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seat of fracture.
would be tightened. The splints hardI have found this procedure to suffice in ened as firmly as was at all necessary; a number of cases until permanent splints they fitted the limb exactly; they were could be procured, and in more than one easily removed or pressed back so that instance have trusted wholly to the salt the limb could be examined, an exceedbag splint for a number of days until all ingly important point in old subjects in local soreness and swelling had given way. whom gangrene and non-union are among It has the advantage of giving opportunity the possibilities. My patient made a for the application to the surface of the most excellent recovery and in less than leg of Arnica, Symphitum, Hamamelis or two months was about on a crutch and other liniments, and admits of gentle rub- cane. bing or massage, so grateful in these in. In this particular case I found much juries.
satisfaction from the external and inIn the case under consideration, ternal use of Symphitum for the above the edema and pain made it necessary pains, from which the patient suffered, to use an open splint all the way through at times quite severely. The 3x was the treatment, so I made & temporized given internally and an application of Bavarian splint from one of the old gen- equal parts of the tincture and water was tleman's woolen socks. Laying it flat on applied externally. the table, I split it down the centre, be- Only last week I discharged with perfore and behind, cutting out the heel and fect union a similar case in a man above trimming off the toe. I repeated the sixty years of age. This gentleman was process with the other sock. I then sat- watching his grandchildren playing at urated one piece of the half sock thor- football when the ball came near enough oughly with plaster of Paris paste, fitting for him to kick at it. As he did so he the corresponding half of the other sock partially turned while on one foot, when to its inner surface. This was then ap- snap! went both bones about the lower plied to the leg and ankle, moulded and third. Here again I called the salt bags held into position until it had dried to the into requisition, they being the only form of the limb. The same procedure was splint applied for a number of days. gone through with with the other halves. When finally the swelling was sufficiently The limb was now lifted from the pillow reduced, I made a pair of Bavarian and a many-tailed bandage was laid upon splints, fashioned after a split sock, from the latter. The leg was lowered upon this, a piece of old blanket. These I strengththe sock splints were applied to the sides ened in plaster and applied with the of the leg and foot, and the bandage was many-tailed bandage, as in the case presnugly drawn and tied above the shin viously reported, examining the leg from bone, the latter being protected by a day to day according to the condition of layer of absorbent cotton. From day to the patient until the sixth week, when I day the 'bandage was loosened and the put the leg up permanently in a plaster leg examined. As the edema was more cast which was allowed to stay three marked the bandage would be loosened. weeks. This cast I removed only ten
. When the leg was more shrunken it days ago, and my patient has as good a leg as before his injury, except that he gery marvelous strides towards perfection has a good deal of edema at nightfall are being made. The patient, a lady aged after being up all day.
30, suffering with cancer of the rectum, Rhus Tox., 3x and 30x, did good service had advanced to a full term pregnancy. in this case in relieving the nightly ach- The cancerous growth occupied so much of ings and pains about the seat of fracture. the pelvic cavity that labor could not
I do not believe that I can ever be take place. The amniotic fluid bad escaped brought to dress a fracture in an old and urgent methods must be employed as subject in other than the open style of life hung in the balance. splint. The heart's action is usually feeble Dr. Pierson, the attending physician, and the return circulation poor. There- held a consultation with Drs. Willis and fore edema is much more pronounced Hasbrouck, and an operation was decided and gangrene and sloughing is much upon as being urgently required. Cranmore possible if the pressure should be iotomy was excluded, being inadequate, at all uneven or in the least too great and Poro's operation given the preference, The satisfaction that the surgeon experi- the family consenting to any measure that ences when he can see with his eyes and might be necessary.
might be necessary. Next day (March 19) feel with his fingers from day to day how was set for operating. the case is progressing is indeed a great At the time specified, after all preparaone, while the dread of a revelation of tions had been made, the patient, under a crookedness or non-union when a per- ether, was brought into the room, her abdomanent or closed splint is removed is a men thoroughly cleansed with soap and dread that I for one do not care to water, followed by a washing with ether. experience often. (Not concluded for An incision extending from the ensipress of time. C. E. F.)
form cartilage to the pubes through to the
peritoneum was made. Texas Association, Fort Worth, May, 1891.
