2 THE MEDICAL BULLETIN. In those cases in which the uterus ha inflammatory conditions they may be lost, so that | bowel. With this preliminary consideration we can readily see how any rupture of a portion of this pelvic floor or a weakened condition of the muscular structure must exert an influence in the support of the vagina and superjacent structures. In order to maintain a proper support of the anterior segment of the pelvic floor, we must have its posterior segment in a normal and healthy condition. Now, this segment may be interfered with by any state of health which produces a weakened condition of the muscular system, by causes which increase the intraabdominal pressure, such as abdominal growths, hypertrophy of the uterus, and so on; or by lesions of parturition, in which a part or the If the whole of the pelvic floor has been lost. perineum, in part or whole has been destroyed, we have to that extent a loss of the resistance to the intra abdominal pressure, so that soon the anterior segment, no longer finding its support, drags downward; with this downward displacement of the anterior wall of the vagina, by the intimate relation already named between it and the bladder, we find the posterior wall of this viscera displaced, and the distress and discomfort of the patient will be increased according to its extent. As the anterior segment sinks below the level of the internal meatus, we find that the bladder is not completely emptied; the retention of a portion of the urine, with the formation of increased secretion of mucus, leads to the development of cystitis and the production of ammoniacal urine. This irritation may lead, subsequently, to deposit of the salts of the urine, forming a calculus. A protrusion of the anterior wall may or may not be associated with the rolling out of the posterior. The latter is usually accomnied but not always, with protrusion of the with that of the vagina; when this takes plac In those rare cases in which the uterus Upon examining the literature of the subjec we find that prolapsus of the uterus and vagin was among the earliest diseases recognized b the ancients. They, however, had peculia ideas regarding its pathology and the manne of replacing and retaining the organ in place Thus, we find Soranus criticizing his confrère for suspending patients head downward fo twenty-four hours; others considered the uteru a sentient body, and attempted to frighten back into place by placing it in contact wit lizards and disgusting insects, or subjecting to disagreeable odors. MEDICINE AND SURGERY. Various pessaries and mechanical means | the vagina laterally and vertically, and take up have been used. Some, mechanical means, in the tissue that has been so abundantly displaced the form of tampons, which combined the outward. astringents for their influence upon the mucous would be a failure, and must be supplemented This operation alone, however, membrane or the walls of the structure. These, by one upon the perineum in such a way as however, acted upon the principle that the to bring the posterior segment in contact with vagina is a retaining power, and when it was the newly replaced anterior segment, thus contracted the uterus was held up by it. these mechanical means, whether in the form of Having freshened a triangular surface All imitating the normal condition of the vagina. tampons or pessaries, act by so dilating the upper posterior commissure, deep sutures are intropart of the vagina that it, together with the dilat- duced and the mucous membrane is brought upon the ing body, cannot slip through the inferior pelvis together by a continuous suture, to make ceror the orifice of the vagina; in cases, however, tain that the union is complete from within. in which the outlet of the vagina has been greatly lacerated or enlarged, it is difficult to maintain a foreign body of this character in place; and in other cases, what little elasticity the vagina may still retain is lost through the distending influence of the foreign body. A variety of surgical procedures have been devised, as the application of caustic agents to the surface, producing sloughing and the subsequent contraction of the vagina. Dieffenbach applied forceps to the vagina, grasping folds of the tissue, which were permitted to remain until the tissue sloughed away. Introduction of a ligature encircling the vagina, drawing this tight, and in this way creating vaginal stricture, closing the perineum, imprisoning the uterus. and vagina within the canal with alternate gold and silver rings, were plans practiced. All of these methods of procedure, however, fail to support the vagina throughout its whole length, permitting the heavy organ to press upon the vulvar outlet, and permitting absorption of what union has been gained. Marion Sims recognized the importance, in any operative procedure, of retracting the anterior wall of the vagina. This he did by freshening the surfaces in the shape of a letter "V" and bringing the arms of the "V" together; this resulted in holding the uterus up, forming a sulcus in the anterior wall, into which the cervix would sometimes slip and give rise to pain and discomfort to the patient. To obviate this, Emmet freshened a surface upon the upper part of the "V," so that he had but a slight opening left. Other forms of denudation have been practiced. patient we operated upon to-day we make a In the star-shaped denudation, or a vertical and lateral bar crossing each other, and bring these together so that we have a vertical and horizontal line of sutures; in this way we retract on an animal-broth diet, avoiding the use of moved at the end of one week; the sutures in ORIGINAL COMMUNICATIONS. con A SYNOPTIC REVIEW OF THE IN BULLETIN of November last, it is stated that administration of arsenic upon the human 4 THE MEDICAL BULLETIN. or accidental, have become familiar topics, the | longed extraneous residence, Professor Gubl having disengaged it from the hair eig Prof. Adolph Gubler, in his lectures upon arsenic, discusses this matter more fully than I He there states that M. have seen elsewhere. Paul Thenard, proceeding to experiment upon the dogma of the substitutive action of this drug, as promulgated by Roussin in 1863 and corroborated by himself in 1865, had added the tribasic arseniate of lime to the food of certain young animals after they were weaned, and, having afterward killed them, he found in "the new layers of the bony tissue the tribasic phosphate of lime was replaced by the tribasic arseniate," thus confirming not only his own theory and that of M. Roussin, but also the great law of substitution advanced and defended by M. Dumas." 