. . 201 Professional Friendship. By William Lane Lowder, B. S., M. D., Puerperal Eclampsia: Its Cause and Indications for Treatment. By D. B. Stone, Puerperal Myelitis, 118 176 Report of a Case of Fracture of Skull, Clavicle, and Compound Comminuted 370 Responsibility for the Condition of our Soldiers, 30, 147, 185, 222, 264, 350, 430, 468 REYNOLDS, DUDLEY S., A. M., M. D., Saccharated Extract of Thymol in Whooping-Cough, Sarcoma of the Choroid. By Samuel G. Dabney, M. D., Smallpox and Vaccination. By Albert Bernheim, M. D., SMYTH, ARTHUR W., A. M., M. D., 404 SOLOMON, LEON L., A. B., M. D., Some Desultory Remarks on Retinal Hemorrhages in Certain Blood Conditions. 441 315 Some Thoughts on the Origin and Prevention of Disease. By J. F. Rascoe, M. D., 176 Something About Water. By T. J. Townsend, M. D., Southern Surgical and Gynecological Association, 40, 80, 120, 159, 200, 240, 280, 320, 360, 400, 440, 480 Strontium Salicylate, Strontium Arsenite, and Other Valuable Salts of the Ele- ment Strontium, with an Original Working Formula for the Preparation of Solomon, A. B., M. D., Sycosis. By John Edwin Hays, A. M., M. D., Symphysiotomy for Dystocia due to a Large Fetus, 79 198 161 317 359 272 277 34 213 39 191 Treatment of Contracture of the Bladder by Hydraulic Pressure, 132 Trophic Lesions in General Paralysis, True Relation Between the Pharmacist and the Physician. By Garrett D. Smock, M. D., : Tuberculosis of the Middle Ear, . Two Cases of Melano-carcinoma, primary in the skin, One in a Negro; With Some Observations on the Pathology of Moles, . Urticaria of Mucous Membranes, Use of a Brooklyn Hospital Offered to the Government, Venesection in Children's Diseases, Western Surgical and Gynecological Association, Where the Responsibility for Cuban Disaster Lies, AMERICAN PRACTIFIQNER AND News BRAR Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN. Original Articles. SURGERY OF THE ENDOMETRIUM AND THE CERVIX UTERI. The Address Delivered at the First Meeting of the Muldraugh's Hill Medical Society, at Elizabethtown, December, 1897. BY WILLIAM H. WATHEN, M. D., LL. D. of the American Gynecological Society, and of the Southern Surgical and Gynecological Louisville City Hospital, etc., Louisville, Ky. The attention of the medical profession has been so conspicuously directed by the gynecological surgeon to such capital operations as vaginal hysterectomy, abdominal section, etc., that section, etc., that the equally remarkable progress in minor gynecological operations has not received the general attention and recognition it deserves. I confess that the tendency with me has been to lean too much toward the major operations in my contributions to medical literature, but in my surgical work I have been more earnestly devoted to the minor operations, because I have learned that they are seldom followed by any untoward symptoms, that the immediate and subsequent results are nearly universally good, and if timely performed they prevent the development or progress of other diseases that require dangerous operations, or can not be cured by any sort of an operation. The minor surgery, to which I wish to call especial attention in my address to-day, includes the operation of curetting the uterus when indicated in endometritis, hemorrhage, etc., and the operation for laceration of the cervix uteri. While curetting the uterus has caused more suffering than it has relieved, and has caused more deaths than it has saved lives, this unfortunate state of affairs was the result of ignorance as to the indications and the time for the operation, the necessity for the observance of asepsis, and of the correct technique. Unfortunately there are some men even now attempting this work who have not practically learued the rudimentary principles of the best methods for this operation; an ignorance born of indolence and avarice, for the simplicity of the operation, if properly studied, is such that any respectable surgeon ought to make few, if any, mistakes in deciding as to the indications for, or in performing the operation. It will not be gainsaid that a thorough knowledge of all that is known about the embryology, histology, physiology, anatomy, and pathology of the female generative organs is essential in every one who expects to become a distinguished and successful surgeon in the treatment of the diseases of these organs, but in addition to all this, a knowledge of the most approved methods of preparing these patients for an operation, of doing the operation, and of directing and carrying out the after-treatment and management of the case, are essential factors, no link of which must be broken if we expect results that every patient is entitled to. Recognizing the correctness of the foregoing, we should go still further and apply in all our surgical operations the most advanced and the most easily comprehended principles in mechanics, so that the simplicity and the practicability of the surgical details can be understood, and successfully utilized by any intelligent surgeon. This finds its perfect application in operations per vaginam, on the vagina, the uterus and its adnexa; and as an illustration I will use the operation for the cure of a lacerated cervix uteri. By the older methods, using more than abundance of instruments, appliances, etc., the operation for lateral laceration performed by a good operator consumes from twenty to thirty minutes, and for bilateral lacerations correspondingly longer. By using no speculum or retractor, and uniting the denuded surfaces with a continuous catgut suture, I perform the operation on either side in five minutes, or on both sides in ten minutes. The results are nearly perfect in every case, and the after-treatment may be carried out by any nurse, for the woman gets out of bed to pass her urine and feces, and the suture does not have to be removed. Nor is a speculum or retractor necessary in curetting the uterus; and I have removed a myomatous uterus, extending nearly to the umbilicus, by morcellation, |
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