DOSA&E OF HEMOGLOBIN IN GYNECOLOGICAL CASES. 
BARTHOLINITIS. POSTERIOR VAGINAL CELIOTOMY. 
MEDICAL TREATMENT OF DYSMENORRHEA. 
SURGICAL TREATMENT OF PROLAPSUS UTERI. 
Notes from the Gynaecological Clinic of 
CHARGES GREECE CUjVISTOfI, B.JW.S., JW.D'. 
Boston, |Sass. 
Reprinted from Annals of Gyn(ecology 
and Pcediatry. 
BOSTON, 1896. Dosage of Hemoglobin in Gynecological Cases. Bartholinitis. Pos- 
terior Vaginal Coeliotomy. Medical Treatment of Dysmenor- 
rhea. Surgical Treatment of Prolapsus Uteri, 
(NOTES FROM THE GYNAECOLOGICAL CLINIC OF DR. CUMSTOM. REPORTED 
BY L. F. G.) 
The importance of knowing the per 
cent, of hemoglobin, as well as a 
blood count, to ascertain the con- 
dition of the blood in surgical and 
gynaecological cases is not generally 
recognized by surgeons. 
mesentery was riddled with infiltrated 
glands. 
There was one fact not to be for- 
gotten. In cases in which there is a 
complete obstruction of the ductus 
communis choledochus, with result- 
ing retention of the bile and its pig- 
ments, the latter accumulated in the 
liver, where they destroyed the hem- 
oglobin, which was eliminated in the 
form of biliary pigment. 
Dr. Cumston resorts to blood ex- 
amination in many cases, both surgi- 
cal and gynaecological, especially 
where operative interference is indi- 
cated. He considers Gower’s hemi- 
globinometer as very satisfactory and 
sufficiently exact for all practical pur- 
poses. In cancer, the per cent, of 
hemoglobin is nearly always low, 
reaching even to fifteen per cent, in 
a case which the professor had seen. 
Exceptions to the rule occur, however, 
and a patient with carcinoma of the 
splenic flexure of the colon, on which 
Dr. Cumston had recently operated, 
had blood containing eighty-nine per 
cent of hemoglobin. A fair prognosis 
was made as to the lease of life in 
this case on account of the good con- 
dition of the blood, and in fact the 
patient survived over six months the 
operation. Nothing radical could be 
done, as the incision showed that the 
The result of this destruction of 
hemoglobin would be a very low per 
cent, when examined. 
A patient was then shown with 
carcinoma of the cervix, not very ad- 
vanced, but invading the vaginal 
walls, thus contra-indicating any radi- 
cal operation. The patient, aged 
forty-seven, was not cachectic. Hemi- 
globinometer showed the per cent, 
of hemoglobin to be thirty-five, and 
an early cachexia with death was pre- 
dicted by the professor. 
A case of abscess of the vulva-va- 
ginal gland in a woman aged twenty- 
four was next shown. This disease 
is called bartholinitis by Dr. Cumston, 
and he considers it an inflammatory 2 
CHARLES GREENE CUMSTON. 
process ending in either a canalicular 
or parenchymatous abscess of the 
vulva-vaginal gland. 
case under consideration. The oper- 
ation in no way changes the static 
conditions of the uterus. 
The affection is always due to a 
pus-producing organism, but may oc- 
cur without gonorrhoeal infection; the 
gonococcus is consequently not the 
specific microbe of this particular 
abscess. 
The modus operand! is not compli- 
cated, although complete bilateral ex- 
tirpation is not easy. The posterior 
incision was in the majority of cases 
superior to anterior colpotomy. 
The vaginal route was decidedly 
indicated for the removal of small 
tumors, and in such cases was far less 
difficult than laparotomy. The 
formal indications of posterior vagi- 
nal coeliotomy were, the small size of 
the diseased organs, their mobility, 
unilateral lesions, the possibility of 
lowering the uterus to render the 
adnexa easy of reach to the fingers and 
instruments. 
The etiology of this affection is 
very often a gonorrhoeal infection, 
but usually there is a mixed infection 
of the gonoccocus and staphylococ- 
cus. The former organism prepares 
the soil for the latter, so that when 
the pus from these abscesses is ex- 
amined bacteriologically only the 
staphylococcus is to be found, Neis- 
ser’s organism having disappeared. 
The pathological anatomy, accor- 
ding to Dr. Cumston, is as follows : 
Considerable epithelial proliferation 
in the excretory ducts; embryonic 
cell infiltration extending around and 
along the ducts; the formation of 
pericanalicular abscess explain the 
pathogenesis of the relapsing form of 
this affection so frequently met with. 
The contra-indications were a large 
sized mass, immobilty, many adhe- 
sions, fixed position of the adnexa in 
front of the broad ligament in the 
prevesical fossa. 
In all operations performed for pel- 
vic trouble, Dr. Cumston insists on 
trying to render the intestinal tract 
aseptic. For this naphtol B, 20 
centigrammes in a cachet after each 
meal, or creolin formulated as follows 
were recommended: 
As to treatment, a simple abscess 
of the gland should be incised. When 
the affection is chronic the gland 
should be extirpated with all aseptic 
precautions. 
E Creolin. 6.0 
Alcohol, dfl. 1.0 
Ext, liquirit. 
Pulv. liquirit. aa 6.0 
Gum. adragant, 1.0 
m. f. s. a. pil. no. C. 
D. S. Take one pill four times daily. 
A patient presenting an enlarged 
tender ovary, prolapsed and adherent 
in the left vaginal cul-de-sac, was then 
brought before the class, and after 
discussing the symptoms and diag- 
nosis, Dr. Cumston said that posterior 
vaginal coeliotomy was a most logical 
and direct way for unilateral extirpa- 
tion of the diseased adnexa, as in the 
Dhysmenorrhoea in well-developed, 
non amemic women, where after care- 
ful bimanual examination no inflam- 
matory process is to be found in either 
the uterus or adnexa, viburnam pruni- NOTES FROM GYNAECOLOGICAL CLINIC. 
