REPORT ON DISEASES OF WOMEN FROM THE FIRST 
CONGRESSIONAL DISTRICT. 
By R. J. NU h§, M D., Savannah, Ga. 
[Reprint from the Transactions, of the Medical Association of Georgia.] 
,TAS. P. HARRISON A CO., PRINTERS 
ATLANTA, GA. REPORT ON DISEASES OF WOMEN FROM THE 
FIRST CONGRESSIONAL DISTRICT. 
R. J. NUNN, M. D., Savannah, Ga. 
INTRODUCTORY. 
For some time my attention has been directed to the in- 
timate association which exists between uterine affections 
and those of other organs of the body, which is the cause and 
which the result it is not always possible to determine, the 
relationship apparently differing in different cases, for 
while in many instances an interdependence between dis- 
eased conditions could be distinctly traced, and could subse- 
quently be proved by the course and the termination of the 
case, in others the complications could be seen to depend 
upon a condition of malnutrition alone. Led by these 
observations to reflect more seriously upon the theory of 
tissue softening as a cause of uterine disease, as advanced 
by Graily Hewitt, and upon Virchow’s statement touching 
the origin of tubercle in depraved connective tissues, I was 
induced to investigate more closely the influence of diet in 
diseases affecting the female economy. 
This explanation is necessary to account for the discur- 
sive character of this paper, which deals at times, nay, in 
great part, with subjects apparently foreign to gynecology, 
yet so intimately are they blended together that in justice 
to the subject they could not well be separated. 
There are also some other matters which, while not com- 
ing strictly within the limits of a report like this, have 2 
Diseases of Women. 
seemed to me to be of quite sufficient interest to warrant a 
passing mention. 
THE INTERDEPENDENCE BETWEEN UTERINE AFFECTIONS AND CON- 
SUMPTION. 
The influence of the unhealthy uterus upon the develop- 
ment of diseases of the lungs is a matter which has received 
little, if any, attention at the hands of practitioners. 
It is not my intention to theorize upon this subject, to 
spend useful time in useless conjectures; my object is only 
to draw attention to the clinical fact, and to endeavor to 
awaken the medical mind to its great practical importance. 
No doubt hereditary tendencies influence, to a very great 
extent, the appearance of these pulmonary affections, and 
one is liable to be led into the error of looking upon the 
lungs as the seat of primary lesion, and as a consequence 
no inquiry is made for a uterine complication. There is 
no doubt upon my mind that cases have died under m v care 
having all the microscopic symptoms of consumption in 
whom the initial lesion was uterine, and the lung compli- 
cation a matter of secondary development. 
In this particular the observant public has been ahead 
of the medical profession. “ Her courses stopped and she 
got consumption and died,” is an expression frequently 
heard, and indicates the natural sequence of events as they 
present themselves to the non-medical mind. Even while 
I write this a young girl consults me for menstrual irregu- 
larity. 
“Why do you come for a matter which hundreds of others 
deem so trivial?” 
“Because I am afraid it may turn to something else.” 
“ What do you refer to ?” 
“ Consumption.” R. J. Nunn. 
3 
“How do you imagine this can give consumption?” 
“When the courses stop all that discharge is retained in 
the system and falls on the lungs and gives consumption.” 
“Did you ever know of such a case?” 
“Oh, yes! my friend, Miss , died just that way, and 
that is what frightened me.” 
This is the conversation verbatim as it occurred. Now 
although this lady’s pathology was at fault, we must think 
a moment before we say that her deductions were also 
wrong. 
My authority for coming to this conclusion may be fairly 
called into question, and therefore I give my reasons. If I 
am consulted by a patient complaining of lung trouble in 
whom, upon examination, physical signs of lung disease 
are present, if in the same patient I find a chronic uterine 
disease, and finally, if the lung disease disappears upon treat- 
ment of the uterine symptoms, without any other kind of 
medical interference, it is but fair to conclude that the dis- 
ease of the lung was dependent upon that of the womb. 
Now, if several such cases can be shown, what may have 
been a coincidence becomes a consequence, and the conclu- 
sion at which I have arrived is unavoidable. 
From a large number I select a few illustrative cases. 
Miss , aged eighteen years, was supported into my 
office by her mother three years ago. The history given to- 
me of her case was that she had then been under treatment 
for consumption for three years without benefit, but on the 
contrary was gradually failing. The girl’s appearance was 
pitiable in the extreme; color livid, with an expression of 
extreme anxiety; large drops of cold sweat bathing her 
emaciated face; her extremities swollen, and abdomen dis- 
tended until it was painful; altogether at first sight the 
case looked most unpromising. Auscultation showed sibi- 4 
Diseases of Women. 
lant ronchus over both lungs, with prolonged expiration ; 
heart’s action feeble; the abdomen was tympanitic. Ex- 
amination per vaginam revealed a prolapsed and inflamed 
uterus; no kidney complications. She was kept in bed for 
six weeks with douches and other uterine treatment; the 
•displacement was corrected; she received no other treat- 
ment; she now wears an Albert Smith pessary, shaped up 
from one of Chamberlain’s rings, and is robust and well. 
From 92 pounds, her weight when she first consulted me, 
she has increased to 140 pounds at this writing. 
Case II. Miss B., 26 years old, has been up to the last 
year or two very strong and healthy. She then became 
subject to menstrual irregularities which she attributed to 
hard and debilitating work. Of late she has been having 
frequent hoemoptyses with shortness of breath, pain in chest 
and great and increasing weakness Back-ache and leu- 
•corrhcea annoyed her a good deal, her appetite was reduced 
to a minimum and she had a constant hacking cough and a 
weak, husky voice. Auscultation revealed areas of dull- 
ness with sibilant ronchus in the lungs. Upon examina- 
tion the uterus was found to be displaced and the cervix 
• congested and tender. To these symptoms attention was 
specially directed, and the patient slowly recovered. 
