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PARKE, DAVIS & CO.,
Manufacturing Chemists, Detroit, Mich. The following drugs, preparations of which containing the medicinal principles in their most eligible form, we offer the medical profession, have for some time been in use by a sufficient number of physicians to determine their value. Such claims as we make for them are based exclusively on the reports which we have collated from the medical press. These reports have been preserved by us in extenso, and we are prepared to furnish copies, gratis, to all who may be sufficiently interested to apply for them. We hazard nothing in asking for these drugs a more thorough trial, with a view to commending them to the use of those who are not already familiar with them.
SIERRA SALVIA. (Artemisia Frigida.) Fluid Extract of the Herb. Dose, i to 2 Fluid
drachms This species of the Artemisia was introduced by Dr. A. Comstock, of Silver Cliff, colorado, as a substitute for quinine. In the treatment of periodic fevers, he gives a teaspoonful of the Huid extract in a glass of strong, hot lemonade, one hour before the expected chill, and repeats in 30 minutes if the stage of perspiration has not set in. In rheumatism, scarlet fever, diphtheria, etc., he uses it hot as above, and repeats every half hour until perspiration and urination are certainly established.
RHUS AROMATICA. This drug has had a very thorough trial as a remedy in nocturnal incontinence of urine and the very general verdict is that it is a remedy of value in this troublesome affection. Its action consists chiefly in improving the tone of the sphincter muscles, but it also exerts a soothing influence over the mucous lining of the bladder, rendering the organ more tolerant of the normal urinary secretion.
Dr. McClanaham, who first prominently called attention to the virtues of Rhus Aromatica, claims for this drug almost specific properties in nocturnal incontinence of urine, either in old or young. He regards it as also useful in hematuria and in menorrhagia, while it is further recommended by some as a remedy in atonic diarrhæa,
dysentery and summer complaints of children.
CORN SILK. (Stigmata Maidis.)
i to 2 Fluidrachms.
KAVA KAVA. (Piper Methysticum.)
Two or three doses should be given during
It is said that 20 minutes after the first dose, a pressing desire to urinate is experienced. The quantity of urine is abundant, and it becomes as limpid and as clear almost as water. The Kava, moreover, acts like a bitter tonic, is pleasant to take, stimulates the appetit., does not derange the digestive functions, and produces neither diarrhæa nor constipation.
PARKE, DAVIS & CO., Manufacturing Chemists.
A MONTHLY JOURNAL OF
MEDICAL, SURGICAL AND OBSTETRICAL SCIENCE,
CONTRIBUTIONS TO OBSTETRICS AND GYNECOLOGY.
BY THOMAS H. HAWKINS, DENVER,
( Continued from March Number.) In the March number of the MEDICAL TIMES I reported two cases of ante-displacement, treated by the Gehrung pessary, of whom wore the pessary for more
than one year
without any inconvenience, and with complete relief from all the symptoms which usually accompany an aggravated case of anteversion. This instrument was worn without her knowledge, and during this time she married and became pregnant. Most assuredly I do not approve of the wearing of pessaries by patients without their being made aware of the fact, and also thoroughly familiarized with the mechanism of their insertion and removal For the particulars therefore of these cases, the reader is referred to the March number of the TIMES.
The object in view when reporting these cases was more especially to call attention to the value of the Gehrung pessaries in the treatment of certain cases of anteversion and anteflexion of the uterus, and these two were selected from a number of others because they best illustrated the ease and length of time this instrument may be worn with perfect safety, and benefit to the patient.
Since reporting these cases another patient whom I saw for the first time, August, 1881, and had not seen since November 13, 1881, called at my office March 10, 1883, to see, as she said, about her support, if it was all right. She had experienced no inconvenience from it whatever,
and had been perfectly well since her last visit to my office. A few weeks ago, however, she noticed more discharge than usual. Fearing that the support, which had not been looked after for more than a year, might be the cause, she tried to remove it, but not having had explained to her its method of removal, she failed. The history of her case in brief is as follows : She was twenty-two years old when first seen, and not married. Anteflexion was diagnosed, and a Gehrung pessary inserted. Considerable difficulty was experienced in fitting and adjusting this instrument. I saw her several times after I had succeeded in getting a pessary properly shaped, and so adjusted that it would stay in place, the last time in November, 1881, and requested her to call again in three months, or sooner if she had trouble; but this was the last I saw of her until a few days ago, at which time I made an examination, and found the instrument and uterus in proper position, and the anteflexion was in a measure corrected. The pessary had produced no local trouble or disturbance, except a slight ulceration on the right side of the cervix, at the vaginal junction, and this doubtless gave rise to the discharge referred to by the patient.