The peritoneum was picked up and cut PORO'S OPERATION. A CASE. on a grooved director and all bleeding
vessels secured by haemostatic forceps. BY C. F. BRADEN, M. D., SAN ANTONIO, TEXAS. Exploration of abdominal cavity resulted
in finding the uterus adherent, and after IN N no branch of medicine has there been being freed it was with difficulty brought such rapid progress as in surgery.
out of the abdominal incision. Long pins Operations that fifty years ago were un- were then introduced through the uterus, dertaken with gravest fears are now per- above the neck, under which was placed an formed with very little hesitancy, and the elastic ligature securely tightened and the results of our modern surgeon are beauti- uterus was opened and relieved of a living ful tributes to human ingenuity.
child. A few cuts with a large knife While in Brooklyn I had the pleasure sufficed to remove the uterus, leaving a of witnessing Dr. Willis perform Poro’s small pedicle which was seared with a modification of Caesarian Hysterectomy. thermo-cautery. The magnitude of this operation, with its Hot flannels were constantly used to glowing result, convinces me that in sur- retain the intestines and maintain their
normal temperature. The abdominal cavi. held a different opinion from that I now ty was then irrigated and the incision hold. stitched up to the pedicle, the latter being The marital relation is a natural one, left external to abdominal cavity. Iodoform and physiological and not pathological was then applied, the abdomen secured conditions are the only ones which should by a snug bandage, and the patient put to follow the consumation of the relations. bed. Strict antiseptic precautions were But alas! what do we find in many inemployed during the entire operation. stances? The modest, the retiring, the
At the time of my departure from faithful bride and young wife finds herself Brooklyn, April 13, the patient had made in a diseased condition soon after marriage. a good recovery, and though still suffer- She suffers and says nothing. Mayhap ing from cancer, bad entirely recovered the suffering becomes unbearable. She from the effects of the operation.
consults her physician and the consola
tion she receives is you have been indisTexas Association, Fort Worth, May, 1891. creet, excessive venery, etc., are hinted if LATENT SPECIFIC URETHRITIS. not spoken.
What is the trouble! It is the latent BY I. C. WEST, M. D., DALLAS, TEXAS. gonorrhea, which the indiscreet husband
has had cured perhaps for months, or years, IT has been the general impression of
which has found a fertile field for its work the medical profession, and the expres- in this innocent, unsuspecting woman. sion of medical writers that gonorrhea is He has no discharge or trouble and the a local disease and self limited in its cause is not suspected, and if the true
That there have been opinions, nature of her trouble is discovered she and some expressions that it sometimes may be accused of having violated her becomes chronic I am aware, but as a rule marriage vows. it has been regarded as a comparatively It may be that the trouble does not harmless disease. We see in medical manifest itself in an inflammation of the works notice of gonorrheal rheumatism vagina, but in endometritis, salpingitis, which would imply constitutional taint, ovaritis, or pelvic cellulitis. Look at the and of gleet, a simply chronic form of mild
cases of female troubles of married women; inflamatory action. But what I wish to women who were the picture of health becall the attention of this association to fore marriage! What is the cause of this particularly, is, that we, or many of us, are
ill health? Certainly no one will pretend teaching a false and dangerous doctrine.
to contend that it is the consequence of I have been guilty for a loug time I be- the proper relations between man and lieve, and have informed my patients that wife. No, gentlemen! It is the latent when no symptoms of the disease were gonorrhea of the husband showing itself. manifest by discharge, we surmise that they were well, and consequently their
The Countess Wanda Szcawinska has just taken former disease was no barrier to marriage.
the degree of doctor of medicine in the University I now hold a very different opinion, and
of Geneva. The lady is said to intend to practice I have had cause to regret that I ever her profession in her native country, Poland.-Ex.
becoming modesty, for one who has not had an extensive practice in gynecology;
but I approach it boldly and fearlessly, as Southern Association, Birmingham, Nov. 1890.
the extent of my experience goes. For THE RAPID DILATATION OF THE UTERUS.
fifteen years have I burned the midnight
oil in the study of diseases of women, givBY A. C. JONES, M. D., MUNCIE, INDIANA.
ing every spare moment and many dollars
hard to spare that I might perfect myself THE rapid dilatation of the cervical canal in this specialty. With all respect to Dr. is not a panacea for all the ills produced Pi
Pratt and his set of uterine sounds, I think by uterine disease, but there are few minor that the best uterine dilator is Goodell’s. operations in gynecology which can show The blades open parallel to each other more satisfactory results.
