TO CURE A COLD.

A journal on our desk states that camphor will abort a cold every time if taken early and to effect. If this be true we wonder that so many millions of people suffer so much of the time from colds. If it were actually true everybody would, in a little while, get on to such a good thing, and such a common nuisance as colds would be banished.

The treatment of colds depends a good deal upon their origin and cause, the occupation and surroundings of the sufferer, and the length of time he can take to be cured. Many colds result directly or indirectly from constipation and its consequent autotoxemia. The proper procedure is here obvious. Colds often spend their greatest force upon the mucous membranes. The proper treatment is also here apparent. Mild stimulation and vascular sedation may be of some value. Useful remedies at times are camphor, sweet spirits of nitre, ammonia, aconite, atropine, and Dover powder. Bathing and depurative measures may be useful if the sufferer stays in a comfortable room and subjects himself to no harsh changes of temperature. No two colds are likely to require exactly the same medication, and ready-made remedies are to be taken with the usual pinch of salts.

Diet is largely a factor of the production of many, if not all, diseases. In hardeneing of the arteries, it is, if not the main cause, a contributory one. An excess of potassium, sodium or any other mineral salt will cause the condition, provided the system is generally depressed. In many instances the cause is unknown.

A man who thinks he understands a woman meets the woman who thinks she

understands a man. Then they have misunderstandings.

If nothing you can do for a stubborn case of "three months' colic" seems of any avail, you might try giving the nursing mother a one-grain pill of asafetida every day. Also look into the mother's diet and habits. Ill temper, fits of anger, despondency, etc., on the part of the mother, sometimes have an adverse reactionary effect upon the babe.

Patients are usually grateful for local pain-relieving remedies, provided they are clean and presentable in appearance. For neuralgia, headache, and any condition. where a local anodyne is needed, this combination will fill the bill: Equal parts of gum camphor, chloral hydrate and oil of wintergreen dissolved in alcohol. If desired fluidextract of cannabis indica may be added. An oily liquid is the result, and its free use will often obviate the need of the hypodermic syringe..

Here is a gargle for tonsillitis that is not disagreeable like many such remedies:.3iv. R Potass. bicarb.

Spirits peppermint, .āā. 3ss. Spirits camphor... Hot water . živ. M. Sig.-Use hot; gargle every hour.

Peroxide of hydrogen is useful as a detergent remedy in many kinds of sore throat. Care should be used in case of young children lest there be started a flow of mucus that may choke them.

A FEW WORDS ABOUT MEDICAL

EDITORIALS.

cease.

We are pleased to note that some of SUMMARY'S recent editorials have been copied with the proper credit by a number of journals of late. That suggests a word or two about medical editorials in general. They are all pretty much alike. with a few happy exceptions. Generally speaking they potter down the same wellworn path. They say the same old thing in the same old way. The phraseology is similarly bromidic, such terms as "therapeutic nihilism," "antiseptic precautions," and "uneventful recovery" never There is an attempt on the part of most writers to give their paragraphs a good scientific web-and-woof, and in trying to do so they often make what they write appear extremely stiff and stilted. There are a few medical writers who write with a virile pen and blue-black ink. They say things and let rhetoric take care of itself. They go right to the marrow of their subject and say new things, or at least some things that will make us think. It is a pleasure to open a journal containing original fresh, juicy, palatable matter.

THANK YOU.

Among the good, practical medical journals that reach this table, I take pleasure in mentioning THE MEDICAL SUMMARY. This journal has been running nearly thirty years. It has cut a niche of its own. It is practical, liberal, up-to-date and is certainly valuable to every busy doctor who desires to catch the practical facts for his every day use.-Ellingwood's Therapeutics, November, 1908.

LITTLE SUMMARIES.

What has become of the old-fashioned people who used to take sassafras tea in the spring to thin their blood?

Without expressing any opinion on the subject, what do you think of the doctor who smokes cigarettes?

An affinity has been described as a Woman who is younger, prettier, and swifter than your wife.

An affinity is also like a sugar-coated pill-all right on the outside, but you're sure to strike the bitter sooner or later.

In nearly every community will be found. a madstone as well as plenty of people who believe in its efficacy. It's hard work to pry ourselves loose from all superstition.

The epigram of a once famous showman about people being fond of humbuggery is being verified every day by thousands of people who are swilling down barrels of bad whiskey labeled as patent medicine.

Why are cults springing up all the time? The medical profession is at fault. should have broadened its platform years ago so that people might have what they want.

We are growing some. Ten or fifteen years ago the average general practitioner knew nothing of psychotherapy and psychiatry. Every doctor has now a speaking acquaintance with these and kindred subjects.

Applied psychology is destined to achieve certain things in the future. Who will cover himself with glory by getting telepathy and thought transference on a working basis?

