Page images
PDF
EPUB

I know, for example, of a large institution in our city entrusted with the education of young women from all parts of the country. In numerous instances young girls with purely functional dysmenorrhoea are taken to a physician, who examines them, inserts specula, and institutes treatments where, as I have had occasion to verify, there is actually no discoverable local disorder whatever.

Other young women are constantly coming to me from a distance with the statement that they have "ovarian disease" or "tubal disease or "anteflexion of the womb," who are perfectly sound and who ought never to have been examined at all; and I have thus to record in my case-book in numerous instances "no pelvic disease" or "metrophobia "-a word I have coined to designate those who are fully assured they have some grave "womb trouble," but are, notwithstanding, perfectly sound.

Aside from all the hospital cases I have seen, I find in my private case-book the records of twenty-eight cases with no pelvic disease out of a total of 550 in all, about 5 per cent.

While male physicians are great offenders in this respect, many of the women who practice medicine are far worse; indeed, they often seem to possess no conscience whatever in dealing with these sacred interests of their own sex.

A young woman with a natural sense of shame, but utterly guileless of any knowledge of anatomy, feels that it is easier for her to speak of her pelvic discomforts to one of her own sex ; but the woman doctor (with many noble and conspicuous exceptions, I am happy to say) then feels, on her part, that it is necessary, in order to make a complete investigation of every case, to inspect the genitals and to insert her finger into the vagina; she generally ends by putting in a speculum, too, and tampons, and so begins a neverending course of so-called "treatments," during which the natural ups and downs of health encourage the trusting victim to think at first that the " treatments are benefiting her, and then, when the pains recur, that there surely is something at fault, and so it continues for years. Sooner or later, in many cases, an infection is introduced, and from having no disease at all she is inoculated with a salpingitis, and she is fortunate, finally, if she escapes a radical operation removing her uterine tubes and her ovaries. The records of this country within the past twenty years could show, I verily believe, thousands of such victims, at first unnecessarily insulted, and then robbed of their distinctive organs of sex for imaginary ailments or diseases acquired.

Such is the character of this evil; of its extent no one can do

more than roughly estimate. My own experience leads me to conclude that these vicious practices are both general throughout our country, and that they affect our young womanhood to the extent of inflicting an unnecessary injury upon many thousands yearly.

In case an examination is actually necessary, it must be made by one who is thoroughly competent to decide at once whether or not there is any disease present, and who will be able to proceed at once to do all that may be required to relieve it. By dilating a cervix, or rupturing a large Graafian-follicle cyst, or breaking up adhe. sions, oftentimes all can be done at once which it is possible to do at all, and the patient will be spared the distress of useless and endless so-called "treatments," which consist in the application of drugs to the vaginal walls or to the cervix, anatomical structures distant from and quite distinct from the supposedly affected organs.

I would urge that there are satisfactory methods of examining young women which need shock no sensibilities and which inflict no injury upon any organ.

In the first place, if the patient has not been examined and treated before and an examination is necessary, it is my invariable practice to propose to do this under complete anesthesia, in this way securing a perfect relaxation, with every facility for making the minutest investigation which it is possible to make, short of actual inspection through an abdominal incision. The anesthetic obviates the inevitable resistance of the abdominal walls, and the examination leaves behind it no disagreeable memories.

In the second place, when the patient is anæsthetized the examination must be conducted through the rectum. The cervix can be easily palpated through the recto-vaginal walls; and as for the body ⚫ of the uterus, the ovaries, and the tubes, they cannot be clearly palpated in any other way. The rectal examination is therefore not only to be recommended because it spares the hymen, but because it is actually indispensable to a thorough investigation.

I have shown on another occasion that the most minute examination may be made by the rectum if the pelvic organs are first skeletonized by putting the patient in the knee-breast position to let in the air and so getting rid of the intestines. After doing this the examination is conducted in the dorsal position. If the finger is not more than 6.5 centimetres in circumference, it may often be inserted into the vagina, slowly and with extreme care, without rupturing the hymen ; this is, however, not a good rule, for the tactile sense of many men seems to be so blunt that there is no appreciation of resistance when delicate structures are being investigated, and harm is done unawares.

In the third place, if it is necessary to dilate and to curette the uterus, this may be done by introducing a finger into the rectum and locating the cervix, and then introducing a pair of tenaculum forceps into the vagina and carefully opening them, and catching the cervix and drawing it down to the outlet, where it may then be dilated and curetted, in many cases, without injuring the hymen.-Abstract, Amer. Jour. of Obstetrics.

THE

THE DISINFECTION OF THE EXCRETA.

BY CHAS. A. HILL, B.A., M.B., B.C.CANTAB.,

AND

JOHN HILL ABRAM, M.D., LONDON, M.R.C.P.,
Assistant Physician Royal Infirmary; Senior Demonst. Path. Univ. Coll.

(From the Bacteriological Laboratories, University College, Liverpool.)

HE methods used for ascertaining the value of any disinfectant are mainly two-namely, the addition of definite quantities of the substance to an active broth culture, with subsequent inoculation upon various media after the lapse of varying intervals, and the action of solutions of known strength upon test organisms inoculated upon threads.

We have limited our enquiry to the disinfection of the fæces, as naturally they are the most resistant. In our earlier experiments the disinfectant solution was added in excess to the solid fæcal mass, but we speedily found that in not a single instance did we get any sterilization of the central portions. Therefore we would insist upon the necessity for thoroughly mixing up the fecal matter with the disinfectant selected.

We have chosen half an hour as the time during which the mixture must be allowed to stand, as being a convenient one in practice, though we admit that it is a severe test, and no doubt explains. some of our results.

The accompanying table gives our results at a glance :

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

It will be seen from the table that we have found corrosive sublimate and crude carbolic good disinfectants. The mineral acids we have not tested, as there are many and obvious objections to their use. Chlorinated lime we find with our time limit of half an hour to be useless. It may be said the preparations were old, but we submit that such an objection necessarily puts the substance out of court. Any of the six disinfectants on our select list may be regarded as absolutely certain in their results when thoroughly mixed with the stool and allowed to stand for half an hour. There are, however, objections to the use of some of them.

Corrosive sublimate is a scheduled poison, acts upon the metal work of the drainage system, and moreover gives a red coloration with stercobilin. This latter point is of importance, inasmuch as it may mask the presence of blood in a typhoid stool; again, albumen is coagulated by mercuric chloride, and thereby protects organisms enclosed in the centre of the coagulum. Crude carbolic acid is cheap and efficient, but does not mix over-well with the fæces; it stains linen, and is poisonous. Formol and creolin are good, but are rather costly. The remaining substance, chinosol, is, in our opinion, the best. It is reliable, an excellent deodorant, and mixes well with the fæces. It is dearer than crude carbolic, but its cost is more than counterbalanced by its portability. It is put on the market in tablet form. The tablets are readily soluble, and may be obtained in such strength that one of them in a pint of water makes a solution of effective strength.

We may sum up our paper with the following conclusions:

1. It is absolutely necessary to mix the fæces thoroughly with the disinfectant.

2. The mixture should stand at least half an hour.

3. Carbolic acid, crude carbolic acid, formol, creolin, chinosol, and corrosive sublimate in the strengths given in the short list are all effective, but chinosol seems the most convenient.-Abstract British Medical Journal, April 16th, 1898.

« PreviousContinue »