These two cases will serve as types of many others of a 
similar character which have come under my notice ; they 
have been selected from among the unmarried females to 
avoid an) suspicion of complication by infection by the 
diseases incident to or consequent upon pregnancy, and a 
tedious over-minute history has been avoided as unnecessary 
to the purpose in hand. 
There is nothing so very extraordinary in the implica- 
tion of the lung substance in connection with uterine dis- 
ease. Other instances are not wanting of tissue-changes R. J. Nunn. 
5 
being produced at a distance by ovarian or by uterine irri- 
tation. Take for example acne rosacea which is often 
resultant from this cause, and medical literature is full of 
examples of other lesions depending for their existence 
upon similar distant irritations. 
My object now is to draw attention to the close connec- 
tion which I think exists between these two classes of dis- 
eases rather than to enter into a lengthy discussion of the 
subject 
It is quite true that the number of women dying in that 
indefinite marasmic condition—at one time vulgarly called 
decline—is now much less then formerly. We have learned 
better to differentiate disease, but it is doubtful if we fully 
appreciate the consequential relations which one abnormal 
condition bears to another. 
In my report of last year I endeavored, in connection 
with my friend Dr. Cutter, to show that in many cases con- 
sumption bears to uterine disorders the relation almost of 
effect to cause. The facts you can observe for yourselves, 
but the manner in which these charges are brought about 
may be an open question. 
It seems not unlikely that the steps in downward march 
may be as follows: First, there is derangement and im- 
pairment of the nervous system and the neuric function by 
the uterine disorder, followed by impaired digestion and 
malassimilation as the natural consequence. Then comes 
the invasion of the contents of the digestive tract by the 
torula cerevisix and consequent fermentation with its attend 
ant disorders constantly increasing, the yeast plant then 
appears in the sputum, having probably found its way 
there through the circulation. All this has been pointed 
out by Dr. J. H Salisbury long ago, and it is but little to 
our credit that the profession has not long since investigated 6 
Diseases of Women. 
the matter. That it is no idle assertion I, and others to 
whom I have demonstrated the fact, can bear witness, and I 
present to you a bottle of alcohol made with the sputum of 
a consumptive patient as a ferment. A test saccharine 
solution of equal strength was kept beside the fermenting 
one during the process but did not undergo fermentation. 
That the yeast plant is to be found in the sputum of all 
patients who are at present considered as having consump- 
tion, would be too wide a statement to admit for a moment, 
that it does exist in the sputum of certain cases is undeni- 
able. and may be perhaps a useful differential test between 
one form of the disease and another. 
Although somewhat out of place, I would like to mention 
that I have found this same microscopic growth in the 
dejecta and vomit of marasmic children. 
Keeping in view these pathological facts, the cure of 
these diseases is effected without difficulty, as has also 
been pointed out by Dr. Salisbury, first by treating the 
uterine disorder ; second, by starving out the yeast plant, 
which is effected by prohibiting the use of fermentable 
materials as food; third, by washing out the system and 
promoting digestion by the scientific employment of a suit- 
able diluent; fourth, by close attention to personal 
hygiene; fifth, by suitable medication when required. 
The yeast plants which I have found in the sputum have 
mostly been of the small, round, the oval, or the cylindrical 
shape, which I learn is regarded by brewers as indicative of 
weakening fermentive power. I have up to this time met 
with the large round cell only in rare instances. This 
plant, although perhaps not identical, is a near relation to 
the my coderma aceti, the existence of which in the excretions 
and secretions of consumptives was likewise pointed out by 
Salisbury. R. J. Nunn. 
7 
As to the independent presence or the co-existence of the 
bacillus tuberculosis in these cases I will not venture to offer 
an opinion. I have not yet succeeded in sufficiently 
familiarizing myself with this body, and I do not propose to 
enter the ranks of these scientific gentlemen, many of whom 
are ready to play the role of critics, without knowing a 
single thing of the subject upon which they hazard an 
opinion. 
“ A time is served to every trade, 
Save censure, critics are all ready-made.” 
THE VOICE IN ITS RELATION TO UTERINE DISEASES. 
The effects of uterine diseases upon the vocal organs was 
first brought vividly before my mind by the assertion made 
to me by professionals, that the voices of women who have 
borne children frequently lose much of the clearness and 
brilliancy they possessed previous to marriage. Repeated 
observations upon numerous cases which have come under 
my notice, would indicate that there is some truth in the 
opinion they expressed, for certain it is that the quality 
and volume of the voice of a songstress having a uterine 
affection will not unfrequently be found to vary apparently 
with the intensity of the uterine symptoms. 
Miss E has prolapse with severe cervical engorge- 
ment, suffering also from pain in the back and nervous- 
ness, with trembling; was fond of singing, and possessed a 
good voice. This patient voluntarily drew my attention 
to the fact that her voice had lost its clear, pleasant tone; 
the high notes had become husky, and her control of the 
voice had grown less in proportion to the amount of pain 
she felt in the back, which I subsequently found to be 
dependent upon the severity of the uterine symptoms 8 
Diseases of Women. 
Treatment and the application of a suitable pessary relieved 
her. 
Mrs. N , a multipara, an amateur vocalist of some 
power, applied to me on account of the loss of her voice, 
which she attributed to some undefined affection of the 
throat. I found, however, that she had chronic metritis, 
subinvolution and complete prolapse. My treatment was 
directed to these complications, and in proportion as they 
were relieved just in like proportion did the voice improve. 
A multiplication of cases is not necessary, as they of 
necessity are all similar; those given will suffice to stimu- 
late further observation, and I would here remark that 
there will not unfrequently be found patients in whom 
pharingitis seems to be intimately associated with some 
uterine disorder. 
