature, but with no motion from his bowels. certainly the intense shock given to pregnant When I saw him on the afternoon of the women could but interfere with the process of 18th the temperature had fallen to about 95°, fetal development, which all know is carried his pulse was about 170 per minute, his skin on in such a delica:e manner, through nerve was cold and clamny, and he complained of and blood forces, so intimately related to the feeling too hot, and he wanted to be constantly parent in every way.
fanned. The abdomen was very much swollen, The student of embryology, no doubt, has but not tympanitic except over the epigastric read the work of Ambrose Pare, translated by region; elsewhere it was dull on percussion, Tho. Johnson, 1579, of monsters and prodigies. and very tender everywhere, but with no special Many, no doubt, have read the opinion of more point of tenderness. His condition was cer. modern embroyologists, viz., Reaumer, Dar- tainly very unpromising. He was an unusually este, Panum, Schroke, Symkiewicz, Schenck, well-developed boy of sixteen years, with Hunking and Marion Humes. These authors, strongly marked vitality. He had for some br contributors to science, have shown many days before his sickness been eating very freely interesting facts relative to abnormal develop- of dried grapes, which was supposed to have ment brought about by interfering with nature's caused the obstruction of his bowels. Feeling laws, of the procreation of certain of the ani- satisfied that in his present condition he could mal species. If mental and moral peculiarities live but a short time, with the consent of his ure transmitted to children through three or family, I decided to give him the benefit of the our generations, why not admit the possibility chance of laparotomy. Not having any very of interference of the development of the phys- clear idea as to what I should find, or what Í cal, knowing that the mind so impressed the should do, I opened the abdomen by an in. Body through the passions, anger, sorrow, joy, cision in the median line, from the umbilicus itc, even to cause death. The fear of some to the pubis. Upon opening the cavity there atal disease, such as cholera, has caused the was a gush of Auid of the appearance and conlisease and death. Men have died from sup. sistency of pea soup, but with a decided fecal posed hemorrhage; only water trickling upon smell. In this there were small particles of a heir arms and their minds impressed with the brownish matter floating, which upon being dea that a vein had been opened, caused them squeezed between my fingers seemed to be fecal o gradually pass into unconsciousness and matter. After cleansing the abdominal cavity inal dissolution.
as well as possible, the wound was closed with Elmira, N. Y. M. M. BROWN, M. D.
a drainage tube in the lower edge of the cut,
for drainage and washing out the cavity. The Money Talks."
wound was closed by three rows of stitches; a
deep row of silver stitches, the peritoneum PLEASE note the following private letter from
closed with a continuous cat gut suture, and in eminent physician and surgeon:
a spherical row of silk stitches in the skin. The Dr. J. J. Taylor:-Allow me to say in re- wound was dressed with iodoform and a comard to the “ Physician as a Business Man,” press and bandage around the body. The boy hat I received $5.00 of value from it. ere I rallied from the operation nicely, and prolad had the book 15 minutes.
gressed favorably toward recovery until the Yours very truly,
25th, when against orders, and in the absence GEO. S. HAZARD, Ph. G., M, D. of the nurse, he got out of bed, and used a i Blue Hili Ave., Boston, Miss.
chamber pot by sitting on it to have a move.
ment from his bowels. I should have said be. there was a continuous discharge of pus, which fore that his bowels moved freely the day after in a few days after the first operation lost its the operation, and continued to act freely. fecal odor. The abdominal cavity was washed The bandage around his body had become out several times a day with a saturated soluloose, and in his straining at stool the stitches tion of boracic acid. With the movement of his all tore loose, the wound gaped open and the bowels the day after the first operation his tembowels protruded. He was seen not long after perature came a little above normal and rethis by Dr. Keever, who replaced the bowels, mained so, except that there was a sharp rise and brought the edges together, and secured it at each successive reopening of the wound. as well as he could with adhesive plaster. I His appetite was good-too good, for there saw the boy again on the morning of the 25th. was difficulty in restraining it. At that time the wound was gaping wide open, His recovery under all the circumstances is the adhesive plaster having slipped. The remarkable, and is largely due to the care and bowels were fully exposed lying in the bottom attention given him by Dr. Keever, under most of the wound; they had formed pretty firm discouraging circumstances. As to the pathadhesions to the side of the cut. He was again ol gy, it is hard to say just what was the con. put under the influence of chloroform, and the dition of things. The intestines were all coredges freshened by the knife and scissors, the ered with a fibrinous effusion and glued to. adhesions between the cut and the intestines gether. The peritoneum was deeply congested torn loose by my fingers. I then sewed it up and inflamed. I did not think it prudent to again, putting in deep silver sutures, which I make a thorough search.