3 
folium will give very excellent results. 
pository composed as follows, recom- 
mended by Farlow: 
In ovarian dysmenorrhoea, when the 
flux is scanty and functional develop- 
ment delayed, the exhibition of iodide 
of soda, combined with mix vomica 
and iron, is indicated. 
E Ext. belladon., 
Ext. cannabis indicse, aa 0.02 
01. Theobrom. q. s. ut f. supposit. no. 
I. D. tal. dos. no. X. 
D. S. Insert one suppository every 
night and morning if necessary. 
Dr. Cumston thinks that antipy- 
rine is of considerable value in cer- 
tain cases of this disorder of the 
menstruation, at the dose of from 
two to four grammes in twenty-four 
hours or combined with the bromides, 
the following formula being given as 
an example: 
Another excellent formula much 
relied on by the professor was: 
E Ext. belladon. 0.01 
Pulv. nuc. vom. 
Ferri reduct. aa 0.02 
Ext. cinclionae q. s. ut f. pil. no.' I. D. 
tab dos. no. xx. 
S. Take one pill three or four times 
daily. 
B Antipyrini. 10.0 
Ammon, bromid. 
Kalii bromid. aa 5.0 
Ext. vibur. prunifol. fld. 20.0 
Spir. vini gallici. 
Syr. cort. aurant. aa 40.0 
Aq. dost. 60.0 
When the patient showed signs of 
hysteria, a pill containing camphor 
was of service. 
M. D. S. Take a teaspoonful four or 
five times daily; 
R Pulv. camphor. 0.10. 
Res. asafoetid. 0.05. 
Ext. gentian, q. s. ut f. pil. no. I. 
D. tal. dos. no. xxx. 
A most important point in treat- 
ment is to keep the bowels open, and 
Carabana water, at the dose of a 
wineglassful before breakfast, was 
most highly recommended. Those 
patients who could not afford the 
water were to take the following:— 
S Take five or six pills a day. 
Medical treatment also included 
electricity, massage and a proper hy- 
giene, the latter should never be over- 
looked. 
Dysmenorrhoea in the vast major- 
ity of cases was only a symptom of 
some gynaecological affection, such as 
perimetritis, metritis, the various 
deviations of the uterus, salpingitis, 
ovaritis or cystic degeneration of the 
ovaries, as well as stenosis of the cer- 
vix, all of which required a proper 
surgical interference. 
O 
R Pulv. jalap. 10.0 
Pulv. rhei. 
Oleosacch, limonis. aa 5.0 
Sulphur, prsecip. 
Kalii bitartrat. aa 20.0 
M. D. S. A teaspoonful in a glass of 
water, to be taken in the morning. 
Dr. Cumston also impressed forci- 
bly upon the class that morphine or the 
preparations of opium were to be 
avoided in the relief of pain, which 
can be very well controlled by a sup- 
In closing, the professor said that 
he desired to point out how necessary 
it was for the surgeon to be familiar 
with the materia medica and to know 4 
CHARLES GREENE CUMSTON. 
how to prescribe, an accomplishment 
which was rarely seen in these days 
of compressed tablets, and also the 
fact that just because a woman com- 
plained of some pain or inconvenience 
in the genital organs it was not neces- 
sary for the young professional man 
to consider his patient as subject for 
operative surgery. 
amputation of the cervix should also 
be performed. 
Complete prolapsus was not cured 
by hysteropexy, according to the ex- 
perience of Dr. Cumstom. This op- 
eration was serious, as the peritoneal 
cavity was opened, a fact that was 
treated too lightly by many opera- 
tors. 
Many cases of dysmenorrhoea were 
successfully treated medically, and the 
tendency of the day was to submit 
women to many needless operations, 
although it was to be distinctly un- 
derstood that many conditions could 
only be releived or cured by the knife 
in the hands of a man posessed with 
a profound knowledge of the tech- 
nique and indications of the current 
gynaecological operations. 
As to vaginal hysterectomy for 
prolapsus, it was only to be per- 
formed in cases in which the parts 
had become strangulated and could 
not be reduced, or if gangrene had 
set in from the strangulation. When 
a uterus, having a fibroid, prolapsed, 
vaginal hysterectomy was indicated, 
not for the prolapsus but for the 
neoplasm. 
The surgical treatment of prolap- 
sus uteri comprised four operations, 
viz: plastic operations on the vaginal 
walls and perineum; Alexander's 
operation ; hytteropexy ; vayinal hys- 
terectomy. 
If vaginal hysterectomy is resorted 
to in cases of prolapsus, the operation 
should always be completed by a re- 
section of the vagina and posterior 
colpoperineorraphy. 
Regarding Alexander’s operation, 
it was only of use when the uterus 
was small and for this reason it was 
often successful in prolapsus in old 
women. But even in these cases, 
anterior colporraphy and perineor- 
raphy should be performed. 
Prolapsus of the uterus was pro- 
duced by two kinds of anatomical 
conditions, viz : (1) insufficiency of 
the means of suspension of the uterus; 
(2) a relaxed condition of all the soft 
parts which make up the pelvic 
floor, that is to say, the vagina and 
perineum. 
No matter what operation was se- 
lected as proper for the particular 
case, it was to be remembered that a 
plastic operation on the vaginal walls 
and perineum should always be per- 
formed if complete success was to be 
attained. 
Slight prolapsus should be treated 
by anterior colporraphy combined 
with posterior colpoperineorraphy. 
When the uterus was hypertrophied,