SUGGESTIONS FOR TIIE TREATMENT OF ANEMIA. 
In many of the chronic uterine affections one of the most 
difficult symptoms to overcome is the anemia. To combat 
this, diet alone often fails, and iron is at first ineffectual; 
its employment must be preceded by the use of other reme- 
dies, addressed to the special dyscrasias of the patient. 
If there exists a syphilitic taint mercury should be 
emplo} ed. 
In the scrofulous diathesis it is to iodine and the iodides 
that we must first appeal. 
The arthritic dyscrasias will yield best to sulphur. 
Cases of anemia in herpetic patients can best be com- 
bated by arsenic or arsenical preparations, particularly the 
arsenite of iron. 
THE MICROSCOPE IN MEDICAL GYNECOLOGY. 
The importance of the use of the microscopic investiga- 
tions in gynecological medicine cannot be over-estimated; R. J. Nunn. 
9 
often as a means of differential diagnosis it will be found 
of immense value; in fact, there is nothing to supply its 
place. Many physicians are deterred* from using the 
microscope by the erroneous idea that an elaborate instru- 
ment is necessary, and that much erudition is a prerequis- 
ite. This is a great mistake, and conies first of too much 
reading of over-crammed books, wAich serve rather to befog 
and mystify their readers than to simplify and elucidate 
the subject in hand; secondly, it is the result of a want of 
a practical effort to acquire knowledge by experience rather 
than by hearsay, which begets an unhealth}7 dependence 
upon the opinions of others, and stunts the growth of and 
desire for original investigation. 
For clinical microscopy no great depth of learning nor an 
intimate acquaintance with fine spun theories is required, 
but a plain, practical knowledge of the names and appear- 
ance of a few of the forms which the microscope reveals. 
It is not necessary to know what every thing seen in the 
microscope is; it is sufficient to know what it is not. Just 
as it is not necessary to be an accomplished botanist to distin- 
guish an oak tree from a turnip, or to be a deeply learned 
naturalist to tell a horse from a goat, so it is unnecessary 
to be a thorough pathologist to be able to make good use of 
the microscope for clinical purposes. 
To examine the secretions and the excreta, the ability to 
recognize a few dozen forms, is all that is required to com- 
mence with, and increased knowledge comes unconsciously 
with practice. Of course the more extensive the acquaint- 
ance with the various microscopic forms the less liability 
there is to mistakes, and the greater the power and accu- 
racy of the microscopic analysist will be. 
A lady applied to me to be relieved of most troublesome 
dysuria, with which she had been annoyed for years with- 10 
Diseases of Women. 
out any benefit from the many treatments she had under- 
gone at the hands of numerous physicians. She had also a 
slight vaginal discharge, and upon examination a chronic 
thickening of the urethra. The constant irritation had 
reduced her very much. Digital and instrumental examin- 
ations failed to reveal sufficient cause for such a grave con- 
dition as was evidently present, but a microscopic examin- 
ation of the vaginal and urethral secretions demonstrated 
the presence of a great number of a species of the tricho- 
monas vaginalis. Based upon this examination an insec- 
ticide douche was prescribed, with the result of relieving 
all the prominent local symptoms in a few days; of course 
the physical and constitutional consequences of such long 
continued local irritation required other and more patient 
treatment. 
In another case in which the patient applied to be treat- 
ed, for what she thought to be an old standing disease, I 
found by microscopic examination the whole trouble to be 
caused by another variety of the same minute organism. A 
course of treatment similar to that adopted in the former 
case resulted equally as well. 
It is unnecessary to multiply cases. These two fairly illus- 
trate the value of the microscope in this class of complaints. 
But for it I, too, might have blundered along in the course 
pursued by others who had treated these cases. Success in 
diagnosis and in treatment comes not always of genius, but 
of the possession of improved means of investigation, and of 
the patient, constant, conscientious employment of them. 
A PLEA FOR SPECIALISTS. 
The members of the medical professison have, as a rule, 
cheapened their services until it has become in many 
instances of but little value, simply because they cannot R. J. Nunn. 
11 
afford to give the necessary attention to their patients for 
the compensation they receive. It is about time that the 
public should learn that a doctor’s opinion, like a lawyer’s, 
is seldom worth more than is paid for it Persons who act 
as if they consider that they are “doing God service” when 
they cheat their doctor or depreciate his services, are ready 
to go a few miles from home and willingly pay large sums 
for opinions not one whit better, and often not as good, as 
those left behind them at their own doors, or else they rush 
—money in hand—to patronize every medical mounte- 
bank who with sufficient loudness “toots his trumpet” in 
their midst. 
If, however, there is a want of proper encouragement in 
our cities and in our smaller communities, to the pursuit of 
special lines of medical investigation, the fault lies no little 
at the door of the profession itself. Until within the last 
few years every physician would undertake to do every thing 
in any way connected with medicine. He would make a 
post-mortem examination ; he would analj’ze the contents 
of the stomach; he would be oculist, aurist, gynecologist, 
neurologist, electrician, surgeon, accoucheur and microscop- 
ist. in fact he would be, or pretend to be, any thing in which 
he could see a dollar. Much of this is changed, but there is 
still much to be done. The general practitioner now is 
willing to encourage special investigators provided they 
reside at a distance from the locality in which he practices, 
but he distrusts and underrates the labors of those around 
him, and this appears to be in inverse ratio to the size of 
the communit}'. It may be that in such a locality physic- 
ians become so intimate that they feel as if they had a right 
to utilize the special acquirements of each other without 
pecuniary recompense, while in a large city the same 
service would be paid for. Here, if an operation is to be 12 
Diseases of Women. 
performed upon a patient of ample means, the operating 
surgeon alone receives any remuneration, while a medical 
friend is expected to administer anesthetics free of charge, 
a service which would be paid for in a large city. If an 
analysis of urine is to be made in a case, some one is cal'ed 
upon to do it as a personal favor, instead of receiving the 
compensation which he would get for such services in a 
more populous locality. 
