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ment, the trunk in the contracted and does a clear idea as to the pathological retracted portion above.
condition I was called to deal with ; “This band or constriction was as firm with his advice also about Cesarean secand resistant as a rope of steel. I could tion being the only proper proceeding with the most determined effort force in such cases, I very much doubt if I the points of one or two of the fingers would have ventured to call to my aid between this and the neck, but for a the strong arms and powerful grasp of time no farther. I certainly never had the woman's miner husband, and events felt anything like it before, but recog- might not have turned out as well for nized the condition called by that emi. the mother and child. nent authority, R. P. Harris, Philadel With regard to this “rope of steel,” phia, 'Tetanoid falciform contraction of “ring of Bandl,” “ tetanoid falciform the uterus,' and by Dr. Hosmer and contraction," "ante-partum hour-glass Dr. Thomas C. Smith of Washington, contraction," there seems to be as much D. C., 'Ante-partum hour-glass con diversity of opinion as to its location as traction of the uterus,' in the latter's there is to its cause. It is claimed by valuable résumé of these cases in the some to be a constriction at the internal American Journal of Obstetrics, volume os, while others contend that it is a te. XV, November, 1882.
tanoid contraction of a band of the or. "I, for a time, feared I would be foiled, bicular muscular structure higher up. but after a most determined effort, I fi My own experience in the few cases of nally succeeded in passing it and ulti hour-glass contraction that have come mately reaching the foot. Still the re to me lead me to adopt the latter view. sistance did not entirely yield, and it It does not seem probable that such was only after further powerful and per. powerful and long-continued contraction sistent efforts that the constriction could be maintained except when the yielded and I was enabled to turn and muscle is better developed than at the extract. I am convinced that I could internal os. not, without injury, have succeeded dur. The difficulty of making even an aping life.”
proximate diagnosis in this very rare acSuch is Dr. Miltenberger's account cident is and must ever be very great, for of this “rope of steel," a condition there is no condition that would indicate which he “ had never felt anything its existence before a determined effort like it before." As his experience at extraction was made. Dr. Miltenextends over a period of nearly fifty berger speaks of the “precious results of years, surely this falciform constriction systematic external exploration by palmust be extremely rare. In none of the pation" in determining beforehand the systematic treatises on midwifery I have existence of such a condition; but in had access to is there the remotest allu the case now being considered this was sion to the possibility of an ante-partum exactly what was done when the woman hour-glass contraction. Always, in called my attention to her size, saying treating of this condition of the uterus, she feared she was going to have twins. it is with reference to retention of the Just such an "exploration by palpation" placenta by this means. The first and was made in tracing the contour of the only information I have received on the child in utero, and surely, if there had subject is from the article above referred existed any sulcus at or below the to, supplemented by my own experience woman's umbilicus in the abdominal in the case under consideration. Al parietes, indicating such a constriction though I had read Dr. Miltenberger's in the body of the uterus, I could not article attentively more than once, I have failed to observe the fact, although failed to recall it at the time when its I might have failed, to appreciate its information would have been most wel significance. Certainly, I observed come. Probably, however, it was fortu. nothing of the kind. nate after all that I did forget it ; for This brings up for consideration anwith it fresh in my mind, affording as it other part of the subject. May not this
ante-partum hour-glass contraction have layer is mainly composed of circular been produced after I gave the ergot rings of muscular fibers beginning and by the ergot?