Some of our states are considering the advisability of taxing men who won't get married. Such legislatures are doubtless composed of married men who are envious of their single brothers.

Perforating wounds of the uterus are always of accidental occurrence. Nowadays they are never intentionally inflicted. They have occurred in the hands of the most dextrous, of the most clever operators. The accident has occurred to Lawson Tait. Auvard had one perforation in 270 uterine curettements. It cannot always be stated that they are due to ignorance, to incompetence, to carelessness; but it can be said that in the hands of a novice, in the hands of the careless, in the hands of the surgically unclean, all intra-uterine instruments are dangerous. It can also be stated that in most of the cases in which death has followed upon uterine perforation, the perforating instrument had been introduced for criminal purposes. In 26 of the cases analyzed in the preparation of this article, the perforating instrument was introduced to end an undesired pregnancy. In some of the fatal cases where the perforating instrument was not introduced for criminal purposes, it had been guided by unclean hands.

All

uterine perforations, treated expectantly and terminating in recovery, reviewed the subject quite exhaustively. In his article. Liebman makes the following statement: "In not one of the cases reported in medical literature, and they exceed thirty in number, was the perforation of the uterine wall followed by alarming symptoms." Liebman compares the accident to paracentesis, to exploratory punctures of organs, procedures which are generally considered harmless. Lenoir says: "These perforations have proved interesting to us, not only on account of their frequency, but also on account of their innocuousness."

Lawson Tait had never seen any ill results follow perforations of the uterus by a uterine sound. In not one of the reported cases in which the perforating instrument was a sound, did death occur. The sound is a much less dangerous instrument than the curette. It makes a smooth hole, while that made by the curette is apt to be ragged. The aforementioned authors conclude from their study of the literature and from their personal experience that perforating wounds of the uterus are relatively benign, are unattended with danger. Their opinion is erroneous and is completely disproved by the study of the literature of the subject that has been published during the last twelve years.

The dangers of perforating wounds of the uterus are manifold. Independent of the danger of shock, there is the danger of hemorrhage into the pelvic and general peritoneal cavities, into the pelvic connective tissues, of injuries to the peritoneum, of injuries of the intra-abdominal organs, etc. In 23 of the fatal cases it is definitely stated that a diffuse suppurative peritonitis was present. There is danger of traumatizing the omentum, of traumatizing the intestines. In 35 cases it is stated that posi

Carle Liebman, in reporting two cases of

or to the omentum. Any of these dangers

can prove fatal. In Donald McCrae's case the patient bled to death. She died three hours after the infliction of the perforation. The uterus, in this case, showed practically no pathology. Several months before patient had had a miscarriage. At the time of the perforation twenty-eight inches of intestines were pulled out through the perforation and twisted off by actual force. Shock, hemorrhage, visceral injuries, and infection may be associated in the same individual case. If a larger tear has been made in the uterus, there is danger of a loop of intestines or of a part of the omentum slipping into the rent and becoming strangulated. The gut may only be incarcerated, not strangulated, in the rent. In Kustner's cases the omentum escaped into the uterine cavity. Following these two (Kustner's) unrecognized cases, prolonged and irregular uterine bleeding occurred. Eventually vaginal hysterectomy was done in both cases, and on section each uterus was found to contain grapelike pieces of omentum. The omentum may plug the uterine perforation. In cases of perforation of the posterior wall of the uterus, near the fundus, if the omentum hangs low into the pelvic cavity, it is very liable to become entangled in the curette and drawn through the perforation into the uterine. cavity, even into the vagina. If the patient recover from the perforation, the site of the cicatrix, apparently, does not interfere with the subsequent development of pregnancy, as evidenced by a number of cases. In one case, though, the uterus had been perforated at seven different places, patient subsequently became pregnant and was delivered of a living child. In one case the site of perforation was sought at the time of delivery of a subsequent pregnancy. No trace of it could be found. Henck's case is the only case reported in which the perforation is said to have enlarged at a subsequent pregnancy and to have complicated delivery.

How can the frequency of these perforations be lessened? How can the morbidity and the mortality, incident to their occurrence, be lessened?

such as pus in the tubes, the ovaries, or around the uterus, and in acute gonorrheal endometritis, in acute septic endometritis, etc. The existence of an extra-uterine pregnancy is a contra-indication to curettage.

D. By perfecting our surgical technique. E. By familiarizing ourselves with the conditions that predispose to the occurrence of uterine perforation. For instance, in removing pedunculated uterine submucous fibroids, the peritoneal cavity is liable to be opened as in some cases.

In a few words, by keeping in mind in connection with intra-uterine work that there are

dangerous instruments,
dangerous uteri,

dangerous maneuvers.