I take the liberty of directing attention to this state of 
things, because I think that each individual has a right to 
expect and to receive reasonable recompense for his special 
knowledge, and should be encouraged in the pursuit of that 
particular course of study or practice for which nature or 
education has best fitted him. 
Let me not be understood as advocating the education of 
young men as specialists; but after an apprenticeship of 
ten, fifteen or twenty years spent in general practice, every 
physician will fall into that line for which he is best 
adapted, and will bring to it ripe experience and thorough 
grounding in the general principles of medicine. Such a 
system should be encouraged. The domain of medical 
science is too vast to be compassed by any one human mind, 
and it is only by directing attention into special channels 
that we can ever make progress. A specialist, such as i 
have described, if carried to the limit of its perfection, 
would fully come up to the well known definition of a great 
man—one u knowing every thing of something andto.ne- 
thing of every thing.” 
MICROSCOPIC EXAMINATION OF THE BLOOD. 
In the examination of the blood a field of investigation 
of great promise has of late years been opened up to ardent 
and persevering clinical microscopists. While from my R. J. Nunn. 
13 
own personal observation I am as yet unable to confirm all 
that has been claimed for the microscopic examination of 
the blood in diagnosis, I can positively state that this pur- 
suit has proved of great value to me, and 1 feel amply 
rewarded for the time, trouble and expense which I have 
devoted to the study. 
In America and in Europe there are quite a number of 
earnest hoematologists, and there is every reason to hope 
that the time is rapidly approaching when the microscopic 
examination of the blood will be universally regarded as a 
powerful aid to the diagnostitian; meanwhile I would be- 
speak from the profession of Georgia a more lively interest 
in the use of the clinical microscope. 
As a rule I examine the blood of all my patients, and I 
hope at some future time to give some of the clinical results 
of these observations, but in the meantime would refer my 
readers to special works on the subject. The study of cer- 
tain diseases in this connection, such as consumption, 
syphilis, etc., has been to me a subject of special interest. 
Occasionally, that is in some specimens of blood, I meet 
with a red corpuscle, which becomes crenelated long before 
the others, and has an independent motion, twirling first 
in one direction and then in another, rotating and vibrating 
with movements not unlike that given by a squirrel to a 
nut which it is nibbling. What is the cause of these 
movements I am unable to say. I have thought it might 
be due to a bacterium, but my instrument is not of suffi- 
cient power to solve the problem. 
Up to this time I have not found these moving corpuscles 
except in the blood of syphilitic patients. I do not wish 
to be understood as saying or proposing this as a sign or 
one of the signs of syphilis, but only say that I have not 
yet found it outside of those persons having a syphilitic 
history. 14 
Diseases of Women. 
A patient, married, who had been for some time under 
treatment for uterine displacement, and who never had the 
least abrasion, nor any thing simulating a primary sore, 
nor yet even a vaginal discharge, consulted me for, as she 
expressed it, “falling away, being weak and out of condi- 
tion.'5 Her complexion was sallow, temperature two 
degrees above normal; pulse 102; loss of appetite, thirst, 
general malaise, but no defined pain ; small, round, brownish 
spots appeared all over the limbs and body. These spots 
would sometimes subside, appearing pale pink under the. 
skin. There was slight sibilant ronchus in the right 
lung. The urine presented no special abnormality. 
The examination of the blood showed an unhealthy con- 
dition of the red corpuscles, and the moving vibrating cor- 
puscles spoken of elsewhere; moreover I found the bodies 
named by Salisbury—crypta syphilitica. Under these 
circumstances I had no hesitation in placing her on an 
anti-syphilitic treatment The subsequent progress of the 
case fully corroborated the correctness of the diagnosis. 
This case I may lay before the Association on some future 
occasion in its details. 
A CASE OF OVARIOTOMY 
Which terminated fatally, has been to me exceedingly 
instructive. There was nothing unusual in the history of 
the case, nor of the operation which was quite successful, 
but the subject was a victim of the opium habit, and 
although I kept her under observation for some time previ- 
ous to the operation, she managed with the cuteness charac- 
teristic of these people to deceive me as to the amount she 
used, which she represented as four teaspoonsful of lauda- 
num, whereas the true quantity was sixteen grains (gr. 16) 
of morphine daily. The first day after the operation I R. J. Nunn. 
15 
gave a quarter (J) grain of sulphate of morphine hypoder- 
mically every two hours, but the patient was nervous and 
restless to a degree not warranted by her other symptoms. 
The next day I doubled the sulphate of morphine, but 
with no better result. The third day I gave three-quarters 
(f) of a grain; still the same condition; then she confessed 
to me that she habitually took sixteen (16) grains daily. 
I then gave her this amount, and increased it until she 
got quiet, but the shock was too great, and she died on the 
eighth day. 
At the autopsy the abdominal wound was found to have 
healed by the first intention. There were no symptoms of 
inflammation in the abdominal cavity, which contained 
only a little bloody serum not in the least decomposed. 
COTTON CANDLE-WICK TAMPONS (FOSTER). 
The time-honored cotton ball tampon has, as a dressing 
in my practice, been to a great extent supplanted by 
Foster’s candle-wick dressing. The wicks are made into a 
rope, containing ten or twelve strands, from which a piece 
is cut off of the length required; to one end a string is 
attached to facilitate its removal, while the other end can 
be moistened with whatever application is to be made. 
Not the least of the advantages of this dressing is the ease 
with which it can be applied through a small speculum, 
and with it the columning and packing can be done to per- 
fection. The facility of its removal is by no means its least 
recommendation. 
LOCAL BLEEDING IN THE TREATMENT OF UTERINE CONGESTIONS. 
