1911 Journal of the American Medical Association  
The two classes of patients who come to me with pessaries are those with perfectly normal anteriorly displaced uteri which need nothing, the patients having been made sick because some fool doctor has put a pessary in, and secondly, the patients with prolapse in which a pessary is of no use. Consequently I feel that nobody in the East knows how to use them, barring New York, and I intend to make a special trip to New York to see whether they are correctly used there. The ability seems to be
more » ... ined to the West or to the Middle West, to Chicago principally. I showed by the model this morning how useless is the weak end of the round ligament in this operation. But I shall convince Dr. Gellhorn of his wrong position by showing him by the model that that end of the ligament is not used at all in the operation. Dr. D. Tod Gilliam, Columbus, 0. : The only criticism made of the operation which I have devised is that it leaves bands in the peritoneal cavity which are liable to produce obstruction of the bowels. "The proof of the pudding is the eating thereof." For ten long years or more this operation has been performed thousands of times by hundreds of dif¬ ferent operators and there has never been a case of obstruc¬ tion of the bowels. Dr. F. F. Simpson, Pittsburg: I think we all recognize the fact that there are many displacements of the uterus that require no treatment and that many others are corrected by the pessary. There are many others in which some coinci¬ dent disease, cardiac, renal, pulmonary, thyroid or other dis¬ ease, contraindicates any type of operation for any purpose. In such cases benefit is obtained from the use of the pessary. The work of Drs. Reynolds, Goldthwaite and others has shown the importance of examination of the sacroiliac joint before the treatment of displacement by any method is to be con¬ sidered. In reference to the employment of other operations than those devised by the individual operator, I have used and am constantly using parts of operations of different types and expect to continue to do so. Dr. A. Goldspohn, Chicago: Dr. Coffey makes several assumptions that are fundamentally wrong : ( 1 ) He assumes that all abdominal as well as pelvic organs are held in their places chiefly by their peritoneal mesenteric supports. The truth is that the abdominal walls hold the abdominal organs chiefly, as we soon find out when these walls are defective. On the other hand, the uterine supports have either connective tissue or muscle in them in addition to the peritoneum. The free expansion of pelvic tumors shows that peritoneum holds not much better than skin. (2) That two layers of stomach or intestinal wall may unite and form one layer permanently, does not prove that the same will be true of the broad rind round ligaments about the uterus, which are subject to the phenomenal and entirely peculiar changes incident to gestation and parturition, which does not apply to intestines, etc. secondary laparotomies I have repeatedly seen all such plica¬ tions and foldings of broad and round ligaments completely wiped out without leaving a trace of the former work, after an intervening childbirth. In rétroversion cases, the displacement had nearly always recurred. That the proposed plications of broad ligaments proposed by Dr. Coffey do give way as above stated, is shown by his declaration that the involved round ligaments disentangle themselves later, and assume their usual course. This they could not do without the giving way of the broad ligament plications. The doctor practically constructs two connected links of a chain, and then claims that they become separated without either one of them being broken. The-operations devised bj' Drs. Webster, Baldy, Ries and a number of others for rétroversion, are inferior as to stability, because they depend on the tapering, feeble outer ends of the round ligaments to do holding, which they cannot do because of their feebleness and because of their course in areolar tissue extraperitoneally before entering the inguinal canals. I have practiced, for some years past, median section with removal of the appendix and other explorations, and have corrected rétroversions in a small number of cases by shortening the sacro-uterine ligaments; in others by transplantation of the round ligaments into the abdominal walls, by several of the different methods, chiefly by a modified Gilliam operation, in « Inch the uterus is drawn up more, so that it comes in contact with the abdominal wall, and the utero-vesical space becomes quite effectively shut off from the entrance of the small intestine. The theoretical arguments about intestinal stran¬ gulation, etc., do not apply to this form of the operation at least, of which I have over 500 that are fully two years old, and without any such disaster, or any difficulty in childbirth. IMMUNOLOGY A Perhaps no other of the medical sciences can be so suitably discussed in relation to animal experimentation as immunology, because no other science has been so dependent on this method of attack for its development. The science of immunity, or immunology, would explain the mechanism by which the animal body is enabled to resist disease. In addition to its fascination as a biologic science, immunology offers the added interest of the greatest human utility, the prevention and cure of disease; and precisely in this vital significance lies at once the importance of the science and a potential danger to its sound development. This danger arises in an overanxiousness to apply supposedly specific agents before the principles that underlie their apparent effect have been determined. The history of immunology has, indeed, brought into particular relief certain interesting relations of theory to practice, worthy of more philosophic discussion, but we may content ourselves with an attempt to point out the usual sequence of observed facts, logical deduction, inductive experiment, and, in concluded chapters, application of principle in the diag¬ nosis and prevention of disease. The relatively recent development of any exact knowl¬ edge of the mechanism of immunity is at first glance surprising, when we consider that certain examples of natural and of acquired resistance to disease have been recognized since ancient times. Some attempts to turn these recognized examples to practical use were from the beginning successful, but none of them was inaugu¬ rated with that understanding of the principle involved which brings the greatest utilitarian reward. It is ob¬ viously no lack of human interest in the subject which has delayed the evolution of immunology, but largely the lack of a suitable method of attack on so obscure a subject. The method was eventually furnished by the recrudescence of the experimental idea as applied to medicine and particularly as exemplified in the progress that has been made in determining the causation of disease. Immunology, indeed, parallels bacteriology both in chronology and in method. Before considering the development of the experimental science of immun¬ ity we may outline: I. THE DATA OF IMMUNITY ACQUIRED FROM CASUISTICS The first and most wide-spread type of resistance to disease is the inborn or natural immunity which is evi¬ dent on the initial exposure to a given malady. With This paper is one of the series prepared for and reprinted by the Council on Defense of Medical Research of the American Medical Association for circulation among the public. Seventeen of these pamphlets are now ready, taking up the relations of animal experi-
doi:10.1001/jama.1911.02560080026006 fatcat:zro7bk6iurgt7f4tggw36yatru