1910 BJOG: an International Journal of Obstetrics and Gynaecology  
August 1910) has analyaed a series of 412 railway (American street cars) accidents to women. Of these 77 (18'7 per cent.) claimed injury to the pelvic organs as a direct reault of the accident. The accidenta varied greatly in severity; the majority were trivial. The caaea are analysed and many of them described and discussed. The following conclusions are arrived at :-(1) Miscarriages during the first four months of pregnancy readily occur, often from comparatively slight injuries or even
more » ... .only, but after the fifth month they very rarely occur from such causes. (2) Such accidents very seldom, if ever, cauee dieease or displacement of the pelvic organa in women whose organs are normal and healthy at the time of the accident. (3) Women with chronic pus tubes or other pelvic intlammatians may have acute exacerbations exoited by accidenta, producing general injurier. (4) Women with old lacerations, displacements, prolapses, etc., may have the symptoms resulting from such conditions temporarily aggravated by general injuries, and they are often particularly prone, either consciously or unconsciously, to attribute all their troubles to injuries, which really had little or nothing to do with causing the conditions preeent. (5) Accidents producing general concussion of the body may produce a temporary irregularity in the menses, usually increasing them, but occasionally suspending them ; such functional derangement8 seldom last longer than three or four months. August 1910) dencribea two caaea of appendicitis, in each of which a mam fomied in the right tubo-ovarian region and siniulated clinically an adnexal swelling. Moreover, the msdo developed so slowly and with so little acute disturbance that i t wau suggestive of a new growth rather than an inflammatory swelling. On exposure of the mma, it WM found to involve the caecum, not the tube or ovary; it was thought to be a new growth or tubercular maas extending from the ileo-cwal valve to the lowest part of the c;ecum. The appendix was, at first, nowhere visible, but after a careful search it was found, greatly thickened, buried in n fold of the caecal wall, which wae also greatly thickened. I n each cane the patient recovered, but i t waa some months before the caecal mass wan absorbed. Croseen has heard of another cane in which the cecum waa excised, with a fatal result, because it was supposed to be the seat of a malignant growth. Subsequent examination revealed an inflamed appendix hidden in the overlapping and inflamed cecal walls. The appendix only was removed. and Ob&h'c8, July 1910) formed a sub-committee of the American Gynascological Society to consider this question. As none of them haa worked at the scientific side of the rubject, the report is b a d upon a critical study of the literature only. After a brief review of the theoretical aspects of the subject, the practical results, as recorded in literature, are analyzed, and the following conclusions are presented :-1. Opsonins undoubtedly play a part in the production of Bctive immunity. On the other hand, the determination of the opsonic index is technically very difficult, and is subject to such variations that it is not available an a diagnostic or prognostic guide, and even among trained bacteriologists there is considerable scepticism an to its practical value. 2. Immunization by means of vaccines is a well-established prophylactic measure against certain infectious diseases, notably typhoid, cholera, plague, and dysentery. Vaccine therapy is undoubtedly a valuable remedial agent in local infection due to the tubercle bacillus or the staphylococcus, less so in local infections due to other pathogenic bacteria, while there is considerable doubt as to its efficiency in acute general infections. 3. I n chronic gonorrhceal arthritis and urethritis i t is a valuable adjunct to other treatment, and occasionally may leed to cure alone. It appears to be useless in the acute infections, while it is more efficient in the treatment of the vulvo-vaginitis of children than any other means, but even here i t does not alwaye result in cure. 4. I n infections of the urinary tract, especially those due to the colon bacillus, it sometimes results in symptomatic cure, but rarely relieves the bacteriuria. The scanty reporte concerning the pyelitis and the pyelonephritis of pregnancy, indicate that vaccine therapy is no more efficient than the usual treatment by reat in bed and the administration of salol or urotropin, as in neither does the bacteriuria disappear until after the termination of pregnancy. 5. In certain casea of endometritis, it appeara to reinforce the curative influence of curettage. The reporti concerning its use in pelvic inflammatory diseases are too scanty to jurtify conclusiam, but it would reem that i t may be of value only in chronic post-operative c a w with rluggish fifitula formation. 6. Ar the ordinary localized puerperal infectiom, irrespective of the nature of the offending bacteria, tend to sponteneoua cure, the field for vaccine therapy is practically limited to acute general infections where it unfortunately appears to be of little value, end the moet that can be said from the reports thua far available is that its employment does no harm. Further research in this direction ie desirable, and definite conclusions can be drawn only after the observation of large series of caaea, with careful bacteriological diagnosis, in which every alternate patient is treated with autogenous vaccines, while the others are left alone, or at most subjected to such general treatment as is common ta both series of canes. write that as long ago as 1905 they described kraurosia and leukoplakia an entirely distinct conditions, differentiated by their etiology, pathology, symptoms, prognosis and treatment. The two diseaees may, however, occur in the same patient, and the authors have given the name leukoplakial krauroeia to the clinical variety in which the physical characters of both diieeaes are present. Two caws are described in
doi:10.1111/j.1471-0528.1910.tb15704.x fatcat:xeatac2oerdcdhoxib3kbh3hsu