Lig. Tong Sal. TONGALINE INDICATIONS: Neuralgia, Rheumatism, Nervous Headache, FORMULA:-Eaoh fluid drachm represents Tonga, thirty grains; Extractum Cimicifugæ VIBURNATED CELERY. A Combination of Celery, Black Haw, Guarana and Columbo. PROPERTIES: Nervine, Stimulant, Anti-Spasmodic, Tonic, Diuretic. INDICATIONS: Neurasthenia, Nervous Prostration, Brain Exhaustion, Nervous Headache, Opium Habit and all forms of Mental and Physical Debility. The ingredients of Viburnated Celery are most carefully selected, whilst by our improved process of Special Percolation, their activity is secured and a constant uniformity is preserved. DOSE: One to two teaspoonfuls in water three to four times a day. The proprietors will send a bottle of Tongaline and of Viburnated Celery to the address of any physician who will agree to pay express charges on the package. PONCA COMPOUND. ALTERATIVE-OXYTOCCIC. PONCA is the name of a small plant growing on the southwestern prairies and is used by the Indian women for troubles of the uterus and its appendages, on account of a strong alterative action. FORMULA:-Each tablet contains Ext. Ponca, 3 grs.; Ext. Mitchella Repens, 1 gr.; Caulophyllin, 1⁄4 gr.; Helonin, % gr.; Viburnin, 1⁄4 gr. PONCA COMPOUND will correct Uterine Displacements, Metritis, Endo-Metritis, Subinvolution, Menorrhagia, Metrorrhagia, Leucorrhoea, Dysmenorrhoea, Ovarian Neuralgia, and Inflammation; checks Threatened Abortion and Miscarriage; restores Suppressed Menses from cold; removes Painful Symptoms of Pregnancy; relieves After-Pains and favors Involution. Upon receipt of $1.00, a bottle of the regular size, containing 100 tablets, will be mailed to the address of any physician. MELLIER DRUG COMPANY, Sole Proprietors, ST. LOUIS. THE SOUTHERN PRACTITIONER. AN INDEPENDENT MONTHLY JOURNAL, MEDICINE AND SURGERY SUBSCRIPTION PRICE, ONE DOLLAR PER YEAR DEVOTED TO Doctors J. S. Cain, James B. Stephens, J. R. Buist, W. G. DISCUSSION-PYO SALPINX. Dr. Buist: The subject before us to-night is one of vital importance, while regretting the forced absence of Dr. Bunyan Stephens, we can not permit it to go by default. Only in the last few years, has the profession grown to look upon the tubes and ovaries as the seat of frequent disease. It is true many writers are credited with hinting at the existence of tubal disease, but its frequency and vital importance were only developed by the laparotomist, who, by his work, was able 52 ORIGINAL COMMUNICATIONS. to demonstrate the existence and nature of the diseases affecting the appendages. To Mr. Tait, of course, we are chiefly indebted for our knowledge on this subject. In former years, we were taught a great deal about cellulitis, now we know that this disease, if it exists at all, is only secondary to tubal or ovarian inflammation. The symptoms of pyo-salpinx are pain, tenderness, with often recurring attacks of pelvic inflammation, excited by the most trivial causes. The local signs are sometimes misleading, but with a favorable pelvis, bi-manual palpation may detect the presence of a tumor, tender, elastic, and sometimes fluctuating. An exact diagnosis can not always be made, and we are often forced to content ourselves with a surgical diagnosis. Dr. Nichol: It is a strange thing to me that Emmet, whom we all must regard as one of the first and foremost specialists in this country, and whose advantages both clinical and pathological, are second to none, should in all his publications adhere to that old classification of cellulitis and peritonitis, the views originally expressed by Nonal. Opposed to this theoretical idea, we have the practical work of Bernutz and Goupil. These authorities published years ago their views based upon post-mortem revelations, claiming that it was the peritoneum involved and not the cellular tissue. Now to-day the teaching comes back to us, as an advanced view, and the tubes and ovaries are regarded as the primary seat of disease, the peritoneum being secondarily involved. I regard cellulitis as always septic. Endometritis is always the starting point for tubal disease. The symptoms are very much as cited by Dr. Buist. I have also found that an intermittent discharge of pus from the uterus was indicative of suppurating tubes. This feature I observed recently in a case with Dr. Ewing. Dr. Buist: