Page images
PDF
EPUB

and perfect tub, capable of holding twenty gallons of water if desired and of being emptied quickly by the large syphon when the bath is finished. Any excess of water is sponged up, the sheet is unfastened, dropped inside the frame, which can now be lifted, folded and set away in less time than it takes to describe it. The sheet may be re

buckets till the body is covered fairly and brisk friction is maintained over the whole surface by chafing with the bare hands or with linen cloths. Continued friction during the entire bath is an imperative feature of the Brandt method, without which its physiologic effects cannot be realized, and harm would be liable to follow.

moved or left at will, with fresh linen over it, for the next bath.

We believe the general principles of the Brandt method of cool baths in typhoid fever to be equally beneficial in all septic and contagious fevers. Not as a specific or abortive treatment, but as modifying greatly the severity of the attacks, reducing liability to complications and lowering death rate. The same physiological effects are to be

Temperature and duration. With timid or delicate patients the first baths may be given with the rubber sheet alone and may consist of ablution and drippings of water over the body from a large sponge, not forgetting the while to rub and chafe the body, turning gently from side to side to get at the back. The temperature may be at 90 degrees F. at first and gradually reduced at each succeeding bath till the patient is soon

FH.SARGENT & CO CHICAGO

sought after in all, as are certainly accom-educated to endure the full bath, as deplished in the Brandt treatment of typhoidscribed. The first bucket of water may be fever, viz.: the stimulation of neural controlat temperature of 85-90 degrees and and resistance, manifested by improved res-quickly reduced by succeeding buckpiration, circulation, metabolism, elimina-ets to 70 degrees or 65 degrees-the tempertion and lastly, and incidental to these im-ature advised by Brandt-to be maintained provements, reduction of temperature. for ten to fifteen minutes. Patients will An ideal bath for typhoid fever, and somecomplain some and shiver considerably. efficient form should be insisted on ab initio, The latter, however, is a beneficial reflex may be conducted in the following manner: and the former will be forgotten in the sen

[graphic][ocr errors][subsumed][merged small][merged small]

the bath and the efficient use of rubbing. As soon as bath is completed hot malted milk and whisky is again administered; warm bottle placed at the feet and body lightly covered. The bath is to be repeated every four hours if the temperature, which is only the symptomatic expression of toxic effects, persists in rising above 102.5 degrees F. Cool baths, instituted early, systematically followed out, have reduced the mortality of typhoid fever in thousands of tabulated cases to less than two per cent. Albert H. Burr, 2036 Indiana avenue, Chicago, Ill.

of

Removal of the Uterus for Bilateral Diseases of the Appendages. Editor Medical World:-Conflict thought is the rock and base of progress and rival action is the best method of benefiting men. The present disagreement among certain physicians in regard to the removal of the uterus for bilateral diseases of the appendages rests on both ignorance and experience. So far as I can observe the opposition to the removal of the uterus for bilateral diseases of the appendages comes chiefly from the general surgeon who knows not gynecology, or from the gynecologist who has neither experience nor acquired skill in the operation. The opposition to the removal of the uterus comes, then, from physicians with limited experience and observation of the operation. So much has been said and written by general surgeons and three-fourths of gynecologists against this operation that it induces me to say a few words from nearly two years' experience, including, perhaps, fifty cases. Three years ago I was opposed to the removal of the uterus for bilateral disease of the appendages for various reasons. But my results in abdominal surgery of several hundred cases were certainly not satisfactory. (I do not speak of post-operative hernia). I mean by unsatisfactory, that some burden of pathologic condition was not removed from the patient. With removal of the appendages without the uterus we had some 10 per cent. of hematomas. By hematoma is here meant an accumulation of blood outside the peritoneal cavity. It generally accumulates in the broad ligament and dissects it up as far back as the rectum. It chiefly occurs on the left side on account of the more extensive complicated venous system there. In

women under 21 we had 12 per cent. The hematoma generally arises at the first menstruation after the operation, which is uncertain in time. We had, however, in one case, a hematoma on the second day after operation and it burst through into the peritoneal cavity and thus became a hematocele. We are not alone in having hematoma following removal of the appendages. Tait told me personally that he had some 14 per cent. of hematoma following removal of the appendages. Now, in the removal of the uterus for bilateral diseases of the appendages hematoma is not a natural consequence. It will scarcely arise. It is possible, but not probable. So that removal of the uterus for bilateral disease of the appendages is devoid of the dangers of hematoma. We admit a hematoma seldom ever kills, but it retards recovery.

