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the torn lymphatic and other absorbent vessels to continuously pour their poison into the general circulation, how long will it be until the excretory organs become overpowered, the balance lost, the blood poisoned beyond recovery, and the patient killed? Does any gentleman here recall such a case and such condition of things from his own private practice, and does it require a Thomas to tell him that if he had scrubbed the ceiling, removed the draping from the window, taken up the carpet and cleaned his obstetric finger nail, that such precautions would have prevented this case of fever? So I am brought to the consideration of the theory of hetero-infection, or infection from without. This theory holds that the disease is preventable, and says that its occurrence is on account of not carrying out certain rules laid down by the advocates of this doctrine that there are vegetable organisms floating in the surrounding atmosphere, specific baccilli which attach themselves to the appointments and furnishings of the lying in room, that they lie in wait, hidden in obscure places, and are ever ready to pounce down upon and enter into the system through the genital orifice of any poor woman who may have the hardihood to bring forth her child and not keep her vulval apperture securely sealed with a wet carbolized rag-therefore her physician attending in this accouchment, and the nurse under him, must do thus and so, and if they dare to do otherwise then in the eye of the law, they are culpable and guilty of gross neglect and heedless to the teachings of modern and good obstetric practice.
I have stated on an other occasion, when this subject was being discussed in our society, that these rigid rules laid down by Dr. Thomas, were in some cases, nay, in most cases, such as the average physician has to deal with, impracticable, and not only that, but utterly useles.
What good can come from disinfecting the walls of a room wherein a patient lies suffering from a case of auto-infection, where she has furnished, and continues to furnish, that toxic element from her sloughing vaginæ, or retained and decomposing bits of placenta? True the advocates of these extreme measures also, tell us to pay attention to the vaginal tract, and to be vigilant in this quarter as well, but, if they admit that the cause resides here, wherefore the necessity for scrubbing the ceiling in a house which has been free from scarlet fever, small pox, and other zymotic diseases? I have been in the practice of my profession now some twenty years and in that time I have seen not a large number of puerperal fever cases it is true, but I have seen sufficient already to convince me of one truth at least, and that is, that in my own individual experience, a large per cent of my fever cases occurring in the puerperal state were due to local lesions, retained and pent up secretions,
imprisoned and decomposing bits of placenta or shreds of membranes, and that the careful and gentle cleansing of these wounds, the opening of a closed os. and thorough draining and washing out of the uterine cavity, mantaining the bowels in a free and soluble condition, keeping the skin active, the kidneys at work, and above all the avoidance of opium, has given such results that I am content to satisfy myself with these rational means, rather than to tie my hopes to the efficacy of such measures as have to do with fighting away bacteria from the walls of the bed
There is a fever occurring in the puerperal state which undoubtedly has its origin from outside influences, I refer to that pyrexia which may be established by conveying to the genital tract, or by being inhaled or swollowed any of the necrotic poisons such as is obtained from dead or decaying animal matter, post mortem filth or eryesipelatous products, etc. Here we have the same effects to all intents and purposes that we might have from the poisoning of a stump from amputation of the thigh or arm after the third day, only modified of course by the altered blood state peculiar to the parturient woman as I stated in the first part of my paper, and also by the peculiar channels of entrance, when that entrance is gained via the parturient canal. Concerning those fevers which are the result of exposure to the eruptive zymotics, I would say that they are a simple repetition of the original disorder, modified it may be, by the peculiar changed blood state of the woman, and that this is true, we need only to refer to the numerous cases, where these fevers have produced in the nonparturient, the original disease such as scarlatina, measles, etc., or whatever it may have been in the first place.
EUGENE CHARLES GEHRUNG, M. D.
Dr. Eugene Charles Gehrung was born in Mulhouse, (Alsace), France, in 1840. In his fourteenth year he accompanied his parents to America, landing in New Orleans in 1854. Soon after arriving in this
country he lost his hearing almost completely by an accident, thus interfering seriously with his school life at its most critical period, and altogether frustrating the plans of returning to Paris for the completion of his academic and professional education, which had been determined upon in the family councils before the loss of hearing Even after regaining his hearing in a partial manner, his studies were surrounded with unusual difficulties and discouragements; to such an extent, indeed, was
he daily and hourly embarassed in the prosecution of his studies. that a man of less indomitable energy would have given up the weary battle in sheer despair. This determination to succeed in spite of all obstacles was retained and kept alive by the hope he had cherished from boyhood, of one day becoming a physician. The habits of solitude and self communion forced upon him by his misfortune were, however, not barren of good results, for they engendered those traits of analytical and dispassionate reflection which form so marked a feature in his character.
By a most peculiar combination of circumstances, over which he had no control, and the consideration of which need not detain us here, Dr Gehrung was obliged, after a long preparatory training, to enter practice without a degree. This failure to secure a diploma was in no way due to a deficiency of knowledge, for he passed a creditable examination for the position of surgeon in the U. S. Army. Once more fate conspired against him, and family matters made it imperative upon him to resign his commission and return to Denver, where he immediately commenced his career as a physician. When he had been settled in Denver some six months, a gun powder explosion occurred next door to his office, which not only destroyed nearly all he had in the world, but put him to bed for months with almost fatal injuries. After his apparently miraculous recovery, he resumed his duties, only to be again interrupted by failing health, which at the expiration of a two year's manful struggle, forced him to try change of air and scene, hoping that country. and physical exercise could be partly substituted for mental overwork and the anxieties of a growing business. Accordingly he moved to Colorado City, then within the range of Indian depredations, when his health soon began to mend.
