Billeder på siden

The heat and moisture of the vagina soon dissolved the ingredients of which it was composed. Engorge ment of the vagina and of the labia majora, uterine pains, ardor urinae and tenesmus soon came on. Anxiety, fear and shame only increased the sufferings of the patient to the point that she decided to send for Mme. H., midwife. This person first wished to consult me, but she took a knitting needle, bent one of its extremi ties into a hook and succeeded in extracting it piecemeal. Some injec tions and an antiphlogistic regimen reduced the inflammation and did away with all malaise. The young woman promised not to recommence."

While interne in the hospital of Lille in 1869, I saw a woman of some 40 years of age. She was scarcely able to speak, and her face, besides suffering, showed an almost complete imbecility. I had her placed in one of my wards, where she died a few days later.

She had admitted, but with many circumlocutions, that she had long been addicted to vaginal masturbation. At the autopsy I found a perforation of the vagina, the direct

cause of the peritonitis that had carried her off-a perforation produced, doubtless, by the instrument which this woman had used to gratify her ignoble passion.

A woman consulted Dupuytren for an ailment in the vulvo-uterine canal. Touch showed easily that there was a foreign body here whose nature could not at first be determined, but the patient persisted in not giving any information on the subject.

Examination showed that the object, whatever it was, had a large opening and a deep cavity. The swollen vaginal walls by covering its edges prevented penetration to the object and furnished considerable resistance to seizing and disengaging it from the vaginal cavity. Finally, a successful extraction was made, and the mysterious object turned out to be-a pomade pot!

These are not isolated facts. A woman from the neighborhood of Vichy has told me that in her country she had often heard of and sometimes seen the peasant women use radishes, carrots or parsnips to calm their desires. O moeurs pures des champs!

(To Be Continued.)


THE TIMES AND REGISTER is published Bi-weekly-Twenty-six issues a year.

All communications, reviews, etc., intended for the editor should be addressed to 367 ADAMS STREET' DORCHESTER, BOSTON, MASS.

THE TIMES AND REGISTER is published by The Medical Publishing Co., 718 Betz Building, Philadelphia, Pa., to whom all remittances should be made by bank check, or postal, or express money order.

Subscription price is $2.00 a year in advance. Foreign countries, $2.50. Single copies, 10 cents.
Advertising Rates may be had on application.

Reprints of Original Articles are not furnished except on payment of cost price by the author.

Original articles of practical utility and length are invited from the profession. Accepted manuscripts will be paid for by a year's subscription to this journal and fifty extra copies of the issue in which such appears.


We wish all our readers a happy and prosperous New Year.

This is not saying that we wish our lay-friends misery and suffering. Far from it. We have not confined first paragraph to physicians


With this issue we begin a new era of work on "The Times and Register," and we trust its new dress and general aspect will commend themselves greatly above our former issues. We strive to work along the lines of advancement, and if we have cut off half our issues for the coming year, they will be more than replaced by the character and increased pages of the issues we intend to give our subscribers.

Our pages have been increased from twenty of reading matter to forty. The whole journal from forty pages to sixty-eight. We have added a colored cover to improve the outside appearance.

The general arrangement of the reading matter has been altered so as to more easily sub-divide our work. We are well provided with accurate translators for our foreign exchanges in French, German, Russian and Italian, and a new department has been added for the benefit of the physician's wife.

Serial articles will be found, which are of the utmost importance to every physician who desires to keep up with the advancement of medical knowledge. Two such articles, Dr. Manley's, on "The Blood and Circulation," which is continued from last number, and which will soon pass from the physiological to the practical part; and Dr. Pouillet's, which is translated for us by Dr. Chandler, on "Onanism in Women," treat of subjects of vital importance to the general practitioner.

The department of Electro-Therapeutics under the efficient care of Dr. S. H. Monell, of Brooklyn, begins its third year with this journal. This department has been exceedingly interesting in the past, and its editor assures our readers that no effort will be spared on his part to make it even more so this year. To this department are invited original articles from any who have practical knowledge of the subject of medical electricity, whether they be considered specialists or not. The department is maintained for the purpose of education along this line, and, although our support from instrument manufacturers has been poor and discouraging, with one exception, from a Baltimore firm, yet

the work has gone on just the same, and has been most practical to the general practitioner. We look for better support this year from the profession, and trust some of our readers will continue their interesting articles.

