History of medical practice in Illinois - Bushnell Historical Society

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228 History of Medical Practice in IllinoisIn the year 1883,a vaginal hysterectomy was performed in Peoria forcomplete procidentia of the uterus which had been prolapsed continuouslyfor six years and intermittently for twelve years. The operation was doneunder ether anesthesia and took one hour and ten minutes. No repair wasattempted, but the denuded posterior vaginal wall and the posterior surfaceof the bladder became adherent to each other and closed off the vagina,thus providing support for the abdominal viscera. The patient sat up alittle at the end of five weeks, easily walked across the room alone in sevenweeks and went home in two months!Dr. Charles Warrington Earle stated in 1885 that postpartum hemorrhagecould be treated by the farradic current with excellent results. Thepractitioner was advised to stay by the patient's bedside for at least an hourafter delivery to assure himself frequently that the uterus was contractingfirmly.Up to this time carbolic acid had been used as an antiseptic for intrauterinedouche. Bichloride of mercury 1:1000 largely replaced it but therewas evidence that some cases showed mercurial poisoning following its use.Eclampsia was now beginning to be better understood, and the relationshipof albuminuria to the disease was noted as an effect rather than acause. The good rules for prenatal care which were laid down were muchlike ours of today:Use of tonics and iron for the blood.Liberal diet.Stimulation of functions of the skin to relieve tensions of the kidneys.Examination of the urine for albumin after the fifth month or earlier, ifthere is probability of renal disease.Warm bathing in water 108 to 1 io° was believed to be of great value andwould not cause premature labor.Force fluids and milk diet.Purgatives and diaphoretics.Induction of labor when these means failed to improve the threateningcerebral symptoms.There were 480 deaths from eclampsia reported in Boston from 1867 to1876; the Chicago statistics were said to be worthless.Management of retained placenta and membranes was well described.A period of Avatchful waiting, often trying Crede expression, was advised,supplemented if necessary by gentle traction on the cord. If this failed, thesterile vaginal examination was resorted to, assisting the exit of the placentafrom the uterus by helping with the fingers of the examining hand. Thedanger of removing a densely adherent placenta was pointed out. Procrastinationin the delivery of the placenta after a few hours, even if there wasno hemorrhage, was considered to be unwise because operation might haveto be performed later in the presence of severe infection. The use of anti-
Obstetrics and Gynecology 229septic solutions during these manipulations and the need for meticulouscleanliness in carrying them out were stressed.Ectopic pregnancy had only recently been understood and naturally hadexcited particular attention. A most remarkable type of treatment was suggestedand practiced by Thomas of New York: When the usual presumptivesigns of pregnancy were followed by paroxysmal pelvic pain, irregularbleeding and a small tumor in the region of the tube, an ectopic pregnancywas suspected or diagnosed. The destruction of the life of the fetus was thelogical answer to the problem of preventing rupture of the tube. This wasthought to be best accomplished by use of the electric current in the followingmanner: the negative pole was introduced into the rectum andthe positive pole over the gestation sac. The current was applied at differenttimes and in different strengths until the size of the tumor diminished,pointing to death of the fetus.In advanced abdominal gestation at term,operation was advocated. In case of prolonged gestation with a dead fetus,a hands-off policy was advised until lithopedon formation had occurred,unless sepsis supervened.Dr. O. B. Will of Peoria in1885 wrote a paper on the use of the microscopein gynecology. He said that this instrument, in the estimation ofmany members of the profession, had at least a very uncertain position inpractical medicine. Dr. Will, however, defended the use of this instrumentby the general practitioner, although he pointed out that training andpractice were necessary to arrive at a definitive diagnosis. He warned hisfellow-practitioners only to interpret microscopic reports in conjunctionwith clinical facts, a conclusion which is just as valuable today as when itwas written. Dr. Will indicated that malignant tumors of the uterus couldbe demonstrated by biopsy specimens but pointed out that several caseshad been misdiagnosed by eminent microscopists, which statement revealedhis keen insight into the subject. By means of a sharp cannula, he removeda plug of suspicious tissue from the cervix, obtaining what corresponds toour punch biopsy, which enabled him to study invasion by the malignantcells. Carcinoma of the uterus thus could be differentiated from ulcers ofvarious forms, and carcinoma of the cervix could be differentiatedfromerosion. The most astounding statement in the light of our present day researchon cytology is seen in the following quotation: "From microscopicexamination of the discharges from the uterus and vagina much valuableinformation has been attained. The existence of malignant neoplasms(carcinoma and sarcoma) has been revealed in this way when it was notsuspected and thereby a correct treatment instituted in its incipiency."Dr. Will related such a case, proved both by biopsy and postmortem. Healso studied fluids aspirated from the abdominal cavity and found columnarcells in some patients with malignant ovarian cysts, as well as hair andepidermal scales in patients with dermoids.
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HISTORY OFMEDICAL PRACTICEIN ILLINO
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PREFACEVARIOUS members of the Illin
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Prefaceixall of its local health de
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PrefacexiDr. E. A. Piszczek, Chicag
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THEEDITOR'S FOREWORDperiod 1850 to
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Editor's Forewordxvand 650 he comme
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xviiiXVIII.XIX.Medical Bacteriology
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CHAPTER IINTRODUCTIONBy DAVID J.DAV
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Introduction 5Smillie 3 wrote on ep
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CHAPTER IIMEDICAL GEOGRAPHY OF ILLI
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Medical Geography of Illinois 9geol
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12 History of Medical Practice in I
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Medical Geography of Illinois 15had
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Medical Geography of Illinois 17of
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Fig. i. Places and regions in Illin
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Medical Geography of Illinois 21ref
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Medical Geography of Illinois 23Cha
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i„r»-l ll'urlnllli• A i!.n»Ut
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CHAPTER IIITHE HARDY PIONEER:HOW HE
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CHAPTER IVORGANIZATION OF THE ILLIN
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CHAPTER VIIINTERNAL MEDICINEBy GEOR
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114 History of Jiledical Practice i
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CHAPTER XIIIOTOLARYNGOLOGYBy ALFRED
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CHAPTER XIVDERMATOLOGYBy B.BARKER B
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CHAPTER XVNEUROPSYCHIATRYBy OSCAR H
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CHAPTER XXIVMEDICAL JOURNALISM IN I
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APPENDIXMISCELLANEOUS NOTESAddition
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5ioIndexAntifebrin, 138, 139Antipyr
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5 1 * Index159, 163, 190, 284; Amer
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5HCollege of Medicine, University o
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516 IndexEpidemics, 5, 507Epileptic
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15 i8 IndexHarris, Dr. J. O., 115Ha
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5 2 ° IndexJacobson, Dr. Daniel Si
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522Index456, 457; Privately Endowed
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524IndexParkes, Dr. Charles T., 181
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