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may be pediculated and movable upon or about the others, and they may occupy any portion of the abdominal cavity (Figures i and 2, H, and figures 4. 5 and 6, F and G). Examination also quickly ascertains the mobility of the growths. If there has been no previous history of local peritonitis, they are usually free from adhesions and movable, especially from side to side. The location and size of the growth have something to do with its mobility. If it is confined to the pelvis and fills the whole of the hollow of the sacrum, it may be so immovable as to give the impression of absolute fixation; yet if there has been no history of previous inflammation, it can usually be readily displaced in attempts at removal. Should, however, the tumor be out of the true pelvis, it is most often found to be freely movable. In making such an examination the ovaries are located more by the pain elicited by pressure than by any distinct impression of their size or shape. If they can be definitely made out, it is generally because they are enlarged by disease, in
Figs. 10 and 11. No. 21.–A, multiple fibroid in anterior wall of uterus with
a large cystoma of left ovary, B. The latter filled the whole upper addomen and forced the fibroid low in the pelvis. The patient was in a most wretched condition. She writes the latter part of August, 1898, in answer to inquiry, more than three years after operation: “I am perfectly well; am stronger and can endure more than I ever could."
which case they may give some assistance in forming an opinion as to how much the broad ligaments are elongated, and if they lie high and near the fundus of the growth it may be reasonably concluded that the broad ligaments are drawn out and extended, a condition rather favoring extirpation than otherwise. The combined examination well-nigh completes our information, since by means of it we determine the position and shape of the cervix and quite accurately the relation of the tumor to the uterus. The cervix may be low down, indicating that the tumor is usually a low-lying one, or it may be practically normal in size, shape, and
position, even with a large growth, which rather means that the tumor is developing upward from the fundus and body of the uterus. When this is the case, however, the cervix has more often become elongated and slender by being dragged upon. Again, we find the cervix short, broad, and even almost entirely obliterated, an accompaniment of a low-lying tumor, or in case of a multiple one, a low developing centre which is pressed upon by those above. Again, the cervix may be so high as to be almost out of reach, especially in a class of tumors which lie in the abdominal cavity. In this connection it should be noticed if the cervix is in the median line, as is usual in a single symmetrical growth, or if pushed to one or the other side, a not uncommon feature in multiple growths. If there is
Fig. 12, No. 61. View from in front.-A, cervix. B, ovaries. C, tumor in
posterior wall of uterus. D, sub-peritoneal tumor grown to the right. Tumor developed almost entirely above and without disturbing normal attachments. Cervix pressed far to the left side by D, causing much discomfort in both sides by pressure. E, F, G, cut peritoneal margin from which line the bladder was separated. A most favorable case for abdominal hysterectomy. Recovery.
marked lateral distortion of the cervix, we may expect to find a lateral tumor lying low in the pelvis, crowding the cervix to the opposite side (Figure 12). It should also be noticed if the growth invade the broad ligaments, a condition more to be expected in multiple than in single growths. These broad ligament invasions are often very serious complications, for the reason that they push
out between the layers of the broad ligaments, even reaching to the pelvic wall, dislocate and press upon the ureters, and sometimes make it exceedingly difficult to develop sufficient tissue for proper ligation. This is not, however, inimical to operation; by shelling out the tumor, the necessary tissue for manipulative purposes is developed (Figure 13). It has been noted by others, and my own observation bears out the conclusions, that this form of tumor is particularly intractable, that it grows persistently and seems to be less influenced for the better by favoring conditions than any other form of growth, and while sometimes very difficult to remove (although they can usually be enucleated), yet I have not observed that recovery is retarded after successful extirpation. The use of the sound gives valuable information as to the depth and direction of the uterine cavity, but many times there is such distortion of the canal that the introduction of the sound is impossible. Its chiefest
FIG. 13. No. 44.-A, cervix. B, uterine body involved by multiple growth.
