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AUGUST AT HOME AND ABROAD.
THE FORMATION OF AN ARTIFICIAL VAGINA.
769
France’s hereditary foes, the Royalarea of the rectum is excised for the purpose of lining the is now proven by a document in thenew vagina there is no difficulty, as a lule, in drawing down Calendar of,Patent Rolls, Henry VI., II., p. 604, whereinthe upper end of the bowel to the anus and so restoring its The fact that the new canal is entirely lined a letter of naturalisation according the right of residence bycontinuity. permit of the King is granted to"delecto "nobis Thome ’with mucous membrane does away, to a very large extent, with the difficulty of keeping it open, and its tendency to Franc Magister in Medicina de Grecia oriundo." contract is much more readily dealt with. As a general no attempt should be made to create an artificial vagina rule, THE FORMATION OF AN ARTIFICIAL VAGINA. in a case of absence of this canal in an unmarried girl, but THE numerous plastic operations which have been performed by different surgeons for the formation of an artificial in the cases which occur from time to time in which a woman has married without being aware of her defect such vagina are nearly all unsatisfactory, since it is almost im- an operation as that devised by Schubert might be quite possible to prevent the subsequent shrinkage and closure of justifiable. the’new canal. The attempts that have been made to cover the raw surfaces with flaps of skin or of peritoneum or by AUGUST AT HOME AND ABROAD. skin-grafting have proved disappointing. In order to overAUGUST of last year set up a record for heat in this come these defects Gersuny devised and practised a method and August of this year broke the low temperature country, of covering the anterior surface of the newly formed vaginal record. August of 1911 was also very bright and dry, while canal with an excised portion of the mucous membrane of the past month was one of the dullest and wettest ever the anterior rectal wall, the defect in the rectum being known. The lack of sunshine and the persistent rain, like closed with sutures, and in some cases the raw posterior wall the low temperature, were not confined to one part of the This of the new vagina being covered with skin-grafts. but were very, general, although, owing to the is not the formation of a kingdom, infrequently followed by procedure disastrous downpour in East Anglia on the 26-27th, that recto-vaginal fistula, and this is not surprising when we district had a greater excess of rainfall than any other part remember that the septic surface of the rectal mucous memof the country. Over these islands as a whole there were brane is in contact with the raw surface of the posterior five or six days without more or less rain, and in some wall of the new canal. For this reason, and because only localities only two or three. In the metropolitan area there even by this method subsequent shrinkage is not prewere no more than five days without a measurable quantity, vented, the operation cannot be considered to be a and the total 5’22 in., amounted to 3-0 in. satisfactory one. The latest - development in this, more than the fall, normal. At Bath the total fall was branch of surgery has been the utilisation of a loop of 1 in., and exceeded the average as much as 6.1 , intestine to form the lining of the new canal. In spite of at Aberdeen it was 4.8in., or the perfection to which abdominal surgery has attained at by 3’3 in., while above. At 1.8 in. where the August average Newquay, the present time, it is obvious that such a procedure, the aggregate figure equalled 7-4 in., is not known, involving as it does the opening of the abdomen, the excision of a suitable portion of the small intestine, and the union of at Brighton it was 6’4 in., an excess of 4 in., at Jersey the divided ends, must entail a considerable amount of 7’7in., 5-2 in. in excess, at Buxton 8-1in., 3.55 in. in excess, and at Harrogate 6’2 in., against an average of danger to the patient and is not to be lightly recom- 2’ 8 in. In some parts of East Anglia, especially round mended. With a view to avoiding these dangers Schubert has devised an operation (described in Zentralblatt für Norwich, the excess was far greater ; at Yarmouth the total in which he makes use of a portion of fall was 8.22 in., being 5’ 8 in. more than the normal; and the lower end of the rectum as a lining for the vagina. The nearly as much as is usually yielded by the four months May to August. The rain in the east of England was all Illew vagina is formed in the usual manner by dissection the more remarkable owing to the fact that the counties between the rectum and the bladder. The rectum is then of Norfolk, Suffolk, and Essex are, on the average, divided circularly immediately above the sphincter ani and the driest in the kingdom. Along the northern seaboard separated from its surroundings for about 3 cm., the of France the weather was only a little less rainy sphincter being left uninjured. With the patient in the than in the south of England, and Belgium was almost lateral position an incision is then made over the coccyx as great a sufferer. At Brussels rain fell on 20 days and