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Now when the fetus is suddenly forced through it, it dilates it and paralyzes it so that its mouth stands wide open for two or three days. During the time the os is wide open infection enters freely. Now, the os recovers from its paralysis and closes its mouth vigorously. Any infection which passed into it is now securely imprisoned in the uterine cavity. There is no drainage, the germs multiply and the uterus and tubes are made into sewers while the pelvic peritoneum acts as a cess pool. This is the reason that abortion is worse than labor,

because its infection is not drained. A similar process occurs when a uterus, already suffering from endometritis and salpingitis is widely dilated. The infection there existing rapidly invades new territory from ruptured tissue, from trauma, and also additional infection comes occasionally on the dilator.

Practitioners do not sufficiently realize the immediate and remote dangers of dilating the uterus. Again, when some dilate they do it so rapidly that the uterus is wounded more than it is at labor. New fresh channels are opened for microbic invasion.

The physiological function of the uterus and os differ so much that it should be studied by those who will act. The uterus gestates and expels while the os is a guard to the uterus, alike repelling invaders and retaining deserters. The tinkering with uterine dilators has made many a pyosalpinx. Again, physicians tinker with the sound. I know of two cases where the doctor actually killed the woman, by the aggressive and foolish use of the instrument given to us by Simpson and Kiwish. One doctor killed a very prominent woman from his lack of knowledge. The woman complained of frequent urination and the doctor on digital examination found the fundus against the bladder. Now he thought that it was the pressure of the uterine fundus on the bladder that caused the frequent micturition, so he said he would replace the displaced uterus by the aid of the sound; so he introduced the sound and pried the uterus back. The woman died three days after, and the autopsy showed that he had penetrated the uterus with the sound and the little fetus had passed out of the same hole into the abdominal cavity. That was a practical murder from tinkering with the sound. The sound in general has done more harm than good. The specialist uses it but little at present. Its chief use now is with the general practitioner. I know of another who used the sound to replace a retroflexed uterus; she died in less than two days, and the post mortem showed that he had ruptured a pyosalpinx, another practical murder from lack of knowledge and sound tinkering.

Again, another foolish piece of tinkering in gynecology is the determined view that a dis-placed uterus must be replaced. Only two weeks ago a colleague insisted on replacing auterus, and the woman died the next day. He had, no doubt, ruptured a pus sac. Really a big humbug has existed in regard to "replacing the womb." It is extensive amongst general practitioners, but I have seen even a New York gynecologist go through the most insipid manuvre with a class of sixty doctors, of replacing the uterus in a young woman. In the first place such vague ideas are held as to the normal position of the uterus, and in the second place the vague and erroneous views as to what a displaced uterus is. The normal position of the uterus is a position of wide range, but a displaced uterus is one permanently out of its normal place. A displaced uterus is one having abnormal stability. A fixed uterus is not in normal position. Now, it is dangerous to force a fixed uterus in normal position, and if a uterus is so mobile that one considers it out of place it is utterly useless to push it hither and thither and call such action replacing the womb. So that merely pushing a supposed uterus into supposed normal position is mere tinkering. There is no utility in it at least for the woman.

Again, how about removing the many ovaries which are nearly normal. Has not tinkering been running at high carnival in removing socalled cystic" ovaries? Are not all ovaries cystic? Are there not scores of tubes and ovaries unnecessarily sacrificed annually in this country. I know myself of many lives being lost by amateur operations in order to learn laparotomy. Is that not tinkering? Is that not "humbug" in gynecology? So that the old doctor's cutting remark is not all untrue. fice it to say unnecessary so-called aggressive operations are really a humbug and should be called tinkering. Now, in regard to the second class, where the so called uterine applications are done with tri-weekly mathematical certainty These doctors tell the woman she has ulcers

Suf

in the womb" whatever that means. Surely I have seen many, many clear cases of tinkering of this sort. Some physicians carry this do nothing treatment to dangerous points while some real and vital pathology is overlooked. Such treatment. reminds one of the philosopher who put a board on Mt. Vesuvius and sat on it thinking to keep down all trouble. Such philosophers forget that much trouble lies in the interior.

