1899 The Lancet  
379 failed to relieve, then she must undergo an operation either 'by the vaginal or the abdominal route for fixing it in position. -have seen many examples of all these in which I have felt it my duty to advise against operation and I do not know of .a single case in which there has been reason for regret that .that advice has been acted upon, while on the contrary I .have positive evidence of its soundness in many cases. With regard to the case of uncomplicated retroversion I have never seen
more » ... e necessity for any operation, either that senseless method of fixing the organ by the vaginal route or the ,more rational method-of course on the assumption of its .necessity-by the abdominal route. It would be taking a "charitable view of the matter to say that errors of diagnosis are answerable for many mistakes in practice. It was a maxim of the late Mr. Lawson Tait, to whose initiative gynæcology owes so much and who has left the impress of his genius indelibly stamped upon the face of gynaecology, 'When in doubt, open the abdomen.' But his words were much misunderstood. He did not mean that the abdomen -rhould be opened to solve a doubt as to whether there was disease or not, but to ascertain the exact nature of a diseased condition of the existence of which there could be no doubt, which is a very different thing. An idea of recent origin is that the ovary secretes a something which is of service in the economy, and that whenever it is possible n an operation involving of necessity the removal of only a part of the generative apparatus one or both ovaries should be left. There is not an atom of evidence to support that idea. The ovary was evidently devised for the purpose of perpatuating the species by providing ova, and in the normal state, having discharged that function, it atrophies and becomes not only a useless but a dangerous organ, for, as we only too well know, it is very liable to disease. In a very targe proportion of cases disease attacks this organ long after it has served its purpose, and it seems to me rather one's duty to secure the removal of such an unsatisfactory appendage when opportunity offers than to take steps for its retention. In my own practice I have had to remove both ovaries in a large number of cases. I have never willingly left an ovary when the uterus or its Fallopian tube has been removed, and over and over again patients thus deprived of both these organs have testified by word of mouth, confirmed by appearances, to a condition of good health, mental and physical, that had not been experienced for years previously, although these organs played no part in bringing about the disease which involved their removal. On the other band, it has occurred to me to have to remove the second ovary after an interval of as many as 11 and even 18 years. Surely the possibility of such an occurrence is a strong argument against the practice in question. Lawson Tait was much nearer the mark when he urged that the removal of the second ovary-as in the case of the appendages-should become a rule of practice, because of the frequency with which it was subsequently attacked." Dr. Bantook concluded his remarks by warning his audience not to promulgate their opinions hastily or upon insufficient evidence, but rather to be moderate and patient in their assumptions of successful results. of cases of fever following delivery. The first, often called "one-day fever," was due to emotion, copræmia, or other transitory causes ; the second was due to complications which were not referable to labour, such as influenza, scarlet fever, acute phthisis, and typhoid fever; the third was due to infection from pre-existing pelvic !e&ions, such as pyosalpinx, appendicitis, &,c.; and the fourth was due to external infection forming what was genetrdlly understood as "puerperal fever." In discussing T.he prophylaxis of puerperal fever Dr. Spencer expressed the opinion that it was not necessary for a medical man to abstain from practice when attending such cases, as thorough disinfection will at once enable him to attend other women with safety. Coming to the serum treatment he pointed out that a large number of observations had now been made upon its use, over 350 cases having been collected by a committee of the American Gynaecological Society. Among these cases there was a mortality of 33 per cent., but the natural mortality of the disease was probably not greater than that. The conclusions he had arrived at were (1) that, as normally applied, serum therapy has no scientific basis in the treatment of puerperal fever; (2) that it has not lowered the mortality ; (3) that it usually lowers the temperature and sometimes improves the general condition; and (4) that its use is not free from danger. , medical officer of health of the Mid-Warwick district, who spoke, as he promised that he would, with great frankness. " In the brief interval at my disposal there is no subject on which I desire to speak out with more direct frankness and sincerity than the relations of bacteriological research and methods of treatment to preventive medicine. And at the outset I may be permitted to say that ever since the great Pasteur announced the results of his prophylactic inoculations with respect more especially to fowl cholera and anthrax I have been a close, and I hope unbiased, student of bacteriological literature. I may say, too, that my attitude towards these newer methods of treatment was at first one of expectancy, though I could never see that there was any legitimate analogy between them and Jenner's great discovery on which they are admittedly based, and the more I have studied them the more firmly I feel convinced that they are based on errors and are the outcome of illogical inductions, every one of them. That, you will say, is a very strong statement to make, but after all these long years of flickering hope I am prepared to contend that the indiscriminate maiming and slaughter of animal life with which these bacteriological methods of research and experimentation have been inseparably associated cannot be proved to have saved one single human life or lessened in any appreciable degree the load of human suffering. I have ventured to make that pronouncement before, but in halting academic fashion ; I reiterate it here and now with the strongest and fullest conviction. In order to make my contention as clear as possible let me refer for a moment to the doctrine of immunity as illustrated by small-pox and vaccination. We know that there are certain infectious diseases one attack of which protects, as a rule, against any future attack and that of all diseases this can be more emphatically said of smallpox than of any other. That was why inoculation was practised for a time and was successful so far as the individual was concerned. The person inoculated suffered from the disease because he was inoculated by the actual materies morbi, but he ran the risk of suffering from perhaps a very severe attack and became a centre of infection unless he was isolated. Now, Jenner's happy induction was this : he knew that it was common talk that milkers who suffered from sores on their hands which they contracted from the vesicles on the teats of cows infected with cow-pox were protected against small-pox. He therefore concluded that if he inoculated with the matter contained in the vesicles of cow-pox instead of with small-pox matter he might be able to confer immunity against smallpox. He tried the experiment and tested it over and over again, and not only so, but by using the matter from the vesicle produced by vaccination he made the further discovery that he could confer immunity from small-pox by vaccinating from person to person-that is, by
doi:10.1016/s0140-6736(01)40395-3 fatcat:7tnm7xxy6vbbbphzd77ojbl2dm