that bone excised. The rectum is separated from its and of 2 in. ; and at Paris, where a total 5.2 gave attachments for a distance of about 12 cm. from the anus, care there were 18 days with rain, the total was 3’2 in. being taken not to open the peritoneum. The bowel is then divided between two clamps, and the upper end of the lower The excessive rains, except in East Anglia, have been portion closed by sutures and attached by means of a equalled once or twice in the preceding 40 years, but the couple of catgut sutures to the pelvic fascia so as to maintain temperature was the lowest on record over the greater yt in position. The lower end of the separated portion of the portion, if not of the entire country. In the metropolitan rectum is then drawn down into the newly made vagina and area the very moderate reading of 700 in the shade was only uriited by sutures to the margins of the vulvar orifice. The reached on one day, the 4th, and on most of the others the - eut end of the proximal part of the bowel is also drawn down maximum warmth was about 650 or less, sometimes only The average afternoon was nearly 60 cooler and sutured to the divided portion of the rectum just above 600 or 59°. than an ordinary August, while it was about 12° during the sphincter so as to restore its continuity. Healing, as a than cooler during the corresponding month of last year. rule, takes place readily, and as there is no interference The temperature of the night showed less divergence from with the sphincter beyond stretching it there is no tendency the normal, being about 3½° in London. In Scotland, where to incontinence of faeces. This operation has now been there was but a feeble attempt at summer even during the successfully performed in a small number of cases, and few hot days experienced in England in July, there were few while it is not without its drawbacks it seems to form the At with an afternoon warmth higher than 60°. best solution of the difficulties attending any attempt to days the and Aberdeen was the maximum 63°, form an artificial vagina. Jt .certainly avoids the dangers highest incidental to the excision of a portion of the small intestine thermometer only rose above the 600 mark on three through the abdomen, and provided that not too large an other occasions. At Kew the mean maximum temperature was 64°, and the same figure was experienced 1 No. 28, 1911, at Bath, and the mean minima for the two places were 50½° p. 1917, and No. 7, 1912, p. 198. Court
family
physician to of England,
-
,
, ,
!I !I
I
,
,
Gynäkologie1)
A NATURAL CORRECTION OF MYOPIA.
770
In the south-west of England the At Newquay there was no higher cooler. days the and than 63°, nights, although less cold than in reading other parts of the kingdom, were much colder than during At Newquay the mean minimum was an average August. about a degree higher than at Kew. On the Continent a large area was relatively cooler than England, especially the north of France. At Paris there was not a single temperature as high as 80°, and the thermometer only ascended above 70° on six afternoons. The mean maximum was 4° higher than at Kew, and the mean minimum temperature 1° higher. Similar conditions occurred at Brussels, the mean maximum temperature being 660 and the mean minimum 51°, while at Berlin the mean maximum was the same as at Paris and the mean minimum 540. It would probably be impossible to find any preceding August when the thermometer at Paris failed to touch The the 800 mark at least once during the month. the Atlantic, which were the cyclonic disturbances from direct cause of the unsettled weather, followed each other so quickly that the intervals between their going and coming were too short to allow much chance of sunshine, and the records over all parts of the kingdom were consequently deplorably low. Over a large area in the west, midlands, and north the total duration of sunshine for the month was between 70 and 80 hours, or not much more than two hours daily, and of this a considerable part occurred between 6 and 8 A.M. when the sun’s heat is the least effective. In no district on the mainland was the total much above 100 hours, and the London area received about the same amount as the south coast. At Kew the figure was 108 hours and at Brighton 109 hours. The respective averages for the two places are 188 and 218 hours. At Bath the total was only 94 hours, at Newquay 73, and at Aberdeen 72 hours. Over the kingdom generally the sun shone only about half as many hours as during an average August. At Jersey, where the average is 243 hours, the total was no more than 137 hours, and at Margate, where there should have been 197 hours, there were only 89. The cloudy condition extended far to the southward and eastward of these islands. At Paris the sun could only shine during 119 hours, and throughout the northern half of France and in Belgium and Holland a cloudless day was very seldom experienced. The summer as a whole has been remarkable for the number of cyclonic disturbances, nearly all of which have arrived from the westward or south-westward ; and during the three months, June, July, and August, the only period at all settled was about a week in the middle of July.