The use in the uterus by inexperienced hands of placental forceps is always dangerous. It is needless, as the finger can do more effective work. Even the finger has difficulty, at times, in differentiating between placental tissues, blood clot, and intestines. The uterine sound, or hysterometer, is an instrument of very little usefulness. In most cases the size, mobility, and position of the uterus can be better and more safely determined by bimanual vagina abdominal examination. Laminaria tents should be always as long as the uterus, otherwise the lower end of the laminaria, instead of projecting a little below the external os, is liable to slip into the uterine cavity. Should then the long axis of the laminaria not remain exactly in that of the uterine cavity, the lower end of the tent becomes impinged against the uterine wall. The uterine contractions may drive that end partly or entirely through the uterine wall. The use of laminaria tents produces a more gradual dilation of the cervical canal. This is an advantage which, in our opinion, is counterbalanced by the fact that the patient has sixteen or twentyfour hours of pain. We believe that tupelo tents can, with advantage, be banished from the gynecologist's armamentarium. The danger of infection from the use of tents is great. (Dudley, Chicago; Kelly, Balti

The three-bladed steel dilator is considered dangerous. It has been nicknamed "the perforating dilator." Its use is to be discouraged. Hegar's graduated metallic dilating bougies are serviceable instru

ments. They should not be introduced much beyond the external os. Their function is to dilate the cavity of the cervix uteri, not that of the corpus uteri. It would be advisable that they be marked off in centimeters, so that the operator would know at all times how deeply they are introduced. Whenever the fundus uteri is perforated by a Hegar's dilator, the operator is to blame.

As to uterine curettes, there does not seem to be any pattern which cannot, suitable conditions being present, determine a perforation of the uterus. The blunt and the sharp, the fenestrated and the non-fenestrated, the even-margined and the sinuous margined curettes are each reported as having perforated the uterine wall. It is better to use a curette, the shank of which may be bent like a probe, so as to be made to conform to the direction of the uterine canal. A curette which is pliable and curved and broad above, is less liable to cause perforation than one which has a narrower upper end and which is rigid and straight. Some models of fenestrated curettes are very apt to catch muscular tissues.

introduction into the uterus of the

The finger or of instruments should not be regarded lightly. With but few exceptions all these perforations have occurred during the operations of dilatation of the cervical canal or during that of curettement of the uterine cavity.

These two operations, cervical dilatation and uterine curettage, when performed with due precautions as to asepsis, as to pro-operative preparation of the patient, such as emptying of the lower and catheterization of the urinary bladder, are, relatively, of great simplicity of technique, of great benignancy and of efficiency. Following their performjudicious after-treatment is of great

bowel

great

ance,

importance, and should not be overlooked.

The se

tions.

two operations should not be performed in the absence of positive indicaaid of an assistant. They are better performed with the The indications for dilatation of the cervical canal are:

I. As a preliminary measure to

(a) intra-uterine exploration.

occurs.

(b) uterine curettage and other intra-uterine maneuvers 2. As a therapeutic measure in dysmen

orrhea.

Dilatation, or divulsion alone, is not to be considered a specific for dysmenorrhea. A considerable number of cases of dysmenorrhea are not in the slightest degree benefited by this operative procedure. In marked dysmenorrhea, at times, associated with uterine ante-flexion, Dudley's operation will be found very serviceable. In dysmenorrhea, due to stenosis of the external os, Pozzi's operation is valuable. Dilatation alone is valueless in the treatment of dysmenorrhea due to any of the various malpositions of the uterus. We must treat the cause or the causes which determine the occurrence of the symptom: dysmenorrhea.

The indications for uterine curettage

are:

1. To remove placental debris, etc. In this connection let us state that in the opinion of such men as Coe, Pinard, etc., the aseptic finger is the best instrument to introduce into the puerperal uterus for the purpose of removing decidual remnants and blood clots. Pinard, for the post-abortum, or post-partum, removal of placental debris, rejects the use of the curette and teaches that in all cases of retained secondines, the finger should be employed for their removal. He considers it safer and more thorough. There are limits, however, to the power of the human digits and, at times, the curette will be found a valuable auxiliary to the finger. For the exploration of the uterine cavity, the finger, by virtue of its tactile sensibility, is far superior to any instrument. The curette is a blind agent. (Le Page, Pinard, Budin.)

2. As an aid to diagnosis: In decidual endometritis, uterine tuberculosis, carcinoma, chorion-epithelioma, and other intrauterine inflammatory or neoplastic processes, the use of the curette as a diagnostic aid is a recognized and sanctioned procedure.

Where carcinoma of the corpus uteri is suspected, the curette must be used with great precaution and only to remove small pieces for diagnosis. Again, in those cases where curettage has been previously performed, great care, great gentleness is necessary, because it sometimes happens that the uterine wall has been previously too deeply scraped, and then the danger of perforating the organ is imminent. remove abnormal

3. To

endometrium