66 This vito physical transposition can, of course, happen only where phosphorous naturally exists, and, as the phosphatic salts are found in all the tissues and humors of the economy, the correspondently extensive affini ties therein implied would explain the wide range of the agency, curative as well as toxic, of this interesting substance; and as its elimination from combination in situ is regulated by the longevity of the parenchyma of the organs where it may have usurped the place of the homologous element, it is to be sought for with reliance in them, particularly the nervous and osseous systems, and in the latter may be detected after the softer textures have entirely disappeared,—a circumstance of importance in criminal jurisprudence, as regards the innocence or guilt of one accused of crime com mitted long before,-although the antiseptic preservation of the gastric parietes usually suffices, together with other physical signs, to sustain incriminating charges. When given medicinally, the renal functi being normal, accumulation to any great exte rarely occurs, it being rapidly excreted throug the urinary channels, having been found in t urine of individuals accustomed to taking shortly after an unusually large amount w swallowed; hence the importance of inquiri into the condition of the kidneys when prescribe arsenic; if they are free from d generative change it may prove beneficia otherwise toxic symptoms may arise and d mand a suspension of the treatment. Although the chemico-vital reaction arsenic with phosphorus in the living orga ism seems to admit of proof, the mann thereof, equally with that of its general co stitutional action in health and sickness, is i volved in obscurity. We see the result, but t process is not revealed to us; therefore, esoteric operations become a matter of co jecture. Of the numerous theories advance are remarkable for the imaginati some fertility they evince, as that of M. Pade who (in popular fashion) solves the proble as regards pernicious anæmia "en montra que les leucocytes peuvent être considerés com des parasites, les arsenicaux a dose mode les attaquent en respectant les hématies," — supposititious discrimination not unlike th formerly spoken of as "almost intelligent between sound and diseased structures likewi ascribed to this agent, when used externally a caustic by means of the arsenical pastes, b now known to be due to the feeble resistan of the neoplasm from deficient vascularit causing it to succumb before the adjace healthy parts, which, being plenteously fu nished with vessels and blood that absorb a remove the redundant poison before its cha acteristic effects can be produced, rema unaffected. M. Lemarie Piquot recommends it, "cont les congestions appoplectiques," without furth Moreover, the tegumentary decidua are in comment, except some statistics of cases whe he supposed it the cause of improvement, hi MEDICINE AND SURGERY. 5 self included in the category, although (had he | when pledgets of lint, saturated with Fowler's In his formulated system of arsenical medication for intermittent fever, M. Boudin does not favor us with the ratio medendi; yet here the theory of M. Padey, with slight modification, would apply, simply by diverting the cytocidal proclivity of the arsenic from the leucocytes toward the protophytum held by some to be the etiological factor in ague; and (were the above hypothesis true), could it escape from the albumen and plasma in which we are told it is incarcerated whilst in the circulation, there would be ample scope for such antagonism, no form of organic life, with one exception, surviving its mortal touch, under certain circumstances the blood itself not escaping, even that vital fluid feeling its baneful presence, as shown by its sinister effect on the hæmoglobin, embarrassing the function of hæmatosis, and impeding tissue-respiration and the progress of the current through the capillaries, and so, probably, causing the effusion constituting the specific anasarca, which occurs when, for whatever purpose, it may be indiscreetly taken. We must, however, acknowledge our ignorance of these occult matters, and admit that in them, as in cutaneous diseases, in asthma, in dyspnoea, in chorea, in angina, in gastralgia, in ague, in neuralgia, in rheumatoid arthritis, in chronic adenitis, and in intestinal catarrh, its use is purely empirical, the therapeutic rationale being unknown. secret, and it becomes apparent that arsenic, by But as a peptic tonic we have a clue to the facilitating the concoction and assimilation of the food, can be of indubitable service in anthe improved appetite and eupepsia it occasions. æmia and the debility incident thereto; indeed, readily explains the respiratory tonicity and muscular strength of the arsenicophagi of Carniola and Styria, as observed and described by Tchudi and others; also, the heightened complexions and embonpoint of those of the gentler sex who resort to it amongst their cosmetic juvantia. Unfortunately, these flattering concomitants