Don't pass an instrument through the deep urethra after operating on the anterior part, until the wounds have entirely healed. If this precaution is followed you will seldom have urethral fever.

Don't-treat stricture of the deep urethra until the anterior portion has been relieved. Stricture of the deep urethra is usually of the spasmodic variety, and disappears when the anterior part of the canal has been rendered free from disease. Don't pass the sound too often when treating stricture by dilatation. A second introduction should not be made until twenty-four hours after all irritation resulting from the previous passage of the instrument has subsided; say, every four to five days.

Don't attempt to cure stricture with the Faradic battery; you cannot do it.

Don't purchase a Galvanic battery and expect to accomplish wonders in urethral diseases without first acquiring a knowledge of electricity, electrical appliances, electro-chemical action and electro-therapeutics.

Gynecology.

Local Uterine Therapeutics. BY WM. C. RICHARDSON, M. D., ST. LOUIS, MO.

THE question as to the necessity and advisability of local therapeutics has always been a vexed one to Homoeopathic physicians, and has been the cause of much useless, if not harmful, polemical discussion.

In the treatment of uterine diseases the matter of local treatment has been discussed in text books, journals and societies until the question has become tiresome.

Our school of medicine embraces two classes of practitioners, one of which bitterly opposes anything in the way of uterine therapeutics other than the properly selected constitutional similimum. On the other hand the class of specialists in gynecology, which has grown up within the past twenty years, has come to depend largely on local measures.

The ultra constitutional and the ultra local therapeutists are both extremists, and while their opinions may be of value to us, yet we should follow neither but learn to depend on the properly selected internal remedy reinforced and assisted by mild, judicious local measures.

Before going into any special consideration of local uterine therapeutics it may be of interest to briefly call attention to what the most emminent old school authorities have to say on the subject. Such men as Simpson, Thomas, Emmett and Hewitt, after years of experience of the largest and most varied character, all finally conclude that the heroic use of caustics, curettes and intrauterine appliances of all kinds whether medicinal or mechanical are not only dangerous but rarely if ever useful.

In fact the best minds in the old school are to-day inclined to conservatism in the use of local measures and one of the latest and best books on the subject from an old school author, Dr. Davenport of Boston, has eliminated nearly everything but

the mildest and safest of measures both in the way of instruments and medicines. It is the object of this paper to call attention to the most desirable and requisite means of local treatment in uterine diseases where operative surgical measures are not indicated.

Displacements of the uterus are per

haps the most common disorder that we are called on to treat and this brings us to a consideration of pessaries. It is safe to say that in most all cases of simple prolapsus, anteversions and anteflexions, of recent origin, that pessaries are not indicated and may prove harmful. In these cases rest and the indicated Homœopathic remedy will generally cure.

In cases of procidentia, retroflexion and retroversion, particularly if they have existed for any length of time, pessaries will not only be found useful but frequently absolutely necessary in order to effect a cure.

Without going into a detailed consideration of the natural supports of the uterus let it suffice to say that one of the chief supports is the vagina. Anything that will destroy the tonicity of the vaginal walls will therefore have a tendency to aggravate uterine displacements.

With this fact in mind it behooves us to be careful in the selection of our pessaries, to exclude everything in the shape of globe, bag or other varieties that would distend the vagina; the stem pessaries are, for the most part, painful and cannot be worn with any degree of comfort, and the only pessary that is free from objection is the hard rubber lever of Hodge with its various modifications to suit special cases.

The intrauterine pessaries are so rarely indicated, and their use is fraught with so much danger that they should never be used except by skillful specialists and even then with the utmost care.

It is not the purpose of this essay to point out the special indications for the use of pessaries or to go into the consideration of methods of adjusting or removing them, and as they are to be cousi

dered as nothing more than adjuncts, the same as splints to the surgeon, to be discontinued as soon as the parts have, by means of proper constitutional treatment, been restored to their normal condition, we will dismiss the subject.

In the treatment of uterine inflammation and its resultant pathological conditions in the shape of catarrhal affections, erosions and ulcerations, only the most bland and emolient local applications will be found of any real benefit.

