Various

“ On the other hand, the onset may be so stormy or symptoms so terrifying, that we at once think of all the horrible conditions to which the genito-urinary tract is heir. But once our suspicion is aroused as to the possibility of tuberculosis of the kidney, the question of an exact diagnosis, the question of which kidney is involved, and the condition of the other kidney (on which naturally depend the course to pursue) are matters not always easy to decide. ”

“ On the other hand the strong mental shock and emotions that come to women in connection with, or as a coincidence to, childbirth are getting no less in this world of ours and I feel that we must all agree that sepsis and toxemia in the puerperal and anæmia in the lactational types of insanity are our real causes:—the emotional factors being secondary or only the exciting causes in the majority of cases. ”

“ New York, N. Y. Renal tuberculosis occupies a pre-eminent place in the list of those diseases whose initial symptoms are apparently so insignificant and whose onset is so insidious that the true state of affairs is either entirely overlooked or else recognized only after it is too late to accomplish the most good. ”

“ These are not very different, except suggestively lower than Jones, of London, who, in 1903, found from 6.4 per cent, private, and 8.1 per cent poor class patients then in the London Asylum.
With so much information, vague and meagre as it is, let us pause a moment and weigh the evidence. As our ideas of pathology change with time, so must our viewpoint as to morbidity and the most recent ideas must settle such questions.
Williams, Hirst, Edgar, Webster, De Lee, Jones and Tweedy & Wrench, refer to it absolutely as a disease. ”

“ Other conditions which excite puerperal psychoses are the painful emotions.
Lewis, of Chicago, who, we must remember, does not call this a medical entity, says: “The inciting factor of insanity arising during the puerperal period are due, in from 70–80 per cent of the cases to either toxemia or infection. In the remainder no exciting cause beyond the general disturbance due to the bodily state can be assigned, * * *. The insanity arising in the lactation period is essentially due to exhaustion and inanition,” occurring in women of the poorer, harder working, more improperly fed classes. ”

“ If the above demands and conditions are fulfilled the maternal mortality should be practically nothing, the morbidity negligible, the end result perfect, and with the exception of those cases undertaken solely in the interest of the mother, every child should be born alive.—Medical Progress. ”

“ In the past fiscal year 12,000 cases of trachoma have been treated, the larger proportion of which were cured, while those in which a cure was not effected have been greatly improved and rendered harmless to their associates. The great majority of these trachoma patients were people who lived in remote sections far removed from medical assistance, and who, but for the hospital care and treatment provided would have remained victims of the disease practically the remainder of their lives. ”

“ General bodily health must be closely watched. The cause of infections must be met on surgical principles, as in any other infection, and the emunctories must be carefully looked after in this class, and, in those of chemical origin, its particular cause must be run down and met, whether in liver, intestine or kidney. ”

“ Edgar says that “there is no doubt that the presence of puerperal sepsis in many of the cases is something more than a coincidence.” Alienists assure us that since the introduction of antisepsis into midwifery the frequency of puerperal insanity has been marvelously diminished. Many cases of this type of psychoses are said to exhibit more the nature of delirium—such as is seen, for instance, in typhoid fever—than of actual insanity. Again, the coincidence of severe local infection has often been remarked, and gives color to the toxic theory ”

“ Acute Appendicitis. John B. Deaver says the important points that have to be learned about this disease are that it is the most common intra-abdominal inflammation; that indigestion is often a forerunner, preparing the soil for the infection; that being an infectious disease and the most common infectious disease of the abdominal cavity, the appendix constitutes the avenue by way of which infection most commonly invades the upper abdomen. ”

“ Clouston, of Edinburgh, among 1,500 women, found 10 per cent were classified as suffering with puerperal psychoses and most of the earlier figures (and here we have the first real thought) before the antiseptic era give similar percentages—the New York State hospitals from 1888 to 1895 give only 5 per cent as puerperal in origin. Before we draw a too hasty conclusion, let me quote Lane based on observations in the Boston Insane Hospital for ten years, “that insanity associated with childbirth occurs only one-half as frequently as does insanity among women in general of childbearing age. ”

“ Although quinine remains the best means of treating malaria, and is also of marked benefit in preventing infection, the eradication of the disease as a whole rests upon the destruction of the breeding places of Anopheline mosquitoes. The Public Health Service, therefore, is urging a definite campaign of draining standing water, the filling of low places, and the regrading and training of streams where malarial mosquitoes breed. ”

“ A long labor, much handling and manipulation, especially in the presence of ruptured membranes, predispose the patient to infection of the peritoneal cavity, and fifth, therefore, intraperitoneal abdominal Cesarean section should not be undertaken under those conditions, with one exception, namely when the religious prejudices of the family demand the saving of the child at the expense of the mother, and then only in the presence of and with the advice of a consultant and a clergyman, after carefully explaining the situation to the family and obtaining their written consent to the procedure. ”

“ Edgar tells us that exhaustion is the usual cause of death but recovery is the rule even from the insanity; if not, it goes on to a terminal dementia or paranoia. A high pulse-rate is a bad sign.
Berry Hart says the prognosis is good under proper treatment and the return of menstruation is such a good sign that emmenagogues should be employed.
Tweedy & Wrench say some 60 per cent of all cases recover, but if, as the patient gets fatter and stronger the mind does not improve, the prognosis is bad. ”

