A new medical journal is to be published shortly in Paris, under Professor Grancher's direction. It will be called the Univers Medical, and the editor proposes to devote a much larger to foreign news than is usually given in French papers. An elaborate system of experiments has established the fact that no milk below 1029 specific gravity can come from cows in a state of health. Any milk which falls below this standard is either diluted or unhealthy, or is the product of cows in an advanced state of pregnancy, in which condition the milk is unfit for human consumption.-Ex. The average weekly circulation of the Britisk Medical Journal has now risen to 14,000, a number which is not only enormously in excess of that of any other medical journal in the country, but will be found on investigation to be considerably in excess of the combined circulation of the whole of the other medical journals in Great Britain.-British Medical Journal. The American Orthopedic Association, recently organized, held its first annual meeting in New York City on June 15th and 16th, Dr. V. P. Gibney, of New York, acting as temporary chairman. The attendance was good and a number of papers were read. The following officers were elected for the ensuing year: President, Dr. N. M. Shaffer, of New York, Vice-Presidents, Drs. A. Sydney Roberts, of Philadelphia, and E. H. Bradford of Boston; Secretary and Treasurer, Dr. L. H. Sayre of New York. The following is related by the Medical Record. Dr. W. J. Cruikshank recovered a $1,600 verdict, in his suit for $50,000 damages, against William Gordon, the trial for which was brought in the Supreme Court in Brooklyn, N. Y. The doctor asserted that Mr. Gordon went to the mother of a child he was at tending, and urged her to secure another physician without delay, as, in his opinion, Dr. Cruikshank had not the skill necessary to attend a sick dog. There are few physicians who do not suffer at times from the class of meddlers to whom Gordon belongs. If a few more of these people were held to account there would be less interference with the work of the physician. Académie de Médecine the results of his treatDr. Pécholier recently communicated to the ment of typhoid fever with quinine and lukewarm baths. He used this method with success in sixty-five cases. According to Dr. Pécholier, the treatment is not only curative, but abortive; it shortens the duration of the illness. M. Dujardin-Beaumetz, having been The Alumni Association of the College of commissioned by the Académie to report upon Physicians and Surgeons of New York offer a the method, said it erred in being too syste prize of five hundred dollars, open for compe-matic. Typhoid fever should be treated in tition to the Alumni of the school, for the best essay upon any medical subject which may be submitted to the committee. Dr. R. J. Levis, of Philadelphia, a wellknown and distinguished surgeon, has announced his retirement from active professional work. A number of Dr. Levis' professional friends gave a reception in his honor at the Hotel Bellevue, Philadelphia, June 23rd, 1887. different ways, according to the great variety of complications that may occur in the course of the disease. Cold baths, calomel and large doses of carbolic acid had been prescribed as certain remedies; but all these were attended with certain risks. M. Pécholier's treatment was employed at the first appearance of febrile symptoms. It could not, therefore, be considered certain that the sixty-five cases said to have been cured were cases of genuine typhoid fever.-Brit. Med. Jour. Original Articles. THE RELATION OF PYOSALPINX BY J. M. BALDY, M.D., OF PHILADELPHIA Schröder held that septic endometritis of the uterus did not extend to the tubes, as a rule; but he qualified this opinion by following it up closely with the remark that occasionally the endometritis did go on to a purulent salpingitis. Nor is Sänger silent on this subUntil within a few years the term fect, for he has only recently stated in a "Puerperal Fever" has been applied to letter read before the Chicago Gynecocertain conditions of the parturient logical Society, in answer to one from woman without conveying any definite Mr. Tait, "that salpingitis septica, coidea as to the exact pathological lesion existing with severe puerperal septicainvolved. As in microscopy we desig- mia has never as yet given the surgeon nate everything that we are unable to an opportunity to remove the principal recognize by the general term "molecu- focus of disease by extirpation of the lar débris," so in the parturient woman tubes. It is possible, however, that unwe have been in the habit of applying der certain circumstances such a prothe meaningless term "Puerperal Fever" cedure might be indicated." Even beto a set of symptoms, the origin and fore these words of Sänger's were in source of which we knew