mary mortality is probably double that of vaginal hysterectomy, and it has not been practiced long enough for permanent conclusions as to the results which may be thus secured. Theoretically it should give better results than vaginal hysterectomy, because the parametria and at least some of the lymphatic glands of the pelvis are removed. In practice this end is not always reached. Aside from theoretical considerations the most encouraging report concerning the operation is the statement of Wertheim, that after two and a half years' experience he has not met with recurrence. Retroversioflexio Uteri and Its Pathological Dignity. S. W. Bandler (Med. Record, vol. 60, no. 13) says: 1. Retroversioflexio per se is not a pathological condition. 2. The majority of retrodeviations are of congenital origin. Retroversioflexio is not an obstacle to the cure of pelvic affec tions. 3. Where retroversioflexio without peritoneal, tubal, or ovarian complications causes symptoms, an hysteroptosis must be taken into consideration, always bearing in mind the possibility of other physical states, especially gastroptosis, enteroptosis, ren mobilis. 4. Prolapsus vagina and cystocele, while often associated with retrodeviations, are independent affections. 5. Where retroversioflexio is accompanied by severe local symptoms, these, if not due to peritoneal, tubal or ovarian complications, may be corrected in the vast majority of cases without surgical treatment. The Treatment of Eclampsia. From October 1st, 1895, to October 1st, 1900, 143 cases of eclampsia came under observation in the Leipsic University Frauenklinik. (Berlin Cor. Med. Press & Cir. vol. 72, no. 3262.) In the same period there were 1902 labors, so that complications occurred in about 2 per cent. of the cases. In Olshausen's Klinik in Berlin there was a case in even 21.6 labors, equal to 4.6 per cent. The treatment consisted in quick but gently emptying of the uterus under an anesthetic. For eclampsia in the after birth period the expectant principle was carried out. Manual removal of the placenta was only practiced in a single case. Dilatation of the cervix was effected either by gradual dilatation by means of elastic bags or by incision, or by both methods combined. The incisions were made by grasping the cervix or edge of the os by two Billroth's pressure forceps and cutting through between them. In this way the cutting is easier to do, and by leaving the forceps on for some little time the bleeding is usually slight. The incisions are not generally sewn up after delivery has taken place. With the fetal head high up and freely movable turning was generally preferred. When it was found that the child was dead either before or during delivery perforation was always effected. If the attacks followed one another very rapidly and no great amount of blood had been lost, venesection was performed. Along with the venesection saline infusions were made. Morphia and warm baths were given in a few cases. No fluids were given to the patient to swallow whilst unconscious, but the fauces were frequently washed out. The treatment described was carried out in all the writer's cases, and it did not fail in any instance. In a large number of them the whole process of delivery was completed within the hour. The author acknowledges that the method has risks of its own, but maintains that such a serious condition as eclampsia justifies a certain amount of risk. The prognosis is much more favorable than in Cæsarean section. As regards maternal mortality he claims that it will compare favorably with that attending any mode of treatment. CLIMATOLOGY AND PHTHISIOLOGY. UNDER CHARGE OF LLEWELLYN P. BARBOUR, M.D., BOULDER, COL. Campbell and Hoagland (Am. Jour. Med. Sciences, November, 1901) give the results of their count of red blood corpuscles at high altitudes, and reach the following conclusions: 1. The blood count increases as we ascend (without exertion) at the rate of 50,000 corpuscles per cubic centimeter of blood per 1000 feet. 2. The pulse rate increases in the same ratio as the blood count, the count rising as the pulse rises, and in like propor tion falling when the pulse rate falls, showing that the heart seeks to overcome the changes brought about by decreased barometric pressure. 3. The increase is not a true multiplication of the blood corpuscles, but is due to a changed vasomotor condition in the peripheral vessels incident to diminished barometric pressure. This condition of vasomotor control of circulation and blood count was demonstrated in the various experiments made, where it is shown that the count can be increased or diminished by any means that will dilate or control the peripheral capillaries. 4. This is further demonstrated by the experiments upon rabbits, which showed the same increase as man, and by the mesenteric count demonstrated that the external capillary count was increased at the expense of the internal abdominal circulation. 5. The increase in blood count disappears and the heart's action returns to the normal when we return to the altitude from whence we started. This is another confirmation of the fact that the increase is a fictitious one, and is due to a diversion of the blood current incident to diminished barometric pressure. 