In removal of the uterus for bilateral disease of the appendages we do not have menstruation following. Menstruation will follow in 6 per cent. of cases where the tubes and ovaries merely are removed. If the author's operation of ligating the uterine artery, as it courses through the broad ligament, down to the internal os, be practiced, perhaps only 2 per cent. to 3 per cent. of menstruation will follow, yet it is uncertain. We have shrunk large uteri and myomatous uteri down with this method of ligation of the uterine artery, but it is not so certain as removal of the uterus. Even after considerable shrinking or atrophy of the uterus it will pass through the menstrual rhythm. strual rhythm. It has retained sufficient automatic menstrual ganglia to perform an imperfect rhythm-simply a hemorrhagic one. After careful removal of both appen. dages (for pyosalpinx) we have had distinct menstruation of a very profuse character for two years; and now, after over two years, we think it will be necessary to remove the uterus to cure the patient. However, the hemorrhage is becoming less in quantity, wider distant in time and less disturbing in effect. In all the series of cases, which includes Dr. Lacy Waite's and my own, I know of no case where menstruation has continued regular after the writer's operation of ligation of the uterine artery to the internal os has been performed. But calculating on our last two hundred cases, the single removal of the appendages has been followed by 6 per cent. of menstruation.

With removal of the uterus for bilateral diseases of the appendages we do not get

tender stumps. In the work of Dr. Waite and myself during the last one hundred cases we noted four distinct cases of tender stump and, so far as I can remember, the 4 per cent. of tender stumps existed in any series of 100 cases. But no tender stump has come to us after removal of the uterus. Patients with tender stumps are pitiable objects and we re-operated on one. It is sometimes difficult to say, absolutely, whether it be merely a tender stump or dragging or pressing adhesions. Tender stumps occur in patients of other operators, for they come to my office. The tender stump is no doubt a neuritis or neuroma of the nerves at the point of inflammation. With the removal of the uterus for bilateral disease of the appendages we avoid irregular uterine hemorrhage. Irregular uterine hemorrhage occurred in our cases about 4 per cent. But no doubt this subject would rather come under the head of metritis or endometritis.

The

One of the chief reasons for removal of the uterus connected with bilateral disease is metritis; the large, hard, stiff, straight uterus. Its walls are often an inch thick, composed of white, glistening connective tissue. It is not an uncommon thing for metritis, hemorrhagic and painful, to last over a year after the operation if the tubes and ovaries are simply removed. But if the author's operation of ligating the uterine artery at the internal os be practiced even the hard, metritic uterus will gradually shrink down to a small mass in two to three months. It is by this operation literally starved down. The patient, however, with a big, metritic uterus is not cured by simple removal of the appendages. uterus is still large and heavy, it does not atrophy well. In bilateral uterine disease, especially with a heavy, large, metritic uterus, the patient is cured by the removal of the uterus. A very important matter which induced the author and associate, Dr. Lucy Waite, to remove the uterus down to the neck for bilateral uterine disease is the fate of the ligature and fistula. So many fistulas occur that it disturbs an operator. I watched carefully one series of 100 cases and actually eight fistulas arose, at first, but soon these fistulas lessened to five and so far as I know three of these fistulas lasted two years. We used silk in those cases. Some would say that was wrong; use catgut. It is not settled that cat-gut is safe. In simply removing the appendages the ligatures are well intra-peritoneal, but in re

moval of the uterus all the ligatures are extra-peritoneal, so that if a suppuration of a ligature did occur, it would be extraperitoneal and hence safer. It is the peritoneal fistula that is persistent and troublesome. The broad ligament is split and the uterine artery is tied entirely outside the peritoneum. Infected ligatures, i. e., in contact with the peritoneum, are the bane of abdominal surgery. Hence, removal of the uterus is the method to get rid of intra-peritoneal ligatures.

Another matter is gained by the removal of the uterus, and that is the vast reflex from diseased uteri are removed. Besides, the menapause is rapidly passed through.

