CONTRIBUTORS TO VOLUME XX. J. D. ALBRIGHT, M.D., Pennsylvania.. W. D. HAGGARD, JR., M.D., Tennessee..... PAUL JACOB, M.D., Prussia....... LOUIS LEROY, M.D., Tennessee...... ARTHUR V. MEIGS, M.D., Pennsylvania......... I. A. MCSWAIN, M.D., Tennessee WM. PEPPER, A.M., M.D., LL.D., Pennsylvania....... A. M. PHELPS, M.D., New York............ 28 443 276 146, 228 91 52, 261 49, 175 113, 491 7, 351 149 .. 181, 363 143 312 ..... 18, 58 500 PHILLIPS' EMULSION exhibits the highest degree of excellence in emulsionizing Cod Liver Oil. 40 per cent, finest Norway Oil-in minute sub-division—emulsifed by Pancreatine combined with the Wheat Phosphates (PHILLIPS'). Acid reaction, precluding saponification. PALATABLE-PERMANENT. Miscible in Water, Milk, Wine, etc. Prescribe PHILLIPS'. THE CHAS. H. PHILLIPS CHEMICAL CO., 77 PINE ST., NEW YORK. THE SOUTHERN PRACTITIONER. AN INDEPENDENT MONTHLY JOURNAL, DEVOTED TO MEDICINE AND SURGERY. VAGINAL INCISION AND DRAINAGE IN CERTAIN BY WM. D. HAGGARD, JR., M.D., NASHVILLE, TENN., Associate Professor of Gynecology in the University of Tennessee; Perhaps if at the outset I distinctly declare my belief that abdominal section is, generally speaking, the preferable operation for a large majority of cases of ectopic gestation, I can more easily define the class of cases to which vaginal section is appli cable. I will confine myself to the discussion of cases of ectopic gestation ruptured in the early months, and which, clinically, *Read at the Twenty-third Annual Meeting of the Mississippi Valley Medical Association, held in Louisville, Ky., October 5-8, 1897. are the most frequent, pathologically are extra-peritoneal by virtue of adhesions, and surgically are simplest treated by vaginal incision and drainage. I realize that the knowledge of the murderous nature and successful treatment of this malady were obtained by abdominal section, and that its brilliant results mark one of the greatest epochs in surgery, and yet I believe that the knowledge gained by these object-lesson operations has taught us that the type of cases I propose to discuss, which are walled off from the general cavity, are appropriate to the vaginal operation. Our lines of progress now are limited to the perfection of our surgical resources in the particular technique of a given procedure, and I repeat that without the acquaintance with this accident acquired by abdominal incision we would be unprepared to select cases for the vaginal operation. I fear I will not have your approval in the advocacy of this route, but in the class of cases designated the repeated successes of many operators, and the increased confidence obtained from my own limited number of cases, give me the assurance to present the subject for your consideration. I hope the discussion evolved will tend to specify the cases to which it is applicable, and strengthen the growing interest in this method. Advances. are only made by widening the scope of our art and specializing its limitations. In the dramatic, clinic picture of a woman the subject of primary rupture of an ectopic pregnancy, the blanched, pulseless, clammy woman, with air-hunger, and the restlessness of impending death, is literally ebbing her life away in her own belly. And the accident whose lack of treatment found no parallel in the history of human injury has come to have but one treatment-that suggested by Harbert in 1849. I do not know of a surgical feat demanding more heroism than a life. saving emergency laparotomy for this perilous accident. The courage demanded is only exceeded by that required in encountering furious bleeding from detatching a universally adherent placenta in the later stages. The triumph of surgery in this condition has in many instances negated Lusk's immortal phrase, "The resources of surgery are rarely successful when practiced on the dying." |