Inaugural Address 
ON 
Obstetrics # Gynecology 
DELIVERED BEFORE THE 
UtijcMgan jitate ifocijetij, 
BY 
GEO. E. RHNNEY, D., 
LANSING, 
Hon. Member of the Mich. State Med. Soc.; Corresponding Member of the Detroit Medical 
and Library Ass’n; Hon. Member of the Pere Marquette Med. Soc.; Member of the 
American Med. Ass’n; Member of the British Med. Ass’n; 
Member of the British Gynecological Ass’n; 
Etc., Etc., 
AT ITS 
ANNUAL MEETING, HELD IN DETROIT 
JUNE 14 & 15, 1888. 
(Reprinted from the Transactions of the Society.)'- [Reprint from the Michigan State Medical Society, 1888. | 
ANNUAL ADDRESS BEFORE THE SECTION 
ON OBSTETRICS AND GYNECOLOGY. 
GEO. E. RANNEY, M. D., CHAIRMAN OF SECTION, 
Lansing. 
Ladies and Gentlemen: 
According to custom, and according to the order of business 
arranged by ;our executive committee, it becomes my duty to 
occupy your attention at this time; but with due regard for 
your patience and my own unfitness, I shall not burden you 
with an exhaustive, retrospective, advisory discourse, nor shall I 
attempt the difficult and extensive task of reconciling the con- 
flicting views and expressions of opinion concerning the many 
questions now on trial and which have been and are now being 
discussed in the journals, monograms and societies devoted to 
this rapidly advancing branch of medical knowledge. 
To submit to close analysis the whole range of the new and 
modifications of the older methods of obstetrical and gynecolo- 
gical treatment, and to scrutinize their manifold relations and 
define their respective merits, is a task calculated to appall a 
busy practitioner and unpretending writer. 
But it is well that at times men powerful in language and 
potent with pen, review, more fully than I shall attempt to do, 
the literature and practice of the day in certain branches—men 
who sift the wheat from the chaff, forcibly commend the many 
new and valuable theories demanding our recognition, and with 
equal force invoke censure upon the erroneous, yet fashionable, 
fleeting and evanescent, practices of the day. 
With no facile element of display, be mine the less laborious 
task of alluding, though in a somewhat cursory way, to a few 
of the practical (therefore, more important) principles of treat- 
ment which should engage the careful attention of the general 
practitioner, and upon the systematic knowledge of which, in 
many cases, may hang the issues of life and death, of disease and 2 
STATE MEDICAL SOCIETY. 
long suffering, of enervated vital energies, invalidism, and a 
weakened, exhausted constitution, which, if not destructive in 
its effects, renders women less able to resist disease to which 
they may be predisposed from hereditary tendencies and unfa- 
vorable environments. 
It may not be expected that, as a rule, the general practi- 
tioner will be able to cope with the many causes of pelvic 
troubles now made possible by surgery, but by a careful study 
of their pathology, and the prevention which thorough anti- 
sepsis affords, he should be able not only to prevent many, but 
to understand the condition which gives rise to others—such as 
the numerous reflex symptoms that uterine diseases produce,— 
and, at least, recommend the proper treatment, without subject- 
ing them to unsuccessful, and therefore harmful, medication. 
Trachelorrhaphy.—Emmet’s operation is no longer an exper- 
iment, nor the conditions requiring it obscure or difficult, as a 
rule, to recognize. Yet, how many women (perhaps reluctant 
to submit to the proper examination) go the rounds of medical 
treatment, and, after years of suffering and despondency, under 
the positive advice of able gynecologists are informed for the 
first time of the real seat of their disease. How many such 
women, suffering from hysteria, epilepsy, uterine paralysis, 
headache, menstrual trouble, disturbed vision, severe cough, lung 
disease, mental irritability, and other innumerable functional 
disturbances, have finally been, under skillful advice and treat- 
ment, restored to health by this safe, and by no means severe, 
operation. In Europe, at least in London and Berlin, it is not 
as popular as in this country, but in that I think we are in 
advance. 
