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discovered, there was no new growth. Thus far the examination was negative. Pressing the abdominal walls well down, I was able to draw the sigmoid flexure into the wound, and found the left ovary cystic and about an inch and a half in diameter, dislocated into the cul de sac of Douglas, and adherent by its posterior surface to the last movable portion of the intestine. The uterus was enlarged and slightly retroverted. I carefully tore through the adhesions of the ovary to the sigmoid with my finger-nail, ligated the bleeding hæmorrhoidal vessels with silk, and approximated the torn edges of the peritonal coat of the bowel with a continuous horse-hair suture; then ligated the ovarian pedicle and the Fallopian tube with twisted silk, and removed them both. The right ovary, on examination, proved to be cystic also, and was removed.

Adherent to the great omentum there was found a colloid body about a half inch in length, similar to those I have seen in cases of ruptured ovarian cysts with colloid contents. This was ligated and clipped off, but was unfortunately mislaid, and the opportunity for a microscopical examination lost.

There was almost no hemorrhage during the operation, and what little blood escaped into the peritoneal cavity was rinsed out with previously boiled hydrant water. After sponging this out the wound was closed, and an impervious antiseptic dressing applied. No suppuration occurred, end the stitches were all removed by the fourteenth day. Convalescence was uninterrupted after the second day, although up to that time persistent bilious vomiting occasioned some anxiety. The bowels were fully evacuated on the fourth day

by the use of saline purgatives, and after that moved naturally and unaided, except by an occasional aloin strychnia and belladonna tablet every day or every second day. One slight attack of constipation lasting four days, occurred six weeks after the operation. Two weeks ago she went alone on a visit to relatives in Cleveland and Toledo, and before starting made two shopping tours in the city. She is still in Ohio, and writes to her husband that her strength does not return rapidly, though her appetite and digestion are good. She makes no mention of the condition of the bowels at present.

I report this case on account of the novel cause of the intestinal obstruction. So long as the bowel contents were perfectly fluid they passed the point of obstruction easily; but once they became of normal consistency, and accumulated in ever so small an amount above this attached obstacle to the last movable portion of the bowel, and the ovary would be pushed down between the promontory of the sacrum and the slightly restroverted uterus. closing the entrance to the rectum very much after much after the manner of a ball valve. The prompt relief following the removal of the ovary is a practical reply to any theoretical objection to the operation.

I wish to state distinctly that this was not a premeditated oophorectomy; had the ovaries been otherwise healthy, I could simply have freed the bowel from them, and perhaps anchored each ovary to its proper broad ligament by a catgut suture, but the peritoneal cavity being already opened, and both ovaries discovered in such a degenerated condition as to be functionally useless and a source of danger if allowed to remain, their

removal was determined upon with as

SUMMER DIARRHEA OF IN

little hesitation as if they had been FANTS.-ITS DIETETIC TREATforeign bodies.

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PHILADELPHIA, August 17, 1888. Dear Sir: Your letter of 16th inst., is received. In the International Encyclopædia of Surgery, vol. vi., p. 74, I have tabulated thirty-seven cases of laparotomy for obstruction of the bowels from tumor, strictures, ulcers, etc., ten of these thirty-seven cases having ended in recovery. I have since added to my list eleven cases, of which five are said to have terminated favorably, so that the figures now stand thus:

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JOHN ASHHURST, JR.

In Dr. W. Gill Wylie's report of seventy-nine laparotomies during the year 1887, there are two cases of partial iutestinal obstruction from "adherent appendages," and one due to chronic. pelvic peritonitis. All of these three cases recovered.

The death rate in Dr. Ashhurst's table is higher than one would expect from such an operation performed antiseptically. This I would explain by supporing that many of the tumors and strictures were malignant in nature, or required resection of a portion of the bowel. In my case only the peritoneal coat of the sigmoid was torn, and this was easily brought together by the continuous horse-hair suture, the operation being otherwise uncomplicated.

MENT.

BY L. N. LOVE, M. D., ST. LOUIS.

Read before the St. Louis Medical Society.

YOUR

OUR executive committee has invited me to present to you my views upon the treatment of the summer diarrhea of children from the standpoint of dietetics.

