force of gravity up to the point of the physiological. Given a patient with fairly intact perineum and cervix, moderate metritis (endo vel peri, etc.), without tumors or extensiv adhesions and with backward or downward displacement of the uterus, a uterus that will not stay where it belongs after it is placed there, that is the kind of a case which the general practician has very often to treat and the kind for which he has to consider the advisability of using a pessary. It is in this sort of cases where by suitable exercise and postures, the patient can do much more for herself than a pessary can do for her and do it much more naturally and physiologically. After examination of such a case and making a diagnosis of backward or downward displacement of the uterus, no positiv surgical condition being present, the physician should place the patient in the kneechest posture and replace the uterus in its proper location. That is, demonstrate to the patient both the knee-chest posture and the usual ease with which the force of gravity assists the uterus to slip into its proper position. The patient instructed along this line soon learns to recognize the uterus as in or out of its right position, and being told to assume this posture from one to three minutes at a time a number of times a day (more or less as may be required), soon works out a system of her own which, with other indicated treatment, will carry her far along the line toward permanent relief. Of course the extremely rare case will require fixation or suspension. The natural axis of the uterus being in a line with the direction from the navel to the tip of the coccyx, the knee-chest exercise will answer for some of the anterior displacements, altho the heel-shoulder exercise will be occasionally required. In instructing the patient for the use of the knee-chest exercise, it is well to remember that in some cases it is necessary to hold the nates apart in order to open the os vaginæ and allow a column of air to enter the vagina to assist in the readjustment of the parts. The patient's attention is drawn to the fact that a uterus out of place means trouble; that the longer it is out of place the easier it is to stay out, and that each minute it is in its proper position it becomes that much more easy for it to stay right. The exercise taken on retiring is, of course, the most impor tant one of the day. From the knee-chest posture she should lie on the face, then on one or the other side, not on the back, and should keep her knees close together (not always an easy direction to follow). Should the last two conditions be disregarded after retiring, she should repeat the whole exercise before sleeping. With the exercises, uterin tonic medication, and any other indicated treatment may be carried out with much better results than without them. Patients with uterin displacements should be instructed to refrain from the use of vaginal douches, as the effects produced thereby are not those that tend toward the natural and, besides, they get along better without them. I hope that no wise individual from the far east will assume that I am trying to say that a uterin displacement with a badly lacerated perineum and cystocele, rectocele, etc., can be cured by exercises. Pekin, Ill. F. C. GALE. Simple Methods in Obstetrics. EDITOR MEDICAL WORLD:-The October and November issues contained articles on "Obstetric Outfits," and it is these articles I wish to make a few remarks on. Forty years' practise in medicin and surgery, with a record of 2,500 obstetric cases, is evidence of some experience and should pass as authority of some value. We do not claim to be any more of an expert than our fellows, but not one woman died and only one child under our care. Total number of women attended in childbirth, 2,507-1,900 in general practise and 607 in London hospitals. "And this record is true," and was accomplisht with only about one-seventh of the obstetric outfit indicated in THE MEDICAL WORLD, November issue. It must be obvious to any one that in the above number of cases all forms of presentation, unnatural and accidental conditions, have been met with. The forceps were used about fifty times in the hospitals (always in a hurry), but only three times in general practise. Nature is the great accoucheur and will accomplish the full measure of procreation, even to the delivery and disburdening the womb of its fruit. To be a useful accoucheur one must learn at Nature's shrine; learn her language, signs, and efforts. We know there are times, and even supreme moments, when something must be done: a kindly spoken word, a skillful helping hand adjusting an awkward presentation, a little medicin to help and sustain Nature seems to be worth more than worlds. But mechanical appliances and sanitation ever present do not contribute to the comfort, safety, or confidence of the woman. It makes a show, that conventional bag or satchel, but to the physician who would know how and when to use most of its contents it is not necessary, and to the physician who does not know how and when to use the contents it is a curse, to which thousands of women can testify. We are living in a mechanical age, and the younger physicians are allured by the tempting multiplicity of instruments and other appliances. To relieve the woman of as much pain, and protect her from all danger as is possible, and deliver the child alive and