I spent November and December, 1886, in the Woman’s 
Hospital of London, and saw nearly every operation made 
there during that time, without seeing Emmet’s operation per- 
formed once during that period. I spent October of the same 
year in Dr. Martin’s hospital, in Berlin, during which time the 
operation was not performed in that institution. Dr. Martin, 
however, frequently amputates a portion of the cervix, and by 
that means, I have no doubt, accomplishes nearly the same 
good effects that Emmet’s operation would; for, by the opera- GEO. E. RANNEY. 
3 
tion, the cicatricial tissue, which is, no doubt, a great source of 
irritation, is removed, and the revulsive effect and involution 
follow, probably, as in the former, and, as I believe, better, 
operation. In cases of subinvolution and extensive disease of 
the endometrium, Martin curretts the womb at the same sitting 
that he amputates its neck, and, maybe, performs Hagar’s 
operation on the perineum. I have often curretted the womb, 
made Emmet’s operation on the cervix, and Hagar’s on the 
perineum, at the same sitting. Notwithstanding all the fear 
that has been expressed concerning the use of the curette, I 
believe, with proper antiseptic precautions, in those cases where 
the womb is patulous, or following rapid dilatation of the womb, 
the operation is comparatively safe; at least, it has been so in 
my hands. I should have great dread of the operation, how- 
ever, following the use of tents. 
Dr. Reamy says: “Emmet’s operation for restoration of 
the cervix to normal conditions in cases where a manifest fis- 
sure exists, is, in my opinion, warranted upon the sole ground 
of prophylaxis against malignant disease, if upon no other.”* 
It is held by some, and I am very much inclined to the 
belief, that fissure of the cervix commonly exists before, and is 
the secondary, if not the direct and only, cause of epithelioma 
of the cervix. 
Perineorraphy.—Laceration of the perineum is often over- 
looked by the obstetrician and puerperum, and, if they do not 
omit to see and recognize the rent, regard it trivial and neglect 
the necessary steps to repair the injury. It is not uncommon to 
hear physicians say that they have never seen, in a somewhat 
extensive practice of midwifery, a lacerated perineum. It 
was but a few years ago that such a physician, writing for a 
medical journal, in his attempt at ridicule, said that it was com- 
ing to such a pass with a certain class of physicians who 
regarded perineal ruptures so common, that ere long they 
would be advocating the necessity of going armed with needle 
and thread to every case of confinement, in order that they 
might be ready to stitch up a laceration. It is safe to say that 
he who does not go so prepared, and he who ridicules such 
*Reamy’s Annual Address, Trans. Am. Gynecological Soc., 1886, p. 55. 4 
STATE MEDICAL SOCIETY. 
practice, does not watch the presenting parts of the foetus, or 
subsequently inspect the perineum, and, very likely, neglects 
the antiseptic precautions made especially necessary by the 
laceration which he does not suspect. 
To be sure, we may not always be able to recognize a 
perineal rupture by inspection alone. There may be no surface 
wound, as the laceration may occur submembraneously; but by 
grasping the rupture between the finger and thumb, it will be 
found that the perineal body is gone and nothing interposes but 
the membranes. The remote sufferings that such accidents 
incur, saying nothing of the immediate dangers of septisemia, 
burning pain in standing, walking or sitting, and especially in 
micturition, are many and severe. It is not uncommon for 
women with long neglected, cicatrized perineal rent, broken in 
health, despondent, and with an apparently bankrupt constitu- 
tion, to consult us, never suspecting the cause of their malady, 
but who, because of a lacerated perineum, to use Dieffenback’s 
expression, “ are ashamed of themselves, even as a woman who 
has been castrated.” 
On examination, we find the rama -pudendi gaping posteri- 
orly, and the anterior vaginal wall gaping, and a diseased, 
enlarged, displaced womb, and the patient suffering from mani- 
fold reflex disturbances unnecessary to enumerate to members 
of this Section. 