Generally speaking, the Gehrung pessaries have not received the attention that they deservedly should, nor has Dr. Gehrung received the honor and credit which he so justly merits, and more especially is this true in Denver, his old home, where doubtless he first conceived the idea of his antedisplacement pessaries, Dr. Gehrurg, in a paper published in the St. Louis Medical and Surgical Fournal, July, 1877, says: “ Under the heading of 'A New Anteversion Pessary,' I read a paper before the Territorial ( now State ) Medical Society of Colorado, about four years ago, which was published in that Society's Transactions for the year 1873, simply describing the instrument, expecting that everybody would see its properties at a glance, as I had become aware of them through several years' trial. But I was disappointed in my expectation,
' as but very few took cognizance of it. Since my removal to St. Louis, I have shown it and demonstrated its qualities to a number of eminent gynecologists, both of this city and New York, and, as I have cause to believe, it operated to their perfect satisfaction. It is not a modification of any of the pessaries which have ever come under my observation, although in its present state it appears much like a modified Hodge's bow pessary, particularly as it can be made of the substance of the latter, The result has been obtained by tedious and numerous experiments and alterations, until it appears in its present simplicity."
It is claimed by an eminent gynecologist of New York, that Dr. Gehrung was not the inventor of this instrument. Now, whether this be true or not, there has never been any mention or reference made in re
gard to this pessary prior to the time Gehrung first called the attention of the medical profession to it, in any medical literature, so far as I can ascertain. This much is certainly true, that Gehrung was in ignorance of any such an instrument being or ever having been in existence, and he was the first to call the attention of the medical profession to it, as well as the first to demonstrate its use and value in the treatment of that class of cases for which it was invented. We have not an anteversion or flexion pessary that will meet all the requirements of such an instrument. But of all the pessaries at present in use or a:lvertised, the Gehrung is better adapted to a larger class of ante-displacements than any other one, and in my judgment than all the rest combined. What I have claimed for this instrument would be more generally admitted and appreciated by physicians if they were more familiar with the instrument itself, and its method of usage.
I have in mind at present a physician who was so ignorant of the mechanism involved in the removal of this pessary, which had been inserted by another physician, as to require a uterine probe bent around the arm of the instrument, in order to extract it from the vagina, great force being used with considerable damage to the patient, and then, to conceal his ignorance from the woman, made this assertion : “ The doctor who would use that kind of a shaped pessary did not know much.” This physician certainly did not understand the correct principles upon which anteversion pessaries are constructed. A pessary to meet the requirements of an anteversion or flexion must draw the cervix forward and tilt the fundus backward, and it must do this by an upward expansion of the anterior vaginal pouch, without distending the posterior pouch of the vagina ; this the Gehrung pessary does when it is properly inserted. Paul F. Munde, in his work on Minor Surgical Gynecology, p. 333, concerning this instrument says: “ The best anteversion pessary therefore, in my opinion is that of Gehrung, the double "horse shoe' pessary.” On the same page he says, after describing its method of insertion, etc., "Obviously there can be
, no anteversion when this pessary is properly fitted."
In regard to the position which this pessary assumes or occupies when in the vagina, properly adjusted, Gehrung and Munde are not agreed. "Gehrung describes the pessary as resting with its whole lower arch on the floor of the pelvis, and the uterus reclining against its superior curve.” (Munde.) The above gives a very imperfect idea of the position of the pessary in the vagina, as really described by Gehrung. Munde further says: “But my experience, and it has been quite large since I reaily learned from the inventor himself
how to use this pessary properly, is that the pessary rests, as already described *
and therefore stands more upright, whereby it elevates the an
terior pouch still more; the uterus then leans against the whole superior arch, not within, as Gehrung's draws.” The truth is that the pessary, no matter whether inserted according to Gehrung's views or Munde's, will assume the same position, but if the beginner attempts to follow Munde's description, when adjusting this pessary, he will have much more difficulty than he would if he proceeded according to Gehrung.
If the patient be placed in Sims' position and Sims' speculum used, the pessary, will apparently be in the position described by Munde, but if examined digitally in dorsal or standing position it will appear as described by Gehrung.
I think that possibly the pessary may stand more upright than would appear from Gehrung's drawings and cuts, but the uterus certainly does rest within and against the superior arch. The advantages claimed for this pessary by its inventor and others, are the following:
“First. —That there are very few cases of anteversion, if any, that can resist its action, when well fitted, unless there are adhesions of such firmness that the pressure necessary to overcome them would cause mortification or ulceration, or when the vagina is so relaxed or the perineum so lacerated that it canno: find a hold. A slight degree of laceration does not interfere.
Second. --That it has no fixed points of resistance, but is supported everywhere, and necessarily allows perfect freedom of motion to the womb.
Third.—That the patient is unconscious of the presence of an instrument, except by the relief she experiences.
Fourth.--That it is as simple as can be desired, there being no mechanism or complications about it that may catch or injure the vaginal mucous membrane; nor unnecessary weight.
Fifth.— That it is inelastic, and therefore under the perfect control of the operator.
Sixth.— That it consists of such material that it can easily be modified to suit the particular cases.
Seventh.— That it does not interfere with the marital relations.
Eighth.—That it is easily introduced and removed, and even by the patient herself, and that the largest size can be introduced through the same aperture as the smallest, and
Ninth.—That it causes no obstruction to the rectum, or the bladder, nor sensible pressure anywhere else ; in fact, if I can trust to my observation and that of others with this instrument, it is perfect in its working and simplicity.
Its Uses : -Besides its use in anteversion, it renders great service in some cases of anteflexion. Cystocele caused by anteversion or anteflexion can frequently be removed, together with the uterine deviation. Exter