and
49½o respectively. were
even
pressure effects of the
superior oblique. On another page ingenious application of the old
(p. 787) publish theory of muscle pressure which we
an
we believe to be new. Dr. 1. B. Muirhead supposes that pressure can be exerted by the combined action of the recti, and the suggestion is quite in accord with what we know of the synergic activity of opponent muscles. Hecontends that by this action the globe is deformed so that the antero-posterior diameter is diminished, the myopia being thereby more or less completely neutralised. The theory is well worthy of consideration, though we cannot accept it without further evidence. It appears to us that there are several difficulties to be explained away. The eyeball is nearly spherical, and the intraocular pressure is evenly distributed throughout its contents; hence any deformation which occurs must necessarily be very slight in the absence of definite weakIn myopia such weakness is ness of one part of the walls. doubtless present at the posterior pole, and if the posterior pole is sufficiently supported by the orbital contents slight deformation may occur. Whether in such low degrees of myopia as two or three dioptres the plasticity of the posterior pole is adequate to produce the necessary deformation, it being admitted for the sake of argument that the external support suffices, is a question which we cannot answer on. the available data. There are other points in Dr. Muirhead’s letter which will arouse criticism, but they all stimulate thought which will serve to elucidate a difficult problem.
QUOTATIONS FROM "THE LANCET." AGAIN we must protest against the objectionable and unfair practice adopted by some advertising firms of using quotations from THE LANCET without preserving the sense of the context. In our critical notices of foods, drugs, and medical appliances which are published from time to time for the guidance of our readers, we make it a rule of dealing with these things in an impartial manner, discussing not only their merits (if any) but their demerits (if any) also. Often, however, the quotations imply that we have written. nothing but words of praise, whereas a reference to the context will reveal that in a great number of instances this is not the case. An instance of this appears in advertisements of "Vitæ Ore"which are circulated from time to time. The statement used here was : "THE LANCET says,. ,the clinical results were satisfactory.’"" It is perfectly true that THE LANCET did use these words, but it said a great deal more, as will be seen from the original notice (THE LANCET, March 25th, 1899, p. 844), which we
reproduce :This preparation is regarded asa valuable and import-ant discovery.’ The discovery amounts to a recognition of THE effect of the pressure of ’the extrinsic ocular muscles the fact that ore containing pyrites or native sulphide of as a factor in the development of myopia has long been a iron gradually oxidises in moist air into proto- and persubject of discussion amongst ophthalmologists. The early sulphate of iron. To the presence of these salts theview that near work was deleterious on account of medicinal value of the powder is attributed. Cold water accommodation is now regarded as erroneous since it has readily extracts both the per- and proto-sulphate of iron. to our analysis the ore yields 13-20 per cent. of been shown that the accommodative act does not affect the According ferric sulphate and 3’9 per cent. of ferrous sulphate. Iron intraocular pressure. There is no doubt, however, that the in these forms is not usually prescribed, being regarded as extrinsic muscles cause a rise of intraocular pressure unsuitable and leading frequently to digestive disturbance’ during their activity, and the deleterious effect of near and decidedly constipating effects. The ore further conwork is now attributed to the act of convergence on this tains unaltered sulphide of iron and free sulphur and & basis. On the other hand, the effect of increased pressure large residue of silicious matters, and presents in fact alL the appearances of the crushed ore obtained from goldin the young eye is to produce the condition known as bearing quartz. The clinical results obtained were satisbuphthalmia, which differs, widely from ordinary myopia. factory, but the preparation showed no superiority over If, however, we presuppose that the eye which has a ’ Blaud’s pills’ or other remedies used in the treatment of hereditary tendency to myopia, whilst otherwise normal, has anaemia." A NATURAL CORRECTION OF MYOPIA.
