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immediately so. In this class of uterine pulled through the uterine rent; wounds the vulnerating agent establishes a Holmes's case, in which intestines were direct communication between the uterine found between the woman's legs; as in and some adjacent cavity; the peritoneal Congdon's case, in which the operator, cavity most always; rarely the vaginal or after pulling out 40/2 centimeters of inthe vesical cavity; still more infrequently testines into the vagina, twisted them off. the lumen of the gut. In other cases the As in Davis's case, during the course of perforating instrument, after having intra-uterine maneuvers, the anterior wall pierced completely through a portion of of the uterus was perforated and the intesthe uterine wall not covered with perito- tines damaged to such an extent that over neum, enters the peri-uterine connective fifteen feet had to be removed. In antissues, penetrating between the folds of other case reported, the operator kept on the broad ligaments, parametrium. If the pulling intestines until he had drawn out violence still continues to act, the vul- six feet of bowel, which he cut off. This nerating instrument may perforate one or case terminated fatally; all the other cases both layers of this ligament and thereby mentioned above recovered. The perforaalso enter the peritoneal cavity. The per- tion may be large enough to allow the forating instrument may enter the vesico- escape of the fetal head into the peritouterine space, may enter and lodge in the neal cavity; may allow the escape of the space of Retzius, may enter and lodge in fetus into the peritoneal cavity, as in Whitthe Douglas cul-de-sac.
ney's case. In Tait's case, nine months Traumatic perforations can involve any
after the date of infliction of the perforaportion of the uterine wall. In my two
tion, the track of the curette could still cases the perforation, as is usual, as is be seen. The size and shape of the openalmost always the case, involved the poste-. ing are, to some extent, dependent upon rior wall; in Van Ripper's case the rent
the size and shape of the vulnerating inwas in the anterior wall; it extended from
strument. the fundus uteri to near the vaginal vault. The perforation may lead to the formaIn Harris's and Whitney's case the ante- tion of permanent abnormal channels of rior wall showed a transverse rent about communication between the uterine and 1/2 inches in length. In a case reported adjacent cavity, as in Dr. Lobdell's case, by Hall the uterus was perforated from in which the perforation of the uterus took horn to horn, and the perforation was place directly into the bladder, and a perfilled with omentum.
manent vesico-uterine fistula resulted; may. perforation was situated at the anterior lead to the permanent prolapse of a porand left lateral surfaces of the supra- tion of the omentum into the uterine cavvaginal portion of the cervix. In another ity. Usually, after the infliction of the the perforation was also in the anterior injury, the vulnerating agent is removed. wall.
In some of the reported cases-exceptional The perforation may be in the cervix cases, I admit-it was abandoned in place, uteri; may be in the corpus uteri or may and was either expelled per vaginam or involve both; may be single; may be mul- eliminated by the aid of a slowly ulceratiple (they are, most usually, single); may tive, suppurative, or other pathological be small; may be large, or as in a case process through newly created avenues. reported in which the midwife produced a The perforating body may be eliminated uterine rent 20 centimeters long. In Ull- through the rupture of a near or of a dismann's case there were two perforations. tant abscess, or may be removed at an In Schenk's case there were three. In operation or at autopsy. In one of Treub's Werelius's case the uterus contained seven cases the bougie was imbedded in a retropunctures. The perforation may be barely uterine abscess. In his other case he revisible—in one of my cases merely a sub
moved, by an incision, the perforating peritoneal ecchymosis was present; may catheter from the space of Retzius. In be large enough to permit the escape of Johnson's case the patient was laparotoa large portion of the omentum and of mized, and the bougie, cause of perforaintestines through the rent, as in Hessert's tion, was found to be almost entirely case, in which four feet of gut had been folded in and covered by the omentum, an
By ROBERT GRAY, M. D.
evidence of the effort of nature to repair the damage and to prevent injury of the abdominal viscera. In Thorn's case the perforating bougie, after the patient had been laparotomized, found lying obliquely in Douglas's cul-de-sac. In Talmey's case the perforating bougie was found lying in front of the proximal edge of the right kidney. In Bullard's case the crochet hook was discharged through the anterior abdominal wall. It did not interfere with the continuance of gestation. In Perle's case the needle or trocar, that had perforated the uterus, was removed, some time after, from an abscess in the right inguinal region, where it had become encysted after its passage through the uterine wall. In Fairchild's case, at laparotomy, the hairpin was found, high up, in the abdominal cavity near the diaphragm. In Patru's case the perforating catheter was found imbedded in an abscess palpable through the anterior rectal wall. By means of an incision made in the anterior rectal wall, all the pus was evacuated and the bougie removed. In Marchand's case a Hegar's metallic, dilating bougie, No. 12, perforated the uterus, and was abandoned in the patient's body. After about a year of invalidism she was laparotomized, and the sound was found between two folds of mesentery. It was removed; recovery ensued.