not. As usual in such a condition of ignorance, principal focus, and, I may say, in this print the opportunity to remove the an innumerable number of theories case the only focus, of disease, had ocsprang up on the subject-the most curred and been taken advantage of by widely accepted of which was probably the surgeon, as witness the following that advocated by Fordyce Barker, viz., case: that it is a specific febrile disease. woman. Thanks to the zeal of bacteriologists, was delivered of a male child after a Mamie P., twenty-three years of age, we have now conquered our ignorance tedious but normal labor, some four and can state without hesitation or fear of successful contradiction that the dis- fined to her bed for eight weeks with years ago. She was at that time conease under discussion is of undoubted "an inflammation of the stomach." She, septic origin. We are therefore justi- however, made a good recovery, and has fied in dropping the ambiguous term of never suffered from a pain or ache in her the darker ages and applying terms abdomen since-she has, in fact, conmore in accordance with our advanced sidered herself a typically healthy knowledge of the pathological lesion. I have no intention of entering into an to attend her in her second labor. AlOn February 3rd, I was called exhaustive discussion of all the phases though going with the messenger I of puerperal septicemia, but shall briefly found the labor over--a dead child totry to add something to our knowledge gether with the placenta, with all its of the particular subdivision which, for membranes intact, lying between her want of a better name, I shall call puer- thighs. Her bare arms, chest, and legs peral pyosalpinx. The belief that a certain portion of No examination was made, but she was were exposed in a room without a fire. our so-called puerperal fever cases are put between warm, dry bedclothes as simply cases of salpingitis septica is by quickly as possible. On the second or no means a new one, nor is it original third day she had a chill, with quick with myself. Martin, in a recent inves-rise of pulse and temperature, a tymtigation, has found the microorganisms panitic and tender abdomen. These of puerperal septicemia in as many as symptoms abated somewhat, and I lost seventy out of a series of two hundred sight of her for several weeks. On the and eighty-seven cases of inflammatory third of March, just one month from the date of her confinement, I was again summoned to her and found that she tubal trouble. Read before the Philadelphia County Medical So- had been suffering ever since I had last ciety June 22, 1887, seen her; she was at this time so emaci- within twelve hours, and remained so ated that I hardly recognized her as my until about the seventh day, when the former patient. Her temperature was drainage tube was removed. Up to this over 102, her pulse over 130; she was time she had done as well as possible having continued chills and creeps, hectic, under the circumstances. There had night sweats, and sleepless nights; her been little or no pain, no catheter used, abdomen was swollen and tampanitic, bowels opened naturally; no drugs of and intensely painful; her bowels were any kind had been administered. The loose and fetid; micturition and defeca- day after removal of the tube her pulse tion were both painful-she was evi- began to rise, as also did her temperadently fast approaching death. An ex- ture; pain developed in her left ovarian amination of the soft parts showed no region, and she began to have hectic and signs of a recent tear; the uterus was cold creeps. About the eleventh day subinvoluted, and on the left side there there was a free gush of pus from the was a large boggy mass, firmly adherent, tube tract and she began to improve tortuous, and extremely tender. The again from that moment. A rubber right side was tender, but no mass could tube was inserted and passed deep down be detected. Abdominal section was into the pelvis and the abscess was advised as the only remaining hope of washed out twice daily. The discharge saving life, and the proposition was gradually diminished and the tube was eagerly accepted by both herself and again removed. The wound is now friends. completely healed and the patient is a well woman. Dr. Joseph Price saw the case with me and confirmed my opinion of imThat these cases exist much more mediate operation. I operated on the frequently than we have any idea is cerfifth of March (the delay being neces- tain, and that oftentimes a life, othersary in order to have her surroundings wise doomed, can be saved by operative cleansed); Dr. Price, of Philadelphia, interference is but a natural conclusion. Dr. McMurtrie, of Danville, Ky., and Mr. Tait mentions four deaths from this Mr. Eckman, of Scranton, Pa., being cause in Queen Charlotte's Hospital, as present and assisting. The