She soon,

at the same time she was still in her unconscious state. however, opened her eyes, and at once placed her hand on her bowels with a look of surprise, yet she knew nothing that I had done to her until I told her. She rallied up, and her father started home with her in an hour. Her after treatment was some simple, soluble, mild cathartic to keep her bowels regular, and iron, aloes, and myrrh in proper doses. At the end of a week she again called, stating all her fits had disappeared, and she was feeling quite well. I ordered her to continue the medicine, and in about four weeks her menses came on all right. She remained well for about two years, when she again called at my office, presenting the same condition and difficulties she seemed to have had before. She stated, her menses had been suppressed for some six months; she consulted her family physician, had taken his medicines faithfully, as all her friends (lady friends) told her to do, all to no purpose of relief.

I again operated upon her, when she discharged something near the same quantity and about the same consistence and appearance. I gave her similar treatment as at the first; she had the fits as at first also.

I did not see her again for some three years, when she came to my office, presenting all the former symptoms, but no fits. She had married, and went to live with her husband some twenty-five miles away. Her menses had been suppressed about four months; then she had taken her physician's medicines until he told her she was now pregnant without any doubt. She fearing the same old troubles, I again performed the same operation with similar results, only less quantity was discharged. Now, on the 20th of December, about three years more has passed, and she again is much in the same general condition, with tendency to disturbance of her bronchial tubes-upper parts of the lungs. I pursued the same line of treatment as at first, with similar results, and at this time, January 29, 1880, she is again in usual health.

I have but this to say as to this case. I am well satisfied she never conceived or was pregnant; that all the trouble arose from a lack of harmony in the fibres of the womb necessary to export the secreted menses; that it was secreted and retained, accumulating from time to time, until this condition of the general system was

the result.

Who can give a better reason? She is of a healthy

family, never sick but with the above troubles.

Salem, O., January, 1880.

SOME THOUGHTS ON THE GENERAL DUTIES AND QUALIFICATIONS OF THE GYNECOLOGIST.

BY H. G. NEWTON, M. D.

(Continued from page 19, January, 1880.)

It is now a well established fact, demonstrated by the evidence of every gynecologist of large experience, that in modern life a great variety of diseases of the pelvic viscera may exist in the unimpregnated and even in the virgin. That although excessive venery may be one cause, and child bearing and miscarriage or abortion still more frightful causes of such diseases, yet there is nothing in the structure and functions of those organs which necessarily preclude attacks, inflammatory or otherwise, any more than in the organs and tissues of other localities. If not, then why should a young lady be allowed to suffer for years from such diseases when the most important part of the treatment must, if scientific, be of a local character, and when no true or undoubted diagnosis can be made, without such local examinations as shall fully and clearly convince us of the exact conditions of the parts affected. It is sometimes contended that such examinations tend to demoralize the young woman, and to detract from those natural safeguards of virtue which every moralist must earnestly wish to have strengthened and perpetuated.

If to any extent this were true, I certainly should join in the opposition to such a demolition of what seems to me to be one of the most sacred elements of civilized society. I think, however, that human virtue rests on surer foundations and more enduring principles than the mere feeling of modesty which may be in most cases its adjunct. In making upwards of nine thousand vaginal examinations, I have had some opportunity for observation in this matter, and must say, that I have not yet seen the instance in which any such moral deterioration occurred in consequence of such examinations. On the contrary, all such young women as have necessarily been subjected to such examinations have, so far as my

observation goes, had a much more profound love of chastity, that bright, particular star in the brilliant constellation of womanly virtue, and a greater detestation of all vices which tend to degradation and misery.

Indeed, a few words of counsel, such as any high minded physician can judiciously speak to a patient under such circumstances, will tend to confirm such principles and impart moral strength and encouragement to those who are naturally deficient in those powers of resistance which nearly all need in encountering the many temptations incident to the great conflict of life. We must remember, too, that disease generally tends, if very long continued, to both moral and physical deterioration; and as morality is in a great measure due to that wisdom and mental stamina which alone exists in a sound body, we see how important is the maintenance of health to the sustenance of moral tone, either in the individual or the mass of the community.

