DILATATION OR DIVISION OF THE CERVIX UTERI.

440 head Obstetrical Society is the and most commend.able :-

following,

which is sensible

" That any members of this Society having a, dispute on any of professional etiquette, and agreeing to abide by the decision of the Society, may, through thesecretary, call a r special general meeting for the decision of the subject at issue.

subject

If this

putes,

an

example were generally followed in all medical good would be effected.

dis.

immense amount of

Correspondence. "Audi alteram

partem."

DILATATION OR DIVISION OF THE CERVIX UTERI.

lo 1. Dr. Gream condemns the whole process ; but I labqur o make it simple, safe, and efficient. If all operations are o be viewed from Dr. Gream’s stand-point, what single one in ,he whole range of surgery could bejustiiied ? I have the right to presume, from what Dr. Gream says, that ie never performed the operation, and never saw it done. Would it be just to condemn the operation of the extraction )f cataract because one of his friends became totally blind after it? Would it be sensible to preach against iridectomy oecause it was done too late to save the vision of another lear friend ? Vrould it be wise in him to repudiate the operation for vesico-vaginal fistula as now so successfully performed because some one may not have been cured by it, or may even have died in consequence of it ? From Dr. Gream’s own showing his opinion would be worth just as much on any one of these four great operations as on the others. He is quite as good authority on iridectomy as on hysterotomy; and no better on one than on the other. For he boasts that his knowledge is not gained by hospital experience, and he would not be likely to attempt such an operation as hysterotomy for the first time in his " matured private practice rather than in ,

"

To the Editor

of THE LANCET.

SIR,—I should perhaps thank the friends of Dr. Cream for calling his attention to my paper on Painful Menstruation, as the great object of all discussion is to elicit truth and establish correct principles of practice ; but if they had shown him the whole series, it might better have subserved the purposes in view. He seems to have misapprehended my paper. It was For dysmenoron painful menstruation, and not on sterility. rhœa dependent upon a contracted cervix, I said that incision was a safer and more permanent means of opening the cervical canal than bougies. From 1845 to 1856, like Dr. Cream, I pursued the method of Dr. M’Intosh, of Edinburgh, and found it most unsatisfactory

and unsuccessful, as most others have done. From 1856 to the present time I have practised, after my own plan, the operation of incision (which originated with Dr. Simpson), and I have great

hospitals.

Dr. Gream asserts that only " the more wealthy classes of society" want offspring, while to " other classes it is comparatively of less importance." I had thought that the wish for, offspring was a deep-rooted sentintent-a yearning desire wisely planted by God in the human heart, and not hidden away by Mammon in the balance-sheet of a bank account. Dr. Gream " repudiates tampering with the virgin uterus °’ under any but the most urgent So do I ; and so does every other honest man. But does Dr. Gream mean to say that he would make no efforts to cure a severe case of mechanical dysmenorrhœa simply because his poor sufferingpatient happened not to be married? If a young lady of twenty-five had a fractured thigh, would he object to have it properly set ?-or a dislocated hip, would he oppose its reduction because she was not married ? Assuredly Dr. Gream means no such nonsense. Shall I remind Dr. Gream of the motto that thrills the heart of every true Englishman when he looks upon the proud escutcheon of his great country-" Honi soit qui mal y pense ?" The words, Sir, of Dr. Gream’s strictures were directed at me, but their animus evidently was not. I do not think it exactly fair in Dr. Gream to take me for a text, and then begin to lash right and left at "certain practitioners,"and thus compel me to their defence. If Dr. Gream means by " certain practitioners" Dr. Simpson, he ought to have had the and theindependence to say so. Dr. Gream is wrong in his strictures as applied to me or my practice. If he is right to Dr. Simpson, he has been wrong to’ smother the truth so long, merely to blaze forth now with such a torrent of virtuous indignation. But I have still the hopeindeed expectation-of seeing Dr. Gream change his mind Like all sensible men, heis on the subject of this operation. open to conviction, and even to conversion. I once opposed, and very firmly too, the operation of ovariotomy. I was then practically as ignorant on the subject as Dr. Gream now is on hysterotomy. Enlarged experience changed my views, and I have for a long time advocated and practised it with success, and am not ashamed of the change. Even Dr. West—recognised, not only at home, but on the Continent and in my own I country, as one of the highest authorities of this age on the diseases of women-has modified his viewson ovariotomy, and that without detriment to his deservedly great reputation But to bring the thing a little nearer home to Dr. Gream, let me remind him that in 1849 Dr. Gream wrote one of the most intemperate and violent philippics against anaesthesia, in midwifery that can be found in the English language; that Dp; Gream afterwards learned better; new lights rose up before him ; the scales fell from his eyes ; he became first the private advocate of anaesthesia in midwifery, and afterwards wrote publicly in its defence. This is noble and praiseworthy, and all that can now prevent Dr. Gream from advocating hysterotomy in proper cases, when properly performed, will be th want of opportunities of seeing the operation and observing its