and it is provided with a screw to keep Stenosis is and has been for years cured the blades apart when desired-e great by the operation of incision, as practiced advantage over any other instrument. and first advocated by Sir James Simpson, To thoroughly and successfully perform Dr. Robert Barnes and Dr. Marion Sims; the operation of rapid dilatation an anesbut this operation is accompanied with thetic should be given, but for incomplete more or less danger to the patient while or partial dilatation, as, for instance, for by dilatation we avoid all danger and cure the use of intra-uterine applications or inour cases more readily. In fact, it is rare- jections, it is seldom necessary. As soon ly now days that we hear of an operation as my patient is fully anesthetized she is by incision, the operation of rapid dilata- brought to the edge of the operating chair, tion having almost entirely superceded the the feet held by an assistant. I then introformer. And, when we consider the sources duce a bivalve speculum, steadying the of danger in the operation of incision on uterus by a tenaculum. In order to asaccount of the anatomical peculiarities 'certain the size and direction of the canal of the part involved, and the dangerous I now introduce a probe. This being method of dilating the cervix by means of dono I carefully and slowly insert the tents, we do not wonder that some better lips of the dilator, pressing the handles method was sought for. Every one present slowly and gently-resting from three to is aware of the danger of intra-uterine in- five minutes between each expansion; upon fections unless there is a perfect patency the expansion being completed—i. e. to of the cervical canal to allow the fluid to its full extent, I allow the blades to remain freely and rapidly escape; and the usual for at least fifteen minutes. The question mode of accomplishing this has been by may be here asked, how do you overcome expansion by tents. By means of rapid the resistence, or, in other words, prepare dilatation more perfect patency may be
for the introduction of the dilator? Some secured without the tediousness and dan- years ago I used to first introduce a small ger of dilatation by tents, and the nozzle sized Atlee dilator, but I now use an inof the syringe can be passed between the strument of my own
much divergent blades of the dilator.
the same in shape as the Atlee, but longer I approach this subject with, I believe, and more delicately constructed. I introduce it as far as possible, then, by stretch- inches. ing the part it occupies, the contraction Different writers tell us that “the above the stricture), yields sufficiently to Seat of the obstruction is generally at the allow of the introduction of the blades of os externum," and where obstruction exthe large dilator. To make sure of no re- ists at the os internum, "it is due to flatcurrent retraction, I carry the dilation to tening of the walls by flexion.” I am not the fullest extent or capacity of the instru- prepared to say whether this is true or ment. If following the operation there is not, but, in either case, experience has considerable soreness; a suppository of taught me that where the conditions of opium introduced into the rectum will stenosis and flexion are both present, rapid allay it and all pain.
dilation will cure both conditions—i. e. Many gynecologists in operating for the operation to cure the flexion will per rapid dilation prefer the left side for posi- necessity cure the stenosis. The condition tion of patient; I prefer the dorsal posi- or result of obstruction are "(1), congestion, unless it be for partial dilation the tion and enlargement of the body of the former position then offering many advan- uterus, causing uterine colic and spasm, tages.
menorrhagia; (2), a similar congestion of When is the operation indicated ?
the fallopian tubes; (3), congestion, enIn dysmenorrhea when the condition is largement and inflammation of the ovaries; due to stenosis of the cervical canal, or (4), as an ulterior result continued obflexion, or flexion and stenosis combined. struction may entail, through the action
It seems to me impossible to differenti- of inflammation or long interference with ate these conditions by subjective symp- function, atrophy of the ovaries and extoms. We understand, and it is stated tinction of the menstrual phenomena.” that where stenosis alone exists, before This being the case, and when we realthe flow the pain is excessive; and as it be- ize the serious consequences which must comes established the pain gradually follow a long congested uterus, the falloceases; but in flexion the flow comes in pian tubes being in the same condition, gushes, caused by the pent-up fluid and the ovaries in even a worse; when we straightening out the canal. There being think of the terrible suffering of those in excessive pelvic and ovarian hyperemia, whom these obstructions exist, can we laud all subjective symptoms are unreliable. too highly a treatment that will afford relief This condition of hyperemia is consequent beyond all peradventure of failure, a treaton the obstruction and tends to mask the ment that we are bound to use by every naturally concomitent symptoms of steno- consideration of humanity? Thanks to scisis alone, or when combined with flexion. ence the operation of incision of the cervix Where obstruction exists the vaginal por- to overcome stenosis, and the various cuttion of the uterus usually becomes elong- ting instruments invented have been releated, somewhat pointed; and often, in fact gated to the past and rapid dilatation is
, nearly in all cases, the os externum is ex- fast taking, if it has not quite taken, the ceedingly small, the fundus is enlarged, place of the knife, scissors and the and measurement by sound is from three metrotome. to three and a half, sometimes nearly four Nothing will overcome sterility where it