around the openings of the Fallopian It has long been a conviction with me tubes and forming wider and wider cir. from watching the action of the uterus cles which touch and interlace with after the administration of ergot that it each other. They surround the internal acted more powerfully on the circular os, to which they form a kind of sphincand oblique fibers of the muscular struc ter. ture of the uterus than upon the longi Now it seems evident that the expultudinal, and that when the fetus filled sive action of the uterus, the force that the cavity of the organ the contraction tends towards extruding the fetus, is caused by ergot had a greater tendency derived from the first two layers of musto crush the child than to expel it. cle ; the third or circular layer is probHence it is with the utmost reluctance ably co-ordinating in its action, and that I ever give a parturient woman er gives strength and support to the organ got until the child is born, or, if I as a whole while it is in action. Hence, greatly fear hemorrhage, when the occi if from any cause, the action of ergot or put presents at the vulva. I gave ergot other, the action of the two first layers in this case with the distinct feeling is suspended or much weakened, while that its administration was injudicious; the action of the circular or internal but the woman was becoming so de layer is stimulated to greater activity, spondent and anxious at the prolonged, we would have the very condition that and to her unusual, effort at parturition, I am sure I have noticed when the uteand as I could discover, after a most rus is under the influence of ergot ; minute examination, no. possible ob powerful and almost continuous contracstacle to the ready delivery of the child tion attended with but little or no adwhen the pains should sufficiently in vance in expelling the child. crease in force, I acted contrary to my Again, Verrier says, in speaking of the better judgment and gave it. I should
I should irregular contractions of the uterus in have applied the forceps and terminated hour-glass contractions, “in hour-glass the labor in that way. Even podalic contraction ergot is contra-indicated ; version would have been preferable, as and not without reason have several audifficult as that operation sometimes is. thors attributed to its administration I cannot say certainly that the hour the production of such spasmodic conglass contraction did not exist before I tractions.” Now if its administration gave the ergot, or that this drug caused is recognized as the probable cause, in it; but I believe it did, so much so, many cases, of post-partum hour-glass that never again could I be induced to contraction, it requires but a feeble efgive ergot in a normal labor.
fort of the imagination to suppose that Helie (Playfair's System of Midwifery, it may also produce ante-partum similar p. 53, Ed. 1880), who seems to have stu results and such I have no doubt will be died the anatomy of the gravid uterus the verdict of the profession after the closely, has pointed out that its muscu effects of the drug in the uterus have lar structure, speaking roughly, is di been more closely watched and attenvided into three layers; an external, a tively studied. Ergot is a powerful middle, chiefly longitudinal, and an in remedial agent, but like all agents of ternal or circular. The external layer pronounced beneficence, it is also pow. arises posteriorly at the junction of the erful for evil, and to use it empirically body and the cervix, spreading upwards is to wield a Hercules club, doing good and over the fundus. The middle layer or injury by accident. is composed of strong fasciculi which run upwards but decussate and unite For habitual constipation, an with each other so that those which are change says that one drop of normal at first superficial become most deeply liquid nux vomica, in half a glass of seated, and vice versa. The internal water every night, will prove effectual.
ATRESIA OF CERVIX UTERI IN PREGNANT WOMEN. READ BEFORE THE CLINICO-PATHOLOGICAL Society of WasHINGTON, D. C., APRIL 16, 1895.
By W. J. Dillenback, M. D.,
Washington, D. C. In presenting a case of this kind, it the use of forceps or other agents emoccurred to me that it would be inter ployed in delivery. In this statement I esting to know how frequently this con am supported by the fact that nine of dition occurs. After making a careful the fourteen cases reported occurred in search of all the literature available on multiparae and but five in primiparae. the subject, I find only fourteen cases The most popular treatment of these on record, the first of which was re cases to facilitate delivery seems to have ported by Dr. Edward T. Roe of Glas been incision and the use of forceps. Of gow, Scotland, in 1836. Since that the cases reported, eleven were delivered time I find thirteen others. Five of in this manner, one by incision alone, these have been reported by American one by Cesarean section, and one (Dr. physicians ; four by Europeans; and Lusk's case) by rupture of the uterus, five from St. Stephen's Hospital, Delhi, which occurred while he was making India.
preparations for an abdominal section, The causes of this complication are the woman having been in labor seyany ulcerative inflammation of the up eral days. This accident resulted in per portion of the vagina and cervix the death of both mother and child, and uteri such as would be produced by was the only fatal case so far as the syphilis, scarlet fever, diphtheria, etc. mothers are concerned. The other One case, however, has been reported thirteen did well. But while the morwhich seems to have been congenital. tality in the mothers seems to be small The woman had been under the obser. it is somewhat higher in the children, vation of several physicians for a long as four out of the fifteen cases, includ. period and no opening of the uterus was ing my own, were still-born. However, ever discovered, nor did any menstrual I believe that in all cases in which the Auid ever escape.