the mother uninjured are the chief ends of the accoucheur. These can be done with very little help apart from the hand, when it is properly directed. G. C. YOUNG, M.D. Washington, N. J. Laws Concerning Prevention of Conception. EDITOR MEDICAL WORLD:-I notice your reply concerning the laws on prevention of conception in the December number, page 531; and while it is no doubt wise to instruct your readers on the subject, the fact is that the law you quote goes out with the last of this year, and a new law comes in on the 1st of January, 1910, which includes all the old, with some modifications which I call "for the worse." If you want to see the new law in the original print, send to the Document Room of the House or Senate, Washington, D. C., and get public document No. 350, a codification of the U. S. penal laws. You will find that it will soon be unlawful to mail any book or even letter telling "how to prevent conception or how to produce abortion." There is a large range of regular and orthodox medical books that will be unmailable if the law be strictly and fairly or consistently applied. Your article toward the end says that the Bible might be unmailable, and this will be the fact hereafter, because the Bible tells the story of Onan, and that story cannot be told and sent by mail. It becomes impossible for any popular book of hygiene to caution the public against unsafe and evil methods of prevention. It would seem about time for the medical profession to take a stand and speak its mind on this subject. It strikes me that any physiological fact or hygienic instruction ought to be printable and mailable, and that if free speech as guaranteed by the constitution means anything, it means that every citizen has the right of access to every scientic fact. I think Congress has no right to deny such access to knowledge, and I think furthermore that it is very unwise to attempt it. Statistics show that the masses of the people are controlling conception somehow. Doctors know that they are making a good many mistakes and doing themselves much harm by unwise methods. The new law will do absolutely nothing to improve people's manners and customs, but it will simply prevent the most proper and normal books of instruction being issued for the public benefit. Many will no doubt agree that a law which puts the Bible on the tabooed list of books is an evidence of inconsiderate, hasty, and foolish legislation. Doctors and medical publishers who sell only to doctors will probably be somewhat immune, but if they escape there is no legal sanction for it. They will all be subject to blackmail, malicious prosecution, and to cases started from spite. The fact that Dr. Malchow suffered imprisonment under such a law shows that doctors and medical publishers would be wise to be wary. N. Y. TRUTH SEEKER. in The Old Doctor Gets Results. EDITOR MEDICAL WORLD: I see medical journals articles now and then in regard to the displacement of the old doctor. These articles amuse the older doctors as tho the old physician does not know anything about a Kelly pad or a stethoscope! Old physicians are students, and most of them are hard students with years of experience, besides their postgraduate work. During the past few years there has been developing and growing a spirit of denunciation: to attack, destroy and annihilate somebody or something; an iconoclastic spirit; an agnostic tendency. Medical literature has contained during the last few years a larger proportion of critical, condemnatory and deprecatory articles than ever before in its history. This spirit has found its way into medical societies as well as many other institutions. It is easier to denounce a fault than to suggest a remedy. The radical is eager to tear down, but often impotent to build up. The critic (in supposition) always finding fault with others Legs Burn and Itch from Poor Circulation and Constipation. EDITOR MEDICAL WORLD:-I see in December issue of THE WORLD, page 530, that Dr. A. LeRoy Moore, of Claiborne, Ohio, wants help for a burning and itching of the lower part of his wife's legs, and I venture to give him aid. I will state that I think the cause of the itching and burning is due to a poor return of the circulation and standing upon the feet with tight hose supporters and probably underwear that is tight on the lower limbs. Constipation is a fruitful cause as is also indigestion. If the doctor will see that nothing in the way of tight underwear, especially that below the knee, be worn and discard tight hose supporters, correct constipation. and indigestion if it be present, and apply with a feather or small mop of absorbent cotton to the whole surface a solution of equal parts of pure carbolic acid and camphor gum it will be relieved. When you rub equal parts of camphor gum and pure carbolic acid together it forms a clear, practically harmless solution for external use. Try it, Doctor, and let me hear from you if you are aided. F. L. BOTT, M.D. Lexington, Miss. Tape Worm. EDITOR MEDICAL WORLD:-A young man, aged 32 years, came to me last Saturday, Nov. 27th, and said: "I have been reading so much about hook worms that I believe I am full of them. Give me something to get rid of them." I gave the following, as it is my method of. treating this trouble: Saturday night I forbade his eating anything; on going to bed ordered 10 grains calomel, with first thing next morning a dose of Epsom salts; no breakfast being allowed. Two hours after the salts, 20 grains of thymol (at 8, repeated at 9 and 10 o'clock, or 60 grains in all). At 12 o'clock another dose of Epsom salts. At 1 o'clock P. M. Sunday he had the first action from bowels after taking the thymol, not only getting plenty of hook worms but a tape worm as well, all of this coming away as I found on examination for its head. Do you think thymol a specific for tape worm or did it just happen so on this occasion? J. H. THOMAS. Milvid, Texas. [Here is a practical problem for the solution of which THE WORLD asks reports of all cases in which thymol alone or combined with a purgativ expelled tape worms.