right tube verified by post-mortem examinations, and ovary were not removed. The left and says that "these cases during life tube was found almost as large as the were all regarded as puerperal fever." uterus and firmly adherent in all direc- Sänger comes forward with two cases tions, especially to the bowel, from which have come to his knowledge in which it was separated with the utmost which the overdistended tubes burst and difficulty. An abscess of the cellular discharged pus into the abdominal cavity, tissue was ruptured while breaking up with death on the fourth day after conthe adhesions, and pus welled up through finement in one case, and on the twentythe abdominal incision. Both tube and first day in the second case. Who can Ovary were removed. A large cheesy doubt that, in the light of our present mass on the bowel at the point of ad-surgical knowledge, if these cases had hesion was trimmed down with scissors been recognized and operated on, the and an application of Monsel's solution women would have all survived? The made to the bleeding points. After a day has passed, I hope, in which we free irrigation a drainage tube was put will allow a woman to die of pus in her in and the incision, which was only one abdomen without at least proposing an and a half inches in length, was closed abdominal section, not merely as a last with three deep silk sutures. resort, but as an early means of relief On examination the tube was found and safety. It is by no means to be to be distended with pus; the ovary was held that because a parturient woman broken down and contained pus. The has an inflammation of her tubes, she is patient rallied quickly from the ether to be rashly submitted to the knife of and had no shock. Her pulse fell to 80 the surgeon. I have, within the past and her temperature to almost normal few months, seen a woman who pre sented an elevated temperature, with quired. I think where pus is found that anorexia, restless nights, and other gen- both sides should be removed always, eral symptoms, and whose tubes, on ex- whether one side is apparently healthy amination, I found enlarged and painful. or not, the patient being willing, of Under careful treatment this local course. trouble all subsided, and with it the Whether or not this disease arises de general symptoms disappeared and the novo, or, having already existed from patient made a satisfactory recovery. other causes, has simply a new inflamThese mild cases, however, often go on mation added by the puerperal condito a chronic condition, when unrecog- tion, must be determined by careful invesnized and neglected, and the woman tigation in each case. Hecker, as early eventually falls into the surgeon's hands as 1878, mentions two cases in which an to be relieved of a pus-tube, and then old pyosalpinx was lit up by the puergenerally gets the credit of having had peral state, and Sänger adds another a gonorrhoea at some period of her life, or some other disease puts an end to her suffering. The following case fairly illustrates this: from his own practice in which the salpingitis had a prior existence. In the case of Mamie P., the patient was apparently perfectly well up to the time of Maggie F., thirty-one years old, mar- her last confinement, but the adhesions ried thirteen years, has had one mis- were of such a firm character that it is carriage and five children. Had always safe to presume that there was an old had good health until her last confine- inflammatory trouble prior to this time. ment, six or seven years ago. At this At her first confinement she had "an intime she had a slow and tedious "get flammation in her stomach," and that up. Her physician told her she had was the probable beginning of her "an inflammation in her stomach." She trouble. She undoubtedly has had tubal was confined to bed for several months. disease ever since (probably pyosalpinx) She has never been well since that time; and has not suffered enough inconvenihas been constantly losing flesh, suffered ence from it to seek advice. This is from pain, and has generally felt wretch- often the history of these women; they ed, not able to work half the time. I complain of pain and general ill-health, was called to attend her on the 31st of loss of flesh, anorexia, and sleepless March last, and found her suffering with peritonitis, of which she had been getting gradually worse for the past three or four weeks. An examination disclosed a pyosalpinx firmly bound down and extremely tender. I made an abdominal incision and removed a large and densely adherent tube and ovary, both filled with pus, from the right side. Recovery was uninterrupted, and she has been relieved not only from her peritonitis but from all her old sufferings. The last time I saw her she told me she was feeling more and more like herself, and was fast regaining her former