“ Tweedy & Wrench have found that insanity of the puerperium is always associated with either severe anæmia from hemorrhage or with sepsis. The patient is first irritable and uneasy about unknown dangers. She had a headache, is constipated, she may refuse food or to see her child or husband, and sleeps badly, and finally becomes definitely maniacal and may have suicidal tendencies. During lactation the patient becomes gloomy, sleeps badly, and is constipated. Definite melancholia develops with delusions and suicidal tendencies. ”

“ Of 203 strictly puerperal cases collected by Jones, of London, about 10 per cent were single and 33 per cent were primiparal. One patient had an attack of insanity after each of her twelve children and another with each of nine, both becoming subject to chronic incurable insanity at the climateric. In lactation cases the insanity did not commonly follow a first confinement, but appeared to be due to the strain of frequent pregnancies and the exhaustion of long continued nursing. Puerperal insanity is most common between twenty-five and twenty-eight ”

“ The patient was now turned back and his left kidney removed. Both wounds healed by primary union, the patient making an uneventful recovery.
In later reviewing the case Dr. Keyes states that he would have been warned of tuberculosis on the left side had he but seen some pus in the urine from that side, for, as he further says, “casts on one side and deficient function with pus and without marked enlargement of the kidney upon the other side, is very suggestive of unilateral tuberculosis.” The 107case is of further interest on account of the greatly hypertrophied right kidney. ”

“ Williams tells that the progress is three to six months and if longer the prospect is very poor, 20–40 per cent fail to regain mental equilibrium and 5–10 per cent die, this high mortality due, he feels, to the underlying infection and not the mental derangement itself, and with these figures Hirst is in practical accord.
Lewis tells us 25 per cent of the infection cases die, but the progress of toxic cases is not so bad. Death occurs usually from sepsis or the exhaustion on account of the motor excitement. Lactational cases recover in 50 per cent, and they take eight to nine months. ”

“ The choice of the anesthetic is of great importance as to the outcome of the operation. The Basedow’s type with predominating nervous, myasthenic and psychic symptoms is best operated on under general anesthesia, the other cases under local anesthesia. 5. Operation is contraindicated in status lymphaticus; if it can not be avoided, a local anesthetic should be employed. 6. In many cases the operation only lays the foundation for successful internal treatment. 7. The most unfavorable time for operation is that of increasing intensity of the disease ”

“ On the other hand, the better or higher the Quality or the Service that is obtainable, the higher the price—which is a great natural law. Hence, high-priced should, and usually does men, high quality or service. ”

“ If the symptoms and signs, namely, pain, vomiting, fever, tenderness, and rigidity are interrupted, the diagnosis of acute appendicitis may be considered doubtful. Leucocytosis is of value as a confirmatory symptom when the patient reacts well to 123the infection. The most important point in the differential diagnosis is the distinction between acute cholecystitis and acute appendicitis. Acute pancreatitis, perforated ulcer, or perforated gall bladder, present symptoms so much more intense than those of acute appendicitis that they should not give rise to confusion. ”

“ The healthy, well nourished and well educated class escapes, the poor, ill-nourished, and ignorant class bears the burden until this burden is shifted on society in the form of beggar, defective, imbecile or criminal. ”

“ The vast majority of women who become insane are between the ages of twenty and fifty. The task of bearing and nursing children occupies a considerable portion of the time of the average woman during these ages. Therefore, we should expect a large proportion of cases of insanity to begin during such time even without casual connection.” According to Lane’s view the childbearing process gives a certain degree of immunity to insanity instead of predisposition thereto! ”

“ It is just as necessary to be able to limit the number of children so that each will at least get a good start in life as it is to bring healthy children into the world, since healthy children can not remain healthy and develop as well under unfavorable as under favorable conditions. ”

“ Both sexes ought to refrain from marriage if they are in any marked degree inferior in body or mind; but such hopes are Utopian and will never be even partially realized until the laws of inheritance are thoroughly known. Everyone does good service who aids toward this end. ”

“ From the right kidney, 14 cc. of urine, containing 2.4% urea, and a slight amount of pus; from the left kidney 3⁄4 cc. of urine, a very little urea and a large amount of pus. A nephrectomy of the left kidney a few days later revealed a small tubercular pyonephrotic kidney, with an apparently normal ureter.
In April, 1910, this patient was heard from directly for the last time. By virtue of his social status he was forced to lead a life which was not in conformity with his personal welfare, doing hard manual labor most of the time. ”

“ It is true we have laws against miscegenation and against certain consanguineous marriages; some States have passed and other States have attempted to pass, laws making certificates of health necessary before marriage licenses can be issued ”

“ For the experiments with mouse sarcoma No. 396 mice were inoculated, with 97.7 per cent positive. Among the mice bearing spontaneous tumors and Crocker Fund mouse sarcoma No. 180, there were no cases of absorption of the tumor under treatment. The Buffalo rat sarcoma showed a much smaller percentage of absorption among the treated animals than among the controls, 37 per cent as compared with 58.4 per cent. In the majority of the experiments the growth among the treated animals was much more vigorous than that among the controls. ”

“ Every few years we must take stock of just such questions and it is perhaps a reasonable duty for some of the younger and less active members of this society like myself to make the inventory.
Definition. Is it an entity? In Peterson’s “Obstetrics,” Lewis, of Chicago, tells us that the opinion is gaining ground that it is a coincidence and without etiological relation to maternity and that to childbearing can we probably assign only an exciting etiologic relation in the production of an outbreak of insanity. ”