Emmet says “That reflex irritation does emanate from the 
perineum as the effect of a local exciting cause, cannot be ques- 
tioned. The presence of sympathetic nerves offers an expla- 
nation of the reflex irritation so often produced by the cicatri- 
cial tissue in the perineum;” and I think he might add that 
branches of the sympathetic and the pelvic and spermatic plexi, 
not involved in the cicatrix, but pressed upon by an enlarged, 
retroverted or retroflexed womb, play an important part in 
these remote sympathetic effects. As to whether the perineum 
and vagina support and assist in holding the womb in place, or 
whether, as claimed by some, it has no more to do with it than 
the diaphragm in supporting the heart and lungs, or the intes- 
tinal tube in holding the stomach in place, I shall not argue here. 
It is a significant fact, however, in my observations, at least, GEO. E. RANNEY. 
5 
that in cases of rupture involving the whole perineal body and 
a portion of the gut, the descent of the womb has been less 
than in cases following partial perineal rupture. This is well 
accounted for in a paper by Dr. S. T. Donaldson, published in 
the Archives of Gynecology, and referred to in the 'Journal of 
the British Gynecological Society, 1887, p. 223, in which 
he says that complete rupture of the perineum has not 
the same amount of influence in producing prolapse as a 
partial tear has, for the reason that in complete lacerations 
the septum between rectum and vagina is done away with 
entirely, whereas in partial rupture the septum remains, only 
much thinned. This septum is gradually stretched by the 
lodgment of fasces and intra-rectal pressure, which bulges 
out the septum, causing a rectocele to form. As the rectocele 
becomes more and more marked, the septum drags on the 
cervix, and so pulls the uterus out from the “ dome of the 
sacrum ” downwards and forwards. This displacement of 
the uterus from under the sacrum brings it into the vaginal 
axis and allows intra-abdominal pressure to come into play, 
thus causing the uterus to gravitate still further in the vaginal 
canal. The mischief begins with the loss of fascial ten- 
sion at and around the seat of lesion. Gradually, other 
neighboring tissues become involved, until, finally, remote 
ones are implicated. When rectocele does not hasten the pro- 
cess, the tissues at the lower end of the vagina are affected, 
and the retro-pubic segment descends, so that a cystocele forms 
and so drags down the uterus. 
Perinorraphy extending high up the vagina, or, what is bet- 
ter, Hagar’s operation, will generally overcome the prolapse 
of the womb; also the rectocele and cystocele, though in severe 
cases I sometimes make a separate operation for the cystocele 
at the same sitting. 
Alexander"1s Operation.—Shortening the round ligaments for 
uterine displacement, first performed December 14, 1881, by 
Dr. William Alexander, has of late received considerable atten- 
tion by gynecologists, both in this country and in Europe. It is 
claimed by its author that the operation is not an obstacle to 
pregnancy or parturition. 6 
STATE MEDICAL SOCIETY. 
Dr. J. Mathews Duncan, Dr. Clement Godson, and Prof. 
W. S. Playfair, of London, speak disparagingly of the opera- 
tion, and Prof. Wallace, of Liverpool, actually condemns it. 
Per contra, Dr. Halliday Croon, of Edinburgh, Dr. John E. 
Burton, of Liverpool, and James A. Adams, of Glasgow, and 
others, speak favorably of it. 
That the womb may, for a time, at least, be held perfectly 
in place by the operation, 1 do not doubt; and I am equally sure 
that in selecting the appropriate cases to operate upon, the best 
skill of the surgeon is shown. 
It is claimed, with a very good show of experimental proof, 
that the main supports of the uterus are the elastic, sub-perito- 
neal, pelvic fascia and the utero-sacral ligaments; also the lat- 
eral, to a small degree; and that the round ligaments do not act 
as such. With these facts in view, I would not expect that 
the suspension of the fundus uteri to the anterior abdominal 
wall by shortening the round ligaments, would be of perma- 
nent value, without correcting the conditions which cause the 
prolapse and flexion. At least, with a lacerated perineum 
and a relaxed floor of the pelvis, and their usual accompani- 
ments, I believe the operation would result in no permanent 
good; for the cords would soon relax, from the constant pres- 
sure brought to bear, in the way mentioned above (in speaking 
of the production of the rectocele and cystocele), and the dis- 
placement become as great as before. 