In conclusion it may be said that to become a skilful gynecologist is probably more difficult than any other medical department. One must not only treat the disease but the patient as well. Mind and matter seem to be at variance

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in some women. The movable, elastic and alterable organs are difficult to comprehend. The anatomy and physiology are both very difficult in the pelvis.

To discriminate real from imaginary pain is not always easy. To know always when to act or not to act in gynecological cases requires much good judgment. The pathology of the female organs requires long and careful study, practice and observation to master. Besides few have sufficient mental balance to make reliable specialists. So many make sweeping generalizations. Unlimited generalization is very dangerous in gynecology. No doubt the knaving and avarice for gold of some so-called gynecologists makes "humbugging" more apparent. It does at times seem that some will work their judg ment simply to get a pay case of laparotomy. The spread of real pathological knowledge with good instruction in practical gynecology will soon lift it above the reproach of "humbug" trade. F. BYRON ROBINSON.

34 Washington St., Chicago, Ill.

Bleeding in Pneumonia.

Editor MEDICAL WORLD:-I have been an active practitioner of medicine (until recently) since 1848, and have been a subscriber of THE WORLD ever since it was published.

I wish to endorse what G. W. Kemper, of Port Republic, Va., on page 41, of the February 1893, number, says in regard to "Bleeding in Pneumonia."

I, too, may be regarded as an "Old Fogy." But his experience is mine in full. His classification of pneumonia, as to condition, into acute or sthenic and typhoid or asthenic, is correct. When I commenced the practice of medicine in Missouri most all cases were of the acute form and if a physician had failed to bleed he would have been charged with mal-practice. When the patient had been bled to syncope, or approaching it, the pain is always relieved. good blister finishes the cure.

If not, a Of course,

there will be a necessity for additional treatment, calomel, quinine, etc., and as Watson, Gross, McDonell, and Drape used to teach in the second or third stage, egg nog. But now a days, especially in southern climates, most of the cases are of a typhoid character, and do not require bloodletting, but a blister always does good. Whitesboro, Texas.

W. H. TROLINGER,

Editor MEDICAL WORLD. THE MEDICAL WORLD is really an invaluable journal, serving as it does in a professional way the purposes of an experience meeting of your subscribers in a high degree. Kinmount, Ont., Can. R. S. FROST, M.D.

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Editor MEDICAL WORLD:-I am asked so many questions about dosimetry and the new manual that I take the opportunity to reply to them through the columns of THE WORLD, well assured that I shall reach the vast body of practical men through it. Dosimetry was assuredly intended by Burggraeve to form a new system of medical treatment. This I believe to be a mistake. No complete system of medical treatment can be formed, leaving out all such remedies as are unsuitable for administration in granules. Selecting a granule for form when there is a better remedy in another shape, shows that the doctor's devotion to the system is greater than his desire to benefit his patient. So, also, I disagree with Burggraeve in his endeavor to reduce all doses to a uniform size. Why give the same dose of two drugs when one has twenty times the therapeutic value of the other? Only by reducing all to the dead level of homeopathic infinitesimalism can this be done. Burg graeve is led by this mistake into the same error as Hahnemann, in attributing to certain remedies valuable properties in doses too little to exert any appreciable effect. What folly to give a milligramme of kousseine, juglandine, piperine or tannate of cannabin, and expect any result! Or what effect is a centigramme of croton chloral expected to manifest when the ordinary dose is twenty to thirty grains? It can not be said that the difference lies in the purity of the drug, for you cannot kill a tape worm with grain of the purest kousseine, and the

