The Medical Herald

Incorporating the

Kansas City Medical Inder-Lancet

Subscription, $1.00 a year, in advance, including postage to any part of the United States, Alaska, the Philippines, Cuba and Mexico. Canada, 25 cents additional. Postage to foreign countries in the Universal Postal Union, including Newfoundland, 50 cents a year additional.

The Medical Herald aims to reflect the progress in the sciences of medicine and surgery, especially throughout the Missouri Valley and Southwest, the territory of its greatest distribution.

Concise and practical articles, news and reports of interesting cases invited, and should be typewritten.

The privilege of rejecting any communication is reserved, and all papers accepted must be for exclusive publication in this magazine, unless otherwise arranged.

To contributors of original articles a liberal number of copies of the Herald will be given (or mailed free of expense if addresses are furnished) and the publishers will furnish reprints at printers' cost, application for same to be made when proof is returned.

The editors are not responsible for the utterances of contributors or correspondents.

Illustrations will be furnished at reasonable rates, if drawings or photos are furnished.

Address all remittances, correspondence, articles for publication, books for review and exchanges to the Managing Editor.

Subscribers changing their addresses will please notify us promptly, as magazines cannot be forwarded without adding postage.

Advertising forms close on the 20th of each month. Time should be allowed for correction of proof.

Electrotypes and changes in advertising copy should be addressed to the Medical Herald, St. Joseph, Mo.

Advertising rates on application to the Managing Editor.

Poetic Reprints-Do not mutilate your Medical Herald by tearing out any piece of poetry that may strike your fancy. Write to the Managing Editor, and he will send you a reprint. Reprints are made of all verse appearing in this magazine.

OFFICIAL ANNOUNCEMENT

The Volunteer Medical Service Corps

An appeal to executive committees and county representatives of the Volunteer Medical Service Corps, and State Committees of the Council of National Defense.

No official or committeemen representing the Volunteer Medical Service Corps or the General Medical Board of the Council of National Defense, is now authorized or has been authorized to favor any organized or unorganized method of coercion in inducing members of the medical profession to join the Medical Corps of the Army or Navy, or the Volunteer Medical Service Corps. Our committeemen are especially urged against favoring any movement that would threaten to impair a medical man's standing in his local, state or national society because he refused to enroll in the army or navy, or the Volunteer Medical Service Corps.

It must be made clear that the Volunteer Medical Service Corps is a volunteer organization which has for its object the enrollment and classification of the profession. Its members are entitled to wear an insignia which will clearly indicate that they have offered their services to the government, when such services are needed. Patriotism cannot be created by coercion. It also must be made clear that the Volunteer Medical Service Corps has for its primary object,

POND'S EXTRACT

furnishing its classification to the army, navy, the Public Health Service, the Red Cross and Provost Marshal, as well as to civilian institutions and communities, as a guide in providing for their needs to the best advantage.

The object of the corps is not to disturb any medical man in the performance of any duty to which he has been assigned by any governmental agency either for service at the front or at home.

(Signed) EDWARD P. DAVIS, President, Volunteer Medical Service Corps. FRANKLIN MARTIN, Chairman, General Medical Board, Council of National Defense.

If you have not received a blank, write at once to Col. Franklin Martin, National Council on Defense, Washington, D. C.

CAUTION! Whenever the true merit of a preparation is authoritatively established, imitation is sure to make its pernicious appearance. To counteract the injurious results of another of these fraudulent proceedings-in this instance affecting firm name and reputation-Sander & Sons have been compelled to appeal to law, and in the action tried before the Supreme Court of Victoria, the testimony of a sworn witness revealed the fact that this witness suffered intense irritation from the application to an ulcer of the defendant's product, which was palmed off as "just as good as Sander's Eucalyptol." Sander & Sons had the satisfaction to obtain a verdict with costs against this imitator, who is perpetually restrained from continuing his malpractice. Dr. Owen, in a report to the Medical Society of Victoria, and Dr. J. Benjamin, in the Lancet, London, both denounced, as others did before, on the strength of negative results, the application of unspecified eucalyptus products.

This forms convincing proof that only an authoritatively sanctioned article can be relied on.

SANDER & SONS' EUCALYPTOL (Ecalypti Extract)

1. Has stood the test of Government investigation.

2. It was proved at the Supreme Court of Victoria by experts to be an absolutely pure and scientifically standardized preparation.

3. It is honored by royal patronage. 4. It always produces definite therapeutic results.

Therefore, to safegaurd the physicians' interest and to protect their patients, we earnestly request you to specify "Sander's Eucalyptol" when prescribing eucalyptus.

The Meyer Bros. Drug Co., St. Louis, Mo., agents, will forward one original package (1 oz.) on receipt on One Dollar.

Vol. XXXVII.

No. 11

number, but of a sufficient variety to be interesting, and I trust instructive.

During the last few years many surgeons, having sharp knives, have been looking for an opportunity to deliver a baby surgically. On the face of things it is one of the most spectacular operations of surgery and exceedingly simple to perform, but from what I have seen it is performed altogether too frequently on women either in a poor condition or when some other method of delivery should have been chosen.

In Omaha I know of seven women who died during 1916 following cesarean section, most of them having been done by leading men, and while I have no record of all the operations performed during this period I think the fatalities must have been 25 to 30 per cent of the cases. There is some risk of cesarean section being over-done on account of poor judgment in selection of cases.