All the work I speak of in this article is supra-pubic-abdominal. Hence, with removal of the uterus with bilateral disease of the appendages, we avoided (a) hematoma, 10 per cent.; (b) tender stumps, 4 per cent.; (c) menstruation, 6 per cent.; (d) irregular uterine hemorrhage, 4 per cent.; (e) the metritis and endometritis are cured. What is the charge of the general surgeon against removal of the uterus? It is that we remove too much. And what do gynecologists say against it? They say our previous operations have been satisfactory and produced good results. To the general surgeon we say that the "sweeping removal" of useless and diseased organs is not bad surgery. To the anti-gynecologist we would say our previous methods are not good enough; we must improve them. It is again asserted that the additional operative procedure of removing the uterus is a severe shock to the woman. In our labor of nearly two years Dr. Waite and I have not found this shock to be much more than that of removal of the appendages. Of course continual practice has made us capable of removing the uterus and appendages in thirty minutes, which time many require to remove the appendages. The method we pursue in removing the uterus is:

First, free the whole uterus and its appendages. Second, ligate each ovarian artery at the mouth of the tube. Third, put a clamp on each side of the uterus to about one inch above the internal os. Fourth, divide the peritoneum on the anterior and posterior surfaces of the uterus and broad ligament, say one and one-half inches above the internal os, and strip it well down for a big peritoneal cuff to cover the stump. Fifth, split the broad ligament on each side down to the vagina and ligate the uterine

artery down to the uterine cervix. Sixth, amputate the uterus at the internal os and apply 95 per cent. of carbolic acid to the lumen. Seventh, sew the flap over the cervical stump, taking care to bring under the flap the two ligatures applied to the ovarian arteries.

To remove the uterus for bilateral diseases of the appendages is a grand progress in gynecology-the greatest in many years. The experience of Dr. Waite and myself for nearly two years in removal of the uterus for bilateral disease of the appendages has convinced us of its great utility, of the beautiful and smooth recovery and of the more perfect results than by other methods. Chicago. Byron Robinson, M. D.,

Copper Head Snake Bite Treated With Permanganate of Potassium.

Editor Medical World:-I was called by J. L. on the 26th of June, 1895, at 12.30 A. M. to see his wife, who four hours before had been bitten by a copperhead snake. The husband stated that she had been given over a pint of whisky and that she was suffering very much. On arrival I found quite an excited crowd of men and women standing around the sick woman's bed. The patient was in a partial

stupor, due to the excessive amount of whisky which had been given her. I found on examination the right fore-arm greatly swelled up to the elbow and very tender to the touch. The wounds made by the reptile consisted of two punctures in the palm of the right hand, near the median line, opposite the thumb. On arousing the woman she began complaining loudly of the pain, saying that a hundred thorns would not hurt worse. I immediately corded the arm above the elbow, took a lance and opened the wounds made by the snake's fangs and, by pressure, succeeded in getting out a considerable quantity of dark green fluid and blood. I then injected hypodermically into the wounds some permanganate of potassium and also gave hypodermics of the same in different parts. of the swollen arm. Applied a strong solution of the permanganate to the hand and over the wounds. In half an hour the pain had lessened very much and in four hours pain and swelling were nearly gone. A hot poultice soon completed the cure. In three days she was attending to her household duties.

Of course I gave by the mouth

[blocks in formation]

Dr. Coon's Treatment for Epilepsy. Editor Medical World:-After having used muriate of ammonia for more than

twenty-one years in epilepsy I regard it as a specific for all forms of the disease, other than traumatic, as from injury to the head.

The first case of epilepsy that I cured with muriate of ammonia was a female of about 12 years of age, who had had the disease from birth. I cured her more than twenty-one years ago and she has never had any symptoms since. In this time I have treated quite a number of cases-not making a specialty of it, but never failed to cure them where the patient would use the medicine according to directions-nor does the disease return after it is cured. I could say many other good things for muriate of ammonia in other diseases, but as the treatinal with me I will only speak of it as a ment of epilepsy with this remedy is origmedicine in this disease. I give it in a saturated solution, and as it leaves the system

quickly you will have to repeat the dose

often.