The use of such powerful remedies as Iodine, Carbolic, Chromic and Nitric acids are reprehensible and the honest admissions of conscientious practitioners show that they are frequently dangerous, sometimes causing death even, and therefore they are being resorted to with much more care than formerly, and will no doubt soon be entirely eliminated from the armamentarium of the gynecologist.

In the treatment of catarrhal conditions incident to the several varieties of metritis glyceroles of such remedies as Hamamelis, Hydrastis, Pinus Canadensis and Boracic acid will be found to render great service.

The method of applying glyceroles is by means of plegets of absorbent cotton and should be done carefully with forceps, after the os, cervical canal, and vagina have been cleansed of the decomposed mucous and other secretions. This cleansing may be done by tepid injections, and swabs of cotton, which may be supplemented and facilitated by Peroxide of Hydrogen, applied with a spraying instrument, after the secretions have been wiped off and before the glycerole is applied,

Glyceroles are rendered more efficacious by the Glycerine itself which is an

agent of no small value in relieving congestions and inflammations of mucous structures.

Occasionaly suppositories may be found useful and beneficial. They should be made of Cocoa butter into which has been incorporated the desired remedy, and if desirable, they can be inserted with safety into the cervix, but never higher, and allowed to dissolve.

In the more chronic forms of inflamma

tory conditions of the uterus powders of Boracic acid or Hydrastis may be incorporated into absorbent cotton and inserted dry into the vagina against the uterus, with perhaps more benefit than the glyceroles.

Electricity in the hands of a careful manipulator, possesed of a good battery, is a potent therapeutic agent in uterine diseases, and finally hot water, more particularly, in the acute stages of inflammation will be found useful.

In conclusion I wish to enter my protest against intrauterine appliances both medicinal and mechanical.

There are unquestionably, cases, now and then, in which it may be advisable to resort to intrauterine treatment, but the careless or frequent use of intrauterine injections, tents, pessaries, curettes and instruments is not only unsafe but positively dangerous. Why uterine inflammations, catarrhs and other diseases should require more heroic treatment than similar diseases of mucous tissues elsewhere situated, is a question that the advocates of cauteries, scrapings and cuttings will have a great deal of trouble to explain.

The conservative practitioner who depends on properly selected internal medicines, and those local remedies which are mild, non irritating and not destructive of

any tissues, will certainly be the most successful in the treatment of uterine diseases.

The Hygienic Aspect of Gynecology.

BY SARAH J. MILSOP, M. D., BOWLING GREEN, KY.

IN these days, when the fascinations of Gynecological surgery are so great, I fear not enough attention is paid to the prevention of diseases of women, nor to the hygienic measures for restoring to health the many women who are suffering with ailments of the pelvic organs.

In my own practice I lay great stress on all hygienic measures, and on none more so than the manner in which my patients shall wear their clothing. I explain to them the relation of the pelvic organs to the other organs of the body, and show the utter futility of attempting to restore to its normal position a misplaced uterus -and to keep it there (?) without mechanical support-when there is a constant downward pressure of the other organs produced by the weight of the clothing, suspended from the hips, and by the shape of the corset, even if it should not be worn tight.

Right here let me suggest that it will be perfectly safe for each of you to have framed and hung in your offices a large and brilliant chromo, to be given to the first woman, old or young, who will admit she wears her corset tight.

I find most women are ready-many of them made so by long suffering-to believe what I tell them; and I do not always have to labor so very hard to induce them to leave off corsets. But to get the corset off is not the only point. The Read before The Southern Homœopathic Association at Memphis, Tenn,, Nov. 14, 1889.

skirts only sag on the hips all the more, without a corset, so in every case I have to suggest some form of waist which will serve the combined purpose of corset and skirt-supporter.

And this is the point I especially wish to make clear, as several of my medical friends of the other sex have asked me to give them some points as to how their patients should dress. Even the old school brethren in my own town admit that I excel in my hygienic measures in treating the ailments of women-if my medicine don't amount to anything.

worn.

I have no hobby as to the make of waist If I can only get the stiff corset off and all the underclothing suspended from the shoulders, by any means, it is all I desire.

When I am called to see a patient, who is half sick, very nervous and wholly disheartened by much treatment, and many burnings by caustic, I don't alway insist on a radical change in the mode of dress, knowing the labor involved would only add to her discouragement. I simply'suggest that she would find much relief from taking the steels out of her corset, buttoning it up instead, putting straps over the shoulders, and holding her skirts up from the hips by a pair of ladies' suspenders, which can be purchased for a quarter.

