THE DOCTOR'S FAITH IN GOD.*

By J. W. CRENSHAW, Cadiz.

As the writer sat in the amphitheatre of Jefferson Medical College in his student days, in the clinic of the then greatest American surgeon, there was ushered rapidly on to the operating table a beautiful curly haired boy, about two years of age, in a state of asphyxia, gasping for breath, with a watermelon seed imbedded in the wind-pipe. Rapidly and skillfully dividing the rings of the trachea, pressing the wound apart, and fixing it with retractors, the body of the child was swiftly inverted, and with a shake and slap on the back, the offending seed was thrown with force upon the floor of the operating room. With the coming of the anxiously anticipated relief, came also, the impulsive, but none the less sincere expression of gratitude from the big heart of the great surgeon, as he exclaimed in choking terms, but heard in the furtherest corner of the vast amphitheatre, "Thank God, gentlemen, thank God." This pithy prayer, made without studied prelude, from the lips of the great Samuel D. Gross, with the remembrance of the mighty shout of triumph that went up from the appreciateive class of six hundred students, gives me the starting point for this brief, and I trust helpful, paper.

THE DOCTOR'S FAITH IN GOD.

In the opening. I am here to modestly, but with firmness, to combat the idea, so often expressed and very commonly accepted, that there is something in the study, if not in the practice of medicine which tends to make the doctor an unbeliever in the one true and only God, and in the Bible as His revelation to men. If there are unbelieving doctors who foster and maintain this idea, I must deny them the right to apologize for their shortcomings behind this specious and utterly untenable plea. For as I see it, from study and experience, the profession which presides at "the incoming and out-going" of life, has the most in it to create an unbounded faith in the God, who did make and does direct the affairs of this Universe. Observation also has taught me, that the greatness of a physician is enhanced in proportion as he recognizes that with all of his skill, he is impotent when confronted with the Divine fiat.

THE TESTING TIME.

There come times in the life of every doctor who has had a wide experience with the anxieties and perplexities of the profession, when he finds himself confronted with conditions parallel to those which called forth the

*Read before the Christian County Medical Society.

expression of gratitude from the famous surgeon, quoted in the opening of this paper. A time when the doctor involuntarily burst forth in praise to a higher and nobler power. This may come with some degree to the man of small faith, but to the doctor of rich experience, it brings the greatest joy possible for the human heart to express. At such times he is not satisfied with a consultation with mem bers of the profession, but supplements this with a communion with the great unseen.

THE PHYSICIAN AND THE MINISTER.

This leads me to observe, that the physician who has to deal with the most sacred confidences of the home circle, and who from his intimate association knows "the skeleton in every closet," should be as faithful to and as conscientious in his calling as the man who occupies the sacred desk, and with the Bible before him, presents its teaching with faithful fidelity. I therefore offer no apology for placing the doctor of medicine along beside of the Christian minister; for the physician need need not be any the less a preacher of righteousness because he is a healer of the body. The greatest of all physicians, was also the greatest of all preachers. Please do not lose sight of the fact that I say "Christian physician" and upon which I lay especial emphasis; for when the doctor of medicine is lewd and lascivious in his private life, and prostitutes his high-calling for gain alone, or becomes a destroyer of the unborn and is a professional abortionist, he puts himself in the class with the baudy-house pimp, the white slave trafficker, and the debauchees of innocent girlhood. There is less excuse for immorality in the private life of the members of the medical profession, than that of any other, not excepting that of the Christian ministry.

ical evidences of the result of intemperance, To what other class is presented daily physof immorality, of decaying flesh on living bodies? To what other class is there given such knowledge of the human body, of what it is composed, how it is controlled, and regulated? To what other class is there the necessity for clearness of thought, of act, of deed, so positively presented as to the over-burdened doctors? The very highest incentives are offered to the members of the medical profession.

