it is of this class of cases that I wish to speak. Dr. Hunt has referred to the advisability of exploratory puncture, and with that I thoroughly agree. In these cases where we cannot outline pus, and yet feel sure there is a possibility of it being there, it is justifiable to puncture the chest, repeatedly, to be sure that there is no pus. Dr. Reynolds has objected to this, but perhaps it is the only way of reaching some of these cases that are surgically curable. In waiting until the last stages when extensive empyema is present with diagnosis easy, then perhaps we have passed the golden opportunity. DR. HUNT (closing): The deformity of older children's chests is appalling; the deformity of the caved in chest, was the deformity I had in mind, and, in many cases, curvature of the spine. This is due primarily to the binding down of the lung. Resection of the ribs in infants is not justifiable, but in neglected cases it is. In infancy where the chest wall is thin, rib re section is not justifiable. In old cases rib resection would be a necessity. In recent cases with thin pleura, a small incision between the ribs is sufficient. Dr. Hoover, in empyema in adults, thinks he gets important information by direct auscultation, putting his ear directly over the chest, and paying no attention to the sounds heard by the stethoscope. Dr. Chambers and Dr. Reynolds did not understand each other, for Dr. Reynolds, I think, was speaking of the aspirating needle. Why we do not find pus, I explain in this way. Take a lung that has been inflamed, cut cross sections, the pus oozes out and it is easy to see how that lung can contain pockets of pus. The inflamed cells have enlarged, and the lung has become studded with cavities. giving a clinical picture of a large cavity, with breath sounds, percussion notes, or resistance to percussion notes, and with repeated punctures we can get pus. It seems to me that in these disappointing cases the pus is there, but we do not reach it. VAGINAL DOUCHE THERAPY. Franklin Perry, M. D., Parker's Prairie, Minn. NDER existing social conditions, there are millions of women in this world who know nothing of vaginal douches; there are thousands of them who do not know why douches are used and who do not realize that they themselves should use them. This ignorance is due to a defect in our educational system, in the home as well as in the school. Every girl as she develops into womanhood should be properly instructed in the physiological functions of her generative system and the care of the organs thereof. Abuse and misuse through ignorance can give rise to troubles just as serious as those caused by traumatism or disease. Negligence of the simplest methods of cleanliness often enables minor conditions to develop into serious ones, and probably the one great besetting sin of civilized humanity is the neglect of cleanliness. The principle use of the vaginal douche is as a cleansing instrument, whether it be in the maiden, the matron or the grandmother, and while there may be a great deal of cant and false modesty about these "private parts" there is no excuse for personal uncleanliness. For more than a quarter of a century I have been giving special attention to the diseases of women, during which time I have made thousands of examinations, and I have no hesitancy in saying that if women took as good care of their pelvic outlets as they do of their teeth, mouth and nose, they would suffer very little of the discomfort, weakness and disease now so common to their sex. Even in infancy and childhood the necessity for the vaginal douche occasionally arises. An attack of diphtheria, scarlatina or other eruptive fever may rise to a vulvovaginitis. An irritating soap, a soiled towel or infected wash-rag may excite an inflammation. Seat or pin worms and foreign bodies of any kind quickly excite the vaginal mucous membrane to inflammation and cause a leucorrheal discharge. Gonorrheal infection is not unkown in the children of the lower classes where they are early subjects to the venereal assaults of older persons. Rarely such cases are encountered among the better classes, where the infection can be traced to some careless diseased servant. During the period of adolescence various disturbances of the maturing sexual organs may require the relief afforded by the vaginal douche. The pains of dysmenorrhea can frequently be relieved by a hot douche. In amenorrhea, especially those cases where the flow is just about to appear, and yet does not do so because of some slight restraining factor, a hot douche will frequently bring matters to a crisis and cause the flow to come on, thus relieving the visceral congestion and immediately doing away with the headache, backache and other distressing symptoms attributed to this disagreeable incident of puberty. Leucorrhea is of quite common occurrence in young women and is usually due to a chronic condition subsequent upon some acute disturbance. There may be a history of a long neg. lected sulvovaginitis of childhood; of repeated attacks of congestive dysmenorrhea resulting in endometritis; of erosions of the os uteri; or the exciting factor may have become a traumatism. Vaginitis, either simple or gonorrheal, if often encountered in young women and the use of a medicated douche is imperative, not only to remove the charge, but to destroy the infecting germs and to prevent the spread of the disease. In pains due to displacements and flexions of the uterus, appearing particularly at the menstrual periods, a douche of hot water does much for the comfort of the sufferer. In ovarian neuralgia, where the pain is more or less constant, the vaginal douche is a valuable adjunct to any other form of treatment that may be instituted. The transition into the martail state brings new needs for the douche. Pregnancy causes more or less increase in the amount of vaginal discharges and calls for more cleanliness. Parturition is apt to give rise to lacerations, ulcerations, fistulae, uterine malpositions and many other distressing feminine phenomena. In a woman's life after she has passed her change of life, several causes may come into being which require the use of vaginal douches. Cancer is one of the most freqeunt of the new developments whilst senile changes of a non-malignant nature quite often give rise to leucorrheal discharges. Where there are lacerations and fistulae remaining unrepaired from the child-bearing epoch, such conditions may be expected to cause trouble and require constant care. In vaginal douche therapy one of the chief matters for consideration is the syringe. Various kinds have been invented and put before the public in the various markets. The old time piston and valved bulb syringes have been almost entirely discarded for the fountain and large hand bulb varieties. The fountain syringe is useful where an instrument is wanted for "all around" family use, but where a syringe is desired for exclusively vaginal use the large hand bulb pattern is best. Of this style there are several varieties, the difference being in the