RAY, J. MORRISON, M. D., Report of a Case of Fracture of Skull, Clavicle, and Compound Comminuted 193 44I 370 396 Smallpox and Vaccination. By Albert Bernheim, M. D., Smallpox at Johannesburg, 91 SMOCK, GARRETT D., M. D., 398 Some Observations on Brain Anatomy and Brain Tumors, Some Desultory Remarks on Retinal Hemorrhages in Certain Blood Conditions. 441 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., Strontium Salicylate, Strontium Arsenite, and Other Valuable Salts of the Ele- ment Strontium, with an Original Working Formula for the Preparation of a One-per-cent Aqueous Solution of the Arsenite of Strontium. By Leon L. Tardy Abscess of the Liver Following Dysentery in a Temperate Climate, Tuberculosis of the Middle Ear, Two Cases of Melano-carcinoma, primary in the skin, One in a Negro; With . Use of a Brooklyn Hospital Offered to the Government, Venesection in Children's Diseases, WADSWORTH, L. C., M. D., . . . Western Surgical and Gynecological Association, Where the Responsibility for Cuban Disaster Lies, 195 AMERICAN PRACTITIONER AND NEWS VOL. XXV. "NEC TENUI PENNÂ.' " LOUISVILLE, KY., JANUARY 1, 1898. No. I 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. Professor of Obstetrics, Abdominal Surgery, and Gynecology in the Kentucky School of Medicine; Fellow 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 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 learned 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, |