I did not allude to the etiology of pyo-salpinx, but in answer to a statement made by Dr. Nichol, to the effect that endometritis is always the cause of tubal disease, will say: I do not think it is so considered; one of the most destructive 1 forms of pyo-salpinx is of tubercular nature, and this begins primarily in the tube. Dr. Ewing thought there was but little to say on this subject, the questions are all settled both as to pathology and to treatment. Dr. Buist wished to state a hypothetical case. If you have a case with the general symptoms of a suppurating type, which is discharging pus and there is no tumor, would you operate? Dr. Nichol. How do you know the pus is coming from the tube? Dr. Ewing: Eighteen months ago, I found a tube as large as my finger. A few days later the menstrual flow came on. At a second examination, I could not find the tube. I take it the flow of pus and blood emptied the tube. Some months later I again saw her and the tumor had reappeared. In this case the pus clearly came from the tube. Dr. James Stephens: I regard pelvic inflammations as seldom idiopathic. The most prominent factor in their production is some mechanical or chemical irritation about the cervix. I have met with a large pelvic abscess directly attributable to the application of the simple tinc. of iodine within the cervical canal. Is it not possible for a suppurating catarrh of the tube to end in recovery. Do all such cases require operation as soon as diagnosed? If I understand the pathology of pelvic inflammation, the recurring attacks of peritonitis result in pelvic adhesions and the distortion of the tubes so produced, arresting the natural discharges, accumulation takes place. I should be pleased if some one would differentiate between true pelvic abscess and pyo-salpinx. Dr. Atchison said he had met with very few cases of pyosalpinx and would be pleased to learn something of the methods of diagnosis. Dr. Douglas: From the rather prolonged discussion, this does not seem to be so settled a question as Dr. Ewing seems to think. Bernutz and Goupil in their work did not quite reach the kernel; they did eliminate cellulitis as a primary disease, 54 ORIGINAL COMMUNICATIONS. but were not able to show that the tubes were the seat of all mischief. In response to some questions, permit me to answer that the principal guide in determining operation in chronic tubal or ovarian disease is the often recurring attacks of pelvic inflammation. In the hypothetical case suggested by Dr. Buist, disease of the tubes without the existence of a decided tumor, I should, if convinced the disease was certainly tubal, advocate operation. In all acute cases characterized by the presence of a tumor, attended by the local and general signs of suppuration, immediate operation is eminently proper. One gentleman has alluded to the tube discharging through the uterus. I have never seen a uterine discharge which I could characterize as of tubal origin. I observe many have alluded to the readiness with which they locate diseased tubes. I must confess my total incapacity to make such accurate diagnosis. I do not think any one can deny that we may have a true cellulitis, acute and septic in character, developing and discharging as a true abscess without there being any involvement whatsoever, of the tubes and ovaries. A point of sepsis, a chain of lymphatics, a mass of cellular tissue, are all that is necessary for a phlegmon. Why could we not have it? The point is that socalled pelvic cellulitis,a sub-acute and often recurring inflammation, is really tubal disease. Dr. Haggard: Sometimes the tube is distended by serum, in other specimens we find pus. Now what determines the character of this fluid? I think if the inflammation is of septic origin, viz: from an endometritis or gonorrhoea, then we will find the accummulation to be purulent in character. The germs of infection have much to do with the character of inflammation. Dr. Cain: Where a satisfactory diagnosis of pyo-salpynx can be arrived at with the tubal orifices occluded, and all the attendant and threatening evils of such a condition present, there can be but one rational course to pursue: that of the removal of the offending organ by an operation. But in a case like the hypothetical one suggested by Dr. Buist, |