worst specimen of croton chloral in the market has not ninety-nine per cent. of impurity. The one thing of eminent importance in Burggraeve's system is the doctrine of "jugulating" acute fevers. I have for many years been in the habit of jugulating acute pharyngeal catarrh by the local use of a powerful astringent acid antiseptic remedy. Acute orchitis is readily jugulated by the application of a twenty-five per cent. nitrate of silver solution. Spitzka, I think, recommended full doses of strychnine in acute myelitis, and I gave this drug successfully several years ago in a curious case presenting all the symptoms of locomotor ataxy, but, coming on acutely. But Burggraeve deserves the credit of popularizing the jugulation of acute inflammations and fevers by this method. The use of strychnine in pneumonia has recently been advocated by Mays, and Petrescu has urged the treatment of this disease by huge doses of digitalis. Both act as jugulators, driving the blood out of the affected tissues by powerfully contracting the vessels.

I have quoted very little from Burggraeve in my manual, because his own is supplied at a very small price, and can be easily procured by those who desire it.

Now for the other advocates of specific medication, the eclectics. I expected a good deal from them, but must confess to my disappointment. Many of their specific indications are taken bodily from homeopathy, and are worthless to those who do not care to pin their faith on such intangible potencies. But a small number of the drugs distinctively identified with the eclectic school have been really studied in a scientific way. Scudder's book is full of appeals to his brethren to furnish reliable information as to the vegetable remedies in common use by them. Instead of this, we are apt to get some such an incongruous jumble as the following:

Properties Anti-spasmodic, alterative, tonic, emmenagogue, parturifacient, diaphoretic, diuretic, and vermifuge.

Principal influence Upon the utero-genital system, giving tone and energy.

Employment-Amenorrhea, dysmenorrhea, menorrhagia, leucorrhea, vaginitis, urethritis, chronic bronchitis, vaginal prolapsus, to promote delivery, after-pains, rheumatism, dropsy, whoop ing-cough, hiccough, hysteria, hysteritis, apthous sore mouth, to expel worms, etc.

How can the little squaw-root be all those and do all those things at one and the same time? Can it be a tonic-a toner or contractor of tissue, and also an antispasmodic and diaphoretic ?

Or, take our much valued cimicifuga. We are told that it has all the following properties:

Alterative, anti-spasmodic, stimulant, diaphoretic, diuretic, expectorant, resolvent, nervine, emmenagogue, parturient, tonic, narcotic, and metastatic. Possesses great power over exanthematous fevers, transfers to the skin eruptive diseases, which have receded from the skin to the mucous membrane, gives tone and energy to the nervous system and contributes to the generation of nerve force.

Employment-Amenorrhea, leucorrhea, dysmenorrhea, hysteria, chorea, chlorosis, to facilitate delivery, rheumatism, coughs, colds, asthma, whooping-cough, phthisis, small-pox, croup, convulsions, epilepsy, neuralgia, scrofula, indigestion, typhoid fever, scarlatina, diphtheria, prolapsus uteri, gonorrhea, gleet, spermatorrhea, intermittent fever, cutaneous diseases, bronchitis, laryngitis.

We presume it would be safe to say in case of doubt give macrotin, for it does about all a doctor could wish except collect his bills.

How can any one get an idea of the real properties of a drug from such a mess? In many cases our eclectic brethren have not clearly distinguished between the effects of their remedies and those of the hot water in which the drugs were administered. I have, therefore, in quoting from such sources placed the indications in parentheses, that the reader may know that I do not consider the authority trustworthy. And this is not at all because the writers are eclectics, for I wish to give these gentlemen full credit for their work, and care not at all from whom I get an idea provided it is a good one. Indeed, I have recommended the eclectic preparations; the "ins," instead of the officinal extracts, because I believe the former can be procured more readily and of better quality. I imagine a doctor who prescribed extract of chelidonium would have a good deal of difficulty in procuring a really active preparation; whereas the chelidonin could be obtained easily. Even so, many of the native plants show but little of their true value, unless given in preparations from the green drug. Hamamelis, rhus and prunus virginiana are examples in point. The dried plants are inert, the fresh possess remedial virtues of undoubted value; but to isolate the active principles and confine them in a granule that will retain their activity indefinitely is beyond the art of the pharmacist. Should we therefore refuse to avail ourselves of these and other valuable drugs because we cannot put them in granules, or because the active principles have not been extracted? Surely, here is the weak spot of all exclusive systems, in that they put the system ahead of the only right and proper consideration of the physician-his patient's welfare. WILLIAM F. WAUGH, M.D.