It will be noticed that the subscription price has been advanced to two dollars a year. This was a necessity from the fact that the cost of output of this journal is increased this year over former years. It is still under the old price of three dollars, which was reduced principally on account of hard times in 1894. We feel con

fident that no subscriber will have cause to complain this year on account of the slight raise in price, for he will be unable to purchase the material we propose to issue for five times the amount of the subscription price were he to find it purchasable in book form.

We, therefore, extend to our readers the compliments of the season, and trust that they will find in this issue of our journal for 1896 sufficient to warrant the continuance of their own subscriptions and a cordial recommendation of "The Times and Register" to others.


Practically there is no condition. which calls for emergency treatment where the demands are so urgent upon the resources of a physician as in a case of profuse pulmonary hemorrhage. The alarm of the patient and friends is extreme, and the shock is always out of proportion to the loss of blood, unless the hemorrhage be sufficient to prove fatal.

With some exceptions hemoptysis is to be regarded as the forerunner of phthisis, and the laity have so been taught to look upon this condi tion.

Bleeding from the lungs differs in many respects from hemorrhages of other organs, the cause of which is apparent when one studies the minute anatomy of the parts. It is here that the objective symptoms differ from those observed in ordinary hemorrhage, the bright blood is venous and the dark arterial.

It must be remembered that there is a general classification of hemoptysis as belonging to one of five varieties: simple, congestive, ulcerative, cavernous and extra-pulmonary, and that it differs very much as to what course of treatment to apply in which class a given case of hemoptysis occurs.

The simple variety, or ideopathic, as it is sometimes called, is rarely met with, and does not generally indicate important lung affection. The

second, or congestive, form, we most often meet with in the early stage of phthisis, and the treatment of this form is most important.

Probably there are not nine physicians in every ten who would consider he was justified, when called to a case of hemoptysis, in giving anything else than ergot, and, indeed, this drug would seem to be indicated were the hemorrhage one belonging to the third or fourth varieties. The variety is not always ap parent or of practical use when one is in a hurry to control a hemorrhage, but we must also remember that it takes some twenty to thirty minutes for ergot to act, and that an ice pack is more often a quicker and certain remedy in sudden hemoptysis.

These congestive hemorrhages generally come from the venous system, and our important point to remember is that we should strive to free the veins from engorgement. This is generally best met with by digitalis. We recognize in this drug an agent which, while it increases arterial pressure, which would seem to contra-indicate it in arterial hemorrhage, will place more power of action on the ventricles of the heart and keep the arteries supplied with a surplus of blood at the expense of the veins. This is just what is most desirable in congestive hemorrhages. In arterial hemorrhages, as are apt to occur in uterine and other organ

ie bleedings, we need to contract the arterial system and place the most of the work on the venous system.

Quiet is always essential, and to procure this we may have to resort to opiates. The condition of the blood

also requires attention, and for a few days we will require hemostatics, such as turpentine, gallic acid, cupric sulphate. Ipecacuanha is also of service in pulmonary hemorrhage when given in large doses.


Professional desire for notoriety never ceases. The American Medical Review gives an account of an interview with Dr. Edson, of New York, in which the latter affirms that a new cure for consumption has been discovered, but the matter must still be guarded as a secret. Indeed, it is of such detail that only few physi cians will be able to apply it without special study. Of course, it is along the line of hypodermic medication, is said to be composed entirely of chemicals, and a sure cure for yellow fever and malaria as well. One case cited cures malaria in one hour; another tubercular hip-joint disease in three weeks.

We are at a loss to know when these so-called wonders will ever cease, and reputable men, who go meandering off for the sake of shortlived notoriety, be restored to true. professionalism. No doubt, a few

pennies might be realized by following such a course from the ever-vulnerable public, but the large part of the profession have become so used to this sort of preliminary advertising of a new idea that they will not be materially affected.