I will give you my way of preparing the lated salt and always dispense my own medprescription. Of late years I use the granuicines. I fill a half pint bottle half full of the granulated muriate of ammonia and fill it the rest of the way with water. I give an adult a tablespoonful every three hours while the patient is awake. You will give a child according to its age. I give children and adults all the stomach will bear and if the stomach should not bear it well, give elm water, mint water or gum acacia. I aim to fill the patient's system so full of the ammonia that the perspiration will yield over-dosing your patient. ammonia plentifully. Don't be afraid of

Colfax, Ind. Hiram J. Coon, M. D.,

Colles' Fracture of Both Wrists. Editor Medical World:-I think I can report a case that is rather rare.

A lady of 73 years of age was thrown from her carriage and sustained a double Colles' fracture of wrists. The left was a simple fracture, easily reduced, and a fairly good joint was secured, with no deformity

except a little thickening of deposits around the joint and stiffening of hand from rheumatism, to which disease she has been subject for years.

In the right we had a comminuted fracture of radius with extensive dislocation of ulna on to side and back of hand. In fact, nearly a compound fracture, as the styloid process nearly perforated the skin. This was a more difficult fracture to reduce and keep in position, but we were successful in doing so and got fairly good results and a useful wrist. Some projection of the styloid process due to the shortening of the radius,due to being broken in several pieces. This hand suffered also from rheumatism and some stiffening of joints, but she is gradually getting the use of them to dress and feed herself and do light housework.

I find double Colles' fracture very rare and perhaps this may be of interest to some, so I report it. E. C. French, M D.,

Watertown, Conn.

Beef Tea as a Stimulant.-Rest Required After Treatment for Alcoholic or Morphine Habit.

Editor Medical World:-I wonder if the profession to-day realize what a stimulant we have in beef juice. If any of our fraternity who are disposed to use whisky or morphine to work on at night will try hot beef tea they will be delighted with it.

I asked an old practitioner why physicians used opiates and alcoholics so much and his reply was, "to make them feel better." Now, brother practitioner, use hot beef tea and you will avoid any habit with its bitter end. We can well say of the habitual user of drugs that "The last end of that man is worse than the first."

Apropos of the treatment and cure and the relapse of drunkards let me drop a suggestion.

A liquor seller of years of experience well said a while ago to me that if a man was cured by the Keeley cure or any other cure that he should not practice venery to any extent. I think that the reason so many fail in keeping cured is that they return home with their sexual powers rested up and keyed up from abstinence and they "go in lemons" so that the debilitated nerves call for some panacea, and the old craving comes back and they try it again and fall.

Dr. Mattison, of Brooklyn, says that one who has been cured of the morphia habit

should be shelved one year. Why, look at it. Recall the poisoned exhausted frame of the habitue before his cure. Does one imagine for an instant that the chaos which reigned in his body for years can be supplanted by health in three or four weeks' sojourn in any asylum?

How long does the Weir-Mitchell rest cure confine patients, and do we think that they are well in an instant?

We should advise patients returning from any place of cure to sleep up stairs and "pull the ladder up after them." As we are told in the Book that "no drunkard shall enter the kingdom of heaven," we must reflect before we make any more drunkards. Who are the drunkard-makers of the world? Are we physicians numbered among them?

I am pleased to have The World take up the subject of national legislation. We are affected by hard times more than any other class. Now, while we are treating on legislation, bacteriology, etc., let each physician strive to give something practical for our journal. I have no microscope to see germs, microbes, etc., but I know that a tea kettle of hot water will put them where they won't flourish.

Let me add my vote against telling our patients what we are giving them. Essex, Vt.

W. W. Styles, M. D.,

Urea Proposed in Hydrophobia. Editor Medical World:-Gentle and expectant reader, do not fancy that I am coming crowned and victorious over one of the deadliest and most cruel foes of the human race. I only come asking knowledge and power to battle with this incarnate fiend. I have just witnessed the death of a poor dog under the horrible tortures of hydrophobia. Never mind whether it be a germ, an inflammatory or a nervous disease, let us try and find the remedy; but I am afraid there is no well-authenticated record of a cure. Let The World family then unite for one month in discussing and investigating this disease in preference to all others.

I once witnessed the behavior of a dog affected with hydrophobia. He was shut in an inclosed yard in which there was a urinal. Round and round he went without stopping, licking the moisture from the stones as he went by. He continued this till he was mercifully shot. I read in "Druit's Modern Surgery," "Other symptoms observed at the commencement of the disease are loss of appetite, propensity

« PreviousContinue »