Any instrument that can be used or misused in the uterine cavity is capable of perforating the uterine wall. All forms of uterine sounds, of uterine dilators, of curettes (curette included), can be incriminated. In one case mentioned thirty-one inches of gut had been torn away by the augur curette. In the cases reported during the last ten years, it is stated in unmistakable terms, that the vulnerating instrument was
1. Uterine douche tube, irrigator, catheter, 12 cases.
2. Uterine bougie, uterine sound, 17
Unfortunately I am reluctantly actuated to dissent from the able and interesting contribution of Dr. W. T. Marrs: “The Mind as a Factor in the Cause and Cure of Disease," in November SUMMARY, because the deductions are erroneous in every acceptation wherever suggestive and hypnotic affiliation is advanced, whose antithesis is as incongruous as the North Pole and the torrid clime, hence deplorably misleading
The text of the contribution is sublime, and the article would be a masterful portraiture of scientific suggestive therapy had it not been spoiled by lugubrious shadings of debasing hypnotism which I am unable to conjecture how so talented a writer could have the heart to introduce.
Suggestion is an attribute divine, whose mystic haunt is the subjective mind in the solar plexus of the brain, above and beyond the realm of mortal faculties, while hypnotism is of the flesh carnal, a domain of personal magnetism, far more intensely positive in some persons than in many others, to whose influence some are subject, others exempt; a power not all unlike that of the serpent's charm, whose victims are "Like the bird whose pinions quake
But cannot fly the gazing snake.” Hypnotism is no element of medical science, while the supreme function of suggestion is scientific medication, applicable to the patient through the medium of the subjective mind, yet entirely free from any hypnotic symptom, and not available for any other purpose, even the infant, the idiot, and the moribund being alike susceptible to its influence, in each of whom the subjective mind is rationally enthroned till the heart pulsates no more, when that immortal element abandons its tenament of clay.
I am inexpressibly pained that Dr. Marrs referred to hypnotism or hypnotic experience, when he is certainly qualified to write a helpful suggestive contribution if he will but disabuse his mind of th harmful unprofessional fallacy of recognizing
3. Uterine dilators, 31 cases.
In other cases the offending agent is either not stated or happened to be either a probe case, a wire, a meat skewer, an electrode. Chicago, Ills.
TO BE CONTINUED.
hypnotism as a participating element. dreds of patients in private practice domi
There is probably no practitioner any- nated by despair, most of whom would die where who employs suggestion more under any state of circumstances without tensively than it comprises a predominat- the stimulating aid of suggestions. Suging part in my practice, nor one who has gestions and hyoscine are the team to used it longer, even before it had a gen- pull the insane out of the remorseless gulf erally recognized scientific name, and none of madness. who has a stronger founded faith in its It may be that I get better help from clinical value.
suggestion than the average practitioner I have repeatedly told SUMMARY readers because my faith is stronger and because my appreciation of suggestive medication I inspire patients with responsive faith. and how I employ it, and even wrote a I am discussing suggestive medication, not nutshell lesson to answer numerous impor- faith cure nonsense, in which I take no tunities for more elaborate explanation in stock; nor do I have any faith in suga booklet, "Specific Medication,” many gestion to perform chemical effects, which physicians in the United States asked me are intensified by suggestion, but not thus to prepare, yet never contaminated with produced, suggestion being a systematic, a hypnotic tinge to which I am a clinical not a mechanical process. stranger.