C, tumor low lying in right side and in front, rendering uterine artery on that inaccessible and distorting usual intra-pelvic relations. Enucleated from D. Abundant lax tissue increased the case and safety of sub
sequent manipulation. Recovery. value is in doubtful cases, where it is a question whether the growth is uterine or ovarian. It should be used, however, with great discrimination. The writer regrets to state that in one instance, abortion at five months followed its use in his hands. The patient was unmarried, about forty years old, and of a social position such as to protect her from suspicion; no amount of questioning could bring an acknowledgment of the possibility of pregnancy, and a history of regular menstruation was insisted upon; the passage of a sound resulted as above stated. In the course of examination, we also determine the degree of mobility without and within the pelvis, how the hollow of the sacrum is filled, and whether there is a lax or tense vagina. We are also often able to make out adhesions, although little definite information can be obtained in this direction.
(To be concluded.)
EUGENE H. PORTER, A.M., M.D.
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ANTITOXIX AND HOMEOPATHY.
HE exact relationship that exists between homoeopathy and
serum-therapy has often been most earnestly discussed, but is yet very far from being settled. Some scoff at the idea that any relationship exists; others claim that such a method of treatment is simply isopathic; while still others insist that serum-therapy in general, and the use of antitoxin in particular, is strictly homeopathic. This last claim seems to us to be untenable. Serumtherapy is, in brief, the treatment of disease in one animal, by the injection of blood serum taken from another animal rendered previously immune. And we understand that the term "disease" in the definition just given means those diseases that are supposed to be produced by specific micro-organisms or germs. These pathogenic micro-organisms produce a toxic product which absorbed by the body will give rise to certain characteristic symptoms. But this toxic product known as toxin may be produced without the body as well as within it. Each variety of germ if given a suitable nutrient medium will quickly produce its own special toxin. The toxin produced by the diphtheria germ is injected into the horse under certain limitations of quantity and time. After a certain period the horse is bled, the serum separated, and we have antitoxin. The serum of antitoxin as it is now called, injected into a human being will often cure diphtheria. Now the claim is made that such an
employment of antitoxin in effecting a cure of diphtheria is homeopathic. Let us see. The homeopathic relationship of drugs involves a comparison of symptoms on the one hand, such as exhibited by the disease, and, on the other, such as produced by the agent employed as the remedy for it. In other words, the principle of similia is to employ for the cure of disease only those drugs capable of producing symptoms in the healthy, similar to those found in the sick. The moment we depart from this rule we cease to cure homeopathically. If a cure results it may not be ascribed to homeopathic means.
Now, toxin absorbed by the tonsil will produce all the symptoms of a disease known as diphtheria. If toxin which produces the symptoms of diphtheria were used to cure diphtheria, we might perhaps call it homeopathy. But toxin is not used. A substance is employed of which we know next to nothing, either as to the changes that effect its formation, or its exact composition. Who knows of what antitoxin is composed or what changes take place in the blood of the horse after the injection of the toxin? The claim advanced by dreamers that antitoxin is dilute toxin is nothing but assumption of the very baldest variety. There is not the slightest evidence to support such a claim, nor can it be said that the use of antitoxin is homeopathic. Antitoxin has never been proved in the healthy human organism; it has never produced symptoms of diphtheria in all the thousands of injections that have been made; and its composition is as yet practically unknown. How can you make a homeopathic prescription when nothing is known of its effects on healthy human beings? And we have very little sympathy with the assumption that every cure made by drugs is homæopathic, and therefore antitoxin, because it cures, must be homeopathic. The assumption is too sweeping. It may possibly be true, but there may be some exceptions to it. There is, however, a reiationship between the use of antitoxin and similia that shows the underlying principle of cure to be homeopathic.
This relationship is well shown by James Johnson, F.R.C.S., in a paper read before the English Homeopathic Congress at Bristol. He compares the action of arsenic and antitoxin substantially as fol