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ence of an intra-abdominal abscess cavity which continues to suppurate. Oviously, no conscientious surgeon would consent to employ drainage in all his cases merely for the purpose of obtaining statistics to prove its undesirability, so Dr. Olshausen bases his argument on a study of 113 cases in which most surgeons would have drained in view of the circumstances. For instance, in 65 cases in which there was accidental contamination of the peritoneum with pus or other infective material, in spite of non-drainage he had only fourteen deaths. Moreover, he had only four deaths in 33 cases of typical pysosalpinx, and he was even more fortunate in cases in which there remained extensive raw surfaces, ten cases having no mortality. Even when there has been no accidental perforation of the bladder or intestine he obtained good results in the absence of drainage. In lieu of drainage he advocates careful cleansing and drying of the surfaces and closure.
The Abdominal and Pelvic Lymphatics,
and their Relationship to Cancer of the Uterus.
W. F. Wakefield (Amer. Jour. Obs., etc., vol. 48, no. 4) says:
b. Removal of the parametric connective tissue.
2. Vaginal hysterectomy has no place as a curative operation in cancer of the cervix. Nothing but palliative benefits should be expected from it. Undoubtedly it will die a hard and lingering death on account of its ease of performance, its low mortality rate, and the fact that the occasional surgeon can readily perform it. It is gratifying, however, in pursuing our late literature, to see the overwhelming preponderance of opinion in favor of some abdominal method of operating.
3. The abdominal route, which would include the combined abdominal and vaginal, is the only one that permits us to be sufficiently radical to obtain results that promise some hope of permanency. I do not deem any operation worthy of consideration that does not succeed in accomplishing at least the
first three of the above-mentioned desiderata; the fourth will gradually grow out of the performance of the other three. Such a radical operation as is here implied presents technical difficulties that will be surmounted only by experienced surgeons, and even with these it will not be popular until they have, with prolonged practice, reduced the operation to a reasonable time-limit of performance and cut down its higher mortality rate. The disease we aim to ameliorate is assuming such awful proportions that we must abandon all traditional routine and thoughtfully adopt such measures as seem to promise more lasting benefits, regardless of the difficulties to be overcome in their adoption.
4. That operation will outlive all others which permits the accomplishments of the previously mentioned desiderata with the least injury to peritoneal structures, and at the same time affords the greatest protection to the ureter and important vessels.
Gonorrhea in Infants.
R. B. Kimball (Med. Rec., vol. 64, no. 20) says:
1. Gonorrhea prevails among infants and children to an extent not fully appreciated by the medical profession at large, and has become a common epidemic in institutions where numbers of children are placed together.
2. The ordinary clinical forms which the gonococcus infection assumes in children are ophthalmia, vulvovaginitis, and pyemia.
3. A series of cases of pyemia, reported in this paper, accurred in infants, in whom no local lesion could be found to explain the mode of entrance of the organism to the general circulation.
4. The suggestion is made, that from a stomatitis due to the gonococcus such a systemic infection may arise. Gonorrheal stomatitis in infants is a disease that needs further study.
5. Only by careful exclusion, by microscopical examination, and by complete isolation can this disease be absolutely debarred from a hospital where infants are cared for.
6. There is urgent need of public enlightenment on this subject. Those in charge of institutions for children, trained nurses and even parents, should be taught the frequency and virulency of this infection and the ease with which it is spread. It should be the duty of health authorities to include. gonorrhea among the acute infectious diseases of children.
Appendicitis from the Standpoint of the Gynecologist.
H. P. Newman (Jour. A. M. A., vol. 41, no. 15) concludes: 1. That the abdomen should be examined in all important pelvic cases and vice versa.
2. Functional disturbance in the pelvis may produce disturbance in the neighboring abdominal viscera.
3. In opening the abdomen for pelvic disease the appendix should always be examined.
4. If catarrhal, adherent or containing concretions, it should be removed.
5. It is not sufficient to break up or separate adhesions of an attached appendix.
6. As the macroscopic examination of the appendix is not always conclusive, its removal or "prophylactic appendectomy," when the abdomen is already open, should be determined by the best judgment of the surgeon and the condition of the patient in each individual case.
7. Any appendiceal or localized peritonitis may be an active factor in the immediate or remote production of intestinal obstruction. Strangulated intra-abdominal hernia has occurred as a result forty years after the primary lesion, and with entire freedom from symptoms during the long interim.