make a thorough search. What was the meanentered about an inch from the edge of the cut, ing of the small brownish particles found floatand bringing them out about the same distance ing in the foul pea soup like effusion which on the other side. I applied these as quilled filled the cavity? Upon mashing them they sutures and took everything in their grasp. looked, felt and smelled like feces. If they were For the quills I used bone crotchet needles, fecal particles where did they come from? I twisting the wire around these needles so that suspected an ulcerative perforation of the verif they should cut the tissues the wire could be miform apperdix, but did not think it best to loosened. I then brought the deep tissues, press the search under the circumstances, preincluding the peritoneum, together, with a con- ferring to trust to the general reparative powtinuous cat gut suture, and closed the wound ers of nature, rather than to turn out the bowels, with superficial silk sutures, putting the drain- break up all the adhesions, and find the leak, age tube in again. The wound was again (which, if I were correct in my hypothesis
, dressed with iodoform, covered with a large nature had already closed), especially in the compress of absorbent cotton, and a firm abdom. almost collapsed condition of the boy. inal bandage placed over all. The boy was
T. A. HARRIS, M. D. put to bed in a better condition than after the Parkersburg, W. Va. first operation. He reacted well, and again made steady recovery for ten days, when I was
Practical List of Forty-Eight Remedies Suit
able for the Pocket Oase, informed by Dr. Keever that he had again ruptured the stitches, and that he did not Being aware that the Philadelphia Dosimetthink anything more could be done .for him. ric Company had offered a prize for the best Several days thereafter, when I was expecting list of forty-eight remedies, in the granule to hear of his death, I learned from Dr. Keever form for the pocket case, we obtained the that not being willing to let him die with his privilege of placing some of the best of these guts out”' he had sewed him up again, and
lists before our readers, as they convey a great that he was doing very well, with a fair chance deal of interesting and useful information. of recovery. The sequel of the case is that the We give first the list sent by Dr. Wesselorboy continued to do well and finally recovered. ski, of Kansas. We shall publish in subsequent The boy was a very intractable subject, and numbers the lists prepared by Dr. Hardwick, , there was a continued tendency of the stitches of Kentucky, and Dr. Dumas, of Arkansas. to cut out. The tendency of the wound to
ASTRINGENTS. reopen was met by the use of adhesive plaster placed on opposite sides of the cut, with eyes,
1. Copper Arseniate.
For cramps, colic,
diarrhea. (such as are used in ladies dresses) sewed to
2. Bismuth Sub-nitrate. Irritative dyspep the sides and laced with rubber bands (such as are used for binding letters or bundles of sia, and acute diarrhea in children. papers) across the wound, and this reinforced
ANODYNES. by a firm abd minal bandage. The drainage 3 Morphine Sulphate. Narcotic. tube was kept in and used for several weeks to 4 Morph. Hydrochlorate.. Generally used wash out the abdominal cavity from which for children, in place of morph sulph.
5. Codeine. Used in pneumonia; also to 33. Calcium Sulphide. The most successful allay cough.
remedy in boils. LOCAL ANESTHETICS.
34. Salicylic Acid. Anti-rheumatic. 6. Cocaine Muriate. Used for sea sickness,
FOR DIGESTION. alcoholism, etc.
35. Pepsin. Used for the lack of the natuDIURETICS.
ral digestive ferments. 7. Digitatine. In organic disease of the 36. Quassine. Tonic to the stomach. heart.
ANTHELMINTICS. 8. Pilocarpine Nitrate. Pulmonic edema, uremia.
37. Santonine. For small worms in chil.
dren. EMETICS AND EXPECTORANTS.
38. Pelleterine Tannate. A sure and safe 9. Apomorphine. Bronchial affection,
remedy for tapeworm. whooping cough. 10. Emetine.
EMMENAGOGUE. Expectorant and counterstimulant in pneumonia and bronchitis-very
39. Ergotine. For hemoptysis, post partum fine for children.
MISCELLANEOUS. II. Podophyllin. Purgative and cathartic. 40. Camphor Monobromate. Given in spas12. Aloin. Cathartic.
modic affections of children, where morphine 13. Eliterin. Good in dropsy.
is not indicated. 14. Colocynthen. In jaundice.
41. Picrotoxin. Good to relieve nightsweats, 15. Calomel. For biliary secretion.
also used in epilepsy. 16. Jalapin. Hydrogogue.
42 Sodium Benzoate. Very good in lith
emia. RECONSTITUENTS. 17. Iron Arseniate. Tonic in cachexy.
43. Glonoin (Nitro glycerine). Indicated
in angina pectoris and asthma. 18. Iron Hydroferrocyanide. Tonic com.
44. Cerium Oxalate. bination with quinine.
vomiting in pregnancy. DEFERVESCENT.
45. Iron Valerianate. Chloro:is and ane19. Aconitine. In acute pyrexial affections, mia. facial neuralgia
46. Caffeine Valerianate. Sick headache. 20. Veratrine. In connection with aconi. 47. Sparteine Skiphate. Cardiac regulator tine and digitaline.
and tonic. 21. Gelsemine. Apyretic.
Stimulant tonic, especially GENERAL TONICS.
used in children, instead of sulphate of strych
nine. 22. Strychnine Irseniate. Stimulant in all chronic diseases where a nervine is wanted.
I also use invariably some preparation of the
seidlitz salts. 23 Quinine Arsen. As a preventative for fevers of malarial origin.
JULIUS WESSELOWSKI, M. D. 24. Quinine Sulph. In ordinary fevers.. Jewell, City, Kansas. ANTISPASMODICSS
A Point in Ethics. 25. Atropine Sulph. Sedative to muscular
EDITOR MEDICAL WORLD:-In answer to system, antispasmodic and narcotic.
26. Hyoscyamine. Very fine in convulsions your “ Problem " on page 33 ; Quiz Dept, I of children.
would say as follows: 27. Caffeine Valerianate. Nervous head.
Dr. B. sends in his bill for all he has done, ache, coma and sunstroke.
and a consultation fee. 28. Zinc Valerianate. For all nervous af
Drs. A. and B. both should consult tofections.
gether as to the cause, &c. of death, and 29. Cicutine. Intercostal neuralgia. cancer
then Dr. A. make out the death certificate, and ous pain, dysmenorrhea.
his own bill regardless of Dr. B's. bill. Each MODIFIERS OF THE BLOOD.
man should make out his own bill. Dr. A., 30. Mercury Bichloride. Antisyphilitic. having been the physician who treated the 31. Mercury Cyanide. Very elegant in case, has not lost his control of the case. Dr. diphtheria.
B. was called in emergency, and should col. ANTISEPTICS.
lect his bill, and let Dr. A. make the death 32. Zinc Sulpho-carbolate. The remedy in
certificate. typhoid fever.
Bedford, Iowa. M. C. CONNETT, M. D.