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Removal of the Uterus for Disease of the Appendages.-A Difference of Opinion. Editor Medical World:-On pages 291-9293 of August number of the World I see an article headed "Removal of the Uterus for Bilateral Disease of the Appendages."

I do not propose to discuss the merits of this article, for the reason that I cannot find any merit in the article, but danger.

I wish, however, to protest against the unwaranted removal of any organ unless it is absolutely necessary from disease of the offending organ, and to caution the many young and old members of the profession

who read the World (as I believe the World is read in every hamlet, town and city of this country) that such surgery as suggested by the author of the article is a violation of all rules held by either a general surgeon or by a gynecologist in regard to the removal of the uterus.

Again, the writer claims to have performed the operation in half an hour.

I shall say that the time that the author keeps the abdomen exposed in his delayed operation would prove extremely hazardous to the life of the patient.

Dr. A. C. Bernays, of St. Louis, Mo., performs the operation several times every day and only consumes five minutes in the operation, involving very little shock and short period of anesthesia. Spokane, Wash.

D. L. Smith, M.D.

Uterine Procidentia and Protruding Hypertrophy of Vaginal Wali.

Editor Medical World:-I have just read the interesting article of Dr. J. W. Lockhart, of St. John, Wash., in the August number of the Medical World. I wish to quote the last two paragraphs and then cite a recent case of my own:

"The midwife referred to by Dr. Taylor may have been grievously mistaken in her diagnosis of the case. But I wish to point But I wish to point out to the doctor that his own statement of

the case is proof positive that he was also mistaken, in part, at least, of his diagnosis." "Seventh month, vaginal portion of neck not thinned out, os forced through vulva. A mechanical impossibility unless the presenting part had engaged in the inferior straits, or there was semi-acute retroversion of the pregnant uterus."

I had not the pleasure of reading Dr. Taylor's article, but Dr. Lockhart's remark

about the "mechanical impossibility," etc., reminded me of the case of mine, which has no parallel in my experience, and may be interesting to others.

I was called to a patient with grippe, a rather severe case. Found woman of 35, in eighth month of pregnancy. Had eight children, oldest 10 years old, youngest 1 year old. She said with the last two pregnancies "something had come down, and was worse this time than before."

On examination this was what I found: The anterior wall of the vagina immensely hypertrophied and projecting from the vulva in a loose pendulous mass as large as a fetal head. It was no tumor, but clearly and simply hypertrophy of vaginal tissue. This projected six and a half inches beyond

the vulva. Below this was the neck of the uterus, which projected beyond the vulva three and a half inches, nearly circular in shape, and with a diameter of three inches. Os was plainly visible and measured one and a quarter inches in length, and quite soft and patulous. Insertion of the finger in the os showed the fetal head to be four inches from the os, and freely movable.

This is not a fancy sketch, but every measurement given was made with a rule. As I was anxious to see the result of a labor in such conditions, I left strict orders to call me as soon as labor began. As I live eighteen miles away, I did not arrive in time. The history given by one of the old women present is as follows:

"Water broke about half an hour after pains began, and half an hour after that the child was born. That big bag of skin (the hypertrophied tissue) just folded over on top of the mother and the mouth of the womb was outside all the time, and until the afterbirth came away." The child weighed six and a half pounds. When I saw the patient the os was visible at the opening of the vulva. At present date it is nearly always within the vulva, but coughing, a muscular effort, causes it to protrude. The hypertrophied tissue is somewhat lessened in size, but still projects five inches from the vulva. Incredible as it seems, this poor woman lives in a rude hut, and does the work of her large family, with what aid the children can give her. She says that her labors are always easy and rapid, but that she has never had so small a child before, the others weighing eight or ten pounds. The pelvis is unusually roomy, and the small size of the head made

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A Case of Protracted Gestation. Editor Medical World:-I wish to report, through your valuable columns, a case that is at least of not very common occurrence. And first I wish to state that the husband and wife are paternal cousins. I was called on August 3, 1894, to see Mrs. M. (primipara). She was suffering with pelvic pains, caused by slightly excessive anteversion. On September 24 I was again called, to find her in much the same condition, excepting that at this time the uterus was very much larger, and on account of other symptoms I pronounced her pregnant at least four or five weeks. After-developments all confirmed this opinion excepting that she menstruated twice afterward. The period of quickening was about on time and everything pointed to maturity in May or early in June. On the 16th of June I was summoned, to find her in pretty hard pain. After using mild sedatives the pain subsided in a few hours. This course was repeated about once a week, until on the evening of July 23, when I found her in true labor, which had been gradually increasing all day and continued to do so all night. After midnight I administered chloroform for some time and the pains almost stopped, but started up when it was suspended. I had kept her for several weeks slightly under the influence of oil of turpentine, to promote the action of the kidneys, it giving more general satisfaction than any other diuretic. Early in the night I learned that the discharge of urine had been very scant and defective for forty-eight hours past. For that and other reasons I feared that convulsions might supervene at any time. By four o'clock A. M. her labor had become so hard and advanced so slowly that I began to fear trouble. I observed that the cranial bones were very firm and that there was no overlapping of the coronal suture, and that the posterior fontanel was hardly perceptible. After using every other means, both physical and therapeutical, that I am in the habit of doing, I applied the forceps and was distressed to find that with the assistance of powerful uterine contractions the fetal head appeared to be stationary. At this juncture, although she was almost perfectly anesthetized, the symptoms of spasm became so imminent