I would reserve Alexander’s operation for those cases of dis- 
placement of the womb not held by adhesions, and not amena- 
ble to perinorraphy or the revulsive effects of trachelorrhaphy 
and curetting, and properly adjusted pessaries. 
The Curette.—The use of the curette, I believe, is in more 
general favor than formerly. In chronic endometritis and sub- 
involution of the uterus and consequent sterility, 1 believe it 
of the greatest value. 
If the new theory of Dr. Johnston, of Lexington, Ky., 
endorsed by Mr. Lawson Tait* and others, is correct, that men- 
struation is the result of glandular function, and that the men- 
strual organ is the endometrium, “ we have an explanation,” as 
♦British Medical Journal, January 22, 1887. GEO. E. RANNEY. 
7 
Mr. Tait says, “of a most intrinsic physiological and pathologi- 
cal difficulty, the riddles of which seem to be wholly beyond 
our grasp. 
“ First of all, we have an explanation of the familiar fact, 
that impregnation and menstruation seem to have a clear rela- 
tion as to coincidence, the plain fact being that an impregnated 
ovum adheres only on a surface denuded of epithelium. When 
desquamative salpingitis has destroyed the tubal epithelium, the 
ovum may be impregnated in the tube, and may adhere to the 
exposed corpuscular tissue, and the dreadful issue of tubal 
impregnation will result.” 
We all know sterility is the common result of chronic endo- 
metritis. If the obstruction be removed by the curette, and, 
as a consequence, a healthy glandular development of the 
endometrium takes place, sterility will be thereby often over- 
come. 
The Uterine Sound.—The sound, formerly so much vaunted 
as an instrument of diagnosis, should be avoided, except as a 
final diagnostic resort; for serious results too often follow its 
use, especially in the hands of the careless or inexperienced. 
The Use and Abuse of Pessaries.—Some tacitly affirm that 
pessaries are an abomination, and, while they do no good, often 
produce harm. Now, I believe that he who cannot use a 
pessary without doing harm, should, of course, abandon its use, 
but he should not criticise those better qualified than himself. 
The one who thinks lightly of their use and speaks with 
derision of their utility, I take it, shows only that he cannot 
appreciate what he cannot understand. Common sense teaches 
us that a broken bone or dislocated joint may require a support; 
and it seems equally rational that a dislocated uterus may be 
benefited by a properly adjusted pessary. To be sure, if the 
womb is bound down by inflammatory adhesions, a forcible 
attempt to replace it with pessary or other means, may result 
in the gravest consequences, by setting up peri-uterine inflam- 
mation or by pressing upon a prolapsed ovary, producing intol- 
erable pain. But, after depleting the displaced and inflamed 
womb by ordinary means, the pessary, though to be avoided if 
such means will suffice, may be of great importance in lifting 8 
STATE MEDICAL SOCIETY. 
the womb from the great sacral plexus, or from its pressing 
upon the rectum or bladder, and by overcoming the obstruc- 
tion to the venous circulation. 
Signs of Pregnancy..—Dr. Reamy says: “ Our manifest 
inability to detect early pregnancy is the opprobrium of obstet- 
rics;” and adds, “Is it not probable that nature hangs out, 
somewhere, an unequivocal sign of this most important event 
in the animal economy, early in its career ? ” 
There is a great diversity of opinion among obstetricians as 
to the value of certain signs, which diversity may be the result 
of accident or a want of a careful study and an accurate recog- 
nition of those signs. Hagar’s sign, which consists in the 
uterus losing its pear-shaped outline, the body being bellied out 
over the cervix in all the transverse diameters, especially 
antero-posteriorly, is looked upon by Drs. Grandin, Reiul and 
Mitchell, of England, as almost an infallible sign. 