I am endowed with physical properties I am writing this hoping to influence Dr. of magnetism proper for high degree hypMarrs to become a disciple of true sug- notic practice. I never employ, not even gestive therapy, for he surely is enthusi- for amusement, much less as a medical astically in earnest and sparkles with legiti- auxiliary, because it has no provice above mate suggestive illumination whenever he the animal realm, as already affirmed, and gets a lucid passage free from hypnotic cannot aspire to enter that of suggestion, enthrallment. I desire that not only Dr. a spiritual domain. Marrs, but every doctor anywhere may Booklet just off press (The Clinic Pubhave the suggestive auxiliary service that lishing Co., Chicago) I wrote to answer is mine so beautifully.
letters impossible to reply to personally, I put a felon in a 20-per-cent. carbolic gives as near a true lesson on suggestive acid solution, and apply chloroform sug
medication as it is possible to write, and gestively, telling the patient the province tells all any one needs to know in adof each treatment with impressive par
vance desiring to migrate to Mexico or ticularity, and especially as to the chloro- the Spanish-Americas to seek medical forform, admonishing not to be foolish and tune-probably a wiser venture than that escape the influence prematurely and not of long study to pass State board examito remain under it longer than necessary;
nations, whose questions ability to answer yet such suggestion exercises no degree of
would not qualify to cope with tropical hypnotic influence as to the mere physical
fevers. action of the anesthetic, but serves to
Pichucalco, Chiapas, Mex. tranquilize the anatomy, preparing mental reconcilement to the lethargic superven
CHRONIC ARTHRITIS. tions over the vital faculties—an influence
Dr. Bayard Holmes, in Lancet-Clinic, that seldom fails to dominate propitiously
says: “The treatment of a chronic arto the end of the operation.
thritis which has been demonstrated to be I cure hiccough ninety-seven times in a non-tuberculous consists in at least three hundred suggestively, usually in a moment, distinct maneuvres. The first is designed yet I never try to cure grave emergencies to increase the elimination, promote nutrithus without chemical auxiliary.
tion and do away with the anemia; the Dr. Marrs is correct about the influence second is the eradication of the primary of the mind and its banefulness when in infection upon which the arthritis is dea morbid trend. I have seen conscripts in pendent; and the third is the repair of the Confederate army die promptly with- the joint, the removal of the deformity and out a symptom of disease other than the the restoration of the joint and the urdemon thought of death that haunted rounding muscles to their normal condithem continually; and I have met hun- lion.”
Under this head we endeavor to present a Condensed Summary of Practical Medicine, drawn from the best and most reliable sources, thus saving our readers much labor in winnowing out from the chaff, medical grains of real value.
PROPHYLACTIC CIRCUMCISION. be slipped under and peel the two mucous
surfaces of the glans and prepuce apart, During twenty years of active practice clear the corona, clear out the smegma in in general medicine and surgery it has the sulcus, apply a lubricant, and instruct been my experience to have seen many the mother to retract daily for a spell. It fads and fancies of our profession arise, is astonishing how many cases of phimosis flourish for a time, and then fade away. and apparently redundant foreskin yield to Crede's method of placental expulsion was this treatment. I most emphatically oppose so thoroughly ingrained in the students of the custom of indiscriminate circumcision, my time, and later, that any expression of and I contend that many, many cases supcriticism of the practice branded one as posedly fit for no other treatment than ciruninformed. In the passage of years I cumcision can be better treated by the have seen many cases of hemorrhage that method outlined above. in my secret mind I attributed to the too
The two main arguments advanced for hasty removal of the secundines. At this
the routine practice of circumcision are time an expression of that opinion does not
that the prepuce causes reflex irritation arouse professional contempt.
and that venereal diseases are the more I have been awaiting a sensible attitude
easily acquired where the foreskin exists. of our brethren in the matter of circumcision, but by the journals I judge that the
A freely gliding foreskin never irritates.