are not only factitious, but transitory, and disappear with the withdrawal of the drug, the robust aspect of persons during a course of arsenical medication being probably largely due to the oedema arsenicalis, as when treatment is interrupted or stopped a changed and haggard appearance quickly ensues, an emaciation caused by the rapid absorption of the effused serum held in the connective-tissue of the muscles of the face and neck. Gubler, the profound and eloquent Trousseau, The illustrious predecessor of Professor "in verba magistri jurare," admits the good recorded of arsenic when properly taken, but open air is requisite to produce it, as with codaffirms that simultaneous active exercise in the liver-oil and other hystogenetic analeptics; he also indirectly intimates that minute doses of it may prove advantageous in chromic digestive disorders, by asking whether the alterative action of certain natural mineral springs, hitherto attributed to their alkaline ingredients, might not in of arsenic then recently detected in them,—an reality result from the infinitesimal modicum inference worthy of consideration, in its relation to hygiene and the salutary consequences of its imbibition in extremely dilute solution, as found in the waters of the surface of the earth. It is said that during arsenical treatment for chronic squamous eruptions, deposits of this metalloid become visible upon the inflamed surfaces, and cures have been credited to that circumstance, to an ouоlos álоs from its specific phlogosis, which, superseding the pathognomonic, modifies it to the end of its ultimate disappearance; a surmise fortified by the not infrequent sudden aggravation and subsequent amelioration of these diseases, follow-with it as an adulterate,ing the adoption of this potent medicament for relief, together with its well known local action in intractable ulcerations; as in onychia maligna and indolent ulcers of the inferior extremities, the thunder" of arsenic, from the frequency 6 THE MEDICAL BULLETIN. and other diseases when introduced through | for long periods, or during life, in astonishin the primæ viæ, employed externally, the latter claims our unreserved confidence, its virtues having been recognized for centuries; since, as Alibert remarks, "Naaman ce chef des troupes de Syrie merveilleusment queri par le prophete Elisee pour s'être baigne sept fois dans les flots sulphureux du Jourdain," until the present day, and it will scarcely fail to reward the physician who prescribes it, alone or combined, in baths or by inunction, especially the latter, not only in scabies in which it is regarded a specific, but also in prurigo, scaly eczema, and psoriasis, palliating and accelerating the cure by its emollient, sedative, resolvent, and antipruriginous properties. In the latter affections some form of arsenic should at the same time be given by the mouth, the consensus of contemporary dermatological judgment being in its favor. As regards its topical employment as a corrodent in the carcinoses, M. Lebert, in his "Traité Pratique des Maladies Cancéreuses," while granting the conservative action of arsenic as an escharotic in chancroid ulcerations, denies that in true cancer it is of any radical service, and promises to prove it, "Mais nous prouveron bientôt que les ulcérs que l'on guerit par la pâte arsenicale ne sont pas vraiment cancereux et que'en outre son action locale est purement caustique." Gubler, however, disHe sents from this estimate of it as a caustic. says: "It is not a caustic substance, but produces a scar like a caustic; it does not produce an eschar by carbonizing the substance of an organ or by transforming it into zantho proteic Also, "the acid or into a soap, it kills it." eschar produced by arsenic contains the histological elements of the tissues, when, on the contrary, the eschar has been produced by sulphuric acid; nothing remains but a magma without form." When we attempt to speak from the book of the protracted administration of arsenic, we realize the dearth of information upon this important phase of our subject; and although there is enough and to spare of literature on its tentative use, for the relief and cure of acute and chronic ailments, we find little to enlighten us in respect to its sequelæ, if any, when given in moderate doses for months and years, without intermission or change, in the quantity prescribed. Although the mountaineers of the Tyrol, already alluded to, are reputed to eat arsenic quantities and with equally astonishing result: Many of the above disorders, when arisin spontaneously, are counteracted by this ver remedy which, under other circumstances, wi produce them,-a therapeutic fact now we authenticated, and of broad application t analogous symptomatic conditions. Arsenic is one of the most reliable weapon we possess, in combating many of the disease of children, to whom it is peculiarly applicable they bear it well, and as it is tasteless, and ma be given in plain or sweetened water, there never any difficulty in induciug them to take it they appear to enjoy complete immunity fro its deleterious consequences, an infant at th breast taking it in the dose of 2 minims with out inconvenience, and little, shrunken, puny weak, cadaverous, and aged looking babie become marvelously healthy, rosy, and strong under its sanatory manifestations. At whatever age it may be given, the prope time is, invariably, directly after meals, as it then taken up by the lacteals, and by way o the thoracic duct enters the general circulation thus avoiding the liver (the organ, according to Ludwig, that confines and conserves it th most and the longest, after its internal use ha been discontinued), which, in the intervals digestion, it would otherwise reach through th vena portæ, and there be arrested. An additional reason for giving this activ |