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AMICK, Dr. W. R., Cincinnati, O.
Ayres, Dr. S. C., Cincinnati, O.
BALDY, DR. J. M., Philadelphia, Pa.
BOGLE, DR. JESSIE, Cincinnati, O.
CALDWELL, DR. C. E., Cincinnati, O.
CARPENTER, DR. JULIA W., Cincinnati, O.
CARROLL, Dr. Travis, Cincinnati, O.
CARSON, DR. WM., Cincinnati, O.
CLINE, DR. L. C., Indianapolis, Ind.
Crouch, Dr. J. M., Union, Ky.
Cupp, Dr. M. F., Edinburg, Ind.
DANDRIDGE, DR. N. P., Cincinnati, O.
DORSCHUG, DR. F. P., Cincinnati, O.
Dunn, Dr. Louis, Corinth, Ky.
Eichberg, DR. Joseph, Cincinnati, O.
EVANS, DR. C. S. Cincinnati, O.
FENNEL, Ph.G., C. P. T., Cincinnati, O.
FRENCH, DR. THOMAS, Cincinnati, O.
HALL, DR. Rufus B., Cincinnati, O.
Harris, Dr. M. L. Chicago, Ill.
HenDLEY, Dr. F. W., Cincinnati, O.
Herzog, Dr. MAXIMILIAN, Würzburg.
JOHNSTONE, DR. A. W., Cincinnati, O.
JUDKINS, DR. WM., Cincinnati, O.
KEBLER, DR. FREDERIC, Cincinnati, O.
KLAYER, Ph.G., Louis, Cincinnati, O.
KRAMER, Dr. S. P., Cincinnati, O.
LASH, DR. H. M., Indianapolis, Ind.
MINOR, DR. THOMAS C., Cincinnati, O.
Mitchell, Dr. E. W., Cincinnati, O.
MACDONALD, ARTHUR, Washington, D. C.
MADDOX, DR. D. S., Marion, O.

Massey, Dr. G. BETTON, Philadelphia, Pa.
McKee, Dr. E. S., Cincinnati, O.
Mills, Dr. Charles K., Cincinnati, O.
MILLs, Dr. ORIN S., Cincinnati, O.
MURPHY, Dr. J. W., Cincinnati, O.
MUSSEY, DR. LINCOLN, Cincinnati, O.
Mussey, Dr. Wm. L., Cincinnati, O.
OSBORN, DR. MARY E., Baltimore, Md.
PRITCHARD, Dr. F. H., Norwalk, O.
RANSOHOFF, Dr. Jos., Cincinnati, O.
REAMY, DR. THAD. A., Cincinnati, O.
REED, Dr. Chas, A. L., Cincinnati, O.
RICHARDS, DR. W. D., Dayton, Ky.
RICKETTS, Dr. E. S., Cincinnati, O.
Ricketts, Dr. B. MERRILL, Cincinnati, O.
ROVER, DR. H. W., Cincinnati, O.
RYAN, Dr. G. W., Cincinnati, O.
Shaw, Dr. W. E., Cincinnati, O.
Shields, D.D.S., Dr. Edwin, Cincinnati, O.
SCHOOLFIELD, DR. C. B., Dayton, Ky.
SMITH, DR. GOULD, Taylorsville, Ill.

N. C.
THOMPSON, DR. J. A., Cincinnati, O.
THORNER, Dr. Max, Cincinnati, O.
THORNBURY, DR. F. J., Berlin.
THRASHER, DR. A. B., Cincinnati, O.
TINGLEY, Dr. W. S., Cincinnati, O.
WENNING, DR. WM. H., Cincinnati, O.
WISHARD, DR. WM. N., Indianapolis, Ind.
ZENNER, Dr. Philip, Cincinnati, O.
ZINKE, DR. E. GUSTAV, Cincinnati, O.








| New Series Vol. XXVIII. CINCINNATI, January 2, 1892. Whole Volume LXVII.

Emmet, Sims, Thomas, Hegar, BischOriginal Articles.

off, Martin, Skene, Winkel, Simon,

Jenks, Tait, Palmer and Reamy with A FEW PRACTICAL POINTS varying results. Thus I have been

taught that it is an error to follow the CONCERNING THE REPAIR

method of any one man in all cases; OF THE PERINEUM.

that some of the operations, Bischoff's, A Paper read before the Academy of Medicine, Simon's, Simpson's and Winkel's are October 26, 1891,

absolutely useless; that all “paring"

methods are faulty and not scientific; GUSTAV ZINKE, M.D.,

that perineal sutures alone are unsatisfactory, and the use of silver wire is an

extreme nuisance. There is, perhaps, no accident more Of all the operations implying recommon to a woman who has given moval of tissue the Hegar method has birth to one or more children than given me the best results, when both laceration of the perineum. Fortunately the vaginal and perineal or stair-sutures the degree of rupture is not always (Etagennath) were employed. (It is but sufficient to disturb the natural relations just that here I should refer to the fact of the pelvic floor and the structures that long before the vaginal sutures resting within and above it.

were employed and suggested by Hegar, Again we observe, not unfrequently, Prof. C. D. Palmer, of Cincinnati, used that an extensively lacerated perineal it in many of his cases in which I body does not cause a serious displace assisted him.) ment of the organs supposed to depend on In a few cases, those in which there its integrity for support. There are, how- exists extensive prolapse of the posever, numerous cases, ranging from a terior vaginal wall, and the patient comparatively small rent to a complete having passed the menopause, I still destruction of this important structure, resort to the Hegar operation, but bring in which a series of complications the denuded surfaces in apposition with follow as a consequence. Whether a continued cat-gut suture. The results primarily or secondarily it has caused obtained have been eminently satisor assisted in the displacement of the factory, except in one case, upon which vagina, rectum, bladder, uterus and I was obliged last year to operate a even the small intestines, is not to be second time for procidentia after an considered this evening. My sole object interval of ten years, and again the is to speak of what has impressed itself prolapsus is gradually returning. In upon my mind as the best method of nearly all of the cases operated upon in operating, how to proceed, and what women who subsequently gave birth to sutures to employ to obtain the best a child, and in whom I removed the results. I have faithfully followed in “ flap," rupture of the perineum rethis operation the teachings of Simpson, I curred during labor. The same I have

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