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good purpose whenever the caustic was required to be employed, but for carrying into the uterine cavity any other medicinal agent it will be seen that the instrument was entirely useless. The instrument I now use is made of virgin silver, flattened and quite flexible, around the extremity of this instrument for a space of two inches from and including the point, a coating of cotton is entwined and the instrument dipped into any fluid preparation which the disease in hand requires, and then carried through the cervix to the fundus. This instrument or applicator, before using, is bent so as to adapt itself to the curve of the cervix, and in order to ascertain the required curve the silver flexible probe is first introduced and withdrawn, which gives the proper degree of curvature required of the applicator.

I believe the ordinary cylindrical speculum and the bivalve specu. lum have had their day, and that they must now be numbered among the things that were. Having been useful in their day they are of no longer use when a better instrument can supply their place. Sims' speculum, with the patient in the semi-prone position, is by all odds the best instrument yet invented for exclusive and general use, for all cases, whether involving operation or simply for topical applications, where the employment of the speculum is indicated. It unhappily possesses one demerit, in that it requires the aid of an assistant as a general rule. To surmount this defect Dr. Emmet of New York, has devised an instrument which is selfsupporting; it is in all its essential features a Sims' speculum with Emmet's addition, and the addition is certainly no improvement, provided an assistant could always be at hand to properly hold the instrument of Sims. I am now using the Emmet speculum, and in the 'absence of an assistant it answers. the purpose well. I much prefer it to the cylinder, but do not prefer it to the Sims' speculum when placed in the hands of a competent assistant. With this instrument in situ the mucous membrane of the os may be siezed with the tenaculum without causing any pain or hemorrhage, unless there be considerable engorgement, and drawn down to view and thus held until the applicator prepared as above described has been introduced and withdrawn from the cavity of the uterus.

After the topical application has been made it has been for a long time a custom of mine to introduce a ball of cotton wadding,

so constructed as to possess a stem or pedicle, made by entwining thread around the stem. This stem serves as a convenient handle in removing the ball or cotton pessary. The cotton is moistened and sometimes saturated with glycerine and retained in situ from four to twenty-four hours, the time being regulated by the degree of annoyance it may cause the patient. All will concede, I think, that the treatment of these diseases of the os uteri has heretofore been somewhat irrational, if not empirical. The great want of the profession has been an instrument, by the use of which remedial agents might be carried directly in contact with diseased tissue. In the construction and use of the applicator, which is berein described, that want is supplied, and treatment made effectual. We need not now tell our patients that two or three months are required, when as many weeks are sufficient to restore the os uteri to a healthful condition.

The diseases appearing to our view upon the os uteri being only an index and sequence of disease within the cervix, treatment becomes rational when the abraided or ulcerated os is passed by, and remedies brought in direct contact with diseased tissue beyond. The tongue is protruded to give us an indication of the state of the mucous membrane of the stomach; if we find upon the tongue an aphthous condition or epithelial tissue destroyed, we do not expect to cure the disease by application of caustics or astringents to the tongue or the walls which encircle it, but knowing the condition of the tongue to be but an index of that pathological condition to be found in the mucous membrane of the stomach, if it could be seen, our remedies are addressed to the relief of this organ, and so soon as diseased tissue is made convertible into healthy tissue, the tongue resumes its normal aspect. Rational treatment here is in all respects what we should call rational treatment in cases under consideration.

I now desire to devote a little space in calling attention to the class of remedies usually accepted by the profession as appropriate for local application, and in regarıl to some remedies of this class, to speak somewhat in detail. A great variety of agents have been in demand, ranging from the light antiphlogistic touch with the crayon of caustic, to the powerful escharotics and actual cautery. Standing at the head of this class of remedial agents should be placed the chromic acid, whether there be much or little disease,

VOL. 7, NO. 8–39.

this acid possesses the merit of attacking diseased tissue and noninterfering with healthy tissue, its caustic or escharotic properties being destroyed or suspended almost simultaneously with its application. The strength of the acid which I have found to be most desirable for use, is that made with three parts of water with one part by weight of the acid. When the lips of the os have become ragged from deep ulcerations, the strength of the acid may of course be greater, and I have often used it with equal parts of acid and water, but the introduction of the acid into the cervix of this strength causes so much pain as to necessitate the recumbent position and rest for some days thereafter. This acid I apply with the applicator, around the extremity of which had previously been laid a coating of cotton; this cotton is well wetted with the acid and quickly applied. Another remedy, and a favorite one, is the tr. iodine, with equal parts of cod liver oil or with glycerine. Sol. of subsulphate of iron is most valuable, but the permanent stains upon the instrument or upon whatsoever it comes in contact, makes it a somewhat disagreeable remedy to use. These remedies proving so satisfactory the nitrate of silver has almost fallen into disuse in our hands, although it is no doubt one of the most valuable remedies of this class.