Jacquemier, in 1876, called attention to a bluish coloration 
of the vagina, as an almost unmistakable sign of pregnancy, 
after the fourth week or subsequent to the time the woman 
would have menstruated were she not pregnant. The colora- 
tion is described as of a blue or deep violet hue of the vaginal 
mucous membrane. The color is sometimes compared to dregs 
of wine. To this color, together with the oedematous, velvet- 
like feel of the rounded os and an increased secretion of the 
mucous membrane, I attach great weight. To inspect the col- 
oration of the vagina, the use of the speculum is deemed 
necessary by some, but, in most cases, it is, I believe, most 
plainly marked at the introitus vagina, particularly just around 
and beneath the urethral orifice, and can be readily seen by 
parting the labia with the fingers. The coloration is supposed 
to be caused by an interruption of circulation through the 
venous plexus, and also the same may occur from hemorrhoids 
or from uterine fibroma, the truth or falsity of which may be a 
factor in differential diagnosis. Dr. Robert Barnes says, “ The 
most valuable sign of all is the violet coloration of the vaginal 
portion and the vagina described by Jacquemier.” Dr. James 
B. Chadwick, of Boston, says : “In scrutinizing the color of 
this part in a large number of women, I early discovered that, GEO. E. RANNEY. 
9 
while in a majority a bluish tinge appeared over the whole 
vaginal entrance, there was a fair proportion in which the 
violet tint was confined to the anterior wall of the vagina, just 
below the urinary meatus, where it shaded off into the normal 
pink color laterally. This, when distinctly perceptible, is soon 
found to be, in my practice, an absolutely sure sign of preg- 
nancy. There were, furthermore, a very few in whom the 
blue tint was universal, but more accentuated on the posterior 
wall of the vaginal entrance, which I found was valueless as a 
sign of pregnancy unless the color was quite deep. The 
recognition of this peculiar localization of the blue tint on the 
anterior wall as a sure sign of pregnancy, I feel is the most 
important new point in this communication.” * 
Electi'icity.—As a therapeutic agent, electricity has been 
going up and down, and the laudations of many of its enthusi- 
astic advocates have only been equaled in earnestness by its 
opponents, who believe that it doeth no good and thinketh no 
good. Disrepute, no doubt, has been brought upon it by a 
class of practitioners, who. with just ability enough to turn a 
crank or set the machine going, have made for it the most 
extravagant claims. They are those who “keep the word of 
promise to our ear, and break it to our hope.” 
Recently, under a more scientific, systematic study of the 
therapeutical effects of this mystic force, especially under the 
lead of Apostoli, at least in gynecological practice, it has 
assumed quite a prominence, and is looked upon with favor by 
many of our ablest gynecologists, who have studied the proper 
indications for its use and the way to use it to meet the require- 
ments of special cases, and proportioning the dose required as 
regards quantity and intensity, the choice of faradic or gal- 
vanic current, the proper choice of poles, localization, duration 
of sittings, proper electrodes, etc. 
Dr. George J. Engelman,f of St. Louis, says that he has 
obtained excellent results by the use of electricity in the treat- 
ment of neoplasms of various kinds, such as fibroids, polypi, 
cystic growths, urethral carbuncles and hemorrhoidal tumors, 
* Transactions of the American Gynecological Society, 1886, p. 407. 
•(•Transactions of the American Gynecological Society, 1886, p. 251. 10 
STATE MEDICAL SOCIETY. 
also in chronic ovarian inflammation, stenosis of uterine canal, 
sub-involution, prolapsus uteri, menorrhagia, chorea, etc. 
In the treatment of fibroma of the uterus by Apostoli’s 
recent method, electricity has attracted, as a therapeutic agent, 
more attention than heretofore, and with a show of favor that 
bids fair to place it among the most reliable, if it does not 
establish it as the most potent remedy in such cases. 
But the growth of myoma seldom or never commences 
before puberty, and its growth ends with the climacteric, if it 
does not actually lessen or undergo spontaneous degeneration; 
hence, under any mode of treatment, either by the ergot or 
Apostili’s method, the most satisfactory results may be 
reported, while the improvement may have been the result of 
causes independent of treatment. 