"
inherent weakness of the walls at the posterior pole, a not incredible conjecture, we have all the factors for the development of the anatomical conditions which are found in myopic eyes. Stilling’s theory lays great stress on the
an
In the advertisements referred to there is not even the indication of a context, which in this case, as in others, containsan important qualifying clause. We are informed that it is doubtful if we have any legal remedy for this sort of abuse of
769
France’s hereditary foes, the Royalarea of the rectum is excised for the purpose of lining the is now proven by a document in thenew vagina there is no difficulty, as a lule, in drawing down Calendar of,Patent Rolls, Henry VI., II., p. 604, whereinthe upper end of the bowel to the anus and so restoring its The fact that the new canal is entirely lined a letter of naturalisation according the right of residence bycontinuity. permit of the King is granted to"delecto "nobis Thome ’with mucous membrane does away, to a very large extent, with the difficulty of keeping it open, and its tendency to Franc Magister in Medicina de Grecia oriundo." contract is much more readily dealt with. As a general no attempt should be made to create an artificial vagina rule, THE FORMATION OF AN ARTIFICIAL VAGINA. in a case of absence of this canal in an unmarried girl, but THE numerous plastic operations which have been performed by different surgeons for the formation of an artificial in the cases which occur from time to time in which a woman has married without being aware of her defect such vagina are nearly all unsatisfactory, since it is almost im- an operation as that devised by Schubert might be quite possible to prevent the subsequent shrinkage and closure of justifiable. the’new canal. The attempts that have been made to cover the raw surfaces with flaps of skin or of peritoneum or by AUGUST AT HOME AND ABROAD. skin-grafting have proved disappointing. In order to overAUGUST of last year set up a record for heat in this come these defects Gersuny devised and practised a method and August of this year broke the low temperature country, of covering the anterior surface of the newly formed vaginal record. August of 1911 was also very bright and dry, while canal with an excised portion of the mucous membrane of the past month was one of the dullest and wettest ever the anterior rectal wall, the defect in the rectum being known. The lack of sunshine and the persistent rain, like closed with sutures, and in some cases the raw posterior wall the low temperature, were not confined to one part of the This of the new vagina being covered with skin-grafts. but were very, general, although, owing to the is not the formation of a kingdom, infrequently followed by procedure disastrous downpour in East Anglia on the 26-27th, that recto-vaginal fistula, and this is not surprising when we district had a greater excess of rainfall than any other part remember that the septic surface of the rectal mucous memof the country. Over these islands as a whole there were brane is in contact with the raw surface of the posterior five or six days without more or less rain, and in some wall of the new canal. For this reason, and because only localities only two or three. In the metropolitan area there even by this method subsequent shrinkage is not prewere no more than five days without a measurable quantity, vented, the operation cannot be considered to be a and the total 5’22 in., amounted to 3-0 in. satisfactory one. The latest - development in this, more than the fall, normal. At Bath the total fall was branch of surgery has been the utilisation of a loop of 1 in., and exceeded the average as much as 6.1 , intestine to form the lining of the new canal. In spite of at Aberdeen it was 4.8in., or the perfection to which abdominal surgery has attained at by 3’3 in., while above. At 1.8 in. where the August average Newquay, the present time, it is obvious that such a procedure, the aggregate figure equalled 7-4 in., is not known, involving as it does the opening of the abdomen, the excision of a suitable portion of the small intestine, and the union of at Brighton it was 6’4 in., an excess of 4 in., at Jersey the divided ends, must entail a considerable amount of 7’7in., 5-2 in. in excess, at Buxton 8-1in., 3.55 in. in excess, and at Harrogate 6’2 in., against an average of danger to the patient and is not to be lightly recom- 2’ 8 in. In some parts of East Anglia, especially round mended. With a view to avoiding these dangers Schubert has devised an operation (described in Zentralblatt für Norwich, the excess was far greater ; at Yarmouth the total in which he makes use of a portion of fall was 8.22 in., being 5’ 8 in. more than the normal; and the lower end of the rectum as a lining for the vagina. The nearly as much as is usually yielded by the four months May to August. The rain in the east of England was all Illew vagina is formed in the usual manner by dissection the more remarkable owing to the fact that the counties between the rectum and the bladder. The rectum is then of Norfolk, Suffolk, and Essex are, on the average, divided circularly immediately above the sphincter ani and the driest in the kingdom. Along the northern seaboard separated from its surroundings for about 3 cm., the of France the weather was only a little less rainy sphincter being left uninjured. With the