that I told the husband that I thought that unless the babe could be delivered at once the mother would go into fatal spasms. It was four miles to the nearest doctor, and we all felt sure that two or three hours' delay meant death to the woman, as well as to the babe, so at the urgent request of both her mother and husband I attempted, for the first time in a practice of nearly forty years, to perform craniotomy. The only instrument I had that was at all suitable ing considerable force they penetrated the was a pair of dressing scissors. By applycranium, but not by merely lacerating a membranous covering, but by fracturing a perfectly ossified skull, after which I succeeded in delivering by the combined help of the blunt-hook and forceps.

After so much violence there was no lacerNow comes the strange part of the case. ation, either external or internal, and as soon as she recovered from the chloroform No excessive flow, no pain, and absolutely she seemed to start on the road to recovery. no fever. Her milk did not develop until the fourth day, and then without the least discomfort. Of course, aseptic and hygienic measures were as rigidly observed as was possible. At present-the 10th day -she is doing well.

Now as to time. From my second visit, September 24, until she was delivered, July 24, is just ten calendar months, and in view of the existing symptoms the oftrepeated attempts to establish labor and the abnormally complete ossification of the skull (all the other sutures, as well as the anterior fontanel, were as completely ossified as the coronal suture or posterior fontanel) are we not safe in putting the time of gestation at eleven calendar months? Or shall we set all these aside and count from the last menstrual epoch?

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may be due to hereditary influence or depressing impressions at the time of or prior to impregnation.

Of course, there are many cases that are inexplicable by the present known laws of physiology; but it is clearly evident that there is no effect without an efficient cause. And since there is no nervous connection between the mother and the fetus, it is certain that no mere mental impression of the mother can directly influence the fetus.

The placenta takes the place of the lungs. and alimentary tract in the fetus, and, of course, the condition of the mother's blood will exert an all-important influence on the fetal development. In the present state of our knowledge it is impossible to say what reactions may take place between the blood of the mother and the nervous system of the fetus, but whatever maternal influence is thus exerted is probably only a nutritive

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For Hot Flashes For Suppressed Lcchia. Editor Medical World:-H. J. Boughton, M. D., in Medical World for June, asks for "a recipe for hot flashes that women suffer from during and subsequent to the menopause." I suggest for this trouble 10 to 20 drops dil. sulph. acid in water three times daily.

Dr. L. L. Aultz, June World, page 231, wants a prescription for suppressed lochial discharge. I advise the following treatment: One-half drachm fluid extract leonurus (motherwort) in warm water every three hours. This remedy, with warm applications over region of uterus and warm antiseptic vaginal washes, has always given me entire satisfaction. If the patient has fever I treat it also.

The World is a valuable journal. "May it live long and prosper." Lookout, La.

R. M, Collins, M.D.

Can you do better than to recommend THE MEDI CAL WORLD to your friends?

How We Cured That "One Line Pulling." Editor Medical World:-In one case the one line pulling was caused by a sharp "wolf tooth." Pulling this tooth made the horse act like quite a different animal.

In another case the front grinders were ornamented by a sharp flange on each side. The bit crowded the cheek against this flange and lacerated the cheek; so, of course, the horse took to favoring the side having the sharpest flange. The horse traveled well enough a few days after his teeth were filed.

In another case the habit was caused by bad teeth and bad breaking, and it took more time and patience to cure the habit. One horse was broken by a "smart aleck" who sat upon the right side all the time and started him off with a flourish of the arm and a snap of the finger. This caused the horse to keep his eye upon the right, and he soon learned to pull that way. Sitting upon the right side and using a "Bonner" bit helped this case.

One had to be helped by a little stable training. Her name had not been well learned and she would not "get over" from the right side. A few good spankings taught her to brace up at the sound of her name and to get off the pole at the words "get over."

One still leans on the pole a little, in spite

of all.

In one case the bridle cheek-pieces were too tight and crowded the cheek against the teeth.

In every case the teeth needed attention. The "Furlong" bit helped one.

After the mouth was well I think the worst of the battle was over.

There ought to be a training school for drivers. Half of our best horses are spoiled in the breaking. A gentleman's driving horse is worth twenty-five dollars more for having been broken by some one who has taught him his place and carriage. You can favor such a horse on the road when a badly broken, half trained scrub will mope all over the road and tire himself out in spite of your best intentions. I have a horse, 17 years old, that any one can drive anywhere, and he always has his head in the air, like a colt. I can pull him out of or around a bad piece of road by a mere twist of the wrist, and he is always drawing a few ounces upon the rein and under immediate control. The man who broke him added

100 per cent. to his value and, perhaps, as much to his life. Again I thank the doctors for their advice. W.

