DISEASES OF WOMEN.

A New Method of Treatment in Uterine Disease The Dry Method.

As a

Dr. ENGELMANN said that this was to be merely a preliminary paper, as he had not yet fully perfected this method of treatment and was not quite ready to place it in full before the profession, but as the same innovation was often in the minds of several, he wished to make the announcement before the society and claim this method which he had gradually evolved as his own. method, in its outlines, it was satisfactory and practically complete-yet he felt that he had not yet reached all he wished to attain until he had succeeded in devising a sensible method of applying impalpable powders to the uterine mucosa and evenly distributing them over the surface of the membrane. The dry treatment with powders and medicated cotton, acting upon the uterus, the body of the organ, and the surrounding tissues, was the leading feature of his method of treatment.

Dr. Engelmann reviewed the various methods of treatment customary in dif

1886-No. I c.

ferent countries, and

ter.

characterized

America as the land of nitrate of silver and iodine; the former, once most popular, now gradually yielding to the latHe had long since given up as injurious, rather than useless, the use of strong intra-uterine applications, generally speaking of course, as in certain cases they were needful, and the only proper remedy; he severely criticised. the very common custom of mopping the uterine cavity with strong solutions, especially the altogether too common and indiscriminate use of nitrate of silver and iodine, to which since the days of carbolic acid iodized phenol had been added-the three fluids, which, in this country generally make up the armamentarium in the treatment of uterine disease.

Dr. Engelmann had at first naturally followed the practice of those about him, but soon gave up the indriscriminate use of strong fluids, using weak solutions, or dilute fluids. Since 1873 he has endeavored to replace fluids, whenever possible, by powders, at first trying tannin, iron, nitrate of silver (in small proportions) in bacilli, but the

preparation was expensive and unsatisfactory; nor did Mitchell's gelatine pencils quite answer, but last spring Mr. Mitchell, of Philadelphia, prepared a very delicate gelatine pencil, which answers better than anything yet made for the purpose of intra-uterine treatment. So also the iodoform pencils of Parke, Davis & Co. are very serviceable.

These he uses in case he deems it necessary to treat the mucosa directly, in certain cases, however, resorting to fluids. In the majority of cases he relies on medication applied to the cervix by means of cotton and the powder blower. He deems it wrong to treat a diseased uterus through its smallest and most delicate part, the mucosa, but would rather rely on treating that sensitive membrane through the uterus, hence the use of powders and medicated cotton.

Dr. E. mainly uses iodoform, borax, bismuth, oxide of zinc, alum, tannin, calomel, and sulphate of zinc, which are dusted over the cervix and vaginal walls. Iodized, carbolized, borated, tannated, salicylated and iron cotton, and corrosive sublimate jute he considers the most delicate means of applying a remedy, as it is kept in contact with the parts, until gradually absorbed; the cotton, at the same time, must be judiciously placed, so as to rectify such malposition as almost always exists more or less in a diseased uterus.

This method is a most happy combination, as it combines the best and least irritating way of ameliorating displacement with a delicate and effective method of treating the co-existing pathological condition. Moreover, a sup port, such as is afforded by the properly placed cotton or jute tampon, is an aid to treatment and a relief to the patient, in morbid conditions not directly complicated with displacement; the sensi

tive afflicted parts are supported; a strain is removed.

The glycerine tampon, once so popular, Dr. E. uses but little, but admits that under certain distinctly marked conditions, it renders admirable service; but even there it is not necessary, other means can be substituted, and he prefers them to this filthy remedy.

The dry method, the treatment of the uterine mucosa through the muscular and surrounding cellular tissue has beyond the advantage of greater certainty tnat of comfort and cleanliness; it is not painful, the patient does not suffer in the office, is not in agony during the treatment, nor does she go home to be reminded of her suffering by hours and hours of cramps and pain. She leaves the office comforted, feeling better.

Dr. E. does not cast aside intra-uterine applications, but claims that they should no longer be resorted to as a routine method of treatment, and when called for, should usually be of milder character than now commonly applied.

Many a victim to pessaries will be spared when the dry powder and cotton treatment is adopted, as the gradual replacing of the diseased organ is far better accomplished by medicated tampons, whilst the morbid condition is at the same time done away with, than by the irritating and dangerous pessary. Not that the doctor desires to interfere with the pessary in its proper place as a support to the movable and healthy, but displaced uterus.

The pessary, the intra-uterine application, the glycerine tampon, all find certain indications, but have done great harm by the indiscriminate abuse to which they have been put. More generally serviceable, more reliable as a method of treatment, and less dangerous is the dry method, the treatment of the entire organ, or the mucosa through