Dr. Robert Barnes says, in his work on Diseases of Women: 
“ A fibroid tumor, being like in constitution to the uterine mus- 
cular wall, and growing in it and depending upon it for its 
existence and nutrition, may be expected to follow closely the 
conditions of its parent organ. Accordingly, it grows during 
pregnancy, and undergoes retrogression or involution when 
pregnancy is over; and, sometimes, involution, being thus 
started, passes into atrophy, and the tumor disappears alto- 
gether. Thus -pregnancy may cure fibroid tumors. The pro- 
cess, no doubt, is fatty degeneration, the same as that which 
melts away the muscular tissue of the uterus. The fatty trans- 
formation of fibroids is very common.” 
Prof. Winkle reports a case of spontaneous degeneration 
of a fibroid, which came under his notice, and says: “One 
must, in accounting for this, think of the fatty degeneration of 
the smooth muscular fibres of, and absorption of the degen- 
erated parts, the same as occurs in the uterus after childbirth.” 
Lohlein, of Berlin, reports, in the Zeitschrift finer Geburts- 
huelfe und Gynaekologie, Vol. i, 1877, eighteen cases of spon- 
taneous cure of uterine fibroids, and says that he has no doubt 
that fibroids are much more frequently a complication of 
pregnancy than is supposed, and their disappearance after 
confinement is more common than is generally recognized by 
the profession. GEO. E. RANNEY. 
11 
The late Prof. Schrader, of Berlin, reports thirty-six cases 
of uterine fibroids, in which pregnancy occurred, and found 
the tumors to disappear in six cases. 
Nouss, of Halle, in Hospital Report, 1872, reports eighteen 
cases of pregnancy occurring co-existing with fibroma, six of 
which tumors disappeared, and in two others but very small 
evidences of the tumors could be found. 
Lawson Tait, in his work on Gynecology, reports one case 
coming under his notice. 
Dr. Lee, in his work on Clinical Midwifery, says that 
“Sometimes the tumor disintegrates or undergoes atrophy, 
and disappears wholly or in part, after labor, or, at least, to 
such an extent as to escape detection. Dr. Ragan reported a 
striking case in which a tumor was mistaken for a second 
child. The woman recovering, the tumor rapidly disappeared 
below the pubes. She had observed the same phenomena in 
preceding pregnancies. Dr. Leonard Sedgwick relates (St. 
Thomas’ Hospital Reports, 1870) two cases in which uterine 
tumors entirely disappeared after delivery. Montgomery cites 
similar cases.” A most important feature occasionally attend- 
ing this complication is the extreme difficulty in establishing a 
correct diagnosis. There is no certain means in some of these 
cases of diagnosing between fibroma, fibro-cystic, uterine 
tumors, and cases of either complicated with pregnancy. 
I have said enough by way of establishing the compara- 
tively frequent occurrence of the spontaneous degeneration of 
uterine fibroids, but might quote many other authors to that 
purpose, besides my personal observation and verbal reports 
from obstetricians. 
I have thus digressed to show that, either by the use of 
electricity or other treatment, fibroid tumors lessen or disap- 
pear, and that care should be taken not to “filch from Nature’s 
good name,” by arrogating to ourselves the credit of the use 
of potent means of cure, which is really brought about by 
natural causes. 
In attempting to impress the important lesson of the self- 
limitation and spontaneous degeneration of uterine fibroid 
tumors, I wish not to disparage the honorable place that elec- 12 
STATE MEDICAL SOCIETY. 
trotherapy has, under the guidance of Apostoli, taken in 
gynecological practice. 
In the few instances I have employed electrolysis in the 
treatment of fibroids, I have obtained almost uniformly 
good results; and the statistics of Apostoli, as well as 
the favorable reports of its use by such men as Engelman, of 
St. Louis, Munde and McGinnis, of New York, Martin, of 
Chicago, and others, are convincing proofs, to my mind, that it 
will hold respectable rank with the knife as a means of cure of 
uterine fibroma. 
Dr. Thomas Keith reports having treated successfully, in 
five months, ioo uterine fibroid tumors by electrolysis, and 
says: “So strongly do I now feel on this subject, that I 
should consider myself guilty of a criminal act were I to 
advise my patient to run the risk of her life—and such a risk 
—-before having given a fair trial to this treatment.” 