The employment of local bleeding as a means of combat- 
ing uterine congestion is not by any means a novel proced- 16 
Diseases of Women. 
ure; leeches being formerly much employed for this pur- 
pose, but the delay, the uncertainty, the inconveniences 
and dangers attendant upon their employment, has led 
them gradually to fall into unmerited disuse. As far back 
as the time of Scanzoni the mechanical leech was recom- 
mended as a substitute for the natural one, but this likewise 
appears not to have met with favor. There are three in- 
struments of the kind in the market, viz: Tiemann’s, 
Heurteloup’s and Reeves’. Dr. Cutter’s instrument and 
my own are similar to Reeves’. The two former make 
circular incisions, and the latter a punctured wound. I 
use both varieties, but the one I commonly employ is one 
which was made for me by Messrs. Tiemann & Co. It is a 
strong, powerful instrument, capable of penetrating as 
much as three-quarters of an inch if desired. It is in 
daily, nay, I should say in hourly, use in my gj-necological 
practice. It is my main reliance for the relief of uterine 
congestions, and so far it has not failed me in accomplish- 
ing its mission more speedily and effectually than any other 
means I have ever tried. I have drawn as much as a gill 
of blood daily for several days in succession from a case of 
bad congestion with most satisfactory results, while in no 
instance have I experienced any unpleasant effects. Even 
when the calibre of the vessels is unusually large, they may 
be punctured without fear. Not unfrequently have I 
wounded an artery and had the stream to spurt beyond the 
speculum ; yet with the relief of the congestion the bleed- 
ing would stop spontaneously. Here I would like to re- 
mark that bleeding of the posterior lip appears to give 
more relief than an equal flow from the anterior one. 
The normal cervix does not bleed much, if any at all, 
when punctured, but I would suggest caution in puncturing 
the endocervical surface, as in this locality the bleeding R. J. Nunn. 
17 
does not stop quite so readily as in the case of punctures in 
the vaginal surface of the cervix. This remark is also 
applicable to the everted endocervicum in cases of lacera- 
tion. 
LOCAL DEPLETION BY OSMOSIS. 
The glycerine tampon is of such frequent use, as a form 
of local depletant, and is so important to the gynecologist, 
that I may be excused if I mention an improvement in its 
composition by the introduction of boracic acid into the 
glycerine which is employed in the tampon. 
This suggestion I owe to Dr. Jules Cheron, of Paris, 
France, and the manner in which I carry it out is as follows : 
To four pounds of glycerine I add one pound of boracic acid, 
and heat them until the acid is dissolved. This I keep in 
stock, and use pure or mix with the glycerine which I use 
for the tampons, in the proportion of about one-fourth of 
the boric solution to the quantity of glycerine to be mixed; 
or more or less if deemed desirable in certain cases. 
The antiseptic properties of this mixture make it of 
great value, as a tampon can with it be easily retained for 
from four to six days without showing any evidence of de- 
composition ; moreover, the boracic acid has a most happy 
effect upon the mucous membrane of the vagina. I have 
been using this preparation for about four years, and I am 
induced to draw attention to it as a matter of justice to 
Dr. Cheron, to whom, as far as I know, belongs the credit 
of the combination, although within the last few months 
it has been brought forward as something entirely new, and 
coupled with the name of Prof. Barff. 
Other antiseptics may be used with glycerine, as, for ex- 
ample, two per cent, of salicylic acid or a little carbolic 18 
Diseases of Women. 
acid. With these, astringents such as tannin or alum, may 
be combined. One combination, particularly praised by 
Dr. Robert Bell, is glycerine 80, alum 10, carbolic acid 3£. 
This has the advantage of not staining the clothing, but 
there are cases in which the alum does not act as well as 
the tannin. • 
FREE LOCAL DEPLETION IN THE TREATMENT OF CONICAL CERVIX WITH 
STENOSIS OF THE OS—CASE. 
This case was presented for treatment on account of 
amenorrhcea of some months’ standing. For six years pre- 
viously she had had dysmenorrhcea. She was 27 years old, 
robust, and unmarried. 
Examination revealed a conical cervix ivith a pin hole 
os, there had been no caustics used, so that this condition 
was not cicatricial. 
Local depletion by scarification was made daily for a 
month with boro-glycerine tampons and hot vaginal 
douches, at the end of which time the conical form had dis- 
appeared. The os was of normal size, and a sound passed 
readily into the uterus. Menstruation came on painlessly 
for the first time in six years, and has returned regularly 
ever since. 
INSUFFLATION OF POWDERS. 
For the insufflation of powders, not only into the vagina, 
but also into other cavities, I have for the last three years 
been using the ordinary “powder gun” sold for sprinkling 
insect powder; costing not more than twenty-five cents, it 
is possible without much outlay to keep on hand a number 
ready charged with difierent powders, and their action is 
quite as good as that of more costly instruments. R. J. Nunn. 
19 
In using these powder blowers, I have with some powders 
found it necessary first to shake the powder down into the 
tube. This is no trouble—is but the work of an instant— 
but it is well to know. 
In this way, by the use of oxide of zinc mixed with ten 
per cent, of powdered boracic acid, I have cured some most 
troublesome cases of nonspecific vaginitis accompanied 
with intense pruritus. 
FACTITIOUS STONE IN THE BLADDER—CASE. 
A case was presented for treatment in my service in the 
Savannah Hospital as being some form of uterine disease, 
the prominent symptoms of which were pain in the back, 
hot flushes in the head, bloody urine, with sudden and 
painful stoppage during micturition. 