Venereal infection is acquired as readily acme of that fad has not been reached. I
by an abraded surface uncovered as by one wish to be numbered among the pioneers
covered. I further contend that an exwho protest against the indiscriminate circumcision of male infants. In my experi- posed gland is more likely to be irritated
than a covered one; furthermore, the proence it has not been usual to find in the
tected nerve terminals are a help to the new-born prepuces that could be retracted
longer preservation of potency. I could easily. Following the teaching I had received I had circumcised prepuces seem
enlarge on the unsightly deformities that
have come under my observation from this ingly redundant and non-retractible in the
practice of circumcision, but I am only new-born up to some years ago. Then, on
pleading for a common-sense stand by phyone occasion, upon preparing to remove
sicians on this fad of clipping foreskins. the foreskin, I fortunately discovered a pneumonia which delayed the operation, and I did not see the child until some
[The above was scissored by us from a months after. On re-examining the pa
recent number of the Medical Record. It tient I found the same apparent condition, was communicated to that journal by Dr. but upon producing stiffening I slipped the J. C. Farmer, of San Francisco, and it is foreskin over and thereafter advised doing
so eminently practical, and shows such so daily and applying a sterile lubricant. Since that time I do not circumcise, if
good common sense, that we have deemed there is a free flow of urine, until the child it worthy of reproduction here. Read it is a year old, and I have found very few carefully, think it over, and see if you do cases that did not yield to a gentle separa- not agree with us as to its practical worth. tion of the foreskin from the glans, and
If you do not agree with the arguments after that a free slipping back of the hood. I apply cocaine to the parts, retract as far
presented, let us have your own views for as possible, slip a probe under the sluce, or
publication in The SUMMARY columns. when necessary nick an opening for it to Ed.].
Notes and Queries
For this Department we cordially invite Questions, Comments and Criticisms on all Topics of interest to the Physician in his daily work for relief of the sick, thus making the Summary a valuable
medium of communication between the medical profession.
Correspondents will give their names and addresses, but initials will only be printed when desired.
The queries in this issue awaits the Answers which our intelligent readers may be pleased to contribute for publication in our next.
A SEVERE CASE OF HEMETEMESIS, tion was asked by me, but owing to the
indigent circumstances of the family, the WITH RECOVERY.
man did not wish to incur the additional
debt. The woman continued in this low Editor Medical Summary:
state of vitality four days. Supposing that This case happened to fall to me very
there had been quite a destruction of tissue recently. The woman was a frail little to account for all this blood, I looked for body of about thirty-five, having a family
an inflammatory action, and this I knew of half a dozen children, the last just the woman could not well combat with so weaned. She had not had a return of her
little blood. The temperature during that When I entered the room I saw
time wavered between 100 and 102. If she was as pale as paper and her lips were
it had gone to 103 or 104 I am of the as white as her skin. Hemorrhage sug
opinion that death would have immediately gested itself to me at once. No history of
followed. But in this case the unexpected hemorrhage concealed or otherwise was
happened, and she became slightly conelicited. I thought of ectopic gestation and
valescent on about the fourth or fifth day. a ruptured ovum, but found no evidence Notwithstanding the low state of vitality, pointing particularly toward it. There she retained a certain amount of nourishwere slight elevation of temperature, ex
ment and stimulants, which greatly aided treme weakness, pulse of 120 per minute,
nature's other recuperative measures. The weak and thready, and in keeping there
nourishment consisted of eggnogg, beef tea, with there was a feeble heart whose first chicken broth and milk, and later butterbeat was almost absent. Strychnine, dig
milk. Codeine and other sedatives were italine, and diffusible stimulants were pre
given until the danger of a recurrent atscribed. The next morning all these symp
tack of emesis seemed past, and after that toms were multiplied several times. The
the bowels were kept open with calomel features were like marble and she seemed
and Abbott's saline laxative, alternating almost exsanguinated. The heart and cir- occasionally with castor oil. Calomel and culation were still feebler, and the pros
soda in one-grain doses were well tolerated tration was extreme. The raising of the
after the immediate danger seemed past. head even slightly produced fainting. The
The most interesting phase of this case, husband showed me, after my brief exami
from my point of view, is that the woman nation, a wash-pan half full of blood and mucus which she had thrown up during the
W. T. MARRS, M. D. night. The emesis was followed by faint- Peoria Heights, Illinois. ing and prostration. The blood was thickly clotted, and looked to be between a pint and a quart of it. The next night an
RAKE “UP” OLD ASHES. other attack of vomiting occurred, and about the same amount of blood was again
Editor Medical Summary: ejected. I do not know where it could have all come from, she being very anemic Some of the old remedies discarded are to begin with. The prognosis looked as the best after all, and do better work. I bad as anything could be, and a consulta- had a case of the old-time itch (scabies).