Antisepsis.—Antiseptic practice in midwifery has resulted 
in a sudden fall in mortality of puerperal women; and the 
diseases incident to septicasmic poisoning, such as puerperal 
fever, cellulitis, phlegmasia dolens, etc., are conditions that 
justly raise the question of neglect, carelessness or ignorance, 
on the part of the accoucheur. *“ The name of Lister is, at 
one step, made the greatest in the practice of midwifery, his 
discoveries having achieved more for the comfort and safety 
of lying-in women than the combined efforts of succeeding 
generations of enthusiastic obstetricians.” 
In my practice of midwifery during the past twenty years 
I have been in the habit of insisting upon a thorough and 
frequent cleansing of the genital tract of my lying-in patients 
with hot water sterilized with carbolic acid or bichloride, one 
part to three thousand, and of lessening the absorbing surfaces 
by closing lacerations as far as possible. In doing this, for a 
large part of that period, at least, I “ builded better than I 
knew,” for, while I practiced this as a matter of cleanliness, to 
assist normal involution of the uterus, and to render the patient 
more comfortable, I did not recognize the importance of its 
antisepsis, which has, during the last few years, been known to 
* Mathews Duncan. GEO. E. RANNEY. 
13 
be so marvelous in the prevention of puerperal disease. 
Doing a fair amount of obstetrical practice during my profes- 
sional career in civil practice (now over twenty-two years), it 
has been my fortune to lose but one patient of my own from 
childbirth or its after effects ; and I attribute no little of this 
good fortune to as thorough antiseptic treatment as is practic- 
able in a general practice. No one who has studied the matter 
can doubt that antiseptic treatment has done marvels in 
lessening the death rate of puerperal women, and the terrible 
results of septic complications following confinement which 
were formerly so common in such cases. No greater duty, it 
seems to me, in the light of the revelations of the antiseptic 
treatment of puerperal women, can fall to our lot than to 
combat, by means of antisepsis, this terrible scourge incident 
to child-bearing. Yet, I fear that the antiseptic midwifery is 
not generally practiced as we would have a right to expect, and 
according to the light we have concerning this universally 
recognized principle, the details of which, as to a thorough 
contraction of the womb and expulsion of clots, antiseptic 
solutions and dressings for physician and nurse, pure air, and 
all the means to prevent the septicgemic poison being conveyed 
to the patient, the limits of this paper will not permit me to 
discuss. 
Dr. W. S. Playfair, of London, in presenting the proofs of 
safety that antisepsis afford the lying-in women in hospitals, 
which were formerly hot-beds of death and disease, says that 
they are rendered as safe, or safer, than in a large and luxu- 
rious private house, with competent nurse and physician, and 
all that money can procure, and adds : 
“There is nothing in the history of medicine more remark- 
able than the change which has come over the working of 
these public institutions since Lister’s life-saving principle has 
been adopted. There the battle is gained. I doubt if such a 
thing can be found as a lying-in hospital in which rigid 
antisepsis is not the rule.” 
He says, however, that he very much questions if even yet 
antiseptic midwifery is at all in general use in private practice, 
for, as consultant, he seldom finds that practitioners in attend- 14 
STATE MEDICAL SOCIETY. 
ance followed any of the antiseptic rules which are universally 
so rigidly enforced in lying-in hospitals 
In preparing the original notes and headings for this paper, 
1 found that to amplify them all would extend the communica- 
tion beyond its reasonable limits, and would include some points 
which would be more appropriate for a paper with a more 
definite title than appears in the index to this address. There- 
fore, under the title, “Treatment of Mastitis and Galactorrhoea 
by Pressure,” I have written a paper which, with your 
permission, I will present later during this meeting. 
In touching upon the many important themes of this 
address, I have tried to give hints, gleams and rays of medical 
truth of practical utility, only discussing such subjects as the 
general practitioner should be familiar with, without subjecting 
himself to the danger of becoming lop-sided by his devotion to 
a specialty.