suffering."

to be satisfied with it. In some cases of dysmenorrhœa it has failed to do permanent good, while great numbers have been cured by it, and in many of cases it has been followed by conception. Dr. Gream says he has seen but one case of conception following incision ; and in that the cervix was split so widely open that a miscarriage resulted in consequence. How far Dr. Gream was instrumental in provoking the miscarriage by thrusting his finger up into the cavity of the uterus to explore its contents, I leave to his own consideration. I take it for granted that he is too good a physiologist and too good an accoucheur to be ignorant of the influence of such a proceeding. But whether Dr. Gream provoked the miscarriage or not, does not in the least affect the question of too largely cutting open the cervix. I have never seen such a result after my method of operating, and Dr. Emmet and myself haveperformed it more than five hundred times. But I haveseen one case of large fibroid of the uterus since I came to London, in which the canal of the cervix had been opened to a frightful extent by the metrotome caché, an instrument to the employment oi which I object for reasons which I have already stated. This is certainly one of the dangers of this method of operating, and those who employ it should thank Dr. Cream for calling their attention to it. But it would be more philosophic to avoida wholesale condemnation of a useful operation because some ont has made a mistake in its performance. According to my plan o: operating by cutting from the os tincæ upwards, this accidem cannot happen. The only trouble with me is to keep th( mouth of the womb open enough, as I have already sufficienth explained in my papers. Dr. Gream speaks of Sir Benjamil Brodie’s division of the mucous membrane of the femaleurethra for the extraction of stone ; and draws an analogy between thi and the bilateral incision of the cervix uteri, concluding tha both must contract alike, although the one is left to the unaide( efforts of nature, while the other is not. Thus we see Dr. Grean objecting to the incision of the cervix uteri, partly because i may open it so largely that it becomes possible to produce at results. abortion by pushing the finger forcibly through this canal int. Dr. Gream volunteered a little friendly advice to me, in the cavity of the womb ; partly because the canal may contrac winding up his strictures against " certain practitioners." Ia again and prevent, as before, the spermatozoa from passing t the same spirit I will now tender him a little counsel. When the uterine cavity; and very obviously, because it was origi Dr. Gream wishes to criticize the views of Dr. Simpson or any nated by "certain practitioners." He cannot recognise th one else, let him do it frankly and candidly, and not by in, possibility of the operation ever reaching the happy medium uendo. If he wishes to criticize mine, I, like Dr. Gream, am and making the canal neither too large nor too small. Di open to conviction; but I protest against being made answerGream inveighs against certain accidents of the operation. S for " instruments so rudely forced through the canal

reason

manliness in their application the

’.

able

441

[cervical]

that acute

symptoms

have

followed,"

and for

APOTHECARIES’ HALL.- The

following gentlemen

"pieces of metal fixed in the uterus, which had remained there passed their examination in the Science and Practice of Mediin some instances for days, and in others for longer periods, cine and received certificates to practise on the 13th inst. :-

while inflammation was set up and abscess resulted ;" and for "sixty instrumental introductions, with the view to remove dysmenorrhœa.’’Such practice is in imitation of Dr. M’Intosh and Dr. Gream. Let Dr. Gream, then, correct the evils of his

teachings and the blunders of his tainly I am not responsible for them. own

own

followers,

for

cer-

I am. Sir. vours faithfullv. J. MARION SIMS. Bolton-row, May-fair, April 10th, 1865.