--ED.] Shall Doctors "Bark" for Herpicide? EDITOR MEDICAL WORLD:-Replying to Dr. Daniel P. Deming, of Cass City, Mich., in the December issue of THE WORLD anent the hair tonic "Herpicide," will say that I remember when some years ago the manufacturers of the article sent me a circular letter, along with the request to prescribe the preparation, to designate "Boro-salycil-resorcin Comp.-Newbro's." This will, I think, give Dr. Deming a good clew and, if he has a little knowledge of drug compounding, will enable him to turn out a nice preparation by, perhaps, the addition of a few drops of caramel or other harmless coloring and delicately scented. The results will equal the advertised preparation. However, the use of any gentle stimulating antiseptic mixture on the scalp would be as effectual since patient and persistent massaging of the scalp is what is most needed in the majority of cases of alopecia. If there is an inherited predisposition to baldness the average person will feel that it is "hardly worth the candle" to give the necessary time and attention to what seems as an apparently losing game. Most any good antiseptic if well advertised will bring testimonials. Clinton, Mo. F. F. NETHERTON, M.D. [This is but one more instance of how nostrum-promotors "work" the profession and so foist their wares on an unsuspecting public. ED.] Sealed Caskets for Shipping Corpses.-Erroneous Ideas on Dread of Death. EDITOR MEDICAL WORLD:-The calling of the physician is naturally antagonistic to activities of the "Grim Monster," Death, but their fields of duty touch and not infrequently lap over just a little. The débris of the dead sometimes jeopardizes the welfare of the living and then it becomes the duty of the physician to champion the interests of the living. It happened to me not long ago to be in a combination baggage and express car on the road of which I am local surgeon; and being of an observing turn of mind, I began to "nose around." In that car were a crate of cabbage, a half dozen bunches of bananas, several pails of creamery butter, two hunting dogs, and a corpse. There was an odor in the car that was simply terrible. It did not come from the rather dry cabbages, because the dogs frequently attended to application of water to them; it did not come from the bananas nor butter, as they are more apt to absorb gaseous emanations than to throw them off. It came from that corpse. Upon a little investigation I found that the body was inclosed in a far from tight casket and box, and had been on the way for four days without having been properly embalmed. The certificate tackt upon the box stated that the deceast died from "Quinsy,' a noncontagious disease. I soon withdrew from the unsavory surroundings, leaving the unfortunate express messenger to his sad fate and allowed my mind to pursue other paths. The following day at dinner I discovered. something with my nose that brought quickly to my mind the scenes in the baggage car. It proved to be the butter. Adjusting my organ of smell close to the offending material I could distinctly recognize the corpse of the baggage car experience. On the other side of the table was a large dish of boiled cabbage. Knowing that my wife usually obtained such articles as butter and cabbage from the same grocer, I promptly removed all cabbage and butter from the house and personally saw them safe in the swill repository. This condition of affairs should not be permitted by law in this country. State laws are not adequate to meet the varied routes of travel across state lines, so it should come under the supervision of interstate commerce. In my opinion all caskets intended for shipping the dead should be absolutely airtight as a matter of public safety. All other rules of safety are nothing compared to this one fundamental requirement. There is no possible objection from any point of view. A prest metal casket which may be hermetically sealed by solder, with an observation glass to satisfy those who wish to view the face of the dead, can be made so that it is just as presentable to the eye as any of the crude boxes covered with flimsy black cloth and ornamented with shoddy trimmings not calculated to last longer than the journey to the grave. A corpse thus inclosed would be free from all present objectionable features which menace public health and offend common sense. I have no way of satisfying myself whether that corpse referred to came to its condition of repose from the effects of "quinsy" or from a concealed contagious disease called by that name in order to evade the rules of shipment. That danger exists, however, in all such cases. There is no good reason why such dangers should be permitted. If the requirements of public safety