When medical men carry on investigations of an experimental character we believe that they would serve their brethren, the public and suffering humanity a much more useful purpose if they would keep still about their discoveries until they had perfected them to an absolute certainty, and then evolve their knowledge in its entirety for professional benefit.

When we arrive at the method of cure of tuberculous hip-joint disease in patients who "could not walk a block" so that in three weeks they have recovered, and can cure malaria in one hour's time, we shall perform feats little short of miraculous.


The operation known as hysterectomy is of comparatively modern


Diseases of the pelvic organs of reproduction in the female had, until recent times, been treated by conservative measures, internal medication and topical applications. The conservative principle was preservation, and not destruction. Singular as it may seem on superficial examination, in the days before radical surgery came forward and claimed

the domain as its own, mortality among women from pelvic peritonitis or general peritonitis was as low or lower than to-day, the claims of operators to the contrary notwithstanding.

Pus accumulations in the broad ligament, the ovary or tube, in some manner, in those times either became encysted, inert and were resorbed, or the pus made its way out through the vagina, when it was said the patient had the "whites or ulceration of the womb."

Then came abdominal surgery, with all the safeguards of modern science, and perfection of technique, when operators have become emboldened not only to eradicate the lesion, but the affected organ as well.

The furor operatique swept over the world; encysted ovaries must be removed, and whoever saw one, after the rupture of a Graeffian follicle, that was not the seat of cysts in its periphery or parenchyma?

Applying the same principle to the uterus, it has now come to pass that this important organ is ruthlessly swept away, not only for fibroid growths or cancer, but for prolapse, endometritis, as a means of reaching and evacuating pelvic abscess and for purposes of "drainage."

The moral and the medico-legal aspect of this procedure seems to have been lost sight of. The only question has been how the uterus could be eviscerated by the shortest route and with the greatest ease.

Hence we have the "abdominal hysterectomist and the vaginal hysterectomist."

The abdominal line of attack was the one generally accepted until Peau, at the Berlin Congress, reported his experience with delivery by the vaginal route, and cited his large experience and success with vaginal hysterectomy.

Here in America, where the tendency is to swallow anything smacking of originality and labeled European, the new operation soon had numerous adherents.

At the general meeting of the Academy of Medicine, of New York, held on the 19th of December, 1895, the respective merits of the abdominal and vaginal hysterectomies were considered, the opening essay being by Dr. W. M. Polk, who was supported by Dr. Cushing, of Boston; Dr. Lusk and others.

The opposite side, which defended the abdominal operation, was led by Drs. Baldy and Noble, of Philadel phia, who made a scathing attack on vaginal hysterectomy, though in the course of their remarks they seemed to labor under the impression that vaginal hysterectomy was the operation of choice among New York surgeons, which is far from the fact. In all truth it must be said that neither of these operations reflects great credit on surgery. Surgery consists in something more than the performance of mutilating operations, however artistically these may be performed. Of the uterus it may be said, as of a limb, better a thousand times save one than sacrifice a score, however successfully. Whatever the abdominal route for hysterectomy may have to commend it, in rare and exceptional circumstances, the removal of the uterus through the vagina is a most unsurgical and barbarous piece of mutilation. But a woman recovers from the operation in a few days or a week, it is said. In all but occasional instances she has been physically wrecked.

The vaginal mucous membrane is widely torn away from the bladder and rectum; those horrible, incurable rectal and vesical fistulae generally follow. The broad ligament, the uterus and accessory structures, which constitute a barrier against vaginal hernia, are all cleared away.

To the uninitiated, the rapid clearage of the uterus through the vagina may seem like the very climax of surgical ingenuity; but let him watch the course of the case, the distressing convalescence, the fistulae, or large open sores, on the mucous membrane, and his enthusiasm will be replaced by an implacable detestation of the procedure. Let us hope, in the name of humanity, this operation will soon be blotted from the category of legitimate surgical procedures.

« ForrigeFortsæt »