tips. Some throw a solid stream, others a number of small streams, but the most satisfatory of all is the one which throws a whirling spray. Every physician should be informed on the matter of syringes, should be familiar with the various styles and makes, their capabilities and qualities and so be in position to advise his patients when they come to purchase an instrument. The method of giving or taking a douche depends much upon the object to be attained. The cleansing douche is a very simple thing and may be administered in any position with a whirling spray syringe, either standing, sitting, squatting or laying down, and without the necessity for a douche pan, slop jar or other adjuncts, or the removal of the clothing, and at any time or in any place. For comfort and effectiveness the water should be warm, and if it be medicated, at least a quart should be prepared, as the first one or two syringefuls should be thown away after being once used, as the water becomes laden with the discharges collected in the vagina. In using the tip the conical guard should be adjusted so as to fit snugly against the outside parts when the tube is in place in the vagina. This is readily done by sliding it along so that only the required length of tube is exposed beyond the guard. After the douche the external parts should be wiped dry and a napkin worn for an hour or so to absorb the water that may drain away from the vagina. After a simple cleansing douche the woman may go about her usual work, but in order to secure the best results from a medicated douche the patient should lie down for half an hour or longer, hence such douches should be taken at bedtime or at a time during the day when it is possible to secure at least thirty minutes recumbent rest. with plain warm water before using, to remove any collected dust, and immediately after using it should again be cleansed thoroughly to remove medicated solutions of any adherent discharges. It should be drained and dried before being put away. Cracks in the bulb can be temporarily repaired with rubber or "L.O." plaster; broken parts can be replaced by addressing the manufacturers. A vaginal syringe should always be for the exclusive personal use of one individual and should never be loaned to friends or relatives. Not infrequently the vilest and most disgusting of diseases have been transmitted through infecting germs carried by a promiscuously used syringe. And when one knows of the many months and years of physical agony which too often follows these diseases there cannot be too much emphasis laid upon this one precautionary and prophylactic bit of advice, "Do not lend your syringe." THE DOCTOR'S BURDENS. Edwin Thomson, M. D., Kansas City, Mo. Of manifold and morbid ails Unknown to medical The science that knows all disease In doleful tones and sighs; These recitations, in degrees, And ofttimes he prescribes a dose That acts heroic❜ly To save the patient when he's close Advises him that it is just Some harmless drug that will Folk work upon his sentiments When they are indisposed, And give him flow'ry compliments; Then shortly he's imposed Upon, for when they gain their strength And former rugged health, He seeks them to find out at length That they've left with their wealth. And the woman at the window, In the court-yard of that prison, None had cared, she was accursed. At the pious homiletic The grave judge at sentence preached His own child, unguessed, he hung. Just a moment in God's sunshine, Whose the crime, whose sin was worst? Doctor, did you ever analyze your thoughts and actions, and tot up the lot that are purely precedent, that are parts of our life, just because "every one does it?" I'll assure you that a really honest wrestling match with one's own inner consciousness, along this line, will knock great big hunks of self-conceit out of a fellow, at least it serves me that way. Hence we hang criminals when we haven't some other fashion for execution, for we read in a very ancient bit of history, that Cain found a cudgel, an effective argument to rid the limited society of that day of an undesirable-from his view-point member. We've been following the precedent since, and whether it be that capital punishment per se, is right or wrong, is a matter for the rural debating societies; what the rest of us may opine will no more alter the facts than will the sighing of the breezes about the scaffold. Doctor, we can exemplify the "ounce of prevention." Really, I consider that it is better to prevent the birth of the degenerate and the criminal than to hang himand cheaper-hence I have labored in season and out of season, to promote the sterilization of the unfit. Can you not help? I do not contend that this sterilization, even of all the unfit, would stop all crime, for there are no panaceas, even salvarsan fails to cure some cases of syphilis. If my efforts prevent one legal murder, though a century hence, because my actions have prevented the bornin' of one degenerate, I shall be repaid for all the effort. Whether the soul is, or is not an immortal entity, we live throughout time by the influences we have left to work adown the ages. Dr. P. I. Leonard would like to have eye and ear cases referred to him as clinics. Dr. Hamer, health officer of the London (Eng.) County Council, has traced an outbreak of typhoid fever to the consumption of fried fish. Incorporating Address all communications to Chas. Wood Fassett, Managing Editor, St. Joseph, Missouri. Vol. XXXI FEBRUARY, 1912 Editorial No. 2 "Nothing is more estimable than a physician who, having studied nature from his youth, knows the properties of the human body, the diseases which assail it, exercises his art with caution and pays equal attention to the rich and poor."-Voltaire. MERCURY, OUR FRIEND MERCURY! Arsenobenzol, salvarsan, 606, has skyrocketed the therapeutic horizon, and we are yet "dodging the stick. Till its advent the treatment of syphilis remained fundamentally unchanged. Today the same question, "when is a case cured" is still answered subjunctively. With this clinging doubt 606 seems, however, destined to eventually gravitate to a therapeutic niche in the treatment of lues. The procedure, how, and the method systema. tized, need definite working out, first, to modify present unfavorable results, and, second, to finally solve the therapeutic possibilities yet undetermined because of faulty methods. We know that Ehrlich's dream of a single dose cure (sterilisans magna) is an historical nightmare, though the drug dose magically obliterate symptoms. Under Prof. Gaucher at the St. Louis Hospital, Paris, more than 60 per cent of recurrences followed a treatment of three to six doses. Prof. Gaucher said, at the French Academy, "it should be considered a cicatrizant, not a cure." (1) He recognizes in his clinic the phantasmal recession of lesions and disappearance of symptoms in the majority of cases but he also observes that quite a number did not improve even after five injections (1). He regards a negative Wasserman, (1) La Tribune Medicale, October, 1911. |