if he does not succeed he again packs the uterus. It would be of interest to have Dr. De Lee tell us how long he would persist in this effort in the presence of increasing sepsis. For my own part I am heartily in accord with the views and practices of the author save in this that I would remove all infected material from the uterus by the fingers or ovum forceps at the very onset of septic symptoms, fearing the consequences of delay for twentyfour hours and longer. The author advises against the expectant plan of treatment for placenta previa. In advising treatment the author keeps well in the foreground the several conditions which should govern the choice of procedure. He favors the Braxton-Hicks version or the introduction of the colpeurynter into the uterus. He condemns cervical incisions and rapid dilatation of the cervix and finds a limited field of usefulness for abdominal Caesarean section. The subject of Puerperal Infection is treated in an exhaustive manner. An anatomical classification of the subject is presented, i. e., vulvitis, vaginitis, endometritis, salpingitis, pelvic cellulitis, peritonitis, etc. This is as it should be, for by so doing the subject can be discussed clinically from a rational basis. The old classification of sapraemia, septicaemia, etc., had led to hopeless confusion. The treatment of puerperal infection is preeminently conservative. The author adopts the policy of non-interference or as he styles it, "nihilism with respect to active local and general measures." He believes that local treatments do more harm than good. He expresses the hope that the curet will soon be recognized as a criminal instrument in simple puerperal infection and that the other operations will be reduced to the one indication-to stop hemorrhage. Negative results have been attained from serums and vaccines in the management of puerperal infection. The work is commended to practitioners and students as an admirable presentation of the subject. PALMER FINDLEY. GOLDEN RULES OF GYNECOLOGY. Aphorisms, Observations and Precepts on the Proper Diagnosis and Treatment of Diseases of Women. By George B. Norberg, M. D. St. Louis: C. V. Mosby Company. 1913. This work of 250 pages is a very practical guide to the general practitioner. It is full of useful suggestions. Following are excerpts from its pages: "Often many things are suggested to the experienced and observing physician by the first glance at his patient. A woman, near the age of fifty, who is anemic, with skin dry and waxy, suggests carcinoma of the uterus or of the mammary gland; one who is thin, with a pinched expression, large abdomen, and who walks carefully and with some difficulty, may suggest ovarian cystoma. A woman in the middle period of life, plump, with a large abdomen, but with rosy cheeks, who walks with a strong, steady step, suggests normal pregnancy. "Don't attempt to examine young girls or unmarried women, especially when it is against their wishes, without an anesthetic. "Dont' make a practice of using a sound in the uterus at every opportunity; this practice should be condemned except in very exceptional cases, for the sake of clearing up a diagnosis or where some intra-uterine treatment is especially indicated, and then with the strictest aseptic precautions; much harm has been done by the promiscuous use of intrauterine instrumentation." "While there is much to be accomplished by local treatment in gynecologic cases, yet in no class of diseases, perhaps, has local treatment been miscarried farther than for ailments peculiar to women. It is doubtful if there is any inflammatory disease (at least chronic) of the pelvic organs of a woman that cannot be relieved temporarily by the use of tampons of glycerin and ichthyol, or boroglycerid and glycerin, with daily hot douches Remember that this practice is perfectly proper and should be highly endorsed when it is done for temporary relief, and when it is so understood by the patient; but when undertaken as a curative measure in all the distorted conditions of the plevic organis, with adhesions and even pus collections, too much cannot be said against it; and if one will only familiarize himself with the anatomy of these parts, as well as acquire an accurate knowledge of the pathology of pelvic disease, he will need no further proof to convince him of the exact limitations of local treatments. "Don't get into the habit of using intrauterine treatments indiscriminately. Women as a whole would have been much better off had this plan of treatment never been instituted. When it does become necessary, use it under the strictest aseptic precautions." The busy practitioner will do well to have this book at hand for ready reference. PALMER FINDLEY (Omaha). A man cannot become a competent surgeon without a full knowledge of human anatomy and physiology, and the physician without physiology and chemistry flounders along in an aimless fashion, never able to gain any accurate conception of disease, practicing a sort of popgun pharmacy, hitting now the malady and again the patient, he himself not knowing which.Osler. Pneumonia, Lobar Treatment. Sodium citrate internally found in most cases, especially in children, to cause fall in temperature, pulse, and respiration to normal within twenty-four hours; process in lung clears up soon after, third stage being apparently escaped. Administered in doses of 30 to 40 grains (2 to 2.6 Gm.) in adults every two hours, with a little citric acid or in lemonade. Dose for children to be calculated from 40-grain dose in adults. Drug to be continued till clearing up of process in lung complete. Active catharsis to be established at beginning of treatment. Sodium chloride should be supplied to system in about the normal daily amount (240 grains, or 16 Gm.), with the diet or otherwise.