I am profoundly impressed with the importance of this question, and beg leave to suggest to the members of this society that placed by the side of rare and exceptional surgical wonders, infrequent malignant growths (which probably affect one person in a million but which for positive fewness and pronounced aspect are alluring and attractive to the average medical mind) the summer diarrheas of infants and their proper management, insignificant and puerile though the subject may appear from the standpoint of good to the state, society, humanity and the dearest sentiments of the heart and home is possessed of a gravity incomparable.

The unthinking vulgar herd, imbued with a love for the horrible, the taste that would enjoy a hanging or a morgue, are impressed with the grandeur of a surgical procedure but look upon the handling of "baby diseases" as small and contemptible.

Properly imbued with a love for the little ones and a desire to serve them, the physician who appreciates the value of an undeveloped human life with all its possibilities and carefully applies himself to the saving of the same, giving his best thought, one entering heart and soul into the work, does as good service to mankind as he who ambitiously devotes his time and talent to the heroic extirpation of the vital and

sacred organs of presidents, kings and emperors, affiicted with incureble dis

eases.

The dietetic treatment of alimentary disturbances of children, if applied early enough, would in the majority of instances be all sufficient, and in the exceptional ones occasioned by internal congestions dependent upon sudden chilling of the surfaces, etc., it forms the most important part. In fact in many cases of this character internal medicine cuts a very meagre figure.

Of course it goes without saying that the ideal food for infants is the healthy mothers milk and if this is impossible then some other healthy mother's milk

should be substituted.

But it is often impossible to secure a healthy wet nurse. The supply is not equal to the demand, and often the parent's purse will not permit.

character honeycombed with vice.

The majority of the intestinal irritations of children, whether mild or severe, acute or chronic, are largely occasioned by errors of diet, and can in the majority of cases be favorably affected by a proper selection, administration and denial of food. In many instances the withdrawal of an overplus of food is all sufficient. More babies are stuffed to death than starved.

In the majority of instances an acute indigestion mild or severe, whether occasioned or aggravated by heat or cold, improper or excessive feeding, can be relieved by a judicious starving and the prompt removal from the alimentary tract of the offending indigestible matter by prompt purgation.

Mothers should be informed of the

fact that when the digestion becomes impaired attention to quantity as well as quality of food is important.

The merest tyro in medicine knows that all babies at all seasons need water oftener than food, and particularly in the hot months should they receive an abundant supply of pure water (previously boiled and cooled) and a dimin

Many things besides the stomach and alimentary canal of the little patient are to be considered. It is very well to say to the mother, in securing a wet-nurse remember you are getting a cow for your child and do not expect too much from her if she be healthy and furnish good milk; but the parent and the phy-ished quantity of food. I cite a case to sician like Desdemona have a divided duty a duty to the family as well as the little sufferer. It were better that the babe run the gauntlet of artificial feeding than that the home and the other little ones suffer pollution by association with a "healthy human cow" that is at the same time a moral leper. As well admit to the home as food supplier a case of virulent variola, marked syphilis or incipient tuberculosis, or an artificial food reeking and saturated with Vaughn's tyrotoxicon as a wet nurse with physique superbly perfect and constitution correct and complete but a

which I was called this morning at daylight, as illustration. Eddie C., aged six months, a bottle baby, healthy when born, and well nourished until six days. ago a diarrhea developed, which became aggravated as each day passed until during last night the operations became almost continuous, enormously large, thin and watery, accompanied with vomiting. I found the child pinched and shriveled, almost in a state of complete collapse, extremities cold and blue, the weight having been apparently diminished fully one-half in a few hours; the pulse hardly appreciable and yet a

nursing bottle with a long rubber tube attached, in the infant's mouth. A few moments after my visit the child vomited a large quantity of the food which had just been taken.

I explained to the mother that it was fortunate that the child had sufficient strength left to reject the food for which its stomach was so ill-fitted-threw away the rubber tube attached to the bottle and prohibited all food, directed the administration of cooling drinks, pure water, external stimulation and warmth and infinitesimal doses of the mild chloride upon the tongue for its sedative effect as well as its anti-fermentative, and gave hypodermically 1-100 gr. morphine and 1-300 gr. atropia. In a few hours I found the child much better. The important thing done was the removal of all food and free stimulation.

As a substitute for a wet nurse, in my judgment cow's milk in its purity or modified in a manner to prevent the formation of hard and tenacious curds stands first upon the list.

