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this form of vaginal obstruction. In these cases tbe hymen may be found, as a hood, projecting over the closed end of the canal.

Cases of double vagina, each vagina baving its uterus, have been reported, in which one of the canals was open and the other closed at its lower end, the closed one becoming distended with the menstrual flow of its uterus. In these cases the atresic vagina should be opened and if there is not a du. plicity of the external genitals the petition separating the two canals should be destroyed, making a common or single vagina.

We have now to consider congenital absence of the vagina. In these patients there are usually associated defects in the development of some one or more of the other genital structures, particularly of the uterus and Fallopian tubes as they are developed, in common with the vagina, by the Mullerian ducts. These patients have been known to suppose themselves normal in formation, because they could perform upembar. rassed, the act of copulation. This latter is made possible by repeated efforts at coition deepening the vestibular space or dilating the urethra so as to admit the male organ. Strange to relate such a dilation of the urethra rarely causes urinary incontinence. If the vagina is absent or practically so and the uterus is fnnctionating, it is imperative that we undertake to make an artificial vagina in order to release the retained menstrual flow and prevent its recurrence.

We will not en. deavor to describe any one of the many methods that have been proposed for making an artificial vagina. Suffice it say, that none of them can give us anything approaching the normal canal, because the structures forming the walls of the vagina do not exist. An opening serving the purpose of menstruation and copulation may be bad, but if pregnancy should occur delivery at full term could not possibly be accomplished without such extensive injury to the pelvic floor as would make Cæsarian section the preferable procedure. These patients should be informed as to the dangers of pregnancy and warned against marriage. If however, the marriage state exist, or is, assumed, then the lesser of the evils is for them to prevent conception. Should they refuse or, as it were, wilfully neglect to follow our advice, and as a consequence become pregnant, I do not believe we would be morally justified in destroying the life of the fetus, a truly repulsive operation. Pregnancy should be allowed to continue to full term and

Cæsarian section performed. Should the efforts to mantain an artificial vagina prove unavailing, hysterectomy, with or without, oophorectomy should be performed to prevent a recurrence of the menstrual accumulation. If menstruation bas been painless, proving the normality of the uterus and ovaries, I believe it is better to leave the latter because, if the uterus is removed there can be no discharge, though the ovaries remain, to accumulate, and by not resorting to ovarian ablation, the abnormal nervous manifestations of artificial menopause are not produced. If, with the congenital absence of the vagina, there is a defect in the development of the uterus, to the extent of its not functionating, no operation is indicated, unless there are painful efforts to menstruate or ovulate, when this is true ovariectomy should be performed.


By W. T. Henderson, M. D., Mobile, Ala.

Gentlemen and Members of the

Mobile County Medical Society: In compliance with the constitution of your organization it is my pleasure, as President of the Society, to submit an an. nual message devoted to an account of my stewardsbip and to the discussion of the interests, objects and business of the Society.

You have conferred upon me an bonor wbich is greatly appreciated, and it has been my earnest endeavor, during my term of office, to preside fairly at the meetings, to appoint the leaders in discussions and to perform all other duties which devolve upon your president.

Since my incumbency we have had 51 regular meetings and one special meeting. There have been read 13 papers out of a total number of 16 appointments, the leaders on these oc casions being unavoidably detained.

Our meetings have been well attended in comparison with other years, there being this year an average of 12).

At the beginning of the present year we numbered 40 and we now have 41 on the roll. There have been elected to

*Delivered before the Mobile County Medical Society, Dec. 20, 1902.


membership in the Society three physicians : Dr. P. J. Glass, Dr. Geo. H. Searcy and Dr. J.J. Peterson. We have lost one by resignation, and death has again visited our body and removed from our roll Dr. Keith Fondé. He was a true gentle. man, a learned physician and possessed to a marked degree those splendid attributes of character which command respect and stimulate in those with whom he came in contact, a desire to do good. It is a great loss to the Society and to the com. munity in which he lived that he was not spared to continue longer a work wbich he had only begun.

The papers which were presented to the Society have been instructive and seemed to bring out from the members many practical points. The off nights have been filled in by the relation of cases, and many have been reported. One factor wbicb added interest to the Society was due to the report of a - steering committee," which divided the members up into five different sections. We have had reports from two of the sec. tions; they were comprehensive and instructive, and I suggest that the same plan be continued. New machinery does not work 80 smoothly, but I feel certain it will be an easier matter dur. ing the coming year to get the members of the different sec. tions together. I am informed that the surgical section is ready to report at any time.