have any force whatever, there can be a law inforced requiring all receptacles for shipping the dead to be of such materials and of such construction that no emanations of offensiv or dangerous material of any kind can escape. Besides the objectiv bad effects of offensiv and dangerous conditions of a corpse, we may well consider the mental impressions which assist other unreasonable but quite common feelings of dread and fear of death itself. Death is but a natural transition from one stage to another. Its inevitable nature and usually painless accomplishment should be used to educate common sentiment away from the awful fear of death which is so prevalent. I say painless advisedly. I who write this once passed the portals of death. I fell into the water near the churning wheels of a Mississippi River steamboat, and my efforts to reach the surface were prevented by the swirl of the water from the wheels. I was conscious until the water entered my lungs; and then with abandoned hope, a dreamy unconsciousness supervened. As I recall the sensations now, I felt no pain. A slight smothering sensation, a buzzing sound, a sensation of distance and nothing more. With no interval of appreciable time I was then being carefully attended in the cabin of the steamer and, after a rather painful period of lung irritation, I was again back in the land of the living. The recovery was far more painful than the death. In my opinion a gentle death, coming at the natural end of life's troubled journey, should not be dreaded. The dread of death is the result of ages of influenced sentiment in that direction. We love to live, but the troubles and sufferings of life after a while become a load much more to be considered a burden than the joy of life a pleasure. And so it is that the old usually contemplate death with feelings of complacency and even a longing for that peace and freedom which is only to be found when the ills of life are left behind. Oh, Gentle Death, I Dread Thee Not. The storms of life, the doubts, the fears, To welcome us to realms of peace. May enter there. When heart beats cease And soon we'll follow thru the door, When I have done my mission here, The shadows. No cause have I to fear Thy kindly touch. I'll welcome thee: God wills it thus; His words are true. Marshall, Minn. A. D. HARD, M.D. Some probably will lag in sending in their renewalssome always do; but don't you be one of them-please. COAL CITY, ALA., December 6, 1909. EDITOR MEDICAL WORLD:-It is not yet time for my renewal, at least I have not received bill. But don't stop the "side issue," and by all means give us Father Cummins' letter, your reply, and lots of the other good articles which this discussion has brought to you. Of course we don't believe all that is said on either side; we don't have to; but it is educational to hear both sides so well argued. Don't leave off yet, for the surface is barely troubled. Dr. Hinkle's pamphlet is good. Continue the fight against narrow-mindedness. E. C. HARRIS. Zygomatic Dislocations and Fractures. EDITOR MEDICAL WORLD:-It has been my experience in a number of cases to run across a rather peculiar condition which is not very extensivly discust in the books, altho it is mentioned in some of them, and that is a dislocation of the malar bone. One might consider this either as a fracture or a dislocation, since it is a dislocation of a bone all of whose attachments are synarthrodial. As the condition is rather rare, and in the cases I have seen, the treatment usually described was impossible, I thought it might be of interest to some of the readers to hear of these cases, and I would certainly be glad to hear in regard to the sequelae following such injuries any of the brothers may have noted in their experiences. The first case coming directly under my observation was in the clinic of Dr. J. B. Murphy, in Chicago. The patient had had a severe fall, striking on the side of the head, and the zygomatic portion of the malar had been deprest and the orbital portion made more prominent, which is the typical injury in all cases. This case was reduced, and suffered no sequelae at all, except a temporary infraorbital anesthesia. The next two cases were in my own practise, and in both of them I reduced the dislocation by the following method: A skin incision was made just beneath the end of the deprest portion of the malar, and then the fascias were separated with a blunt dissector which precluded injury to even the finer nerves, and then the bone was raised by placing the end of a periosteal elevator under it, and simply lifting. This required about forty pounds of lifting force in both cases, and after the first case I lookt thru all the texts available for any better method and found a method described, which was to insert the finger in the mouth behind the molar teeth, and make pressure from within. This I knew would not have succeeded in the case I had, and in the second case I tried it without any success. Another patient had been a surgeon in the British navy for four years, and previous to that had been a regular practician in England. He is now practising in New York City, and I have been able to keep track of the case. In his case infraorbital anesthesia was present before the operation, which was done within two hours of the injury. Also there was a little ptosis, all of which disappeared within a few weeks, with no further sequelae. |