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the dura mater was detected. from which blood oozed out rather freely. After applying a ten per cent solution of chloride of zinc to the wounded surface, which checked the hemorrhage completely, and irrigating the scalp with a one per cent sublimate solution, the wounds were united hermetically with cat-gut sutures, using twisted cat-gut as drainage and the usual antiseptic dressings were applied. The greater part of the wound healed by first intention, there was subsequently hardly any suppuration, notwithstanding the ragged, bruised condition of the scalp. From the record I kept, I find that the temperature never rose above 99° and that the boy fully recovered, without at any time showing one symptom of concussion of of the brain. The good result obtained in this case was due to the strict antiseptic precautions followed up during the entire treatment, lasting two weeks.

ARTICLE V.

REPORT OF THE COMMITTEE ON OBSTETRICS AND GYNECOLOGY.

BY G. M. STEELE, M. D., OF OSHKOSH, CHAIRMAN.

In the history of another year in the department of Obstetrics and Gynecology, now already written, very little of strictly original discovery has been tabulated, but much that is of exceeding value in solving many debatable questions, and in confirming and disestab. lishing results in others. In gynecology some work supposed to be original will first be noted, and then some attention given to the progressive questions awaiting solution.

One of the most novel suggestions of the year originated in the mind of a Swiss physician, and consists in the extensive dilatation of the uterus so as to be able to view and photograph its interior. The dilatation is accomplished by means of tents and tampons and the photography by the use of reflectors. This is suggested in cases of endometritis and when various morbid growths are suspected.

Dr. Apostoli has furnished a paper on a "New Treatment of Chronic Metritis and particularly of Endometritis by the Intra-Uterine Application of the Chemical Galvano-Caustic." This treatment is claimed to be simple and inoffensive, and to possess positive merit. Its benefits are felt with the first treatment, and continue to beco.ne more marked with subsequent treatment until perfect cure results It causes a disintegration of the mucous lining, which is far safer than curetting, and is under perfect control as to rapidity of action. The treatment requires no adjuvants and the patient is not compelled to remain at absolute rest. The exact method of its application may be found in the January number of the Ameri.an Journal of Obstetrics and Gynecology.

Dr. Malanco, a Mexican physician, has projected a new operation for prolapsus uteri. It consists in passing a trocar from the anterior

vaginal fornix to the abdominal wall, and applying the actual cautery to the track, by passing a thermo-cautery from the front. This is stated to have been employed several times w th most successful results.

In the midst of the numberless indications for the surgeon to invade the abdominal cavity, still another has presented itself. Kelly of Philadelphia, has removed the ovaries and tubes for the relief of subinvolution and chronic metritis which was attended with severe symptoms, aggravated by menstruation, and not relieved by long continued medical treatment. The recovery was typical, and the uterus rapidly undergoing involution at the time of report. Anything short of an extremely rare performance of this operation will undoubtedly meet with condemnation by the profession.

While not a recent discovery, another year's experience in the suspension of the prolapsed and misplaced uterus to the abdominal wall serves to establish this operation in the rare and extreme cases not otherwise relieved.

So also does the year's work place additional and brilliant success to the credit of abdominal surgery. Increased experience is yearly eliminating the errors and more clearly establishing the true principles for success, with the result of a constantly diminishing mortality

rate.

When we reflect upon the fact that both ovaries have been removed during pregnancy without molesting the progress and termination of the same and other perhaps wonderful works, the ultimate limits of possibility in this direction seem as yet to lie beyond our vision. The sine qua non for such success has come to be known so well, and the principle is now acknowledged to be so fundamental for all brilliant surgery that there should no longer linger in the mind of any surgeon the belief that carbolic acid, mercuric chloride, or any other antiseptic will in itself secure the best results.

To day the most brilliant of the world's surgeons cast these aside, some entirely and others except for the cleansing of instruments and protection of wounds. Few of the most successful operators now use anything but distilled, or boiled or common clean water for cleansing their wounds. For these incidentals so conscientiously used, and which served to more or less successfully accomplish the result without appreciating the principle involved, the simple prin ciple of cleanliness has been substituted. And in proportion as the

ideal of cleanliness in all details of an operation is reached, other things being equal, will the success be great.