Recognizing that the practice of medicine is a calling out of which the physician has a right to expect a support, and from which he should be permitted to lay up a competency for a later day, we should keep in mind also that it offers the widest field for Christian charity. Another thought worthy of emphasis is, that the hour of the "out-going" of

human life, at which the minister is expected to bring comfort to sorrowing hearts, is not so sacred as the "incoming" when the doctor is the good genii. The end of one's passing is of small moment, for the life has been lived, the record has been made; but the hour of birth has its possibilities before it; life combining the human and the divine. Happy is he who can preside on such an occasion with clean hands and a pure heart.

THE DOFE DOCTOR.

To relieve suffering is one of the most sacred duties committeed into the hands of the doctor. I know of none other obligation demanding the wisest discrimination and painstaking care. The appeals that come are often the most persistent and tantelizing. Happy is the medical man who can say at the close of his career, that I have never taught any one, the lesson "that happiness might be bought for a penny, and carried in the waistcoat pocket. or that "peace might be sent by the mail" to use the classic language of DeQuincey. Happy indeed is he who can say "I have never to my knowledge made a dope fiend." But that the "dope doctor" has been "abroad in the land," with the handy hypodermie, the censoring of the profession just at this time under the Anti-Narcotic Bill, bears annoying and painful evidence.

PROPRIETARY AND PATENT MEDICINES. America has been called "The Paradise of Patents. For the immense fortunes that have been accumulated by the proprietary and patent medicine combinations, the promotors owe a debt of gratitude to the members of the profession, that will never be revealed until the victims file their complaints at the opening of the books of "the recording angel." The course pursued is not so much a reproach upon the integrity of the doctors, as a reflection upon their common sense and business acumen. While enriching the manufacturers, the dispensers have gained little and the patients have been made "poor indeed." The "proprietary prescribing habit" has been as fatal to the best interest of the doctors as the "dope habit" has been destructive to the health and happiness of its unfortunate victims.

THE AMERICAN MEDICAL ASSOCIATION

On the "firing line" and in the "forefront of the battle in meeting the evils referred to in my last paragraph, has stood the American Medical Association with its "best Journal in the world." With a full knowledge of the mistakes complained of, and that may have been made, I still believe, that these two combined agencies stand for that which is highest and best in the profession. The lead

ers have made a fight against odds, that would have discouraged less determined men. The general public and the rank and file of the profession, will never know what they owe the Association and the Journal, for the efforts put forth to protect them from the most mercenary gang that ever infested a free country. Entwined with the very warp and woof of the political organizations of the country, having for their champions some of the most prominent men in public and political life, it has demanded the soul and sinew of the American Medical Association to dislodge them and to provide the public and profession the protection to which they are entitled; and while much has been accomplished, the "end is not yet." It has been a mighty "man's job," and will demand the very best efforts of our strongest men.

I close these reflections with a plea to each of you present. to lend yourselves to the encouragement, endorsement, and support of the American Medical Association and The Journal and its efforts to uphold the dignity. of the profession.

If what I have said along the lines of religion, morality, cautiousness, and fidelity to the highest ideals of life, shall have added to the sum-total of a higher standard of living and inspired any one to a nobler purpose. then the object that I had in mind, when I accepted a place on your splendid program will have been accomplished.

AMENDUM.

Since completing this paper, two incidents have been called to mind, illustrative of the points that I have endeavored to emphasize.

PRESCRIBING PROPRIETARIES.

Having a patient, who I thought needed the attention of a "specialist," I sent her to a city doctor. While under his care, she presented seven prescriptions at intervals furnished by this distinguished gentleman. All seven prescriptions were for "proprietary remedies." I asked a friend how he accounted for this, and whether he thought that the doctor was getting a "rake-off" or was in any way financially interested in the combines. His reply was, "He is wealthy and above reproach. How do you account then? “Downright laziness" was his laconic reply. Too indolent to write a prescription.

GOOD WORK OF THE ASSOCIATION.

Recently the daily and weekly papers of Kentucky, have been selling space, in a most flagrant manner, to an outrageous quack. The Journal of the American Medical Associa tion in the issue of June 5th, has a write-up of "Tanlae" with an expose of the promoter. The chemist report is worthy of more than a

passing notice. Containing nearly 16 per cent of alcohol by volume according to the report, makes the stuff a fine drink for a blindtiger territory, and furnishes another good reason why every doctor should stand by the "Propaganda for Reform."