The Post-Partum Douche. Editor MEDICAL WORLD:-It is an old and trite saying that "meddlesome midwifery is bad," and this idea is often carried to such an extent that it becomes a mania or rule with some to never interfere in an obstetrical case at all, and to "leave everything to nature." It may not be out of place right here to inquire what we are called for at all in such cases, for if everything is to be "left to nature," we are not needed and it would be cheaper for the patients not to call us, as nature can do the work without us. However it is a consoling fact that the sect of ultra never meddling peo ple are greatly in the minority and are rapidly dying off. But with so much conflicting advice as to what to do, and what not to do, the younger obstetrician is often in a quandary, and in evading Scylla he often falls into Charybdis, and in the language of the puzzled legislator of the last Congress, he will not even know "where we are at."

Experience is a good teacher but she charges sometimes exorbitant prices, and we should not trust entirely to our own knowledge and experience for our methods of work, but must draw largely from the great storehouse of the lives and work of others.

"One swallow does not make a spring," neither does one success or failure establish or abolish the value of a principle, and it requires a careful mind to find a suitable and safe mean between the extremes.

In the ordinary course of obstetrical practice, the physician for reasons of convenience to himself and economy to the patient, is not called to attend in confinement until there is either real or fancied need for his services. Therefore, the ante-partum care and treatment is not so much under his control as is the postpartum attention.

In hospital practice the usage is more often different, but even there there are emergency cases that receive no care prior to delivery.

The care of the patient, before and during labor will not be treated of in this article, but our consideration will be in regard to that immediately following delivery of the child and pla

centa.

In case of post partum hemorrhage, I trust that none of us will not advocate the rapid and thorough evacuation of the contents of the uterine cavity, by some means or other. I believe the favorite method of delivering the placenta and clots is by the method first advocated by Credé, viz.: the conjoined manipulation of the fundus externally and by manual traction upon the placenta internally, although

most often the external kneading of the fundus is alone sufficient.

It is too often the case that the puerperal woman is left to the mercies of an ignorant or unskilled nurse, and even where they are attended by one who is experienced, it is often some old woman with many crochety notions, not unmixed with superstition and an animosity to young men and new ideas, and your instructions will either be ignored entirely or not half executed.

Therefore it is usually best for all concerned to either wait and see that your instructions are obeyed, or to "do it yourself and then you know that it is well done." How often have you known, by the sense of smell, that there is a puerperal woman in the house, as soon as you enter the outer door?

How often have you been called to cases where neither the clothes nor bedding had been changed, nor the patient bathed for several days? None of the lower animals will allow themselves to lie in such a fix, but will immediately remove to a clean spot and proceed to "clean-up," yet civilized and enlightened beings, and I regret to say some seemingly intelligent physicians, will compel a woman to lie in a lot of rotten filth for several days after delivery.

Of course none of us are perfect, and all of our ways are open to criticism and improvement, and he who lives in this day and age and knows it all and cannot still learn something, has become a nuisance to the world and a burden to the body politic, and would better die.

As we all know, a certain amount of tissues must be thrown off in the form of the lochia, which are commonly and properly called "cleansings," and it is our duty as careful and progressive physicians to aid nature in this effort. The method that will do this the most safely quickly and pleasantly is undoubtedly the best; water, the blood of the earth, is the universal solvent and cleansing agent. Heat is nature's antiseptic and germicide. Then what is more rational than the free use of hot water as a detergent and cleansing agent for the parturient canal after labor? By its use small clots and shreds of placenta and membranes, mucus, blood, urine, feces, and all foreign matter may be removed, and the parts rendered clean and pure. It will cause a sense of wellbeing and restfulness that is very grateful to the patient and hastens the convalescence.

