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discovered, there was no new growth. by the use of saline purgatives, and after Thus far the examination was negative. that moved naturally and unaided, ex

Pressing the abdominal walls well cept by an occasional aloin strychnia down, I was able to draw the sigmoid and belladonna tablet every day or every flexure into the wound, and found the second day. One slight attack of conleft ovary cystic and about an inch and stipation lasting four days, occurred a half in diameter, dislocated into the six weeks after the operation. Two cul de sac of Douglas, and adherent by weeks ago she went alone on a visit to its posterior surface to the last movable relatives in Cleveland and Toledo, and portion of the intestine. The uterus before starting made two shopping was enlarged and slightly retroverted. tours in the city. She is still in Ohio, I carefully tore through the adhesions and writes to her husband that of the ovary to the sigmoid with my her strength does not return rapidly, finger-nail, ligated the bleeding hæmor- though her appetite and digestion are rhoidal vessels with silk, and approxi- good. She makes no mention of the mated the torn edges of the peritonal condition of the bowels at present. coat of the bowel with a continuous I report this case on account of the horse-hair suture; then ligated the novel cause of the intestinal obstrucovarian pedicle and the Fallopian tube tion. So long as the bowel contents with twisted silk, and removed them were perfectly fluid they passed the both. The right ovary, on examination, point of obstruction easily; but once proved to be cystic also, and was remov- they became of normal consistency, and ed. Adherent to the great omentum accumulated in ever so small an amount there was found a colloid body about a above this attached obstacle to the last half inch in length, similar to those I movable portion of the bowel, and the have seen in cases of ruptured ovarian ovary would be pushed down between cysts with colloid contents.

the promontory of the sacrum and the ligated and clipped off, but was unfor- slightly restroverted uterus. closing the tunately mislaid, and the opportunity entrance to the rectum very much after for a microscopical examination lost. much after the manner of a ball valve.

There was almost no hæmorrhage dur- The prompt relief following the removal ing the operation, and what little blood of the ovary is a practical reply to any escaped into the peritoneal cavity was

theoretical objection to the operation. rinsed out with previously boiled hyd- I wish to state distinctly that this was rant water. After sponging this out not a premeditated oophorectomy; had the wound was closed, and an impervi- the ovaries been otherwise healthy, I ous antiseptic dressing applied. No could simply have freed the bowel from suppuration occurred, end the stitches them, and perhaps anchored each ovary were all removed by the fourteenth to its proper broad ligament by a catgut day. Convalescence was uninterrupted i suture, but the peritoneal cavity being after the second day, although up to already opened, and both ovaries disthat time persistent bilious vomiting oc- covered in such a degenerated condition casioned some anxiety. The bowels as to be functionally useless and a source were fully evacuated on the fourth day of danger if allowed to remain, their

This was

YOUR executive committee has in



removal was determined upon with as

SUMMER DIARRHEA OF IN little hesitation as if they had been

FANTS.-ITS DIETETIC TREAT. foreign bodies.


Read before the St. Louis Medical Society. In reply to an interrogation, Dr. John

OUR executive committee has inAshhurst, Jr., has kindly given me the following statement of similar recorded

vited me to present to you my views upon the treatment of the summer

diarrhea of children from the standPHILADELPHIA, August 17, 1888, Dear Sir: Your letter of 16th inst., is point of dietetics. received. In the International Encyclo

I am profoundly impressed with the pædia of Surgery, vol. vi., p. 74, I have importance of this question, and beg tabulated thirty-seven cases of laparo leave to suggest to the members of this tomy for obstruction of the bowels from society that placed by the side of rare tumor, strictures, ulcers, etc., ten of and exceptional surgical wonders, inthese thirty-seven cases having ended frequent malignant growths (which in recovery. I have since added to my probably affect one person in a million list eleven cases, of which five are said to have terminated favorably, so that nounced aspect are alluring and attrac

but which for positive fewness and prothe figures now stand thus: Recovered

tive to the average medical mind) the

15 Died

summer diarrheas of infants and their

30 Undetermined

proper management, insignificant and

puerile though the subject may appear Total

48 from the standpoint of good to the state, Very truly and respectfully, society, humanity and the dearest sen