During my experience cesarean has been modernized and made a strictly up to date operation to a greater degree than ever before. Originally cesarean section was done wholly on dead or dying women in the interest of the unborn child. I have had no experience with this class of cases but two years since pregnant woman fell on the street of Omaha, was picked up unconscious and hurried to her home. Dr. Mack of Omaha was called and arrived about fifteen minutes later. He found the woman dead, did an immediate cesarean and saved a live baby girl that is alive and well today.

The next step in cesarean was practically in the interest of the baby as the maternal mortality was nearly 100 per cent. These were the cases where pelvic deformity was so great that it was impossible to deliver a child even after embryotomy had been performed. This was before the days of aseptic surgery, the uterus was not sutured and the cases were little removed from the class of dead or dying mothers so far as actual results were concerned. But occasionally both the mother and child would be saved.

In 1882 with the limited knowledge of asepsis of that day Sanger conceived the idea of suturing the uterus after section and from that day cesarean has become one of the recognized operations to be performed in the interest of both mother and child.

After recommending multiple incisions of the cervix as a method of opening the close cervix in 1890, Duhrssen in 1895 successfully performed vaginal cesarean and saved both patients.

During the last ten or twelve years both the Sanger and Duhrssen operations have been perfected to a high degree and have become the established operations of the present time.

The mortality statistics of value at the present time do not extend back ten or twelve years. I have had no experience with extra peritoneal cesarean and hence omit that subject from the present discussion. Having two methods, vaginal and abdominal cesarean established as legitimate methods of emptying the uterus surgically in the interests of mother and child, it is well to discuss the applicability of the two methods.

Case 1. Primipara about forty years of age, near full term, gave every indication of impending eclampsia. After two or three days' treatment, it was decided to bring on labor. This was done by introducing a bag into the cervix. Labor came on promptly and the woman went into convulsions. Vaginal cesarean was performed and the child delivered by version, died very shortly after, recovery of mother uneventful.

Remarks: Being a toxemic case, I believe that the concensus of opinion would favor the vaginal rather than abdominal method so far as the mother was concerned, as being less liable to produce serious kidney lesions. In this case the efforts at cervical dilatation contra-indicated abdominal section on account of danger of infection. Another point of interest in this case is that labor often becomes an exciting cause of convulsions in an eclamptic woman and must always be carefully considered in these cases.

If we consider the interests of a full grown child there is no doubt that the vaginal method is more disastrous, especially when delivery is complicated by version.

Case II. Primipara 36 years of age, 26 weeks pregnant, profoundly toxemic with every indication of impending convulsions. It was decided that welfare of baby being non-viable should be disregarded and the woman be promptly delivered and vaginal cesarean was given the preference of methods. The mother made a complete recovery but it was many months before her kidneys were restored to a normal condition.

Remarks: Labor either induced or normal often precipitates convulsions in toxemic cases. This was the result in Case I and I believe that Case II would have gone into convulsions with the advent of labor. The child being non-viable there was nothing to consider only the interests of the mother.

Doubtless the major number of cases indicating cesarean are in justo-minor flat pelvis or extreme disproportion. These women present

histories of previous labors with disastrous results to the baby. I have seen numerous such cases giving a history of difficult labors with forceps extraction or version, resulting in a dead baby. I was called to see one woman who had had four dead babies as a result of delivery. I saw another woman whose baby was permanently defective as a result of difficult delivery. There being no contra-indication these cases are ideal for abdominal section, if resorted to as a primary operation by a skilled operator with surgical environment, there should be no mortality for

either mother or child.

It should always be borne in mind, however, that efforts at delivery by natural passages, repeated examinations, any examination only under strict asepsis, early rupture of membranes, prolonged efforts at delivery on the part of mother, or general exhaustion of mother for any

reason are contra-indications to cesarean section.

I recommended a cesarean in one primipara, a rachitis dwarf, with justo-minor flat pelvis; the operation was a success in every way and she subsequently gave birth to a living child normally. In two cases I have known of normal labor following cesarean, so "once a cesarean" does not mean "always a cesarean" in my experience. I know of no bad results from labor following a cesarean. With few exceptions primipara should be put to the test of labor in these conditions, but the test should not be unduly prolonged, then cesarean will not be called for except in cases where the presenting part does not enter the pelvic cavity. All my cases in this class have given 100 per cent recovery.

Cases III-IV-V. Unterine tetany. Of this series Case III primipara was seen in consultation at or near full term, with tetany of uterus, hemorrhage, close cervix and impending convulsions with a dead baby. Diagnosis, eclampsia of uterus, ablatio-placente. Urinary findings gave all the evidence of acute nephritis. Abdominal cesarean appeared to be the only way to deliver this woman alive. She died six weeks later of kidney lesions. There was no drain put into the cervix and as a result the cervix had to be dilated two days later to allow drainage to take place.

Case IV. Primipara was under our own observation and at about the 36th week she suddenly developed albumen in urine with headache and other toxemic symptoms. She also developed prolonged severe uterine muscular pain that required full doses of morphin to relieve. She was placed in the hospital where the urinary findings were albumen and casts. There was high blood pressure and the uterine pain developed into continuous contraction (tetany). With my previous experience staring me in the face, I feared ablatio-placente. We decideed on immediate delivery. The entire uterine muscle,