Dr. A. T. McCormack, Secretary of the State Board of Health, is trying to revive the indictments which were filed away at Lexington against the man who is at the head of the company pushing the fraud business.

DYSENTERY, OR ILEO-COLITIS.*

By E. T. RILEY, Trenton.

An acute inflammation of the mucous membrane of the large intestines either catarrhal or croupous in character. Catarrhal dysentery may occur at any age from birth to puberty, but is most frequent from the first to the tenth year. Sex has no influence, neither has the race. It occurs under all social conditions from the highest to the lowest, but is more prevalent among the pauper and the laboring classes, it is more frequent in the city than the country. The liability to dysentery is increased by such vices as tuberculosis, congenital syphilis, warm climates, errors in diet, impure drinking water. and several other causes, such as during the period of the eruption of the deciduous teeth. Morbid Anatomy. The lesions of catarrhal dysentery are usually confined to the lower part of the colon, and even into the ileum. The congested mucous membranes varies in color from a bright red to a dark purple, it is usually covered with thick, tenacious mucus, the large intestine is usually empty, while the small intestine is distended with gas, and contains a greenish fluid. Ulceration may take place. The ulcers at first are round and superficial, but soon enlarge, their edges are everted and flattened and irregularly shaped. Patches resembling pseudo-membrane may also be found. Perforation and peritonitis, which are seldom seen may result. The liver, which is usually congested, may be the seat of multiple abscesses; may also have some oedema of the lower extremities.

Symptoms: The onset may be sudden, without any premonitory symptoms, with one or more chills, or preceeded with diarrhoea, temperature is usually elevated, loss of ap petite, and nausea, the pulse becomes rapid, small, and compressable, the strength is rapid ly diminished; the face presents a pinched and anxious expression. The tongue is moist and covered with a whitish fur, there is seldom pain on pressure, there is a constant de sire to go to stool, with pain and straining.

*Read before the Christian County Medical Society.

and the stools, which at first contain fecal matter. soon become small, odorless, and consist of blood, mucus, and pus.

As the inflammatory process advances to ulceration the stools contain shreds, resembling washed, raw meat, mingled with pus and blood. The straining now becomes more severe, and prolapse of the rectum frequently results from same. The abdomen becomes tympanitic and tenderness marked along the whole course of the colon. The tongue becomes dry, with brown center and red margin. The pulse becomes rapid, thready, and intermittent. The respiration becomes sighing, the eye lids are partially closed, and the pupils are widely dilated, the child becomes restless, and tosses from one side of the bed to the other, and delirium or convulsions may be present. The urine is high colored and scanty, or there may be total suppression.

Diagnosis: The blood stained stools, tenesmus, abdominal pain, and the history will aid in distinguishing dysentery from other enteric conditions, the variety of the disease may be recognized by the symptoms.

Treatment. There is a great deal that could be said about the treatment of dysentery, and I will take up very little of the society's time in relating my own treatment from same, and am willing to leave it to the discussion of the society.

The patient should be confined to bed even in the mildest attack and if possible use the bed pan and thoroughly disinfect the discharges with chlorinated lime.

The child should be bathed once a day, and oftener if the weather is warm, if circumstances compel him to remain at home, he or she should be placed in a room where pure fresh air will be admitted freely. An occasional sponge bath of equal parts of alcohol and water will prove beneficial; if your patient is a baby the diaper should be removed as soon as soiled.

The hygienic surroundings should be looked after and watched after every day. The diet should be prescribed in the very beginning, and be positive with the family or nurse; we may use the peptonized milks, beef-tea, beefjuice, or mutton broth, these should be given in small quantities at frequent intervals, so as to not over-feed.

Local Tratment: The most rational treatment of dysentery is intestinal irrigation, washing out the colon and rectum, thereby relieving the pain and straining to some extent. and this is best done by having a continuous flow, and should use a double injection tube, and should be very careful in introducing same as it will sometimes cause a great deal of pain, and you should have your patient placed on his or her left side with hips ele

vated higher than the body and the knee and chest position is still a better way, and would advise the physician to always give the first one, and the frequency of the irrigation is governed by the number of stools or actions would use either hot or cold water with some antiseptic in same, such as mercuric chloride.

