Page images
PDF
EPUB

UTERINE INJECTIONS.

With regard to injecting resorcin solutions into the uterus, and the consequences of it, I would beg to make a few practical remarks, which I trust may be of benefit to some of our younger colleagues in the practice of gynecology. In reading paragraph three of the above abstract from Dr. Andeer's article, it seems clear to me that in his opinion the "generally pretty severe reflex symptoms" following the injection, are due to the effect of the resorcin. I have frequently met with similar sentences in my readings of medical journals, attributing the reflex symptoms to the irritant or specific effect of the drug used. This way of putting the matter is apt to create an impression, in the inexperienced young practitioner's mind, that injecting the uterus, in itself, is a perfectly safe and painless operation, provided the materials used are not of a nature that would cause irritation or "reflex symptoms." The operation is spoken of so glibly, so freely, and without a word of warning against rashly and incautiously undertaking it, that the beginner is often tempted to try it on the first occasion. Medical journals are read by the younger and more inexperienced practitioners probably more than by their elder brethren, simply because the latter, having a larger practice, can devote less time to reading. Hence I think that whenever any possible danger is likely to arise in consequence of any manipulation fair warning should be given in describing it. In perusing any of the better works on gynecology, we most invariably find it plainly stated, that even a drop of water, injected, purposely or accidentally (when syringing the vagina) will occasionally produce those reflex symptoms in their greatest violence. In practice I have several times had the misfortune to produce them, notwithstanding every possible precaution, and am now satisfied that it is not so much the nature of the application as the presence of a foreign substance (no matter how bland) in the uterus, which under certain conditions causes these reflex symptoms. And what does the vague expression-"reflex symptoms "-convey to the inexperienced practitioner's mind? I will try to describe them as I have seen them more than once, in various degrees of intensity. They are labor-like pains, grinding, remitting or intermitting, so intense sometimes that the poor woman writhes in agony, with ashy face, and cold, clammy perspiration standing on it in large beads, the pulse irregular, fast, and weak, the hands and feet cold, urgently indicating danger of collapse. Sometimes prolonged fainting follows. One woman told me she would never again willingly go through the same torture; she would rather have gone through the labor of childbirth twice, than to have endured that agony. This condition sometimes continues for more than an hour. Nor does it end there. Sometimes an obstinate

metritis and parametritis is set up, adding to the suffering of the patient, and keeping her in bed for weeks, so that she may truly say that the treatment is worse than the disease. Not only liquid injections will produce this suffering, but also solid intrauterine bougies or pencils, no matter of what material or how medicated. The practitioner who would introduce an anodyne in either shape into a neuralgic or irritable uterus, with the view of relieving the pain, would make a sorry mistake. But these consequences, though frequent-much too frequent to be ignored, do not always follow. If they did, intrauterine medication would be an impossibility. The great question therefore, is: "When and under what circumstances can intrauterine medication be attempted without risk, or with a minimum of risk of exciting the above described consequences?" This question I will try to answer, in a few words, in so far as practical observation enables me to do so. I give my answer, however, with some degree of diffidence, and subject to possible correction, either by myself, after further experience, or by some one of our readers, and I would also call attention to the old adage, "No rule without exception."

Firstly, I would state that the "irritable" uterus does not bear internal medication. This irritability shows itself in various ways; there may be either spontaneous neuralgic pains, darting, stabbing, grinding, or "like the toothache," occurring apparently without any provocation. Or there may be an excessive sensitiveness of the uterus to the touch, or when it is attempted to slightly move it. Or, finally, there may be an almost constant sensation of burning, the location of which by women of the lower classes is generally described as "across me," with some backache. This burning sensation may occur in the absence of either intra-uterine or extra-uterine erosion or ulceration, and the uterus may be quite tolerant of palpation or motion.