For Pulmonary Hemorrhages. Editor Medical World:-Dr. Collins, in last Medical World, page 304, describes a typical case of weak blood vessels with the consequential hemorrhages, indicative of weakness and changes in the walls of said blood vessels. He has tried ergot, ergotine, hamamelis, cupri sulph., guaiacol, gallic acid, aromatic sulphuric acid, etc., and with no good results.

Well, I, too, have tried the list, and many others, to no purpose. There are two remedies that work to a charm in most hemorrhages from the lungs. The first s syrup lacto-phosphate of calcium, in doses of one teaspoonful or a little more in water three times daily with meals. It may be necessary to combine with it the second, muriate of hydrastin, in one-eighth grain doses, or ten-drop doses, or even larger, of fluid extract golden seal.

These remedies are worth their weight in. gold to cure conditions of the lungs where hemorrhage is a prominent symptom. The altitude (8000 feet) is too high for weak blood vessels, and in my opinion 2000 feet is far safer.

The secretions must be looked after. If appetite is poor, give one-tenth grain of calomel, tablet triturate, two hours after each meal for a few days. If very constipated, begin with one-fourth grain of calomel at bed-time, just for one dose, then one-tenth grain thrice daily for a week or so; then regulate the bowels with cascara and a little mandrake, always giving laxative two and a half hours after meals. After a pint of syr. lacto-phos. calcium has been taken, nothing works so well for the anemic condition as Freligh's constituent tablets, one pulverized with breakfast and dinner one day, and one with dinner the next day, and so on. If there is cough I use Freligh's cough tablets, one dissolved on the tongue after meals an hour or so.

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Dr. W. S. Newlon, of Oswego, Kan., writes us a letter in which he urges that we should protect our profession, not by State laws, but by greater usefulness in our professional calling. We must meet the competition of women physicians by being, like them, careful, tender, sober and by leading clean, pure lives. The Doctor thinks the following are among the leading mistakes among our profession at large: Over-medication in practice (especially in self-limited diseases); use of hurtful medicines in practice; too much meddling in obstetric and gynecologic cases; prescribing narcotic drugs, thus establishing bad habits; drunken doctors and educated blockheads allowed to practice. He observes that the education of a blockhead will never give him sagacity; that a skillful man with limited learning is more successful than an educated man without practical brains.

Quiz Department.

Questions are solicited for this Column. Communications not accompanied by the proper name and address of the writer (not necessarily for publication), will not be noticed.

The great number of requests for private answers, for the information and benefit of the writer, makes it necessary for us to charge a fee for the time required. This fee will be from one to five dollars, according to the amount of research and writing required.

Editor Medical World: - In the July number of the World, on page 262, you have kindly published a question from me as regards the danger of treating obstetrical cases at the same time with cases of erysipelas. Please allow me space for a few words more. Will the World readers make known, through its pages, the best treatment for the vomiting of pregnancy, and when, if ever, is the doctor bound to produce abortion for vomiting unrelieved by treatment?

I could not get along without the World, though could we not have a column devoted to "New Uses for Old Remedies" and get your contributors to keep it filled? There are so many "new remedies" flooding the journals daily that I think that we could, with profit to our patients, pay more atenion to the old remedies, without missing any of the new that prove themi selves to be good. How much better it has been for the profession that Dr. Moore discovered a new use for an old drug when he used permanganate of potassium for opium poisoning than if he had wasted

his time with the many oftentimes worthless and dangerous "new remedies," with names commencing in "anti" or ending in "ine."

May I make another request, namely, that your contributors will kindly lead in the education of the profession in the use of the alkaloids, in the form of granules, by giving their experience in the use of this class of remedies which is, in my opinion, the greatest blessing to patient and physician, and is destined to be used to the exclusion of the most of the more nauseous and bulky remedies? I have used with great satisfaction the granules from the Abbott Alkaloidol Company and from the Philadelphia Granule Company. I do hope for the good of the profession and suffering humanity that The World will prove itself a great factor in inducing a general use of alkaloidal medication. I feel as if I would like to write a long article on the many advantages of this form of medication, though to mention all of them a very long article would be required. Chester Wesley Hunt, M.D.,

Brevard, N. C.

Editor Medical World:-Over 30 years since I heard Professor Agnew remark to his class in Philadelphia that in puerperal fever, after child birth, veratrum viride was nearly a specific. I have since learned that when you have a full, bounding pulse, I don't care how rapid, veratrum viride will pull said pulse down in any disease. Should you happen to give veratrum too fast and cause vomiting, a little tincture of opium. in a little brandy will stop the vomiting, as it strikes the stomach. Do not give veratrum in any other kind of pulse. If you do you'll kill patient.

Will some brother M. D. give some inert, cheap fluid as a body or excipient to add remedies to? I desire said body to not spoil in summer or freeze in winter, but keep the year around.

Also, I desire an inert body for ointment, one that will not become rancid; one I can fry herbs in.

If you have a patient with cerebro-spinal meningitis give gelsemium with prudence and discretion until the spinal muscles relax. If you have a patient with the sphincter urinae muscle shut down tight and can't make water, set him down in a tub of water as warm as he can bear, and keep adding

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