There are doctors in the city and members of the Society wbo have never attended a meeting since the last election night, and consequently, the natural inference I get from this action is their failure to elect their man. The doctor who fails to attend these meetings misses many things which weuld be of use to him in his daily practice. One will tell you he could come any other night but Saturday, believing perhaps, the few dollars he may collect a few days earlier compensates for his absence from the Society, while on the other hand he is burn. ing up his candle of knowledge without resplenishing his supply.

I will agree with him when he says a man may be a good doctor if he reads his journals and remains away from the So. ciety, but this same man can be a better doctor by attending its meetings, and he owes to his patients the best be can acquire. Preachers tell me a man can be a good christian who never enters a church, but they also say a man will be a better christian when he attends tbe services regularly, as his field of usefulness is much enlarged.

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We do not want a Society composed mostly of sap-suckers and wood-peckers; we expect every man to bring in some. thing and carry a way much. The way to make this a greater Society is to attend its meetings; should all attend and report their cases in a scientific manner there would be a diffusion of knowledge wbich would redound to the good of all.

There is a general opinion held by the laity and shared by a few physicians that one of the purposes of a county medical society is to directly promote the financial interest of its indi. vidual members.

This conception of our organization is entirely wrong, and the physician at all times should be ready to explain to the public that the true objects of the Mobile County Medical Society is to promote scientific research, encourage the members to study and stimulate among them a fraternal feeling which should exist among all true physicians.

Neitber is it the business of the Society to prosecute those parasites who live upon the good name of the profession which the regular doctor has always endeavored to maintain, but the physician should be always ready to furnish evidence and testify when called upon by the grand jury and the prose. cuting attorney of the county in which he lives.

On February 15, 1902, tbere was a motion made and car. ried that the President appoint a committee to codify the By. Laws and Constitution of the Society, the committee to report in 90 days. This committee is still out, they having ex. perienced some difficulty in getting the transactions of the Society for some of the years, and I suggest that the Society authorize its new President to appoint a committee to draft a new constitution, the same to be copied as much as possible from the old one, and to create new By-Laws such as will be in accordance with the needs of the Society of to day.

As your representative on the Quarantine Board of Mo. bile Bay, it has given me much pleasure to attend its meetings, where I was treated with great courtesy. The board is in sound financial condition and the members work in harmony.

I cannot close my remarks without referring to the ethics of the profession. We younger men must take care lest we allow the high standard of professional honor practiced by the older men to degenerate into mere commercialism.

If there is one thing that this Society stands for it is pur. ity of principles in the practice of our art.

You are violating the ethics of this Society and of the American Medical Association when you send your patient to a quack specialist for treatment.

I care pot how competent you may consider a quack or how skillful he may be in his manifestations, when he resorts to dishonest means of enticing his victims he is a dishonest man and you have inflicted your patient with a greater injury than his so-called skill can remedy, wbile you, Mr. Doctor, occupy the position of best man in this most ipfamous farce. I believe in maintaining the dignity of our profession and insist that no member of this Society has a right to consult with an advertising quack and the members of this Society have no right to consult with any regular physicians outside of the So. ciety who recognizes these disreputable vampires.-A man is no better than the company he keeps.

The whole problem of handling this question comes to tbis :

Are you a man or a monkey ; are you a true physician or a disreputable quack; are you honest or dishonest ?

I can conceive of no greater parody on the virtues of legi. timate practice than to see a physician scaling the walls of a vessel, hanging perbaps for a few minutes on the rail of the ship until the quarantine flag is lowered, that he may present his card to the captain, and there in the presence of other competitors of his ilk offer to attend the crew for 2 cents per ton or even 1 cent a ton; yes, Mr. Captain, I will take your ship for cent per ton and furnish you the hospital expense before I

I will be under bid.

The regular pbysician has the whole field of therapeutics before him. Should he wish to cure a patient by moral teaching, coupled with the administration of some inert remedy, he does not hoodwink the public and call this any particular kind of pathy. Should be resort to any of the recognized baths as his agents, he does not call this hydropathy; or, should be deem it advisable to administer massage to his patient he does not call this osteopathy or any other high-sounding misnomer. Should he believe in the earnest solicitation of the Ruler of the Universe to help him relieve suffering humanity, he does not call this Christian Science; or, should he administer the proper drug, proper because based upon sound physiological teachings he does not call this Allopathy. He is broad in his views and will resort to any honest means to bring relief to those who place their lives in his care.

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