DRS. WATSON AND GILLESPIE IN REPLY TO MR. SYME. To the Editor

of THE

LANCET. SIR,—I regret to see that Mr. Syme, in his letter of the 10th inst., makes no anaerade honorable for the unauthorized publication of a summary of his colleagues’ cases in his previous letter of the 23rd ult., for I feel confident, that had anyone ventured to take like liberties with cases under Mr. Syme’s care, both he and the profession generally would have thought that he had been treated with but scant courtesy. In stating what he believed to be the results of the employment of acupressure in the Edinburgh Infirmary, I must also express my regret that Mr. Syme, in publishing with the imprimatur of his name a summary of cases under the care of his colleagues, should have to acknowledge that he proceeded only upon the authority of a resident medical officer instead of that of his colleagues themselves, from whom he might have ascertained the facts at any time, as his duty brought him to the hospital daily at the same hour as that of their visit. Mr. Syme would seem to palliate his reference to these cases upon the ground that they had already been publicly quoted as evidence of his hostility to improvement. I have sought in vain for any such publication of my cases, and I acknowledge that I am at a loss to understand how any cases of mine, which were never seen by Mr. Syme, could be employed to afford evidence of such a kind.-I am. Sir. vours &c..

PATRICK HERON WATSON. Charlotte-square, Edinburgh, April 14th,

1865.

To the Editor of THE LANCET. SIR,—I am very sorry indeed to find that Professor Syme considers an anonymous article in a newspaper, containing a cursory allusion to my acupressure cases,-for which I am in no way responsible, and which I am not prepared to justify,sufficient ground for breaking through the first principles of etiquette. I would most willingly have given him all the information he required, had I been requested to do so ; and I cannot help feeling hurt that Prof. Syme, with whom I have always been on a friendly footing, and for whom I entertain the greatest respect, should have thought the observations and opinions of his house-surgeon, who has no connexion whatever with my wards, sufficient for his purpose. I am. Sir. vour obedient servant. JAMES D. GILLESPIE, M.D., F.R.C.S.E., Edinburgh, Apl’ll17th, 1865. Surgeon to the Royal Infirmary.

Medical News. ROYAL COLLEGE

OF

SURGEONS

OF

Birtwell, Henry Hargreaves, Blackburn. Edwards, Henry Nelson, Finsbury-square. Megget, Archibald, Scarborough.

AsAssistants:Barrett, Charles Henry, Bristol. Emmott, Christopher, Gray’s-inn-road. The following gentlemen also on the same day passed their first examination :Leverton, Edward James, St. Bartholomew’s Hospital. Mule, Philip Henry, St. George’s Hospital. Smith, Henry Cecil, Guy’s Hospital.

ST. THOMAS’S HOSPITAL.-At

a

full

meeting

of the

governors of this institution, held on the 19th inst., Mr. was re-elected Senior Surgeon by a very large majority.

To

Solly

Correspondents.

COURT OF ARBITRATION. A CORRESPONDENT, with the signature of J. B., suggests that the Medical Council should establish a Board of Arbitration to settle disputes amongst practitioners. He recommends that they should be assisted by an eminent Queen’s Counsel, and that they should be paid liberally for their services. There are so many objections to this proposition that we do not publish the communication of " J. B." in fall. Very few of the disputes between medical practitioners involve questions of law, and would be usually settled far more satisfactorily by arbitrators appointed in the locality in which the dispute originated. By this not only would expense be avoided, but the facts would be more likely to be impartially adjudicated upon. The Western Times.—We are obliged to our correspondent for the paper which he sent us. The contest seems to have been creditably spirited, and While there is we congratulate the successful candidate and his friends. nothing in the facts calling for more special notice from us, we can well understand they have local interest and significance. F. A. G., M.D., (Faversham.)—There is no definite rule. The new-comer, however, generally calls upon the residents, who are naturally expected to return the courtesv. THE GRIFFIN TESTIMONIAL FUND. To the Editor ofTHE LANCET. SIR,—The following subscription has been further received on behalf of the above Fund :Richard Wilding, Esq., Church Stretton RO 5 33 Amount previously announced 123 6 0 0 Received at THE LANCET Office 9 9 Yours obediently, ROBERT FOWLER, M.D., Treasurer and Hon. Sec. 145, Bishopsgate-street Without, April 20th, 1865. ......

