The gonococcus numbers among its biological peculiarities an unusual intolerance of extremes of temperature, its growth in culture being inhibited by temperature above 38° C. or below 18° C. Text-books on bacteriology state that exposure to a temperature of 60° C. for a period of ten minutes destroys the gonococcus. Experimentation in the laboratory of the Dimmer Clinic in Vienna in April and May, 1913, with cultures from forty-two cases of acute gonorrheal urethritis, seemed to indicate that this point may be placed from one and one-half to two degrees lower than this, i.e.,—from 58° C. to 58.5° C.

Thus, theoretically, at least, it would appear that, if the conjunctiva could be subjected to a temperature as near as possible to this without injury to the tissues, a marked effect should be observed in the course of the disease, particularly if the heat can be applied in such a way as to penetrate as deeply into the tissues as does the gonococcus. This theoretical requirement has, in my opinion, been perfectly met practically by the local use of steam as practiced in the Dimmer Clinic since February, 1913, with the apparatus devised by Lauber and modified by the writer. Goldzieher of Vienna was probably the first to employ steam in the treatment of the purulent ophthalmias; and in his first series of cases reported fifteen patients treated with the application of steam passing through a nozzle held at a distance of about four centimeters from the eye, the temperature of the steam striking the tissues being about 45° C. (113° F.). Although the results indicated that the method was a distinct step in advance there were still a number of important details to be worked out, in order to get the best possible results. First of all, experiment showed that the temperature of the steam at a given distance from the nozzle was not constant, so that an arbitrary distance could not be set. This suggested the advisability of providing the apparatus with a sliding-guard, which could be set at the exact distance from the nozzle where the steam was shown by the thermometer to be at the desired temperature. Secondly, it was determined that the tissues would sustain without injury a considerably higher temperature than that set by Goldzieher, and that the effect upon the diseased process was markedly better when the temperature was raised. Steam at from 50° C. to 53° C. gave the best results; and in one case in which a temperature of 55° C. was inadvertently reached no injury was done the tissues. Further experience naturally suggested other changes in the original technic. In the first place, the lids were held apart by an assistant in the usual manner; but, even with gloves on, the exposure of the fingers to the steam was more or less painful, and gauze wound on little sticks was substituted. The time of exposure was finally set at six minutes; and since the application of the steam could not be borne for longer than from forty-five to sixty seconds without severe pain it usually took twenty minutes or so to complete the six-minute exposure. This was done once every twenty-four hours, and was combined with half-hourly irrigations with potassium-permanganate solution. No other treatment was used. The results attained with this method in 34 cases (7 adults, 2 children and 25 infants) has left nothing to be desired. In no case has there been any corneal complication; swelling and pain subsided with unusual promptness; and the course of the disease was notably shortened, whereas, after the first application of silver nitrate a considerable increase in the number of gonococci in the discharge is often observed. A striking diminution in the number is noted after the initial application of the steam. In 8 of the cases in the series mentioned (all infants), the disease affected both eyes; and in 5 of these cases the experiment was made of treating one eye with steam in the manner described and the other with applications of silver nitrate in the usual manner, using the permanganate irrigations in both. The difference in the results attained was very striking. In every instance the eye in which the steam was used was brought much more quickly under control than the one under nitrate. In cases brought under treatment early the edema of the lids did not become severe; and the course of the disease seemed, in general, to be shortened by about one-third. There were no corneal complications, except in one case in which there was a corneal ulcer present when the man presented himself at the clinic. In no case was canthotomy necessary; and no case was followed by a chronic hypertrophic conjunctivitis. The application of the steam is undeniably painful, but not unbearably so.

VAGINAL HYSTERECTOMY UNDER SPINAL ANESTHESIA: REPORT ON A CASE

By R. R. Cranmer, M. D.
MINNEAPOLIS

I wish to report this case of vaginal hysterectomy under spinal anesthesia on a patient whose age and physical condition were not favorable for the use of ether or chloroform. The case belonged to that comparatively small class in which a general anesthetic cannot be used; and it was because of this fact that spinal anesthesia was resorted to. Had it not been necessary for this patient to earn a livelihood by hard labor the operation would not have been done; but, in her case, it was necessary, and the condition of prolapse, therefore, was a source of continual pain and trouble. The fact that the diet was not restricted after the operation assisted greatly in shortening her stay in bed and her rapid recovery.

Patient, aged 59, married, mother of six children. She had been suffering from prolapsus uteri of a severe degree for five years. The cervix presented at the vaginal orifice at times. Mitral insufficiency and arteriosclerosis were present. She also had chronic bronchitis and a mild nephritis. Chloroform and ether being contra-indicated, spinal anesthesia was used, two drachms of 2 per cent novocaine solution being injected through the fourth lumbar interspace. The vagina was prepared for operation, and the hysterectomy started within four minutes after the spinal injection. The patient did not complain of any pain; and there was no shock or other untoward symptoms. She was immediately put upon a general diet and was able to leave the hospital on the twelfth day.

The
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