An irritable uterus, is in a great majority of cases (but not necessarily always) a contracted uterus i. e. the internal os seems to be spasmodically closed, admitting with difficulty even the smallest rubber bougie. Whenever, therefore, I find such a condition, I proceed first in the most careful tentative manner before using any method of intrauterine medication. Such a uterus hardly ever contains any unusual amount of secretion. Even a uterus with a normally closed os internum is usually very intolerant of internal applications. In these cases I proceed in one of two manners. Before applying any remedies to the inner surface of the uterus I make sure of a wide, open, gaping condition of the inner os by gradual dilatation by means of tupelo tents. This seems to prevent reflex symptoms. Or else I use the remedies in the shape of gelatine bougies or pencils, (without dilatation of the os) which after being introduced into the uterus, dissolve in from one to two

hours, and seem to be better tolerated than liquid applications. But, before introducing them I invariably adopt the following precaution. I tie a piece of stout thread to one end of the bougie, leaving it long enough to reach below the vulva, in such a way that it may be easily withdrawn by the patient herself, if severe pain should follow. When I find a subinvoluted uterus with gaping external and internal os, with flabby walls, I generally also find its inner surface and cavity bathed in some kind of abundant viscid secretion, which varies according to the nature of the uterine disease. In this condition almost any medicinal application, whether in form of ointment, liquid, or solid seems to be well tolerated. Dr. Andeer, in his article on resorcin confirms my experience by saying: "These injections are better tolerated, even if of greater strength, in those cases where there is a copious accumulation of septic secretions in the uterine cavity.

Before closing these remarks I must explain my reference above to the bougie: I hardly ever use the uterine sound. Instead of it I use the common rubber bougie, selecting the number to suit each case. It has great advantage over the sound, in the adaptability in size to the case in hand, and in not being so liable to cause injury. Where there is flexion of the uterus, it is sometimes next to impossible to introduce a sound, its end being caught in the baggy, atonic walls of the uterus. In these cases I take a bougie, withdrawing the wire, and place it for a few moments in hot water. This renders it perfectly pliable, and after its end is once engaged in the inner os, it follows the intrauterine curve without difficulty. When the fundus is reached, a piece of copper wire, with a nicely rounded end (so as not to tear the bougie), and of as large a size as possible, is then passed into the bougie with a slow, rotary motion. By this means the bougie is straightened, and with it the uterus, without any of the friction and abrasions caused by the sound even in the most experienced hands. This method of erecting a flexed uterus I consider far superior to the use of any sound, whether stiff or jointed. It converts a sometimes very difficult operation into an exceedingly simple and easy one, and does away with a great deal of irritation and injury to the uterus-D'ARY.

Translations from French Journals for THE PHYSICIAN AND SURGEON.
BY R. A. PACKWOOD, LES ILES, BERMUDAS, WEST INDIES.

"TRANSMISSION OF RABID VIRUS FROM MAN TO RABBIT."

M. Raynaud communicating the results of experimental researches made, assisted by M. Lanuegue, on the transmission of rabid virus from man to rabbit, concludes on the inoculability of the saliva and the non-inoculability of the blood, these fluids being used from the living subject.

In a second series of experiment inoculations were made with different fluids from the tissues of the cadaver. Negative results followed the use of mucus from the buccal, parotid, and sub-lingual glands; but positive results were obtained by fluids from the submaxillary glands, lymphatic ganglions and

sensitive nervous filaments.

Other inoculations were made from rabbit to rabbit, under the most varied conditions; with fluids from the salivary glands and lymphatic ganglions death ensued.

It remains to be known whether the disease thus communicated was really hydrophobia.

MM. Colin, Dujardin-Baumetz and Pasteur do not think it was. M. Raynaud, himself, favors the same opinion, for he has noticed the absence of the period of excitation, the short duration of incubation and the extreme rapidity of death. He further observes, in some cases, that the inoculated animals recover from the disease after a few days.

