pathology and practice, obstetrics and gynecology, materia medica and therapeutics and surgery would be debarred from the society and consequently from license to practice in the State. There is still one other matter to which I wish to direct your attention, and like the foregoing it, too, requires creation by our lawmakers. I refer to a State Board of Health.

Let us again turn to our Code of Ethics and see what we can find there touching this subject. Chapter 3, article 1, section 1, says: "As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens; they should also be ever ready to give counsel to the public in relation to matters especially appertaining to their profession, as on subjects of medical police, public hygiene and legal medicine. It is their province to enlighten the public in regard to quarantine regulations, the location, arrangement and distances of hospitals, asylums, schools, prisons and similar institutions; in relation to the medical police of towns, as drainage, ventilation, etc.; and in regard to measures for the prevention of epidemic and contagious diseases; and when pestilence prevails it is their duty to face the danger, and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives."

Our duty to the healthy is as great as to the diseased. Indeed, the protection of the public health is of far greater importance than the well-being of any individual. I have carefully examined the bill introduced at the last session of the legislature by Judge Mershon, of Glynn county, entitled "An act to create and maintain a State Board of Health," and find that this can be made an excellent measure by a few changes. I understand that the objection urged against it at the session was that the bill gave the health officers too much authority, when, in my opinion, that is the most important feature of the measure, for if the health officer does not have the necessary authority to act quickly he will be a mere figurehead.

Let us have a committee who will urge the passage of this or some similar measure, using all the powers which they possess to engineer it through. Some of you may urge that a few years since

let

our association had a similar committee, which failed in its objects, and therefore it would be useless to appoint another, but I say us follow the schoolboy's lines: "If at first you don't succeed, try, try again." Besides, I think now we have a far more intelligent legislature than we had then. The time seems to be a propitious one now, from the danger of an outbreak of cholera in this country at any moment.

May we be able to wield the desired influence over our lawmakers, and if these remarks tend in any way to assist in awakening our populace to the urgent necessity of such laws, I will consider my time well expended.

ANTE AND RETRO-POSITIONS OF THE UTERUSTHEIR PATHOLOGY, SYMPTOMATOLOGY AND TREATMENT.

BY W. W. STEWART, M. D.
COLUMBUS, GA.

CASE 5.-Mrs. P., age thirty, four children, was sent to me from Florida, for bladder trouble and epileptic fits. At birth of last child, three years ago, had considerable trouble, the nature of which could not be learned. Was in labor forty-eight hours when an instrumental delivery was accomplished, after which she had fever for two weeks and was in bed forty-five days. On resuming her duties was troubled with a constant desire to pass water. Pain in loins; bad and almost constant headache, occipito-parietal. Constant leucorrhea, constipation to a fearful extent.

Two months after resuming her duties, patient was seized with what was diagnosed to be epilepsy of the grand mal type, for which she received constant treatment to no avail.

Attacks grew more frequent and more prolonged. After an attack would remain unconscious for six to seven hours.

This was her condition, augmented by irritated dyspepsia and dilated stomach, when I first saw her.

Uterus retroflexed and drawn backward and upward by sacrouterine ligaments. Marked endometritis. Roof of bladder taut and paralyzed. Marked cystitis, 20 per cent. by measure of pus in urine.

Perineum torn to second degree which is not shown in this drawing. Cervix bilaterally lacerated. Facies uterina marked. She was first curetted and uterus packed with iodoform gauze. Six days thereafter cervix was operated upon and in fourteen days perineorraphy was performed. After this had no more epileptic seizures and returned home in good health, the uterus returning to normal position after curetting and other operations mentioned.

Our next case, is another form of retroversion, which for its causation has a contraction of the sacro-uterine ligaments, without other pathological conditions than those secondary to version.

of anteversion, due to The sacro-uterine ligaBladder was examined

Plate No. 5 represents an interesting case sent me from Eufaula, Alabama. Mrs. R., age twenty-five, had two children. With the first there was no trouble, patient being perfectly well till the birth of second child, two years ago, at which time she had some slight septic trouble which caused a rise of temperature for several days, which soon subsided. She had at this time some soreness over abdomen with tympanites. On coming to me her greatest complaint was from bladder in the form of chronic cystitis, and also obstinate constipation, with chronic dyspepsia and meteorism. On examination a clear diagnosis was made chronic posterior parametritis and metritis. ments were contracted, and cervix fixed. with cystoscope and a large ulcer detected, caused by decomposition of urine in the bladder. Treatment consisted, first, in curetting and packing uterus with iodoform gauze. After four days this was withdrawn and a tenaculum caught in posterior lip of cervix, and gentle traction practiced for ten minutes at each sitting-they being every other day. The ligaments stretched quite rapidly, and with the aid of glycerine tampons and hot water in four weeks cervix was about in its normal position. The bladder trouble was treated at the same time, and at the end of two months patient was dis

charged with a cradle pessary, which I removed permanently five months after, to find everything in good condition and patient enjoying good health.

Plate No. 6 gives us an illustration of a form of anteflexion

often found after confinement when there has been some septic infection, followed, as is always true in such instances, by subinvolution. The fundus uteri becoming too heavy for its supports, either forward or backward, as the determining influence tends. In

falls

this instance forward. If this patient should fall into my hands soon after the deformity had taken place, I would hope-with good grounds-for a cure. I would first treat the metritis and endometritis, which is sure to exist, then the subinvolution, with the potash

salts and ergot, assisting it to retain the normal position by the aid of a cradle-shaped pessary and douches, which will aid largely in reducing its size. Add to this good tonics, an abdominal belt, skirt supports, corset waist, good food and fresh air, and our treatment is complete.