But with the brilliant success attending gynecological surgery may not there spring up, or has there not already arisen another error? Does the surgeon always await with sufficient patience the results of nature's efforts and medical care in the struggle for health, before resorting to the scalpel? Without individualizing the conditions, it is undoubtedly the opinion of a large and intelligent part of the profession that such is the case.

Electrolysis in uterine fibroids has been actively discussed during the past year and the reports of many cases presented to the profession. The results of its use are mixed and the opinions as to the utility and safety of this treatment are varied. While some cases seem to have been cured by its use, death has resulted in others where the current has been applied with sufficient strength to cause the disintegration necessary for cure. Taking into consideration the natural history of the fibroid, the other and safer means of treatment, and the verdict concerning electrolysis will be doubtful.

The success reported during the year of the treatment of puerperal mastitis by spirits of turpentine warrants a careful and thorough trial of it, in view of the uncertainity of other methods.

A new method of dilating the uterus has been proposed and consists in accomplishing this result by the use of tampons. The time required is about ten days for complete dilatation, but has sometimes required more. This is especially recommended to allow of inspection and more thorough treatment. It is considered to be of most value in combating the development of cancer, and useful in cases of chronic endometritis and morbid growths. Yet, septic poisoning has complicated this procedure, the operation is sɔmetimes painful, and other means, as tupelo tents, are considered by some as equally useful and not as dangerous. This is known as Vulliet's method.

Passing to the consideration of obstetrics, we find the same problem receiving much merited discussion that has been mentioned as so important in gynaecology, viz.: Antiseptic or aseptic management of labor. There are those who believe so thoroughly and extremely in antiseptic management in its minutest details, that nature must be put to shame before such opinions for so far falling short of being able to accomplish its own legitimate processes. On the other side may be found those who look with abhorrence upon antiseptic de

tails, and thereby perhaps allow themselves to be even careless about the protection of their patients. The truth does not lie in either

extreme.

For the purpose of arriving at a candid and enduring solution of this question I submit the following proposition: Given a healthy parturient canal, a normal labor, no contamination introduced within this canal, mere cleanliness maintained during period of lochial discharge, is not nature, barring future accidents, always able to care for herself? This proposition, as you observe, casts no reflection upon nature, and holds man accountable for in no way thwarting her ways. It not only allows, but demands that hands, instruments, clothes and all things about the lying-in woman should be absolutely clean, but not of necessity treated with antiseptics. Nor does it contemplate that the parts shall be bruised and abraded by oversolicitous and meddlesome hands, by the necessity of operative interference of any kind, or allowing these surfaces to be contami nated by decomposing sweet oil or lard, or decomposing lochia. Nor does it presuppose that any part of the placenta has been retained, or a portion of the membranes torn off and left in the canal. My convictions are decidedly in the affirmative of the proposition.

In the care of the lying-in will not the greatest safety, as in gynoecological surgery, lie in extreme cleanliness? If it is necessary for any portion of our profession to make use of some antiseptic in order to reach this result, if used in a harmless way, let them use it. When, from some error or another, or the severity or complications of labor, a pathological condition springs into existence, then treatment may be demanded and that of a kind to secure the same condition which the attendant should early seek to secure by prophylaxis.

That this proposition is true is proven by an abundance of evidence in country practice, and should the conditions of external contamination be eliminated the same would undoubtedly be true in hospitals.

During the past year Dr. Hiram Corson, of Philadelphia, has furnished the profession with the statistics of 3,036 cases of labor with. out the use of antiseptics, with remarkable results. Dr. H. H. Whitcomb has also published the statistics of 606 cases of labor in private practice, without antiseptic precautions, without a single instance of the death of a mother. But in these cases puerperal fever has not been an entire stranger, though its advent has followed,

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