6. The dilation of the external capillaries (skin and lungs) would not alone account for all the increase, but with this dilation we have another effect of diminished barometric pressure, viz., diminished arterial tension. With vessels of an increased caliber and a heart with a diminished force we can plainly see that we will have more or less of a temporary stasis in the dilated capillaries. In the course of time nature seeks to adjust an equilibrium in the economy of those who live at high altitudes. The heart becomes more forcible by the strengthening of its muscles, and the circulation becomes more equitable. Hence the gradual decline in the blood count of those who remain at a high altitude. 7. The want of increase of hemoglobin in proportion to the increase of blood count in ascents is accounted for by the fact that the blood corpuscles, the carriers of hemoglobin, are not increased at once at high altitudes. After remaining some time at a high altitude the true increase in red blood corpuscles takes place, and with it the increase of hemoglobin. Memphis Medical Monthly Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880. Memphis Lancet, established 1898. LYCEUM BUILDING, MEMPHIS, TENN. Subscription Per Annum, One Dollar in Advance. Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR. W. B. ROGERS, M.D. DEPARTMENT EDITORS. A. G. SINCLAIR, M.D. T. J. CROFFORD, M.D. W. D. HAGGARD, M. D., Nashville. B. F. TURNER, M.D THE ST. LOUIS ANTITOXIN CATASTROPHE. A SHORT WHILE ago the lay and medical press throughout the country quickly disseminated the news of the death of a number of children in St. Louis from tetanus caused by the use of impure diphtheria antitoxin. This sad calamity was of course at once seized upon by a few skeptics and advanced as an argument against the serum treatment of disease. Unfortunately it is true that such untoward results do supply a rabid opposition with material for combating the earnest efforts of an almost united medical profession in their attempts. to secure the proper and widespread use of a method of therapy in diphtheria whose efficacy in this disease cannot be questioned by anyone who will devote a short time to the study of statistics, or who has ever had the opportunity to witness the almost miraculous working of antitoxin. Another class of cavilers who secure ammunition for onslaughts upon medical science by such mishaps are the shrieking propagandists who howl against the practice of vaccination. Thinking people, however, will not assume that since in occasional isolated examples bad effects may follow the introduction of impure serum into the blood of patients, that this method on the whole is a failure and should accordingly be generally discarded. Such accidents as occurred in St. Louis cannot be prevented under existing conditions unless more rigorous supervision of the preparation of antitoxin and vaccine virus be instituted. Very few city boards of health are adequately supplied with the means for the proper preparation of antitoxin. Practically every city board of health is subject to political dominion, and it is usually difficult enough to secure sufficient appropriations for the conduct of public charities, such as city hospitals, etc., from the local governing board, to say nothing of the acquirement of the large appropriation that is necessary to equip a biological laboratory for the production of antitoxic serum and vaccine lymph. The environments for such a laboratory must be aseptic beyond question, and in order to secure this condition there must be enforced a most vigorous regimen. Then again there is too little question of responsibility in a public establishment to secure the attention to detail that is necessary in the preparation of these agents. Unless the conduct of these laboratories be under government supervision, it seems to us that we will have to continue to look to the large pharmaceutical houses which have invested considerable sums in the equipment of proper laboratories for turning out aseptic and carefully tested antitoxin and vaccine lymph in order to get an article of unquestioned purity. These establishments are conducted on the highest plane of scientific skill, and since they are corporate bodies with individual responsibility, they certainly will always be alive to the fact that they are in the highest sense responsible for the productions of their laboratories. A SPLENDID MEETING. THE Tri-State Medical Association of Mississippi, Arkansas and Tennessee met in eighteenth annual session in Memphis on November 19, 20 and 21. This meeting was the best attended and most interesting that the Association has ever held, and bore out in every respect the prediction that was made for it some weeks since, as promising to be the very best meeting ever held in the history of the Association. The attendance ranged from three hundred to four hundred physicians, and in a list of fifty-one papers, only six essayists failed to present their contributions to the program. Discussion was free and interesting. |