SECTION ON GYNECOLOGY. REPORT OF THE CHAIRMAN. By J. F. Y. PAINE, M. D., GALVESTON, TEXAS. GENTLEMEN: In looking over the field of gynæcological literature for the last year, I find the harvest so rich that I am compelled to select that only which seems to me to possess especial interest; for, were I to attempt to cover the whole ground, I would justly lay myself open to the accusation of selfishness, as I fear there. would be but little time left for the presentation of the excellent reports with which I am sure the chairmen of the various sections have provided us. Therefore, will I confine myself to culling, from this abundant harvest, only such cases and suggestions as seem to me to possess a peculiar interest to the ordinary practitioner of medicine, and an acquaintance with which will, I trust, aid each and every one of us in our daily avocations; for this is the true end and aim of all reports-it is the desideratum towards which all efforts should tend in every branch of labor, and, to this broad, general rule, we find no exception in our professional work. It would seem to me that one of the most important APPENDIX-Section on Gynecology. points to which I could invite your attention is the great question of the day, in gynæcology, the question. of the removal of ovaries, for hystero-epilepsy, and for other allied conditions. This operation is fashionable to-day, and every aspirant for gynææcological distinction "has a strong desire to hang to his belt of fame. the ovaries of a woman, as has the Indian of the West to display the scalp of his white-faced victim." That this operation has been abused-that it has been frequently resorted to unjustifiably, there can be no question; indeed the distinguished Professor Parvin, tells us that the day will soon come when it will be considered as criminal to remove the ovaries for the cure of hysteroepilepsy, and allied conditions, as it is now regarded to remove the clitoris for nymphomania. Yet, this operation is sometimes perfectly justifiable, and, indeed, is imperatively called for, but we must carefully select our cases, and not rush headlong into removing the ovaries of every woman whose condition seems to us to be such that the supposed abnormal condition of these organs would account for it. How are we to determine? Only by patient and prolonged observation. Dr. Goodell, the great authority, believes in the operation, but he only resorts to it when he is thoroughly satisfied that the ovaries are diseased, and when he has unavailingly tried every remedy, short of removal. Therefore, I would say that the operation is a proper one, in suitable cases, but, that we must be very careful that we select only suit able cases for the operation. Report of J. F. Y. Paine, M. D., Chairman, Galveston, Texas. The question of child-bed fever is one upon which I feel that I ought to touch, for the whole subject is in a very chaotic state. But, I feel that our present correct ideas on the subject, may be well expressed in the languge of Dr. W. C. Neville, who says, in the Dublin Journal of Medical Science, that (1) there are a variety of puerperal fevers, but no one "puerperal fever,” so-called. (2) Some of the less serious fevers result from local inflammations, combined with some degree of toxæmia. (3) Various exanthemata-notably scarlatina-may occur about the period of child-bed, and are then manifested in a more or less blurred form, though they can usually be recognized by specific peculiarities. Such fevers are apt to be complicated by endogenetic toxæmia, septic poisoning, or septic infection. (4) There are two chief types of puerperal toxæmia accompanied by fever-the infective and non-infective. (5) The non-infective form is the result of septic poisoning, and comprehends the greater number of sporadic, and, in its uncomplicated form, more remediable cases of puerperal fever. (6) The infective form results from heterogenetic infection-septic, erysipelatous, diphtheritic, etc., and includes the greater number of serious child-bed fevers, especially such as assume what is usually known as the "epidemic" type in the practice of hospitals or individuals. The succession of cases is kept up by the actual transfer of the infective contagia (almost certainly consisting of pathogenic bacteria, or their spores, contained in the unhealthy secre APPENDIX-Section on Gynecology. tions), by hands, instruments, etc., from one patient to another. The initial case of such a series may be due to the infection of the patient, with septic material derived from the juices of some corpses, especially such as are but lately dead from some infective malignant disease-from gangrenous, sloughing, erysipelatous, or diphtheritic wounds, etc. (7) There are exceptional cases, in which, though the symptoms and progress resemble closely those of the infective fevers, no foreign source of infection can be discovered. Some of these cases may originate in unusually severe traumatisms, or crushing occurring during labor, followed by slough ing, etc.; others in an intensification of a pre-existing catarrhal or gonorrheal inflammation of the genital passages; and, others again, in the local and neighboring inflammatory consequences of the retention, within the uterus, of decomposing portions of the placenta. As, for nearly every ill to which human nature is liable, cocaine has been recommended, so, I find, it has been accorded a place in gynæcology. I note that Dr. John Forrest, of South Carolina, has derived benefit from its use in dysmenorrhoea. It was used hypodermically, and, while it acted admirably, both locally and generally, it had no effect, apparently, on the bearing down pains and pain in the back, but only upon the local pain in the neighborhood of the spot where it was injected. It was also noticed that, while it relieved the nausea and vomiting, of a reflex origin, it sometimes caused slight nausea and vomiting itself; but this was Report of J. F. Y. Paine, M. D., Chairman, Galveston, Texas. only temporary. No other unpleasant effect was experienced, if we except a slightly bitter taste imparted to the tongue. If cocaine can thus be made to supersede morphia in such cases, it will certainly prove an inestimable boon to many an unfortunate sufferer; and, if it is able to relieve the excruciating intestinal pain usually called "wind colic," which, in so many cases, is sure to follow the slightest surgical interference with the uterus, this, of itself, will be no mean trophy added to .ts many wonderful triumphs over human suffering. The question of accidents during coitus is one that, it seems to me, rightly belongs to the domain of gynæcology; yet, it is a subject upon which but little has been said. We all know that the parturient parts are very intolerant of injury, and that serious disease will often result from injury to them, as, for instance, witness the grave results that often ensue from even a slight laceration of the cervix during labor. How much more grave might be the results of some of the severe accidents that occur occasionally during coitus; and yet how little do we hear about them. Dr. Zeiss, of Erfurth, reports two cases. In the first, there was dangerous hem orrhage after rupture of the hymen. There occurred, on the first night after the wedding, and, in consequence of connection with her husband, hemorrhage from the genitalia. This could not be stopped by means of ablutions or cold applications. When the author was called, on the afternoon of the next day, he found the hemorrhage still continuing; the patient had |