The water should be hot, and by that term is meant hot, not warm or tepid water

It is a well established fact that the mucous and serous membranes are not as well supplied with sentient nerves as is the skin, and that

these surfaces will tolerate a degree of heat, without discomfort, that would be unbearable to the skin.

In order to prevent the hot water flowing over the skin of the vulva and being painful, it is best to use some appliance that will fill or block up the external opening of the vagina, and yet allow a free circulation of the hot water in the vagina.

Such appliances can be secured of all instrument makers, and while the cost is not a little, yet the ease of operation and the comfort and safety guaranteed by their use will bring praise from the patient and an increased patronage, which will in the end justify the extra expense. While using this method it might be an advantage to incorporate in the solution some one of the many well-known antiseptics, germicides and healing chemicals. Of these carbolic acid is about as good as any if not the best. Corrosive sublimate may be used but there is more danger of poisoning by absorption when in contact with torn or raw surfaces.

By the use of what is known as the "Ideal" or "Knap" douche, given with a fountain syringe, the vagina can be ballooned, all the folds washed clean, clots removed and emptied into a vessel beside the bed, without spilling a drop of water or wetting the patient or the bed.

With an Alpha fountain the reservoir can be filled and emptied easily by syphonage, and gives a steady, constant flow, the force of which is easily regulated at will.

The objection may be raised that water may be forced into the fallopian tubes, and it is probable that by using great pressure it could be done, but a little judgment will avoid any such trouble.

It has been said that it is too much trouble to do so much work, that it is the duty of the nurse to attend to that work, or that the physician can get his fee just as well without as with that extra attention; yet if we have our patient's best interests to serve, and we wish to do our whole duty, we should use every means to attain those ends.

Usually one douche is sufficient, but it is best to leave orders to report any signs of offensive odor of the lochia, and it can be at once removed by one or two hot carbolized water douches, and maybe prevent systemic infection, and possible death.

It has been my experience that but few of my multiparæ have been previously treated to a post-partum douche, and they never object but always are pleased with it and are grateful for the comfort it affords; while the primiparæ always like it and they and their friends who see it used always commend it.

It may be a mere coincidence, and it may not be, but it is a fact, that after using it in over fifty puerperal cases there has never been a single case in which there were any bad symptoms, while I have had a number of cases fall into my hands where it had not been used by the accoucheur, and all sorts of complications were fourd, but on the beginning of the use of the douche they were either partly or entirely relieved.

It has been objected that many thousands make good recoveries without any douching. True, yet how many thousands of us are never exposed to small-pox, and therefore cannot take it, yet how many of us are there who, because of there being no danger of small-pox, will be satisfied to go unvaccinated? The hot douche is the parturient woman's vaccination against puerperal septicemia and kindred troubles.

It has become part of my necessary treatment and I almost invariably use it, and have no doubt whatever that it has been the means of saving life, as some of my cases have been delivered under the most favorable circumstances for puerperal infection, yet by a free use of hot antiseptic douches a rapid recovery followed.

If you wish to have the gratitude of the women, the admiration of the nurse and friends, and the satisfaction of knowing that you have done your duty and fully earned your money, whether you get it or not, and fortified your patients against disease, then use the hot post-partum douche. HOMER C. BENNETT, M.D. Lima, Ohio.

Med. Dept. Univ. Wooster, 1888.
Med. College of Ohio, 1889.

Quiz Department.

Questions are solicited for this Column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication), will not be noticed.

The great number of requests for private answers, for the information and benefit of the writer, makes it necess ary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

Editor MEDICAL WORLD.--Having observed the Samaritan spirit not only of the editors but of the numerous correspondents of THE WORLD in giving aid to those in need, I am encouraged to ask assistance in the following case:-Mrs. B., aged 50, mother of four children, youngest 15 years of age, had change of life ten years ago without any trouble, and, excepting occasional attacks of indigestion, as evidenced by nausea and vomiting and usually followed by lienteric diarrhea lasting a day or two, her

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