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to say, "I never had a case of puerperal infection in my practice." We all have them. The physician that claims he never had a case, simply admits his ignorance in being able to recognize such cases, and is akin to the "old fogie" who "never had a case of lacerated perineum." The principles of aseptic and antiseptic methods of preventing puerperal infection should be understood by all, and needs no further comment. In the treatment there is a diversity of opinion, as expressed to-day.

One man gives opiates in full doses, numbs the sensibilities of the patient, in a measure relieving the pain; also uses the coal-tar group to reduce the temperature, ignoring the cause of the trouble, simply combating the symptoms, often doing more harm than good, and aiding the death of his patient.

Another class in septic cases invade the uterine cavity, break up nature's barriers, tear up the endometrium, scrape open closed sinuses, adding untold traumatism, and for fear nature would eliminate or throw off the noxious material and débris, they stuff the uterus with gauze, thus putting a tampon in the way of nature's elimination and drainage; as well fill the trunk-sewer of a city with gauze and expect free drainage, with a healthy, happy people. The latter would bring disease, suffering and death; so will the former.

I again emphasize the statement that the curette and tampon in septic infection has killed more patients than their use has saved. I care not how expert the operator, he cannot remove all the septic germs in puerperal septic infection by the use of curette, sharp or dull, neither can any man efficiently drain such a uterus by a gauze tampon, for we all know it will not drain off anything but a liquid serous discharge, and that for a few hours only, and not even that if the operator plugs or packs the cervix. It retains cellular elements of the blood; débris. dead leuco

cytes, ladened with septic germs and alkaloidal poisons, preventing their egress or elimination, thus favoring and foreing their absorption. Such treatment is irrational, unscientific, and produces more pelvic complications-i. e., disease of uterine body, tubes, ovaries, lymphatics, blood-vessels, pelvic cellular tissues, pelvic peritoneum,etc.,than any other recognized method of to-day in treating septic infection. Establish tubular drainage in these cases, and it not only drains from uterine cavity, but establishes a current of elimination and drainage from endometrium, wall or body, extending, by lymphatics and blood-vessels, to all the pelvic organs, relieving and preventing serious lesions of these structures; also obviates the necessity for so much heroic surgical measures and destruction of pelvic organs.

The soft rubber tube, as shown (see figure 1), has been more satisfactory in my hands so far, yet I am trying tubes of this pattern (see figure 2), which may be constructed of hard rubber, glass or aluminum.

To tubular uterine drainage I add alimentary drainage and elimination, by use of salines, and believe both are essential in every case.

I unqualifiedly condemn the reckless, indiscriminate dosing these cases with whisky as uncalled for, unnecessary and injurious.

Systematic feeding of easily digested, nourishing diet, or giving some of the prepared foods, coupled with the judicious use of quinine, strychnia, and digitalis, is far more beneficial, rational, and scientific.

I have not condemned the use of the curette and tampon without a trial, for I have used them to my sorrow. Neither do I recommend drainage and elimination without investigation sufficient to demonstrate their claim and recognition as the best treatment at present at our c command.

I am lately informed others are now trying this same method with the same success, and I hope it will not be long

until it is universally adopted. All I ask is a fair trial of the method, exercising a reasonable amount of dexterity and skill in the use of the tube.

From my own experience, and a considerable experience in consultation work, I am of the opinion that when we fail to get good results it is due to improper selection, placing or manipulation of the drainage-tube. It should be as large as the cervix will admit, usually one-half inch in diameter, of pure, soft rubber, opening large enough to drain freely, not bent upon itself, carried to fundus of uterus, cross-bar so adjusted as not to let it slip out.

REPORT OF SOME UNUSUAL AND RATHER UNIQUE CASES IN ABDOMINAL AND GYNECOLOGICAL WORK.

BY K. P. MOORE, M.D., MACON, GA.

It is interesting to look back over a life of twenty-eight years spent in the practice of medicine, and recall some of the unusual and unique experiences. I suppose all of us who have grown somewhat gray in our professional battles could bring out of the archives of past observations some pleasant things, as well as many that are not perfumed with very sweet recollections. Some of the cases to be mentioned in this brief paper are not of very recent date, and some may have no great deal of practical utility, only so far as they illustrate some curious freaks of nature, and put us on our guard as to diagnosis and caution against unnecessary pro

cedure.

Case 1.-Some years ago I was called to see a beautiful well developed young lady eighteen years of age, then on a visit to our city, who had never menstruated. She was the picture of health, and had only indifferent and vague symptoms, if any at all, of an attempt to menstruate. Her father, who is an intelligent physician, wrote me that he had a suspicion of something wrong with his daughter, and asked me to investigate her case. I found the external genitalia perfect and well developed, and the mons covered with a rather unusually fine supply of hair. Any attempt to enter the vagina was entirely futile, and I suspected nothing more than an imperforate hymen. With no grave apprehensions, I went back to my office to get some instruments,

chloroform, and assistance. I found my friend, and then copartner, Dr. Ross, and asked him to go with me to administer an anesthetic while I punctured an imperforate hymen. The patient was soon anesthetized, and I proceeded to make an incision in the direction of the vaginal outlet. Cautiously I cut down at least a half inch or more deep, and an inch or more long, expecting and hoping at each stroke to find the opening; but the fact that there was possibly a complete atresia began to dawn upon me, and the necessity for further physical exploration confronted me. Still not suspecting anything of greater gravity than a vaginal atresia, I introduced my finger into the rectum, and could find no evidence whatever of the existence of a vagina. Not the slightest thickening, or other evidences, so far as the touch could determine, of even a rudimentary vagina. The mercury in the column of interest in the case now began to rise more rapidly. She was thoroughly under the anesthetic and I could easily get two fingers well up into the rectum, and the further the exploration went the more intense became my anxiety in the case. Bimanual palpation could be thoroughly practiced, the bladder could be easily outlined, but not a trace of vagina, uterus or ovaries could be found. I now invited Dr. Ross to make a careful examination, and he fully concurred with me as to the entire absence of vagina, uterus and appendages. From a professional standpoint, we were lead to examine her breasts, and I have never seen more perfectly developed mammary glands for a girl of her age than I found in this case. I wrote her father of what I found, but asked him at some convenient time to have some gynecologist of more extended observation to see her. A year or two subsequent to this time she was on a visit to Atlanta, and was seen by my friend Dr. V. O. Hardon, who confirmed the diagnosis. Any move towards an operation in this case could have

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