A careful examination failed to reveal any uterine com- 
plication, and while the patient was under observation a 
menstrual period came on without any abnormality. The 
microscopic and chemical examination of the urine showed 
that the renal function was unimpaired. It was evident 
then that we had to deal with some derangement of the 
bladder. Proceeding to the examination of this viscus, a 
small, white, very friable calculus was found lying in the 
urethra, just within the meatus. The next step was the 
dilation of the urethra to allow a digital and endoscopic 
examination of the bladder, as the sound failed to reveal 
the presence of any calculi. First, by catheter drawing off 
the urine, a clear amber fluid was obtained in place of a 
bloody urine which the patient was then passing, at the 
same time no abrasions could be discovered, although most 
carefully sought for. The source of the hemorrhage was 
then and still remains a mystery. 20 
Diseases of Women. 
In the dilation of the urethra the warnings of Dr. 
Emmett, as to the production of incontinence, were kept 
in view; and here it may not be out of place to remark 
that this unpleasant feature has never resulted in any of 
the many cases in which the female urethra has been dilated 
by me. This comes perhaps of the fact that the dilation is 
always a slow proceeding, the sphincter being fatigued into 
yielding, but not ruptured or paralyzed. 
In the present case, several days were consumed in the 
process of gradual dilation of the urethra, during which 
time four calculi (?) were found on succeeding days, each 
one being situated, like the first, just within the meatus. 
About this time the patient mentioned that several such 
pieces had been taken from her while under treatment in 
another city. 
The required calibre of urethra being attained, the blad- 
der was carefully explored but not a trace of calculus could 
be found, and the organ itself was perfectly healthy, the 
sphincter at the external meatus was, however, remarkably 
rigid and unyielding. 
From this time the bloody urine and the calculi disap- 
peared, although the patient was kept under close observa- 
tion for two months. 
The calculi are presented for your observation, two of 
them at least seem to be pieces of mortar, the grains of 
sand in them being plainly visible with a lens. 
The patient strongly and persistentl}r denies placing the 
calculi within the urethra. R. J. Nunn. 
21 
VAGINAL STRICTURE OPERATED UPON WITH RIGHT-ANGLED SCISSORS. 
Unless one has had practical experience in the matter, it 
is difficult to appreciate the 
obligations the profession is 
under to Dr. Emmet for his 
many ingenious modifica- 
tions of scissors for use in 
gynecological surgery. I 
beg to add one to the list of 
these instruments; it is a 
right-angled scissors, bent 
on edge, made for me by 
Messrs. Shepard & Dudley. 
This instrument was con- 
trived specially for a case 
of traumatic stricture of 
the vagina. It has been 
used in two cases of strict- 
ure of the vagina, and one 
of imperforate hymen, and 
has proved so convenient 
for this class of operations 
that I venture to bring it 
to your notice. 
Of course these scissors 
are made either sharp or 
blunt pointed, as desired. 
FIG. l.—% SIZE. 
THE PILLAR SLIDE—A NEW SLIDE FOR THE MICROSCOPE. 
Every microscopist knows the difficulty of estimating 
exactly the amount of fluid which will completely fill the 22 
Diseases of Women. 
space between a cover and the slide, and consequently a 
bibulant must be applied to absorb the excess almost always 
present. This takes a little time which, to one who has 
many examinations to make, and who is otherwise pressed, 
is a matter of some importance. 
The following is a description of a slide intended to ob- 
viate this difficulty: 
Take a small, thick cover (round or square, as desired,) and 
cement it on the center of a slide with Canada balsam. Let 
this harden thoroughly so that the cover will not slip 
during warm weather, and also to prevent water insinuat- 
ing itself between the glasses during the frequent washing 
to which it will be subjected. Of course it would be better 
to have these little pillars ground upon the slides, but with 
care in using them the cemented ones will answer every 
purpose. 
A drop of the fluid to be examined is placed upon the 
pillar just described, a cover larger than the pillar is placed 
upon it, when it will be seen that the excess of fluid flows 
into the annular space surrounding the pillar. Not the 
least advantage of this new form of slide is that evapora- 
tion takes place from the fluid in this annular space, and 
may go on for a long time without affecting the stratum 
under examination. 
If desired, the annular space may be filled with oil, and 
evaporation thus be entirely prevented. 
CHEMICAL—NEW SLIDE FOR TIIE MICROSCOPE. 
For the application of chemical tests to fluids under mi- 
croscopical examination, the “pillar slide” presents many 
advantages. The method usual in such cases, is to place a 
drop of the reagent at one edge of the cover, and a bit of R. J. Nunn. 
23 
blotting paper at the opposite edge, with or without a hair 
inserted between the cover and the slide to facilitate the 
inflow of the reagent. 
If the circular pillar slide be used, then the cover must 
be pushed so that all the space is on one side, there will 
thus be formed a crescentic instead of an annular space. 
It is evident that in the latter, if the space is filled with 
reagent it will affect the film, but slowly, because evapora- 
tion takes place from the reagent itself, and there is nothing 
to draw it between the cover and the pillar. In the round 
pillar this is best corrected by having the diameter of the 
cover smaller than that of the pillar, and pushing it to one 
side so as to project a little beyond the pillar, the lunate 
space thus formed is filled with reagent, while the rest of 
the edge of cover is evaporating and drawing upon the 
reagent to supply the deficiency thus created, or, to hasten 
the reaction, a bit of blotting paper may be applied in the 
usual way. 
Another good way is to use a square cover, let one of 
the corners project beyond the pillar, and under this 
corner put the drop of reagent, in this way nearly the 
whole of the edge of the cover will be left free for evapo- 
ration, and the rapidity of the reaction will of course 
be proportionately great. If desired a different reagent 
may be placed under each of the four projecting corners 
of the square cover. 
The “square-pillar slide” seems, however, best adapted 
to this class of work, with a cover the same size or smaller 
than the pillar, and projecting a little beyond it; the 
reagent will then occupy one side of the square and evapo- 
ration go on from the other three sides. If an oblong cover 
is used which projects on opposite sides of the pillar, then 
the same or different reagents may be placed on opposite 24 
Diseases of Women. 
sides of the same specimen, without danger of mixing with 
each other. 