Joux AsHHURST, Jr. timents of the heart and home is possesIn Dr. W. Gill Wylie's report of sed of a gravity incomparable. seventy-nine laparotomies during the The unthinking vulgar herd, imbued year 1887, there are two cases of partial with a love for the horrible, the taste intestinal obstruction from “adherent that would enjoy a hanging or a morgue, appendages," and one due to chronic are impressed with the grandeur of a pelvic peritonitis. All of these three surgical procedure but look upon the cases recovered.

handling of "baby diseases" as small and The death rate in Dr. Ashhurst's contemptible. table is higher than one would expect Properly imbued with a love for the from such an operation performed little ones and a desire to serve them, antiseptically. This I would explain by the physician who appreciates the value supporing that many of the tumors and of an undeveloped human life with all strictures were malignant in nature, or its possibilities and carefully applies required resection of a portion of the himself to the saving of the same, givbowel. In my case only the peritoneal ing his best thought, one entering heart coat of the sigmoid was torn, and this and soul into the work, does as good was easily brought together by the con service to mankind as he who ambitioustinuous horse-hair suture, the operation ly devotes his time and talent to the being otherwise uncomplicated. heroic extirpation of the vital and sacred organs of presidents, kings and character honeycombed with vice. emperors, affiicted with incureble dis

The majority of the intestinal irritaeases.

tions of children, whether mild or The dietetic treatment of alimentary severe, acute or chronic, are largely disturbances of children, if applied occasioned by errors of diet, and can in early enough, would in the majority of the majority of cases be favorably afinstances be all sufficient, and in the fected by a proper selection, administraexceptional ones occasioned by internal tion and denial of food. In many incongestions dependent upon sudden

sudden stances the withdrawal of an overplus of chilling of the surfaces, etc., it forms food is all sufficient. More babies are the most important part. In fact in stuffed to death than starved. many cases of this character internal In the majority of instances an acute medicine cuts a very meagre figure. indigestion mild or severe, whether oc

Of course it goes without saying that casioned or aggravated by heat or cold, the ideal food for infants is the healthy improper or excessive feeding, can be mothers milk and if this is impossible relieved by a judicious starving and the then some other healthy mother's milk prompt removal from the alimentary should be substituted.

tract of the offending indigestible matBut it is often impossible to secure a ter by prompt purgation. healthy wet nurse. The supply is not Mothers should be informed of the equal to the demand, and often the fact that when the digestion becomes parent's purse will not permit.

impaired attention to quantity as well Many things besides the stomach and as quality of food is important. alimentary canal of the little patient are

The merest tyro in medicine knows to be considered. It is

very well to say that all babies at all seasons need water to the mother, in securing a wet-nurse oftener than food, and particularly in remember you are getting a cow for the hot months should they receive an your child and do not expect too much abundant supply of pure water (previfrom her if she be healthy and furnish ously boiled and cooled) and a dimingood milk; but the parent and the phy- ished quantity of food. I cite a case to sician like Desdemona have a divided which I was called this morning at dayduty-a duty to the family as well as light, as illustration. Eddie C., aged the little sufferer. It were better that six months, a bottle baby, healthy when the babe run the gauntlet of artificial born, and well nourished until six days feeding than that the home and the other ago a diarrhea developed, which became little ones suffer pollution by association aggravated as each day passed until with a “healthy human cow” that is at during last night the operations became the same time a moral leper. As well almost continuous, enormously large, admit to the home as food supplier a

thin and watery, accompanied with case of virulent variola, marked syphilis vomiting. I found the child pinched or incipient tuberculosis, or an artificial and shriveled, almost in a state of comfood reeking and saturated with

plete collapse, extremities cold and Vaughn's tyrotoxicon as a wet nurse blue, the weight having been apparently with physique superbly perfect and con- diminished fully one-half in a few hours; stitution correct and complete but a the pulse hardly appreciable and yet a


w At the late meeting of the American

nursing bottle with a long rubber tube the presence in the alimentary canal of attached, in the infant's mouth. A few this chemical poison, the necessity for moments after my visit the child vom- aiding its elimination and antidoting it ited a large quantity of the food which was clear, and as a preventive of its dehad just been taken.