As the patient begins to improve, and to realize how much relief even this simple measure gives, I venture to suggest that she leave off the corset and adopt a waist, which will bring all the weight of the undergarment evenly distributed over the shoulders, and thus do away with the discomfort of the shoulder straps in warm weather.

I have here a kind of corset known as the Ferris Waist. I have induced a great

many of my patients to put these on, in place of the regular corset. While they are stiff, and even the bones in front can be removed, there is the objection that the buttons for the underclothing are not in the right place, and more have to be sewed on. These waists and the suspenders could not be obtained in Bowling Green two years ago.

I asked one of the merchants to order them, which he did, sending for one waist at a time as called for.

Now two of our merchants keep them in stock. The first one to keep them tells me he has sold one hundred and twentyfive of the waists, and ten dozens of the suspenders.

Many ladies are wearing both articles, who have no knowledge of me, only through these waists. They have been recommended to them by my patients, who say they have experienced more relief from this manner of dressing than from all other measures combined.

Where patients can afford it, and will take the trouble to arrange their underclothing for it, I recommend the Flynt Waist. This waist is the patent of a Boston lady, who supplies not only the waists, but the underwear to go with them.

One especial advantage of these waists is that the four rows of buttons are so arranged for the support of the undergarments that the bindings do not overlap; and this does away, in great measure, with the constriction and heat of from twelve to eighteen thicknesses of cloth around the body in a place where so much heat and pressure is so pernicious.

I know many ladies of wealth and fashion who are wearing these waists and underwear, and many mothers have put them on their young daughters.

Another waist which has many admirable qualities is the Equipoise. As will be seen, this, too, is suspended from the shoulders, and has buttons for the attachment of skirts. Another good feature about it is that it laces in the back as well as buttons in front-the spine being protected by one thickness of cloth under the lacing. This allows for expansion, if snugly fitted. One lady, who has a gaseous distension of stomach and bowels from dyspepsia, said she could wear no other waist.

The Jenness Miller underwear is worn and liked by many ladies, but I have no personal knowledge of it.

It is not necessary to go to the expense of purchasing any of these waists if your patients have ingenuity enough to make their own. I have for many years worn waists of home manufacture, and have several patients who are wearing waists of their own make.

Stout ladies, more than others, are reluctant to leave off their corsets, fearing their size may be made more apparent by the reform waists. But this is not the case, as I have proved to them. When the vicelike pressure of the stiff corset is removed from organs long squeezed out of place, they gradually go back to their normal position, the bust and abdomen become smaller, and the woman not only seems slimmer but confesses that she feels far more comfortable.

Another advantage of these waists over the corset is that they can be washed as often as is necessary without spoiling their fit. Among other sins the corset has to answer for is uncleanliness. In the first place, it is not intended to be washed, for that would hurt the trade! If it ever is washed its perfect shape is ruined; so

ladies, who are otherwise immaculate in their toilets, will wear for months a corset with but one garment between it and the body and often not even that.

Where the combination or union suits are not worn, all bindings should be attached to the waists, seven button-holes being made in each binding for that purpose. In every case the binding should be from one to two inches larger than the waist, so that the clothing may swing from the shoulders, and when the shoulders are raised all the clothing can be lifted up at the same time.

By taking off this downward pressure, I seldom have to resort to pessaries to hold the uterus in position, except in case of a bad retro-dislocation, when I sometimes introduce a pessary to support the uterus during the increased weight attending the menstrual flux.

I no longer resort to the use of a repositor to lift the retro-displaced uterus, having found in many cases a good deal of irritation following its use. I place the patient in the knee chest position, use the Sim's retractor and reposit by what is known as the Campbell method. With the pressure of the corset removed from the abdomen the poor crowded down uterus will gravitate into position far more accurately than any instrument can place it there.

Anothor evil in the dress of our women and girls is the unequal distribution of clothing over the body.

During the present autumn I have been called to see several young ladies suffering from menstrual irregularities, with evident pelvic congestion. I have found in every case the upper part of the body comfortably clad, sensible undervests worn, and several thicknesses of garments over the abdo