confusion, H. eviscerated the entire contents of the orbit. This was followed by a decided improvement of the symptoms, but this was only temporary and death from thrombosis of the cavernous sinus and meningitis occurred four days later. The veins in the orbital tissue were found to be transformed into lines of pus. The post mortem showed that the infection (pure culture of the yellow pus coccus) had spread to the cavernous sinuses and the meningeal veins. The reviewer has seen two of these desperate cases; one following the extraction of a tooth and leading to blindness of one eye, the other to death from brain abscess. There can be no doubt that Hertel's suggestion, if carried out early enough, would have saved many lives. The trouble is that neither surgeon nor patient can be brought to consider so radical a course until it is too late. One lesson which these cases teach us is that every furuncle in the nose or neighborhood of the eye should receive the most respectful consideration. GIFFORD. Obstetrical and Surgical Treatment of Puerperal Eclampsia (Surg. Gynaec. Obst.) "In conclusion, while the etiology of eclampsia is still unsolved, its clinical phenomena and pathology point to a probable intoxication, of foetal, maternal or combined origin. Therefore, evacuation of the uterus elimination and sedation are the chief indications in the treatment." The sedatives are valuable for their tranquilizing influence while delivery is being promoted or effected by other direct means. The result in a given case will depend upon the severity of the attack, the judgment and skill of the physician and the rigid observance of asepsis. Essential to success is a wellthought-out plan of prompt but not over-zealous procedure, based upon the various phases of the disease, combined with a knowledge of the condition of the cervix and the change it must undergo before pregnancy can terminate or be terminated. The author wishes to supplement this conclusion with the following "Don'ts": Don't delay terminating the pregnancy after the onset of the first convulsion. The earlier the uterus is evacuated, the lower the maternal and foetal mortality. Don't treat the patient haphazardly, as the mortality and morbidity are exceedingly high under such conditions. Endeavor to choose the right method of operation in the first instance. Don't forcibly dilate an intact or rigid cervix. It is irrational and unjustifiable. Bear in mind the physiological and anatomical changes necessary to soften and unfold the cervix, and dilate the external os. The divulsion of the cervix in a few minutes by instrumental or manual methods-what Nature takes, under normal conditions, hours to do to preserve the integrity of the soft parts-is unscientific, dangerous and brutal. It is in this class of cases that the cutting operations, when done primarily, give such excellent results. Vaginal hysterotomy is the operation of election up in the eighth month, and the abdominal Caesarean section after that time; particularly when the child is of average size or has a weak foetal heart beat, in cases of corpulency or when the cervix is high and in posterior positions. SOMERS (Omaha). If these "don'ts" be universally observed we will see a great reduction in the mortality and morbidity of eclampsia. Gallstones Shown with X-Ray Thurston Holland of Liverpool discusses the value of the radiograph in diagnosis of gall stones. As far back as 1905 he secured good radiographs of stone in the gall bladder. Since that time he has succeeded in clearing a number of diagnoses. Gall stones are often cholesterin in the central portion, covered outside with a thin layer of lime pigment salts. This type gives a ring-like shadow in the radiograph. Where the stones are multiple serial radiographs will show them in changed relation to each other.-(Archiv. Roent. Ray, March, 1913). TYLER (Omaha). Can Modern Life Insurance Survive? Dr. George W. Hopkins, of Cleveland, Ohio, says that life insurance is theoretically a philanthropic institution designed to protect the dependents of the insured from pecuniary loss because of his death. The basis of insurance is the determination of the mortality rate at various ages of individuals in various occupations and under various economic conditions. The main purpose of the man of moderate means should be to secure the maximum protection for his family at the lowest annual premium rate. Thus every doctor should be vitally interested in insurance, its variations in policy forms, costs, and benefits. The paper by Dr. Hopkins is a criticism of cash surrender values. Hopkins asks whether modern life insurance can survive when we see how the solvency of the whole system is constantly threatened by what he calls the prevalent cash surrender evil. Cash surrenders, he says, are not, and never will be, in any sense life insurance. Life insurance is a substitute for a mans' earnings after his death. Anything more than pure protection for one's dependents is not life insurance at all, but banking or investment.