Medical Treatment: I use ipecacuanha, giving large doses, 5 to 30 grains in milk, and especially where we have greenish stools, mucus and blood. Castor oil as a mild catharsis given in small doses every hour for a few doses. Magnesium sulphate is good in acute form where we have pain, straining, and stools containing blood. Opium as enema with starch and milk, after the canal has been emptied with saline or irrigation, may use silver nitrate, gr. 1-4 to 1-2 after acute symptoms have subsided. Bismuth subnitrate and subgallate may also be given every few hours, quinine if there is any malaria. Mercury in small doses. And a great many others that I might mention.

INVERSION OF THE UTERUS, WITH REPORT OF A CASE.*

By G. C. RANKIN, Walton.

My principal reasons for offering this paper this evening is, first, to comply with a request of our distinguished President, Dr. Hayes and secondly to furnish the incentive for a discussion which I sincerely hope will prove of more value to all of us than the pa

per.

The case that I am about to report is the first seen in my limited experience. Notwithstanding the fact that most of the authorities hold that the inverted uterus is the result of a misconducted labor. I am not willing to hold myself responsible for the condition that arose in this case.

Inversion of the uterus may be complete or partial. In complete inversion the organ is turned inside out and upside down. In partial inversion it presents a cup-shaped depression of greater or less depth at the fundus. Frequency: Fortunately this accident is exceedingly rare. Winkle had never seen a case of complete inversion of the uterus in 20,000 cases of labor, nor had Braun in 250,000. In 192,000 cases at the Rotunda Hospital in Dublin, covering a period of nearly a century, one case was reported. Jewett says it is believed to occur once in 2.000 cases of labor. Inversion of the uterus, seldom takes place except at term, yet we have records of cases complicating miscarriage at six months.

*Read before the Boone County Medical Society.

Woodson reports a case of complete inversion following a miscarriage of four months.

Varieties: The inversion may be acute or chronic, the latter will not be discussed in this paper. There are three degrees of acute inversion recognized:

First: A cup-shaped depression at the fundus, the latter not engaged in the os-uteri.

Second: Partial inversion, the fundus protruding from the os. This is a true intussusception.

Third: Complete inversion, the uterus being turned inside out.

Etiology: All of the writers agree upon the fact that in the absence of atony or paresis of the uterine muscle, inversion is impossible Crampton says that inversion is preceded by paresis of some portion of the uterine muscle, not necessarily at the placental site, the main causes being too frequent child-bearing, tedious labors, repeated miscarriages and traumatism. For traction upon the cord or pressure upon the fundus to produce inversion in the absence of paresis would be impossible, in the former the cord would brake, in the latter the pressure would have to be so great that surely no sane man would be guilty of. The inversion may be spontaneous. the placental attachment is at the fundus an atony at this point may cause a dipping down at the fundus and the beginning inversion may be increased by the weight of the placenta if still attached. The inverted portion now acts as foreign body and being firmly grasped by the non-paralyzed segment of the uterus it is carried down at each contraction of the organ. The accident may occur by undue pressure upon the fundus. A common cause is believed to be traction upon the cord, shortly after the second stage of labor is completed not allowing firm contraction to take place.

When

Symptoms: The usual symptoms of inversion are pain, hemorrhage, vesical and rectal tenesmus and profound shock. The intensity of the symptoms vary greatly in different cases, ordinarily the pain is severe and is referred to the lower abdomen and pelvis. The hemorrhage may or may not be severe, depending upon the degree of relaxation of the uterus.

Diagnosis: As a rule the acuteness and severity of the symptoms are such that can scarcely fail to arrest the attention of the physician should he be present when the inversion occurs. The absence of the usual abdominal tumor, the presence of an intra-vaginal tumor and the character of the tumor It must however be differentiated from uterine polypus. In uterine inversion the implantation of the pedicle is circular, while in polypus it is lateral. Sometimes it is possible by

the aid of the speculum to detect the opening of the Fallopian tubes. The possible presence of the placenta still adherent may be borne in mind.

