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LIST OF CONTRIBUTORS.

VOLUME XXVIII.

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.
TAYLOR, DR. H. LONGSTREET, Asheville
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. Wм. H., Cincinnati, O.
WISHARD, DR. WM. N., Indianapolis, Ind.
ZENNER, DR. PHILIP, Cincinnati, O.
ZINKE, DR. E. GUSTAV, Cincinnati, O.

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Emmet, Sims, Thomas, Hegar, Bischoff, Martin, Skene, Winkel, Simon, Jenks, Tait, Palmer and Reamy with varying results. Thus I have been taught that it is an error to follow the method of any one man in all cases; 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,

BY

GUSTAV ZINKE, M.D.,

CINCINNATI.

There is, perhaps, no accident more common to a woman who has given birth to one or more children than laceration of the perineum. Fortunately the degree of rupture is not always sufficient to disturb the natural relations of the pelvic floor and the structures resting within and above it.

Again we observe, not unfrequently, that an extensively lacerated perineal body does not cause a serious displacement of the organs supposed to depend on its integrity for support. There are, however, numerous cases, ranging from a comparatively small rent to a complete destruction of this important structure, in which a series of complications follow as a consequence. Whether primarily or secondarily it has caused or assisted in the displacement of the vagina, rectum, bladder, uterus and even the small intestines, is not to be considered this evening. My sole object is to speak of what has impressed itself upon my mind as the best method of operating, how to proceed, and what sutures to employ to obtain the best results. I have faithfully followed in this operation the teachings of Simpson,

absolutely useless; that all "paring methods are faulty and not scientific; that perineal sutures alone are unsatisfactory, and the use of silver wire is an extreme nuisance.

Of all the operations implying removal of tissue the Hegar method has given me the best results, when both the vaginal and perineal or stair-sutures (Etagennath) were employed. (It is but just that here I should refer to the fact that long before the vaginal sutures were employed and suggested by Hegar, Prof. C. D. Palmer, of Cincinnati, used it in many of his cases in which I assisted him.)

In a few cases, those in which there exists extensive prolapse of the posterior vaginal wall, and the patient having passed the menopause, I still resort to the Hegar operation, but bring the denuded surfaces in apposition with a continued cat-gut suture. The results obtained have been eminently satisfactory, except in one case, upon which I was obliged last year to operate a second time for procidentia after an interval of ten years, and again the prolapsus is gradually returning. In nearly all of the cases operated upon in women who subsequently gave birth to a child, and in whom I removed the "flap," rupture of the perineum recurred during labor. The same I have

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