The one great difficulty in the way of using cow's milk as a diet for infants, particularly in cities, is the troublesomeness of securing it fresh from the We are all familiar with the fact that no article of diet so promptly absorbs the impurieties around it as milk, and so readily undergoes fermentative and putrefactive changes.

Cow.

The investigations of Victor C. Vaughn of Ann Arbor, Michigan, in establishing an organic poison. or ptomaine the product of fermented milk as being the cause of many of the bowel troubles of children was an important step forward in the management of these troubles. Recognizing

the presence in the alimentary canal of this chemical poison, the necessity for aiding its elimination and antidoting it was clear, and as a preventive of its development, it soon became apparent that severe sterilization of the milk, the complete antisepsis, cleanliness, was of prime importance.

At the late meeting of the American Medical Association at Cincinnati, May 5, 1888, in the pediatric section, an entire day was given to the discussion of infant feeding. Many of the ablest workers in the department of diseases of children in America and England contributed to the interest of the occasion,

Dr. G. Wheeler Jones of Danville, Ill., one of the ablest writers and clearest thinkers of his state, gave evidence that to him artificial feeding had no terrors. He had no hesitation in removing a child from the breast and at once putting it to the bottle. His favorite food was cow's milk, the cow well fed and cared for, the attendant impressed with the importance of the fact that cleanliness was godliness in this connection. As an evidence of the fact that the sterilization of the milk was of the primest importance, he stated that he had never failed to find a child do well when taken to the barnyard with his bottle and the lacteal fluid milked directly from the cow into the same and promptly taken by the child. This testimony and experience is valuable where the conditions will permit of its application, but in the majority of cases under the care of doctors in large cities the idea is not feasible, and yet it emphasizes an important point to us, the value of sterilizing the milk.

In acute disturbances the withdrawal

In the selection of a diet for infants we must meet two demands, a temporary and a permanent one.

of all milk diet is frequently necessary. Raw meat finely chopped has been strongly recommended by some, and I have frequently found in years past, an In acute indigestion the absolute advantage in it, but the danger of tape-withdrawal of all food for a time is freworm is pronounced.

The accomplishments of the chemist in his laboratory aided and abetted by capital in these latter years has furnished us with many foods as substitutes for milk that are of great value, and I feel that the profession and the public are under great obligation to them for their work.

What could the profound, patient and poverty-stricken physiologist do in the direction of developing food possibilities without the aid of money.

While advising the severest scrutiny upon the part of the medical adviser in the application of these commercial foods I would also advise religious regard for the interests involved and the importance of careful conscientious personal investigation upon the part of the delver in this field of work.

Professional prejudice has no right to place itself in the way of a patient's good, whether it be a question of physic or pabulum.

The proof of the pudding is the eating of it, and if my child be saved by a food presented to me for purchase by a commercial firm or an honest son of toil from the rural districts I care not.

The laborer in medicine and science can no more dissever himself from capital, if he would accomplish his greatest good, than the horny handed worker of factory or farmer. Whether then it be the field of dietitics or pharmacy, we should acknowledge our obligation, cease to indulge in the sentimental rot of objecting to food of physic because some proprietor's pocket is the gainer.

quently demanded, and to tide over well received, easily digested, nonpresent dangers a substitute which is irritating unfermentative is indicated. In these conditions it often becomes

necessary to withhold the cow's milk, and where in years gone by I gave raw meat, I now give Bovinine, (a peptonized fluid extract of raw beef combined with pure egg albumen) in doses ranging from ten drops to a teaspoonful properly diluted every two hours.

If the requirements demand, I sometimes add a few drops of cognac or blackberry brandy.

Occasionally the use of pure egg albumen in water (white of an egg to half-pint of water) gently mingled without beating to a froth will serve a good purpose.

For temporary use in acute or even chronic disturbances, I have found condensed milk more or less diluted as the requirements demand serve me well, but only for temporary use would I recommend condensed milk, as, if used as a long continued food, though it may agree with and apparently well nourish the child it is deceptive. It fattens but does not build up muscle, bone and nerve. After ten year's observation of and preference for condensed milk in the majority of cases, I eight years ago came to the conclusion that children long fed on condensed milk were fat but not solid. Adipose abounded, but at a later period the little ones became flabby-muscled, weak-boned, neurotic and prone to gastro-intestinal indiges

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