............

............

Mr. Dudley, (Over Wineford, Cheshire.)-Though the statement made may be perfectly correct, and we have no reason to doubt it, it could not be published in its present form. There are, however, means, which will, no doubt, suggest themselves to our correspondent, of making the facts known in quarters where a knowledge of them is likely to be advantageous to the profession. A Constant Couutry Subscriber and Surgeon.—Dr. Brown-Séquard is not at present in England. He is, we believe, on a visit to Paris. F. should consult the article "Variola" in Dr. Copland’s Dictionary. WE regret, for the sake of Mr. Arthur Sargeant, that his letter betrays so much passion and so little self-respect. T. B.—If the person alluded to can be proved in three distinct cases to have practised as an apothecary, the Society at Blackfriars would sanction a prosecution in their name. The Medical Act affords no protection whatever.

ENGLAND.-The

following gentlemen passed their Primary Examinations in Anatomy and Physiology at a meeting of the Court of Examiners on the 12th inst., and when eligible will be admitted

to the pass examination:Bell, J. H., King’s College. Loane, Thomas, London Hospital. McLean, E. H., St. Barthol. Hospital. Bernard, D. E., Bristol. D. St. Barthol. Boulton, F., Hospital.. Moore, R. B., St. Barthol. Hospital. Burn, W. B., St. Barthol. Hospital. Molecey, 0. T., King’s College. i Parsons, F. W., King’s College. Bush, J. D., Newcastle. Cant, W. E., St. George’s Hospital. Pattinson, H. B., St. Barthol. Hospital. G. Canton, A., King’s College. Quick, John, St. Barthol. Hospital. Dalton, B. N., Gny’s Hospital. Renshaw, Bernard, St. Bartholomew’s Elliott, A. B., Guy’s Hospital. ; Hospital. Evans, A. G., Middlesex Hospital. Ridge, J. J., St. Thomas’s Hospital. E. J. St. Barthol. Hospital.. Sawyer, James, Birmingham. Finch, M., Fisher, George, Leeds. ; solely, S. E., St. Thomas’s Hospital. Haynes, F. H, St. Barthol. Hospital. Stainthorpe, T. E., Middlesex Hospital. Holmes, F. A , St. Mary’s Hospital. Strange, T. W., Liverpool. Hyde, J. K , Charing-cross Hospital. Tindal, W. R., St. George’s Hospital. Ireland, Edward, King’s College. Wi’son, H. G., St. Barthol. Hospital. Kemp, W. G., St. Barthol. Hospital. Wright, R. T, King-’s College.

A CASE FOR A COURT-MEDICAL. To the Editor of THE LANCET. SIR,—I ask your advice in the following case:—I have been attending along with my colleague, Dr. Kirk, a labuurer, sunering from compound fracture of leg and simple fracture of arm, for the last fortnight, and all seemed going on well, when a few evenings ago a man presented himself at and told me he did not wish our attendour surgery, with our splints, &c., The man ance any longer, as the relations had employed another doctor. refused to assign any reason for such conduct, nor would he tell me what medical man had been called in. On making inquiries, I have since ascertained that Dr. Munro had charge of the case, and that he had actually visited the patient during the time we were attending, when he persuaded the patient and his friends that the leg was " all wrong." Now, from the date of the accident up to that time neither the patient nor any of his relations ever expressed the slightest dissatisfaction, although on one occasion a neighbour brought a local bone-setter, who, of course, tried to persuade him his leg required re-setting ; but this the patient refused. Now it seems the logic of this Dr. Munro has been more efficacious than that of the bone-setter. I have asked the advice of several members of the profession here; but as none of them had ever heard of such a case, and as we unfortunately have no Medical Society to lay the case before, they all recommended me to ask your advice, and that of the profession through THE LANCET.—Yours, &c.,

West Hartlepool, Durham, April, 1865.

S.

GOURLEY,

M.D.