SLIDES WITH HOLLOWS FOR CHEMICAL REACTIONS. 
Many of the advantages of the pillar slides for the obser- 
vation of chemical reactions may be obtained by using 
polished glass slides with one or more hollows. 
In using these the drop of fluid to be examined is placed 
by the side of the hollow, or between them, if there be two 
or more, and the cover is allowed to project over the hollow 
or hollows a little distance; under this projecting edge the 
drop of reagent is placed, and the bit of blotting paper may 
be used as usual upon the slide if desired. 
HYPODERMIC SYRINGE WITH PELLET HOLDER. 
The instrument which I show you is the outcome and 
perhaps the completion of a series of hypodermic syringes, 
some of which have already been exhibited to the Associa- 
tion, of which the first was made for me by Messrs. Arnold, 
of London, about five or six years ago, of glass and metal; 
next in an improved form by Messrs. Tiemann & Co., of 
New York; next in celluloid with other improvements by 
Messrs. Otto & Son, and this one in hard rubber by Messrs. 
Tiemann. It of course could also be made in celluloid. 
You will perceive that externally the syringe and the 
pellet holder present the same appearances, that of a ther- 
mometer case—perfectly smooth from one end to the other. 
The objects in view in designing this hypodermic syringe 
were— 
1. To enlarge the piston rod to full size of the bore of the 
barrel, and to make it hollow. In this way increased R. J. Nunn. 
25 
strength is attained, and a convenient receptacle formed 
in which can be stored the various attachments of the 
syringe; in this instance two needles can be carried in the 
piston rod. In this way the utmost degree of compactness 
is arrived at. This principle is applicable to all syringes 
or pumps of this class, irrespective of size. 
2. Making the joints perfectly tight when closed, so as to 
prevent the drying of the piston. 
3. Attaching to one or both ends of the 
syringe, or forming into an independent 
rod, a number of boxes to be used as 
pellet holders, in which also test paper 
can be carried. 
4. Making an elastic expanding piston. 
5. In the case of glass barrels the use 
of a revolving fenestrated sleeve to pro- 
tect the glass as giving the lightest and 
most compact form of case. 
6. Making the whole without shoulders 
or projections, so that it can be slipped 
into the pocket case. 
7. Making all the screws interchange- 
able. 
Fig. 2 shows the syringe with three 
compartments ready for use. 
Fig. 3 is the syringe packed up. 
Fig. 4 is the pellet holder with six 
compartments. 
FIG 2. FIG. 3. FIG. 4. 
The figures are a little smaller than the instrument 
itself. 26 
Diseases of Women. 
Some of your lady patients may be annoyed by the 
growth of hairs upon the face. These may be removed by 
the use of the electrolytic method, but a good deal of pa- 
tience is required if the number of hairs is large. 
One would suppose this plan to have originated within 
the last couple of years, to judge by recent articles which 
have appeared in medical journals, but I know that I used 
it previous to 1876, and did not think I was doing any 
thing very new or wonderful, being fully impressed with 
the idea that I had seen the suggestion somewhere, and I 
saw it in use in England in 1877 at the Royal Ophthalmic 
Hospital in London, and to the operators there it seemed 
to be an old story. Although the governing idea may be 
identical with all, still each operator will have more or less 
of individuality, and hence I venture to give my method 
of procedure. 
I early found that steel needles became rough after a 
little use, and this together with the shape of the point, 
rendered them difficult of introduction. After trying vari- 
ous metals, including gold, silver and platinum, I finally, 
at the suggestion of a dentist, tried a wire of an alloy of 
gold and platinum, such as is sometimes used in dental 
plate work. The dentist referred to furnished me with 
some of this wire about the year 1875, and since then I 
have used no other needle. The angle of the point should 
be acute—not rounded like a sewing needle, and if properly 
made it will slip in beside a hair without the least trouble. 
The needle should be connected with the negative pole of 
the battery, and a large sponge, which the patient holds in 
the hand with the positive pole; a couple of cells are turned 
on, and the needle introduced alongside of a hair. Then 
EXTIRPATION OF HAIRS BY ELECTRICITY. R. J. Nunn. 
27 
additional cells are introduced until the skin round the 
hair begins to whiten. The action is continued for five or 
ten seconds, and the needle is withdrawn. The hair may 
then be pulled out, and if the operation has been perfectly 
performed, the bulb comes with it. 
It will be observed that the current is to be established 
before the introduction of the needle. By doing this the 
electrolytic action serves as a lubricant, and the compara- 
tively soft needle slips in without the least difficulty. The 
depth of penetration should be sufficient to reach the bulb. 
This you will observe, in the needles shown you, is regu- 
lated by stripping off the non-conducting coat with w'hich 
the needle is covered to the distance desired. 
The battery employed is the ordinary Stohrer cell. 
To pick out the hair, an excellent forceps may be extem- 
porized out of a ruling pen, and as a magnifying apparatus, 
I use a watchmaker’s glass, slipped into a spectacle frame, 
as I show you. 
With this arrangement, I have destroyed and taken out 
as many as three hairs a minute for several consecutive 
minutes, and have eradicated two hundred and fifty (250) 
from one patient at a single sitting. The largest number 
which I have destroyed for any one person is a little over 
six thousand (6,000). 
From the time spoken of to the present I have had but 
two wires, and I have them still, apparently ready to do as 
much service as ever. I take the liberty of laying them 
before you. 
URETHRAL, VAGINAL AND RECTAL CERVICAL AND OTHER STRICTURES 
TREATED BY ELECTROLYSIS—INSTRUMENTS. 