Finally, when fully restored, he returned in 1870 to St. Louis and secured the coveted diploma, which one circumstance after another had deprived him of for so long. It is needless to add that the mere possession of this document, although highly prized by Dr. Gehrung as the legitimate seal of his labors, added nothing to his knowledge, nor to the esteem in which he was held both in and out of the profession. This same year he was married, and again took up his practice in Denver. His success in gynecology, which from the first had absorbed much of his time and attention, made it necessary for him to gradually drop other branches, and devote himself more and more to his present speciality. In 1871 Dr. Gehrung invented the anteversion pessary known by his name, an account of which he published in 1873. The invention and description of his other pessaries rapidly followed. In 1872 he wrote a valuable
and original paper on "Circular Bandaging in certain Diseases of the
Chest," and a number of other articles, mostly on Gynecological subjects.
In 1876, acting upon the advice of medical friends, he moved to St. Louis with the intention of giving his time and labor exclusively to the treatment of the diseases of women, Denver, at that time, being too small a place for the successful cultivation of the specialties of medicine.
Dr. Gehrung is one of the founders of the St. Louis Obstetrical and Gynecological Society, of which, as well as of other learned bodies he is still an active member. As a matter of interest to Coloradoans, it may be stated that the subject of the sketch was one of the originators of the first medical society in this state, the Denver Medical Association, and also of the Colorado Territorial (now State) Medical Society, of which he was one of the incorporators. Many of the more important gynecological operations were performed by Dr. Gehrung for the first time in Colorado; in fact, it may be truly said that modern gynecology found its earliest exponent and most active supporter in his person.
Dr. Gehrung's writings, whether in the theory or practice of his branch, are marked by great originality of thought and a calm judicial tone of treatment, and have always been greeted with respect and attention by the profession. His name is well known in gynecological literature, and his views are quoted in the text-books and medical periodicals wherever diseases of women are studied.
J. MILNER FOTHERGILL ON FOODS AND FEEDING.
A great deal of time is spent on materia medica with disproportionate results. A medical man now deals with a reputable druggist, and buys not raw materials, but preparations, many of them very elegant. Why should time be spent over acquiring knowledge which scarcely can ever come into play, when so much that is highly desirable is not even attempted? To my mind, being neither engaged in medical teaching nor examining, it would be far better to cut off much of materia medica from one end of the lectures on therapeutics and develop the other end into some lectures on foods and feeding, or the modifications of function in the assimilative organs wrought both by disease in them and by gen. eral maladies like pneumonia or enteric fever. It is all very well to tell a man to put the patient upon slops and fluid foods. But what are slops? Some little time ago I was witn two general practitioners, no bad specimens of their class -one indeed decidedly a strong man, specially in a surgical direction-when this question cropped up. Both got to
beef tea and milk and seltzer water, and then the well of inspiration dried up. Nor were they behind others of whom similar interrogatories have been made. It may be all very well to say that my experience has been unfortunate; possibly it may have been; but at least it has been extensive, all must admit. As physician to a hospital of repute in the shape of the resident medical officer, favorable specimens of the latest teaching come under my notice, and it must be said that on this topic there remains to be taught much that would be useful alike to the young practitioner and his patients. The student may be taught the distinction between Senega and serpentaria, calumba and rhubarb, cascarilla and cinchona, Epsom salts and sulphate of zinc or oxalic acid, and forget all about the distinctions shortly after the last examination has been un fait accompli. But who tells him to remember that the saliva is apt to be limited in acute pyrexia, and therefore the farinaceous elements of food must be given in a readily assimilable form if they are to be of any use to the patient? Arrowroot was in great vogue thirty years ago, and is certainly a very soluable form of a raw starch; and, after all, solubility is the essence of digestion.
The physiologist cannot well enter into these matters of clinical medicine. The lecturer on Practice of Physic feels that he cannot include these matters in his course, already conveniently large. Who, then, should teach the youthful mind these details, of such transcendent importance in acute disease when life is trembling in the balance and the question of supporting the patient has become imminent? Suppose the family decide to nurse the sick man; if the doctor cannot give directions as to the food and dietary, what follows? The patient gets such things as the knowledge of the family can suggest, and the feeding of the sick person is a question of such scraps of information as the family and its intimate friends may be able to muster. Suppose the patient loathes milk, how is that strength to be maintained upon which the issues will turn? The medical man has been carefully taught the use of drugs, and the medical-or rather the medicinal-management of the case is excellent; but that alone will not save the patient, any more than a ladder could consist of one side-pole. Who is to teach the other half of the knowledge requisite to give sufficient succour to a man stricken down by acute disease? Certainly Sidney Ranger recognizes the necessity for some knowledge of foods suitable for the sick, and gives the ways of their preparation; but in what examination is a question on this matter ever asked? And without that the student will not get the subject up. He has enough to get up, he feels, without voluntarily and spontaneously adding to his load. Then when the examination is over he does not