As the uterus began condition is recognized early and the to enlarge, it was supposed to be a case woman speedily delivered, the life of of retention of the menses, but as the the child will be saved. It is almost fetus developed, it was diagnosed to be superfluous to add that in the foregoing a pregnancy; and the woman was sub cases, incision and forceps have given sequently delivered of a full term child. very satisfactory results and seem to be There can be no doubt, though, that the proper method of delivery in the there must have been some minute majority of cases. opening sufficiently large for the entry The following is an account of a case of spermatozoa.
tbat came under my own observation. The most frequent cause given in the Mrs. E., white, aged 40, had been cases reported is the use of forceps in married eighteen years, eight previous labor. This statement i do months gone with first pregnancy. I was not think is fully sustained, as in order called to see this patient July 16, 1893, to have complete occlusion of the cer and obtained the following history. vix, the exciting cause must occur after About three days previous to my visit the ovum has been impregnated ; and it she had been seized with pain in the abis fair to suppose that all effects of the domen and had called in a physician, previous use of forceps have subsided. who upon examination pronounced it a A more likely cause in my mind would case of threatened miscarriage. After be the treatment by caustics or the ac prescribing something which I judged tual cautery, of ulcerations produced by to be an anodyne, he left and did not
call again. Upon examination per va agreed with him in his diagnosis. In ginam, I found the patient suffering the morning I joined Drs. Cuthbert and with a membranous inflammation ex Van Rensselaer and made an inspection tending over the whole surface of the of the parts through a Sims's speculum. vagina and partially over the labia There appeared in the region of the os minora. I diagnosed the case as one of nothing but a smooth, glistening surface diphtheria and treated it accordingly; and as far as the eye and finger could but whether it was a case of diphtheria detect, there was not a vestige of the or not I am unable to say, as I did not original opening. have a microscopical examination made. Dr. I. S. Stone was called in consul. During the next few days the patient tation and it was decided to make an passed several complete casts of the va antero-posterior incision about one and gina, and in about ten days from the be a half inches in length and allow the head ginning of the attack she made a good to dilate as the pains were still violent. recovery ; the membrane had disap- The patient was anesthetized, the incipeared and the ulceration healed.
sion made and the head allowed to make About one month after this I was again pressure. At the end of an hour there called, as it was thought the patient was sufficient dilatation to allow the apwas about to be confined. When arriv- plication of forceps to the head. The deing at the house I found the patient's livery was accomplished without event, pains had entirely subsided. She told except a slight laceration of the perime that she had had intermittent pains neum. The child was still-born and for two hours of the day, but they had probably been dead for days, as it had passed off and she had gotten up
a state of maceration. The and gone about her householå duties. mother made a good recovery and, the I instructed her to send for me at once perineum having united, the stitches should the pains return.