patient in the than in the south of England, and Belgium was almost lateral position an incision is then made over the coccyx as great a sufferer. At Brussels rain fell on 20 days and that bone excised. The rectum is separated from its and of 2 in. ; and at Paris, where a total 5.2 gave attachments for a distance of about 12 cm. from the anus, care there were 18 days with rain, the total was 3’2 in. being taken not to open the peritoneum. The bowel is then divided between two clamps, and the upper end of the lower The excessive rains, except in East Anglia, have been portion closed by sutures and attached by means of a equalled once or twice in the preceding 40 years, but the couple of catgut sutures to the pelvic fascia so as to maintain temperature was the lowest on record over the greater yt in position. The lower end of the separated portion of the portion, if not of the entire country. In the metropolitan rectum is then drawn down into the newly made vagina and area the very moderate reading of 700 in the shade was only uriited by sutures to the margins of the vulvar orifice. The reached on one day, the 4th, and on most of the others the - eut end of the proximal part of the bowel is also drawn down maximum warmth was about 650 or less, sometimes only The average afternoon was nearly 60 cooler and sutured to the divided portion of the rectum just above 600 or 59°. than an ordinary August, while it was about 12° during the sphincter so as to restore its continuity. Healing, as a than cooler during the corresponding month of last year. rule, takes place readily, and as there is no interference The temperature of the night showed less divergence from with the sphincter beyond stretching it there is no tendency the normal, being about 3½° in London. In Scotland, where to incontinence of faeces. This operation has now been there was but a feeble attempt at summer even during the successfully performed in a small number of cases, and few hot days experienced in England in July, there were few while it is not without its drawbacks it seems to form the At with an afternoon warmth higher than 60°. best solution of the difficulties attending any attempt to days the and Aberdeen was the maximum 63°, form an artificial vagina. Jt .certainly avoids the dangers highest incidental to the excision of a portion of the small intestine thermometer only rose above the 600 mark on three through the abdomen, and provided that not too large an other occasions. At Kew the mean maximum temperature was 64°, and the same figure was experienced 1 No. 28, 1911, at Bath, and the mean minima for the two places were 50½° p. 1917, and No. 7, 1912, p. 198. Court
family
physician to of England,
-
,
, ,
!I !I
I
,
,
Gynäkologie1)
A NATURAL CORRECTION OF MYOPIA.
770
In the south-west of England the At Newquay there was no higher cooler. days the and than 63°, nights, although less cold than in reading other parts of the kingdom, were much colder than during At Newquay the mean minimum was an average August. about a degree higher than at Kew. On the Continent a large area was relatively cooler than England, especially the north of France. At Paris there was not a single temperature as high as 80°, and the thermometer only ascended above 70° on six afternoons. The mean maximum was 4° higher than at Kew, and the mean minimum temperature 1° higher. Similar conditions occurred at Brussels, the mean maximum temperature being 660 and the mean minimum 51°, while at Berlin the mean maximum was the same as at Paris and the mean minimum 540. It would probably be impossible to find any preceding August when the thermometer at Paris failed to touch The the 800 mark at least once during the month. the Atlantic, which were the cyclonic disturbances from direct cause of the unsettled weather, followed each other so quickly that the intervals between their going and coming were too short to allow much chance of sunshine, and the records over all parts of the kingdom were consequently deplorably low. Over a large area in the west, midlands, and north the total duration of sunshine for the month was between 70 and 80 hours, or not much more than two hours daily, and of this a considerable part occurred between 6 and 8 A.M. when the sun’s heat is the least effective. In no district on the mainland was the total much above 100 hours, and the London area received about the same amount as the south coast. At Kew the figure was 108 hours and at Brighton 109 hours. The respective averages for the two places are 188 and 218 hours. At Bath the total was only 94 hours, at Newquay 73, and at Aberdeen 72 hours. Over the kingdom generally the sun shone only about half as many hours as during an average August. At Jersey, where the average is 243 hours, the total was no more than 137 hours, and at Margate, where there should have been 197 hours, there were only 89. The cloudy condition extended far to the southward and eastward of these islands. At Paris the sun could only shine during 119 hours, and throughout the northern half of France and in Belgium and Holland a cloudless day was very seldom experienced. The summer as a whole has been remarkable for the number of cyclonic disturbances, nearly all of which have arrived from the westward or south-westward ; and during the three months, June, July, and August, the only period at all settled was about a week in the middle of July.