-Weaver. Migraine According to Hare, the following is a most valuable combination for migraine, and also in sick headache. It ought not to be used in bilious headache, which will often be made worse by it: WESTERN MEDICAL REVIEW Per Published Monthly by WESTERN MEDICAL REVIEW COMPANY, Omaha, Nebr. Annum, $2.00. The WESTERN MEDICAL REVIEW is the Journal of the Wyoming State Medical Society and is sent by order of the Society to each of its members. OFFICERS: Secretary: DR. W. H. ROBERTS, Cheyenne President: Dr. Amos W. BARBER, Cheyenne All matter for publication in this section should be sent to COLLABORATORS—SUBJECT TO REVISION. Keith, M. C., Casper; Marshall, T. E., Sheridan; Nelson, N. D., Shoshoni; Wicks, J. L., Evanston; Wiseman, Letitia, Cheyenne; Young, J. H., Rock Springs. Vol. XVIII. CHEYENNE, WYO., SEPTEMBER, 1913 ABSTRACTS Emmenagouge Oils. No. 9 After reporting a fatal case of pennyroyal poisoning in which the patient had taken thirty-five pills to produce abortion and reviewing the literature of similar cases, D. L. Macht, Baltimore (Journal A. M. A., July 12), reports a study of the various effects of the so-called emmenagogue oils on a cat's uterus suspended in a chamber filled with Locke's solution at a constant temperature of 38 C. through which a constant stream of oxygen was bubbling. The freshly exposed organ was put, under these conditions, in a highly tonic condition gradually subsiding for the first fifteen or thirty minutes, after which it is ready for testing. He tested in the above way the actions of the following oils: "oleum hedeomae (pennyroyal), oleum sabinae (savine), oleum terebinthinae (turpentine) and apiol." All of these substances, even in small quantities, have absolutely no stimulating effect on the uterus. The most toxic are pennyroyal, tansy and apiol but the difference between them in this regard is only in degree. Macht is led by these experiments to the following conclusions: "1. The so-called emmenagogue oils are by no means innocuous substances. 2. They have absolutely no direct stimulating action on the uterine contractions or tonicity. 3. On the con trary, they inhibit such contractions, and even paralyze the uterus. 4. Their action as abortifacients, if they act as such, is no different from that of any other powerful systemic poison, such as phosphorus, or arsenic. 5. They have very little, if any, therapeutic value and do not deserve a place among the official pharmacologic preparations which many of them hold." Auricular Fibrillation After describing the normal mechanism of the heart beat and the use of the electrocardiograph and polygraph, J. D. Heard, Pittsburgh (Journal A. M. A., June 8), says that through recent researches, as summed up by Lewis, we are in full possession of the facts in regard to a hitherto uncomprehended manisfestation. We now know that the "mitralized" pulse, with the frequently attending phenomena of circulatory breakdown, are due to fibrillation of the auricle. This knowledge is regarded by Makenzie as the most important gain thus far in regard to the functional pathology of the heart. We can now make a sane prognosis of some hitherto puzzling cases, and have data for instituting a treatment hitherto impossible. Auricular fibrillation is a condition in which the auricles no longer contract coordinately, but are constantly in a position of diastole, while individual groups of fibers are in ceaseless activity, causing frequent and disorderly impulses to be transmitted to the ventricle, which responds by contracting without any rhythm. When this is the case the disorderly ventricular contraction impairs efficiency of the heart, which is somewhat enlarged, and unless proper treatment is institudted, the ventricle is gradually exhausted. A disturbance of conduction, if present, is exaggerated, and partial or complete block may follow, though with this the clinical condition of the patient may improve. The condition is induced by myocardial affection, notably the post-febrile infections, though other causes may occur. Overstrain may be a predisposing cause, and the use of the drugs of the digitalis group may bring it on in the predisposed. Organic changes in the auricle seem to be essential, but the pathologic histology needs more study. Makenzie's estimate of 70 per cent of all cases of heart failure being due to auricular fibrillation or aggravated by it, may be accepted. Subjective symptoms may fail for some time when compensation is maintained, but this is not the rule. There may have been previous attacks of tachycardia, and the signs and symptoms of the early stages are those of broken compensation. In severe cases there may be orthopnea, cyanosis, dropsy, hemoptysis, local pain and albuminuria. The pulse is usually rapid and disorderly, and gives the usual evidence of hypertrophy and dilatation. The presytolic murmur of mitral stenosis is absent. The affection may be transient or permanent, and one attack predisposes to another. If permanent, the prognosis depends on the rate of pulse and the response of the heart to treatment. It is not incomptible with long life. A slow pulse is more favorable than a rapid one, and the prognosis depends in great measure on the ability to lower the rate. The one sovereign remedy is digitalis, but it usually fails where the pulse is regular, and is contra-indicated in cases accompanied by partial block. Prevalence of the Heroin Habit. Heroin, which is derived from morphin, is so frequently employed in the treatment of various diseases that the question of formation of habit from its use is a serious one. It is often prescribed for cough, the result of irritating conditions in the air passages, and physicians not infrequently tell their patients what drug they are prescribing, so that indirectly the patient comes to look on heroin as a harmless remedy for his cough. Even physicians are not sufficiently alive to the danger of habit from its use. In one instance a patient told a physician, who was called to treat him for an attack of laryngitis, not to give him anything that contained opium, because he had formerly been a slave to this drug. The physician replied: "I will give you some heroin; there is no danger of habit from that." This the patient took, with the result that he later had as much difficulty in breaking away from the heroin as from the opium habit. Some patients who are addicted to the use of morphin substitute heroin because it is easier to obtain. A further reason for the use of heroin is that firms advertising preparations containing this opium derivative call attention to its harmlessness. In a recent issue of The Journal of the American Medical Association, Dr. John Phillips of Cleveland calls attention to the fact that heroin is being used extensively by means of "snuffing," in the tenderloin districts of large cities. One patient said that he knew at least twenty of his associates who used the drug in this manner. The dangers of this practice should be known as the heroin habit is just as bad as the morphin habit. |