were removed on the ninth day. After the lapse of a month I was again An examination made one month after called, but being unable to respond, my delivery revealed simply an antero-posfriend Dr. Van Rensselaer did so for me. terior laceration of the cervix uteri. He found the patient suffering severe I do not think my treatment of the labor pains at intervals of three to five case above criticism. If I had made the minutes. Upon examination per vagi. diagnosis of occlusion of the cervix at nam, Dr. Van Rensselaer was unable to my second visit, when labor first began, discover the os, and believing it to be a I think the life of the child might have case of occlusion of the cervix, called been saved. Dr. Cuthbert in consultation, who
New Food FOR CONSUMPTIVES. desire to eat, and unless it is too unreaDr. Brewer of Chicago has a new idea sonable I humor them. concerning food for consumptives. In ladies have become quite plump, and addition to inhalation of the fumes after a year's inhalation have ceased of vinegar he feeds them on peanuts, coughing, and I pronounced them well. gives them all they can eat without The peanut was long known as an ex. dangering their digestive organs. Two cellent fat producer, and much young ladies who had been the rounds agreeable than rancid stark oil that ofof cod liver oil and tonics without ma tentimes is sold for cod liver oil. While terial benefit were put on his treatment not all can digest peanuts, a great many, and recovered.' Concerning the diet he even with feeble digestion, eat them says: “I now commenced feeding (do without discomfort. It beats the Koch not laugh) peanuts. One would think lymph and is the most satisfactory treatthis a very indigestible diet, but they ment I have ever tried for these discraved them, and it has always been eases.” my policy to find out what my patients
SOME CASES OF CHRONIC NERVOUS DISEASES CURED
BY RELIEVING EYE STRAIN.
READ BEFORE THE PENNSYLVANIA STATE MEDICAL SOCIETY, MAY, 1895.
By Jean Gaylor Brown, A. B., M. D. The long list of chronic incurables search outside the established authority has always appealed most strongly to for the aid that it fails to give; othermy sympathy; the acutely ill get well wise science and art would never ador soon go to “the land of the living.' vance." I decided to learn his methods Alas for the paralytic, the insane, the and was compelled to believe that for consumptive and the diabetic; how long me at least was found something new and weary is the road for many of these under the sun, powerful for relief in before this relief comes. I watched a many intractable cases. case of the last named in one of my own It is to bring before you the results in household. That was the hardest work a few cases I have treated in the past I ever faced, to watch day and night the year that I come before you today. As unappeased hunger, un quenchable the time is limited, I will not give dethirst, broken, restless sleep, changed tailed treatment, but symptoms and redisposition, anxiety and deep depres- sults. sion, nervous symptoms, emaciation, ex Dr. Prentice says in his new book : haustion, death. To see him look at “Viewing all disease as localized nervous me so wistfully as though I held the derangement, we have erratic, abnormal keys of life and death in my hands; and actions in certain functions of the body, realize in agony of spirit that, though and we give them names. For instance, I had sought every avenue for some if a patient has excessive thirst and the thing to give relief, temporary amelio kidneys are secreting a great amount of ration was all I was able to gain. A few water, the liver has taken upon itself, months later I heard of a physician who through erratic action, to manufacture had cured many cases of diabetes ; I at larger amounts of sugar than are to be once entered into communication with met with in a state of health ; we name him. His methods seemed strange to these functional derangements diabetes me ; I had never liked eye-work, and mellitus. A large train of other sympknew comparatively little of the results toms which vary greatly in different gained by properly fitted lenses, still cases will be noted in various forms of less did I know of, or believe in the this disease, from the fact that the irrimarvelous results to be gained in the tation in the central nervous system is cure of seemingly incurable diseases by so varied in its character that it sends relieving eye strain, but fortunately, out corresponding impulses, which perbelieving it to be the part of wisdom form erratic work in various parts of the not to sneer at or condemn what I did body. Whatever the nature of the er. not understand, I found that the receiv. ratic function that falls to the liver, ing of a new truth has added a new spleen or kidneys, it is entirely due to sense.
the character of its nerve impulses. In “ It is common and natural to cling to diabetes, it is safe to say, there is no a belief in things and methods that have function in the whole animal economy long been established, in which leading that may not be coincidently more or men and authors concur, and if the re less deranged or erratic ; but whatever sults of such following are universally the nature and train of symptoms, the perfect, more cannot be desired ; but name of “diabetes mellitus when they fall far short of satisfaction, vail, provided an excessive quantity of we are warranted and even impelled to urine containing sugar is secreted, and