But beyond all is the basal principle that the physician should do all in his power to preserve and extend human life. And, in many cases, both the prolongation of life and the present existence of the patient depend on the restoration to a healthy condition of the uterine organs.

A gentleman recently succeeded in saving a young lady from drowning, by seizing her at the last moment by one of her feet and drawing her out of the water in a very immodest manner. It was the best that he could do under the circumstances, and he naturally expected to win the lasting gratitude of the person whom he had snatched from a watery gråve. Instead of this, as soon as she was able to speak, he was roundly abused as a horrid wretch for pulling her out of the water feet first.

I conclude that if such examinations are ever desirable or necessary, no age or condition should be exempt. All delicacy of manner and deportment should of course be maintained, in order, if possible, not to offend the most fastidious. In my opinion, the matter of having a third party in the room had better be left almost entirely with the patient; manly confidence in the honor of a patient will seldom, if ever, be betrayed.

√.

In diseases of the uterus and other pelvic organs, we have a great variety of disagreeable symptoms to meet and combat. We should ascertain, first, in what organs or tissues there are structural lesions, and in considering the relations of those organs in health and in disease with others, contiguous or remote, or with the system in general. Seek for the origin and causes of morbid or unpleasant phenomena in other localities, as well as those general or constitutional disturbances which are concatenated with, and, in many cases, are dependent on those affections.

When nervousness, as it is termed, and in some cases fever, is symptomatic of such uterine disease, the recognition of this fact will tend to make our diagnosis, prognosis and treatment much more rational and scientific than it would be without such knowledge. This is especially true in hysterical cases, in which so many diseases are simulated. I can readily conceive how many a young practitioner has in such a case supposed he was treating a disease of some remote organ. And on the other hand, there is danger of making the almost mythical hysteria the hobby on which we saddle a multitude of complaints. We should first be sure by very evident signs of the hysterical diathesis before ascribing to it all the strange, obscure symptoms. A case is related by one author, in which a lady at the change of life suffered from severe and constant pain in the right side, and was considered hysterical because she had suffered from hysterical fits several years before. Not being able to shake off the pain by exerting herself as she was directed to do, she could only find relief from large doses of morphia. When she died, a few years later, an autopsy revealed an abscess of the liver.

It could not have created a very pleasant reflection in the mind of her medical adviser to learn that he had made so egregious an error in diagnosis.

One important point in these cases which we are likely to overlook, is what might come under the head of mental symptoms. The life of women is more in the affections and emotions than in the intellect. They have little to do with logic, or the arriving at conclusions from the force of reason, though they generally entertain more sanguine opinious than men, and are, no doubt, more self

willed, as the more any one reasons the less tenacious he becomes of his cherished ideas. These peculiar mental characteristics of women, if better understood and more constantly borne in mind, will enable us much more clearly to understand the true nature of the otherwise enigmatical being, who seeks our counsel and assistance with such a generous confidence.

Much more could be written on the various topics I have so briefly hinted at, but I leave that for discussion by the members present, whose experience and mental capacity render more sapient the views which they may put forth. At some future time I hope to give some of my views on the treatment, which as eclectic, I have found to exert so happy and beneficial an influence in various forms of uterine diseases, both simple and complicated, that have come within the range of my experience. It would take many sheets of paper to tell all that I know or suppose about medical practice.

MR. EDITOR:-The puerilities of "codes of medical ethics" are very disgusting to many physicians, who are not flattered by the assumption that they do not know how to conduct themselves as gentlemen. I say this with very great respect for my excellent friends who have drawn up "codes" for the Massachusetts Medical Society, but whom I consider to be working here for no good. I send you a "code" which I drew up myself some two years ago, and designed to have sent into the meeting of the councillors, but withheld for cause. I think you will find it simple enough, and comprehensive. We practice by here, although it has never been presented, and are happy; and Worcester is the paradise of physicians, socially. Publish it if you think it will do any good.

Worcester, December 31.

Yours respectfully,

JOSEPH SARGENT.

CODE OF ETHICS FOR THE MASSACHUSETTS MEDICAL SOCIETY.

Assuming that membership of the Massachusetts Medical Society is conceded only to worthy persons, of good character and