Prognosis: Death may occur within a few hours from hemorrhage and shock or later from septicemia. The total mortality may fairly be stated from 25 to 35 per cent.

Prophylaxis occupies the same place in this condition as in all others, the old maxim holding good an ounce of prevention is worth a pound of cure.' Avoid traction upon the cord while the uterus is still relaxed, and of manipulation which may indent the fundus, and finally of properly directed efforts to bring about a prompt and persistent retraction of the uterus. The hand should be kept upon the abdomen over the anterior surface of the fundus, from the moment the child is expelled until retraction is complete, so that the slightest dimple at the fundus may be noticed and reduced.

Reposition: There are three methods of employing taxis in the reduction of a recent inversion of the uterus. The first consists of grasping the fundus of the uterus in the hollow of the right hand and making gentle but firm pressure upward in the axis of the pelvis,

In the second method the hand is carried into the vagina with its back toward the uterus, and with the fingers part of the uterine lateral wall is pushed upward through the constricting ring. With the fingers of the other hand applied over the abdomen the cervical ring is dilated. As the ring yields the lower uterine segment and finally the entire body of the uterus, is pushed upward through the cervical ring. The third method consists in making alternating pressure at the middle of the fundus with the coned fingers.

Reduction of whatever method should not be undertaken without the use of an anesthetic. Should the placenta be attached to the uterus it should be separated before reduction is undertaken. Reduction should be done as early

as possible, but the fact that the uterus has been inverted for several days does not contraindicated an attempt. If the uterus is infected, early amputation is generally advisable.

I was called to see Mrs. A., on April 20th, of this year, age 22, occupation housewife, one pregnancy two years previous, never miscarried. She was anemic, a very delicate woman, with an inherited tubercular predisposition. After the usual preparation for the conduct. of a labor case I proceeded to make an examination. I found the cervix well dilated. left occipito-posterior presentation, a good roomy pelvis. Labor pains strong, occuring at intervals of every two or three minutes. In fact, everything normal. The first stage of labor

being completed in a very short time after my arrival, the second stage of labor was of very short duration, the child born with the cord wrapped around the neck some two or three times. There was no laceration of the perineum, child weighing eight pounds. After ligating the cord I placed my hand upon the abdomen and noticed a small depression at the fundus but did not realize the significance of it at the time. There was no hemorrhage at this time. As usual during the time between the second and third stage of labor (in this instance which was at least three quarters of an hour) I sat down and engaged in some frivolous talk with the ladies that were present. I then proceeded to terminate my case by the delivery of the placenta, by placing my left hand upon the abdomen and using the Crede method of delivery, still noticing the dimple which was very small. After gentle manipulation all at once the uterus left my hand, upon raising the sheet I found the still adhered. When the placenta began to uterus completely inverted with the placenta separate there was a violent hemorrhage, almost uncontrollable. The treatment instituted to meet the emergency was not what would certainly was effective. I grasped the body of be employed in a well regluated hospital but

the uterus with both hands and made firm pressure, my only assistant in this case at this time was the husband and I had him wash up and reiieve me, as our hemorrhage was pretty well controlled. I then put the uterus in the vagina and attempted to reduce the inversion, which I found I could not

Af

do as I was very delirious at this time. ter failing to reduce I packed the vagina with ice. I then proceeded to combat shock by raising the foot of the bed and giving strychnine hypodermically and using hot water bottles. By this time my delirium began to subside. I then realized that my patient needed a doctor and had Dr. C. N. Paul called hur

riedly, and he very readily reduced the in

version. This woman made an uneventful recovery, the treatment being the same as any other case during the lying-in period with the single exception of saline being given per

rectum.

I am of the opinion that the causes of the inversion in this case was due first to the general relaxation or rather lack of muscular tone, second when the child was born with the cord entwined about its neck, traction was made upon the placental site causing the dimple in the fundus above referred to. I do not believe that hardly any general practitioner would have attached any significance to the depression in the fundus.