8. In opening the abdomen for intestinal obstruction the appendix and pelvic viscera should be looked to for the cause of trouble.
9. In removal of the appendix the invaginating operation should be done, or such other painstaking work as all intraperitoneal affections demand, to protect the wounded surfaces from subsequent adhesions.
10. The frequency of implication of the appendix by contact with diseased pelvic genital organs (Kelly cites twentyseven adherent appendices in one hundred hystero-salpingooöphorectomies, and the figures of Peterson correspond) renders important not only the early removal of the pus tubes, infected cystic tumors and the like, but also after operations. where the appendix remains, its careful protection from any possible denuded peritoneal surfaces or involved areas.
11. Barring the greater liability of infection from neighboring viscera and the somewhat greater difficulty of differential diagnosis in the female, we have more available means of exploration, a better prognosis and greater facilities for operative and non-operative relief.
Memphis Medical Monthly
Memphis Medical Monthly, established as the Mississippi Valley Medical Monthly, 1880 Memphis Lancet, established 1898.
LYCEUM BUILDING, MEMPHIS, TENN.
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Official Organ of the Tri-State Medical Association of Mississippi, Arkansas and Tennessee, Memphis Medical Society, and Yazoo Delta Medical Association. C. H. BRIGHT, BUSINESS MANAGER. RICHMOND MCKINNEY, M.D., EDITOR
W. B. ROGERS, M.D.
A. G. SINCLAIR, M.D.
T. J. CROFFORD, M.D.
W. D. HAGGARD, M.D., Nashville.
B. F. TURNER, M.D.
IN the Medical News for January 23d, Dr. J. W. Kime, of Fort Dodge, Iowa, has a short but very interesting article on the subject of bovine tuberculosis which, in view of the much discussed relationship between this condition and human tuberculosis, is exceedingly timely. Kime states that the exact relation of bovine to human tuberculosis is not yet made out, but when this relation has been definitely ascertained it will no doubt be found to be a very close one. The morphology of the bacilli is practically identical, the bovine bacillus being very slightly shorter and a little thicker than that of human origin. The bovine bacillus is pathogenic for a wider range of animals than the human bacillus, and the morbid changes which follow its introduction are much more marked, and the disease is much more rapidly fatal than is that produced by the human bacillus. In a number of instances human tuberculosis has been experimentally transferred to cattle, and, accidentally, a number of well authenticated cases of bovine tuberculosis have been transferred to man. Hence, the two diseases must be held to be identical in man and in bovines, the only differences being those which might be expected in mammals differing so widely from each other. The author personally believes that the milk of tuberculous cows is just as dangerous as the sputum of the consumptive patient, and that it produces fully as many cases of tuberculosis in man as
come from bacilli of human origin; and that it is very probable that those cases derived directly from the cow are more rapidly fatal than are those which have for a number of generations been confined to man. He believes that in the cow we find the natural habitat of the tubercle bacillus. This view is strengthened by the fact that in a very large percentage of cases of human tuberculosis we are able to trace no source from which the disease has originated.
He says that it is estimated that there are no less than 2,500,000 tuberculous cows in this country, and from these milk, butter and other dairy products are daily distributed to our homes. If a cow respond to the tuberculin test she should at once be condemned for dairy purposes, as foci of infection may be present in the udder, and may not be sufficiently large to be detected by any known methods of examination; nor is it known that milk from tuberculous cows whose udders are healthy is free from bacilli. In fact, the contrary is held to be true. Milk from an infected dairy herd is especially dangerous to children whose diet is so largely composed of this single article of food. The author speaks of the great difficulty being encountered in the attempt to stamp out tuberculosis in cattle, the earnest efforts on the part of physicians, veterinarians and other well-informed people during the past few years to eliminate this disease from our herds of cattle having been met in many parts of the country by most bitter opposition on the part of dairymen and live-stock men. He says that the unfortunate utterances of Koch at the London Congress of Tuberculosis have materially lengthened the time necessary to stamp out tuberculosis in our dairy herds.
EXIT THE TOY PISTOL.
THE statistics of Fourth of July tetanus show such a great and widespread mortality from wounds inflicted by blank cartridge explosions in the hands of that perverse juvenile, the American small boy, that the public is being stirred to take action for which the medical profession long has contended. The realization of the great number of fatalities occurring on the occasion of the celebration of Independence