I think I should hesitate a long time, and exhaust the materia medica in search of a remedy and exhaust my practice too, before resorting to the actual cautery. It appears like a barbarous remedy, if it be not such; and the civilization of our time would be much less shocked, and science receive greater homage and respect by limiting the use of this method of treatment to the brute creation, and forbearing to use the actual cautery as a remedial agent for diseases of the female sexual organs. I may entertain this much of disrespect for the use of the cautery, and at the same time acknowledge its usefulness in certain instances. Did I not make this acknowledgment what has been herein written, would indicate disrespect to the teachings of Ricord, and others, whose opinions are always entitled to consideration.

Mention might be made of other agents of this class, but this article has already exceeded the limits proposed for it in the outset, and must be brought to a close. Nothing could be gained by going through the whole catalogue of remedies; some one or all of which might be made available, although not possessed of equal merits.

As pertinent to the question of imposition I recall to mind now an extraordinary case of skilled diagnosis by a popular physician at the head of a "water cure establishment.” He possessed the astonishing ability of looking through the speculum into the cavity of the uterus, through the uterus into the peritoneal cavity, and there beholding the work of destruction which had been going on for years, and explained to the satisfaction of his patient that certain bands within the abdominal cavity as a result of previous disease, had so much contracted as to draw down the whole abdominal viscera into a heap, which, of cousre, was the cause of her ailment, and that the treatment he should adopt would expand these bands and restore the parts to their former condition.

The most extraordinary thing connected with this extraordinary diagnosis is, that the aforesaid physician made a most intelligent and cultivated lady believe in his absurd statement. On examination of this lady some time afterwards we found simply a retroverted womb.

The community of women, much more than members of the medical profession, are, or should be, interested in the subject matter of how they may enjoy immunity from medical imposition. In the absence of institutions managed by a corps of competent and skilled physicians, these women seek, as a dernier resort, a “cold water cure,” and are at once put upon a course of treatment for uterine disease extending over a period of months. chance one escapes this treatment, it is only an exceptional case. If the physician in charge be competent and honest, all is well, but if he be incompetent, then upon the poor uterus rests the curse; then is the unfortunate uterus made to pay tribute to ignorance and the penalty for the overweening and misplaced confidence of its possessor.

It is time the profession had awakened from apparent lethargy; there is pressing necessity that the profession bestir itself, not indeed so much on account of itself, as on account and in behalf of those who are victims of misplaced confidence of those who annually congregate at these popular places of resort for medical treatment. The profession should at once take this large class of invalids out of the hands of pretenders, by creating healthy public sentiment, and inciting the community to the importance of establishing a place of refuge adequate to the exactions of the opulent and the necessities of the poor.

If per


Removal of a Neuromatous Tumor.

BY GEORGE D. SLOCUM, M. D., WYOMING, N. Y. Dr. Miner:- In the December issue of your Journal I noticed the remarks concerning your extirpating two tumors of nerve, and the perfect success of the treatment in relieving pain, and I therefore send you the following account of a case which recently came under my observation:

The patient, Mr. Edwin Stanley, aged 70, consulted me over a year since, in regard to a tumor situated on the inner side of the leg, just above the knee-joint. I advised removal, to which operation be consented on the 15th of January last. The tumor had existed for over eight years, gradually increasing in size, and measured two and one-half inches in length and one and one-half in breadth, ovoidal in shape, firm, and inelastic, and exquisitely tender on pressure.

He could assign no cause for its occurrence, having never received any external injury—as wound, blow, or bruise. He experienced much inconvenience in walking, though no decided pain in the tumor itself, except from pressure, but down the inner side of the leg and foot he suffered exceedingly severe, sharp, and stinging neuralgic pain, felt most at night, and in proportion to the amount of exercise during the day. An incision three inches in length was made over the tumor. The tissues separated, when the filaments of the internal saphenous nerve were found separated, about two-thirds spread out upon the posterior surface. These immediately uniting in a common trunk at the lower extremity of the tumor. The tumor was easily removed after dividing the nerve above and below. The internal

was quite se, nearly wbite, and homogeneous. The wound was closed by sutures, and a firm compress applied beneath the part, and treated in the ordinary manner. It healed nicely, and the sutures were removed on the sixth day. The relief from pain was complete, he resting better at night than he had for years before. The third day he complained of the neuralgic pain returning, and he suffered severely therefrom, but that gradually subsided, and at this time—one month after the operation-he enjoys perfect freedom from pain, there being only a loss of sensation and coldness on the inner side of the leg, which will probably remain some time.


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