-Medical Review of Reviews, September 1912. The Anesthetic Effects of the Intravenous Injection of Paraldehyde Experiments prove that paraldehyde, given intravenously, gives ideal anesthetic effects (Annals of Surgery, Jan., 1913). The patient passes into a perfectly natural sleep, respiration deepens, the pulse gets slower, and the color remains absolutely unaltered. Paraldehyde is a respiratory and cardiac stimulant, and is remarkably free from disagreeable after effects. There is a momentary depressant effect, but this transient influence can be overcome by dilution with an equal quantity of ether. Mix 5 to 15 c. c. of paraldehyde with the same amount of ether, and dissolve the mixture in 150 c. c. of cold 1 per cent solution of sodium chloride in sterile distilled water, free from dead bacteria. The solution should be perfectly clear after shaking. It may be used cold or not exceeding 25° C. Introduce slowly into the veins the same as salvarsan, at the rate of 5 to 10 c. c. of the solution per minute. The following phenomena are noted: In five seconds the patient tastes paraldehyde; in ten seconds it can be detected in the breath; in twenty seconds a sensation of general warmth, with dizziness or a sense of floating, is felt; in thirty second consciousness begins to disappear; in forty seconds unconsciousness is complete; in sixty seconds unconsciousness is deep; in ninety seconds there is no corneal reflex and anesthesia is complete. Up to this point 5 to 10 c. c. of the solution will have been administered. Elimination is carried on very rapidly through the lungs, and for a lasting effect the whole 150 c. c. of solution will have to be used. Recovery takes place in twenty minutes with no bad or after effects. Grave cardiac or pulmonary disease does not contraindicate it.—The Lancet-Clinic (January, 1913.) Nitroglycerine Tablets The deterioration of nitro-glycerine tablets is such a seri; ous matter that the attention of the profession should be directed to it. This drug is never prescribed except in urgent cases, and it is very disconcerting to learn that many of the tablets on the market are so old that they contain practically no nitro-glycerine at all. A man's life may thus be lost. Perhaps the manufacturers could take steps to prevent this danger by placing a date upon the sealed packages, and if physicians use it in this form they must be sure that patients get perfectly fresh preparations, which have been kept in hermetically sealed glass retainers. We are quite certain that the failure to get results from this drug is due to the fact that the patient did not get enough to have any physiological effect whatever. It would be best for physicians to dispense these tablets themselves, in order to be absolutely sure that the patient gets what is prescribed. A prescription may fall into the hands of a druggist who does not know that his stock has deteriorated, and thus sells it, through ignorance, rather than dishonesty. It is one more instance of the absolute necessity for knowing that our patients get exactly what is prescribed. A few manufacturers have been warning against using anything except fresh tablets, but they should set a date, beyond which the tablets are worthless.-Am. Med. COUNTY SOCIETY EDITORS E. G. BARNHARDT, M. D., Department Editor A. B. Anderson, M. D. Pawnee City, Pawnee Co. Alma, Harlan Co. E. D. Banghart, M. D. David City, Butler Co. Hebron, Thayer Co. Stockville, Frontier Co. Neligh, Antelope Co. Minden, Kearney Co. Sidney Eastman. M. D., C. L. Hooper, M. D., S. R. Hopkins, M. D., Albion, Boone Co. Superior, Nuckolls Co. A. P. Overgaard, M. D., Syl. Person, M. D., Stanton, Stanton Co. St. Paul, Howard Co. D. J. Reid, M. D., McCook, Red Willow Co. Schuyler, Colfax Co. Neb. NEBRASKA NOTES AND NEWS. Dr. C. J. Beirne is a new physician recently located in Ceresco. Dr. J. H. Monro of Los Angeles, Cal., has recently located in Casper, Wyo. Dr. J. W. Padgett of Lander, Wyo., is reported to have located in Kem merer. Dr. Hapeman of Minden has been holidaying in Omaha and eastern points. Dr. G. H. Morris of Big Springs, Neb., has returned to Oshkosh, Neb., and will relocate there. Dr. J. Cameron of Kearney, Neb., is rejoicing over the arrival of a baby girl in his home recently. Dr. C. M. Duncan of Edison, Neb., has recently moved to Kimball, where he will reside in the future. Dr. J. L. Bennett of Kearney, Neb., has been appointed physician at the boys' industrial home there. Dr. O. E. Liston of Plattsmouth, Neb., is the happy father of a baby daughter, born the latter part of March. Dr. Moore of Campbell has sold his practice to Dr. Ostergren of Axtell, the latter to take possession on April 15. Dr. Neville of Hildreth was appointed county physician of Franklin county, to succeed Dr. McElwee, deceased. Dr. McWilliams of Charter Oak, Ia., was fatally injured in an automobile accident near Missouri Valley April 2. Dr. A. C. Evans of Loup City, Neb., has removed to Goodland, Kas., where he will make his home in the future. |