and
49½o respectively. were
even
pressure effects of the
superior oblique. On another page ingenious application of the old
(p. 787) publish theory of muscle pressure which we
an
we believe to be new. Dr. 1. B. Muirhead supposes that pressure can be exerted by the combined action of the recti, and the suggestion is quite in accord with what we know of the synergic activity of opponent muscles. Hecontends that by this action the globe is deformed so that the antero-posterior diameter is diminished, the myopia being thereby more or less completely neutralised. The theory is well worthy of consideration, though we cannot accept it without further evidence. It appears to us that there are several difficulties to be explained away. The eyeball is nearly spherical, and the intraocular pressure is evenly distributed throughout its contents; hence any deformation which occurs must necessarily be very slight in the absence of definite weakIn myopia such weakness is ness of one part of the walls. doubtless present at the posterior pole, and if the posterior pole is sufficiently supported by the orbital contents slight deformation may occur. Whether in such low degrees of myopia as two or three dioptres the plasticity of the posterior pole is adequate to produce the necessary deformation, it being admitted for the sake of argument that the external support suffices, is a question which we cannot answer on. the available data. There are other points in Dr. Muirhead’s letter which will arouse criticism, but they all stimulate thought which will serve to elucidate a difficult problem.
QUOTATIONS FROM "THE LANCET." AGAIN we must protest against the objectionable and unfair practice adopted by some advertising firms of using quotations from THE LANCET without preserving the sense of the context. In our critical notices of foods, drugs, and medical appliances which are published from time to time for the guidance of our readers, we make it a rule of dealing with these things in an impartial manner, discussing not only their merits (if any) but their demerits (if any) also. Often, however, the quotations imply that we have written. nothing but words of praise, whereas a reference to the context will reveal that in a great number of instances this is not the case. An instance of this appears in advertisements of "Vitæ Ore"which are circulated from time to time. The statement used here was : "THE LANCET says,. ,the clinical results were satisfactory.’"" It is perfectly true that THE LANCET did use these words, but it said a great deal more, as will be seen from the original notice (THE LANCET, March 25th, 1899, p. 844), which we
reproduce :This preparation is regarded asa valuable and import-ant discovery.’ The discovery amounts to a recognition of THE effect of the pressure of ’the extrinsic ocular muscles the fact that ore containing pyrites or native sulphide of as a factor in the development of myopia has long been a iron gradually oxidises in moist air into proto- and persubject of discussion amongst ophthalmologists. The early sulphate of iron. To the presence of these salts theview that near work was deleterious on account of medicinal value of the powder is attributed. Cold water accommodation is now regarded as erroneous since it has readily extracts both the per- and proto-sulphate of iron. to our analysis the ore yields 13-20 per cent. of been shown that the accommodative act does not affect the According ferric sulphate and 3’9 per cent. of ferrous sulphate. Iron intraocular pressure. There is no doubt, however, that the in these forms is not usually prescribed, being regarded as extrinsic muscles cause a rise of intraocular pressure unsuitable and leading frequently to digestive disturbance’ during their activity, and the deleterious effect of near and decidedly constipating effects. The ore further conwork is now attributed to the act of convergence on this tains unaltered sulphide of iron and free sulphur and & basis. On the other hand, the effect of increased pressure large residue of silicious matters, and presents in fact alL the appearances of the crushed ore obtained from goldin the young eye is to produce the condition known as bearing quartz. The clinical results obtained were satisbuphthalmia, which differs, widely from ordinary myopia. factory, but the preparation showed no superiority over If, however, we presuppose that the eye which has a ’ Blaud’s pills’ or other remedies used in the treatment of hereditary tendency to myopia, whilst otherwise normal, has anaemia." A NATURAL CORRECTION OF MYOPIA.
"
inherent weakness of the walls at the posterior pole, a not incredible conjecture, we have all the factors for the development of the anatomical conditions which are found in myopic eyes. Stilling’s theory lays great stress on the
an
In the advertisements referred to there is not even the indication of a context, which in this case, as in others, containsan important qualifying clause. We are informed that it is doubtful if we have any legal remedy for this sort of abuse of