M. Colin considers that the disease induced by inoculation was only septicemia. And M. Pasteur observed a different disease from hydrophobia, characterized by the presence, in the blood, of new microscopic organisms.

M. Raynaud attributes the singular differences in incubation and symptoms observed in hydrophobia from man and that from the dog to the inequality in the quantities of inoculated virus.

M. Jules Guérin is of opinion, that hydrophobia like the infectious or virulent diseases may have indefinite forms, which would explain the recovery of some inoculated rabbits. M. Gosselin suggests that to demonstrate whether this is indeed hydrophobia, will be to carry back the disease from rabbit to dog by inoculation-from the diseased 1abbit to the uninfected dog.

M. Bouley took part in some new researches aided by M. Galtier, relative to the preceding; his results are: (1) That the virus in mad dogs is found only under the lingual glands and bucco-pharyngeal mucous. (2) That the virus may be preserved a certain time in the cadaver, or in some surrounding medium. (3) That absorption seems to take place immediately after inoculation; should treatment be resorted to an hour after or less it will not prevent the development of the disease.

M. Pasteur communicated a paper on the new disease induced by the saliva of a child who died from hydrophobia.

Having described the lesions which determined it, namely, swelling of the ganglions on both sides of the trachea, cellular tissue of the kidneys and axilla, which were almost always emphysematous, and having exposed the symptoms of the disease, he studied the character of the microscopic organism, which to him is the indispensable element of this new affection.

It remains to observe the effect of these micrococci when diluted, as has been done in chicken-cholera.

Translations from German Journals for THE PHYSICIAN AND SURGEON.
BY VICTOR C. VAUGHAN M. D.

THE USE OF HYOSCYAMIN IN NERVOUS DISEASES.

The employment of hyoscyamin in neuropathology is nothing new, since it was used as early as the middle of the last century by Stoerk, of Vienna, as a sedative in mania and various nervous diseases. Later, Fothergill and others made the same use of the drug. The alkaloid is now found in com. merce in two forms, crystalline and amorphous. The latter is cheaper and is more effective in action and is especially suitable for subcutaneous use. Sepilli, at the insane asylum at Reggio, employs a one per cent. solution, and gives at a dose from .002 to .01 of a gram. A few minutes after the injection a gradually increasing dilatation of the pupil begins. The pulse loses from twenty to thirty beats per minute, and arterial tension is diminished. The saliva is lessened in quantity and the mucous membrane of the mouth becomes red and dry. Sometimes there is marked tenesmus of the bladder and rectum. Later the patient is quiet, there is slight hesitancy of speech, no diminution of sensation, but slight deafness, and finally aphonia. Reflex activity is heightened, and the countenance may be either anxious or pleasant from illusions and hallucinations. Finally after doses of from 0.008-0.01 gram there is sleep with marked diminution of sensation. After a few hours the graver symptoms disappear and there remain only slight mydriasis with difficulty of accommodation, dryness of the mouth and throat, lessened appetite, constipation and headache. Savage and others in rare instances have observed symptoms of collapse from the drug. Hyoscyamin quickly leaves the body, for the most part, through the kidneys, but in small part, by the bowel. Small doses increase peristaltic movements, while large doses lessen the same.

The alkaloid varies in its manifestations with individual peculiarities, sex (the effect upon women is more rapid, more intense and more lasting), quality of the preparation, dose and method of administration. After continued use, it loses to a great extent its effects. Hyoscyamin evidently influences the heart, but whether through the vagus or sympathetic is not known. It seems at first to excite and then to soothe the vasomotor system. This accounts for the increase in temperature from small, and the diminution from large doses. Hyoscyamin disables the brain and spinal cord. Besides the irritation produced on the nervous centers, it probably produces congestion.

Authors are even more at variance concerning its therapeutical effect and use than over its physiological action. However, all agree that it is sedative and hypnotic. Melancholia agitata is regarded by some as a contraindication to the use of

[ocr errors]
« PreviousContinue »