weight. nights, etc., but oftentimes they do not even suspect the real origin of all their trouble. The result in the case of this particular patient is a valuable lesson of the dangers of such a neglect, and is an additional reason why the disease should always be removed when recognized. Of course, the possible contagion of gonorrhoea can never be eliminated excepting by a microscopical examination. In both my cases, although the trouble seemed very clearly to have arisen at the time of confinement, yet the chances of gonorrhoeal infection both before and after pregnancy are not to be denied; however, in lieu of a microscopical exThe only regret I have in either of amination, the chances are all in favor these cases is that I did not remove both of a purely puerperal origin. But whatappendages. The case Mamie P., has ever the source, the results are the same, recently had an inflammatory attack in and it is only by prompt measures we the remaining tube, from which she has may hope to save some of these cases. recovered, but I am afraid the time will It is no longer surprising that even uncome when another operation will be re-der the most careful antiseptic treatment of the uterus, vagina, and person of the patient as well as the person of the at Selected Article. BLADDER, RECENTLY RE- tendants that still patients are lost from TWO CASES OF TUMOR OF THE septic poison. This disease has been recognized and operated on at least four times in Philadelphia; one case operated on just two weeks previous to mine, by Dr. Longaker, in which a was REMARKS.* pyosalpinx was removed, the patient BY SIR HENRY THOMPSON, F.R.C.S., M.B. LON. Surgeon Extraordinary to H.M. the King of the dying on the second day. I may state here that this operation was delayed three or four days after an abdominal section had been urged. Dr. Joseph These two cases so well illustrate cerPrice has since operated twice, and in one case found more than a quart of pus the bladder, that it may be useful tain conditions met with in papilloma of in the abdominal cavity; the case, unfortunately, came into his hands too to place them late and the patient survived only two record. Each was brought to me by my friend, Mr. O. C. Maurice, of Reading, days. who was present at both operations. thus distinctly on two or three weeks. Little or no undue frequency in micturition, and very little pain are experienced. These cases, though few in number, certainly teach us that the work done 1. A gentleman, aged 62. April 22nd, in this direction is encouraging, and al- 1887, I saw him for the first time. One though a large percentage of the patients year and a half ago, he first saw blood have died, it only warns us of the ex-in his urine; he then passed a long intreme importance of an early diagnosis terval without seeing any; lately a and prompt surgical interference. It rather free bleeding has occurred every becomes our imperative duty in every case of post-puerperal trouble to make a thorough investigation on the appearExamined rectum: no enlarged prosance of the first symptoms, and should a fulness be found on either or both sides tate, bladder soft and yielding; no of the uterus, accompanied with pain on marked feature to be noted. Sounded: touch and with constitutional symptoms nothing felt. I then washed out the of gravity, there should be no hesita- bladder to obtain débris, and observ tion as to the course to pursue. This ing a single shred of filmy semi-gelatinbeing secured, our present high mortality ous matter in the fluid, I put it under of one woman out of every hundred de- the microscope. It was a perfect specilivered in large cities, as recently men of papilloma; the central axis with stated in a statistical paper on lying-in its vessels, with columnar epithelium charities in the United States, must be radiating therefrom around the extremity very largely diminished and the fatal and on each side. Mr. Maurice saw it results now surrounding our parturient with ine, and recognised its exact corwomen must become infinitely less. respondence with the THE BUREAU OF GENERAL INFORMA-inquiry, and advised operation without THE BUREAU OF GENERAL INFORMA- needless delay. The patient is very TION, WASHINGTON, D. C.-Physicians stout, his perineum, almost concealed and others who desire to obtain informa- between the nates, was inaccessible for tion and references from the library of the Surgeon-General's office, or from any purpose of operation by that route. the Surgeon-General's office, or from I advised, therefore, the suprapubic any other sources in Washington, will find it to their advantage to communi-operation; great obesity adding less to cate with the Manager of this Bureau, the perineal route, where the task of rethe difficulty above the pubes than by Joseph B. Marvin, P. O. Lock Box 379, Washington, D. Ć. *From Brit. Med. Journal. |