The tendency to return of strictures of various passages, 
such as the urethra, vagina, rectum and cervical canal 28 
Diseases of Women. 
when treated by dilatation, and .indeed by other methods 
also, led to the adoption of electrolysis as a means of perma- 
nent cure, of course there is nothing new in this mode of 
treatment. First Crussell, then Willibrand and Wortliei- 
mer employed it, and MM. Mallez and Tripier wrote about 
it in 1867. Since then every electrician has, more or less, 
used it. The latest writer who has come to my notice is 
Dr. Robt. Newman, of New York. I bring the subject be- 
fore you simply to point out the advantages of the instru- 
ment I employ. 
I always have been and still am an enthusiastic advo- 
cate of the medical employment of electricity and other 
cognate forces, and as soon as the treatment by MM. 
Mallez and Tripier became known to me I changed 
an old set of Wakeley’s dilators by soldering a wire to the 
tips and passing it up the inside, and thus I had an 
electrode which I could slip down over a conducting bougie. 
These home-made instruments have done me good service 
in past years, and I have had a set made by Messrs Tiemann 
& Co., on this principle, which I take the liberty of bring- 
ing before you. There are both flexible and stiff electrodes 
and they could be made to carry both poles if desired; 
they can also, of course, be used without the conducting 
bougie. 
In employing these instruments there is first passed 
through the stricture a conducting bougie, over which is 
slipped the electrode, and then the connection is made with 
the battery in the ordinary way. 
You will see here electrodes of all sizes, from those to be 
used in the urethral and other strictures of small calibre, 
to large ones which are intended for use in the rectum and 
vagina. 
These instruments recommend themselves as being R. J. Nunn. 
29 
absolutely safe even in the hands of 
the veriest tyro, as the conducting bougie 
keeps the instrument in its track with cer- 
tainty. 
One of the greatest mistakes that can be 
made in the employment of galvanism for 
this purpose, is the use of too strong a current. 
It is not necessary that the action should be 
painful. A slight, but not disagreeable sensa- 
tion of warmth is all that is required, and 
this current, patiently applied for a sufficient 
length of time, will certainly accomplish the 
result desired. This has been my experience 
so far, in cases of traumatic stricture, and in 
those in which the condition was congenital, 
but when the contraction has been de- 
pendent upon malignant disease, I cannot 
say that I have attained the same pleasing 
results. 
This figure of the inflexible electrode for 
the male urethra, will serve to illustrate the 
principle. They are made of all sizes, either 
flexible or stiff, straight or crooked, as re- 
quired. 
FIG- 5. 
Note.—Another form of electrode which I have devised and used in 
the treatment of these diseases is intended to convey the current during 
the extraction of the instrument. 
I have been unable to procure a cut of this electrode in time for inser- 
tion in this report. 30 
Diseases of Women. 
a series of metallic 
olive-shaped electrodes,which 
screw on to an insulated con 
ducting flexible stem, Fig. 
7, as recommended by Dr. 
Guyon. 
Figs. 8 and 9 are electric 
bougies of Dr. Mallez. 
Fig. 10 is also the invention 
of Dr. Mallez, and is intended 
to apply the galvanic current 
to the neck of the bladder.- 
CANULA AND WIRE AS A SUBSTITUTE 
FOR THE NEEDLE IN THE ELEC- 
TROLYSIS OF TUMORS, ETC. 
One of the most successful 
ways of treating abdominal, 
and, indeed, other tumors also, 
is by the use of the electro- 
lytic current, but it is a matter 
of no little difficulty to intro- 
duce the insulated needles— 
the varnish used for insulation 
causing the tissue to cling to 
the instrument. To obviate 
this difficulty I substitute a 
fine trocar and canula which, 
being introduced, the trocar 
is withdrawn and a fine insulated wire passed through the 
canula which can then be withdrawn. This plan works 
admirably. 
t'- 
U) 
s 
00 
fcc 
s 
o 
bp 
Ul 
S R. J. Nunn. 
31 
For the benefit of those who, like myself, are often com- 
pelled to use home-made instruments, and who may desire 
to know a ready way of insulating the wire, I would say 
that the wires I have used, and now show you, are insulated 
by successive coats of collodion, and the wire itself is of gold 
and platinum alloy. These wires are over eight years old, 
have been used a great many times and are still as good as 
ever. 
I mentioned this arrangement to a manufacturer of elec- 
trical instruments in New York in 1876, but for some reason 
best known to himself he never took advantage of the in- 
formation, and the instrument has never been placed upon 
the market. 
ANTIMONY AS A NEGATIVE ELEMENT. 
This brings me to mention the value of plates of anti- 
mony as a substitute for carbon in the cells of the galvanic 
battery. This was communicated to the same manufac- 
turer at the same time, but has since lain upon the shelf. 
While it is quite true that these plates are not perhaps as 
electro-negative as carbon, their superior conductivity seems 
to more than compensate for the difference. They are 
easily made by any metal founder, and the broken plates 
can be remelted and cast into any desired shape, such 
as plates, cells, etc., of almost any size. The only draw- 
back is the brittleness of the metal which, however, is, 
I think, not greater than that of the carbon, but this 
may be remedied by the use of a small percentage of lead 
which seems not to appreciably affect the working of 
the battery. 32 
Diseases of Women. 
IMPROVED PISTOL-HANDLED UTERINE DRESSING 
FORCEPS. 
This is an improved form of the pistol- 
handled forceps exhibited at previous 
meetings. It is somewhat shorter, the 
grip is stronger, and the curves of the 
handles have been changed so that the 
catch will in no way interfere with its 
use as a dressing forceps, while it may 
still be employed as a polypus forceps 
or artery forceps if desired. 
This figure is not strictly correct. 
The handles should be shown half 
an inch apart when the points are 
in contact. 
Note.—The writer is under obligations to 
Messrs. Shephard and Dudley and Tiemann & 
Co., for the illustrations used in this report. 
FIG. 11.