velopment, it soon became apparent I explained to the mother that it was that severe sterilization of the milk, the fortunate that the child had sufficient complete antisepsis, cleanliness, was of strength left to reject the food for which prime importance. its stomach so ill-fitted—threw away the rubber tube attached to the Medical Association at Cincinnati, May bottle and prohibited all food, directed 5, 1888, in the pediatric section, an enthe administration of cooling drinks, tire day was given to the discussion of pure water, external stimulation and infant feeding. Many of the ablest warmth and infinitesimal doses of the workers in the department of diseases mild chloride upon the tongue for its of children in America and England sedative effect as well as its anti-fermen- contributed to the interest of the occatative, and gave hypodermically 1-100 sion, gr, morphine and 1-300 gr. atropia. In Dr. G. Wheeler Jones of Danville, a few hours I found the child much 11., one of the ablest writers and clearbetter. The important thing done was est thinkers of his state, gave evidence the removal of all food and free stimu- that to him artificial feeding had no lation.

terrors. He had no hesitation in removAs a substitute for a wet nurse, in ing a child from the breast and at once my judgment cow's milk in its purity or putting it to the bottle. His favorite modified in a manner to prevent the food was cow's milk, the cow well fed formation of hard and tenacious curds and cared for, the attendant impressed stands first upon the list.

with the importance of the fact that The one great difficulty in the way of cleanliness was godliness in this conusing cow's milk as a diet for infants, nection. As an evidence of the fact particularly in cities, is the trouble. that the sterilization of the milk was of someness of securing it fresh from the the primest importance, he stated that

We are all familiar with the fact he had never failed to find a child do that po article of diet so promptly ab- well when taken to the baroyard with sorbs the impurieties around it as milk, his bottle and the lacteal fluid milked and so readily undergoes fermentative directly from the cow into the same and and putrefactive changes.

promptly taken by the child. This The investigations of Victor c. testimony and experience is valuable Vaughn of Ann Arbor, Michigan, in where the conditions will permit of its establishing an organic poison or application, but in the majority of cases ptomaine the product of fermented milk under the care of doctors in large cities as being the cause of many of the the idea is not feasible, and yet it embowel troubles of children was an im- phasizes an important point to us, the portant step forward in the manage value of sterilizing the milk. ment of these troubles. Recognizing In acute disturbances the withdrawal


of all milk diet is frequently necessary. In the selection of a diet for infants Raw meat finely chopped has been we must meet two demands, a temporstrongly recommended by some, and I ary and a permanent one. 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 quently demanded, and to tide over in bis laboratory aided and abetted by well received, easily digested, non

present dangers a substitute which is capital in these latter years has furnish

irritating unfermentative is indicated. ed us with many foods as substitutes

In these conditions it often becomes for milk that are of great value, and I feel that the profession and the public necessary to withhold the cow's milk,

and where in years gone by I gave raw are under great obligation to them for their work.

meat, I now give Bovinine, (a peptonWhat could the profound, patientized fluid extract of raw beef combined and poverty-stricken physiologist do in with pure egg albumen) in doses rangthe direction of developing food pos- ing from ten drops to a teaspoonful sibilities without the aid of money.

properly diluted every two hours. While advising the severest scrutiny. If the requirements demand, I someupon the part of the medical adviser in times add a few drops of cognac or the application of these commercial blackberry brandy. foods I would also advise religious

Occasionally the use of pure egg regard for the interests involved and albumen in water (white of an egg to the importance of careful conscientious half-pint of water) gently mingled with. personal investigation upon the part of out beating to a froth will serve a good the delver in this field of work.

purpose. Professional prejudice has no right to For temporary use in acute or even place itself in the way of a patient's chronic disturbances, I have found congood, whether it be a question of physic densed milk more or less diluted as the or pabulum.

requirements demand serve me well, The proof of the pudding is the eat- but only for temporary use would I reing of it, and if my child be saved by a commend condensed milk, as, if used as food presented to me for purchase by a a long continued food, though it may commercial firm or an honest son of agree with and apparently well nourish toil from the rural districts I care not. the child it is deceptive. It fattens but

The laborer in medicine and science does not build up muscle, bone and can no more dissever himself from capi- nerve. After ten year's observation of tal, if he would accomplish his greatest and preference for condensed milk in good, than the horny handed worker of the majority of cases, I eight years ago factory or farmer. Whether then it be

came to the conclusion that children the field of dietitics or pharmacy, we long fed on condensed milk were fat should acknowledge our obligation, but not solid. Adipose abounded, but cease to indulge in the sentimental rot at a later period the little ones became of objecting to food of physic because fabby-muscled, weak-boned, neurotic some proprietor's pocket is the gainer. and prone to gastro-intestinal indiges

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