John Duncan Emmet.

The American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 online

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Online LibraryJohn Duncan EmmetThe American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 → online text (page 40 of 79)
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cavity by means of the drain, and dech
the results. The author indorses this n
of it is the facility with which the flui



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Status of GytuBcology Abroad, 4<

examined. Quite recently the author had occasion to congratulai

Wmself for having used this method, and for having submitted tF

peritoneal discharges to bacteriological examination. He was ui

fortunate enough to rupture a pus sac in the cavity. Aseptic gau:

was us^d to remove the pus, and an abdominal drain inserted. T\\

^Vs l^ter the symptoms became serious. The abdomen was vei

tymp^^j^jtic; pulse 120, small and wiry; respiration 50. No vomi

"igr, l>xat thirst excessive and tongue dry. Previous to washing 01

the c^-vity, the author had the serous fluid examined, and found r

">Jcro— organisms, and from that he was able to diagnosticate tl

"^S^^^^x^ing of an intestinal occlusion, caused perhaps by the asept

^^^^- This was immediately removed and cathartics given, ar

^ X^stient recovered. Intestinal occlusion following operatic

o/rex^ simulates peritonitis. Intestinal obstruction may be caus<

^ I^^-thogenic germs introduced into the peritoneal cavity, but

^^ ^.Iso occur as the result of compression, or by intestinal paresi

■^^i-cteriological examination will determine this with certaint

J^nci sliould not be neglected. In all cases, and especially when

^^-^<^ertained that no peritoneal infection exists, cathartics shou

I>**omptly administered, and, if necessary, electricity should ]

^^-^'i^^ />er rectum. In the class of cases referred to a cathartic h

'"^^^^^^arkable effect, and the author is inclined to believe that mai

j/^^^ of peritoneal infection cured in this way were cases of inte

I '^"-* 3)2iresis, or were obstructions caused by compression. Dout

^ ^ irritation or compression of the intestines during operation m;

J, ^^^ serious symptoms, and in these cases cathartics are used wi

''^-^K^tage.
p '^ ^^n true peritoneal infection the author does not rely upc
jjj. ^Sr^ttives, but believes that the best results are obtained by tl
jjj -^^^-^^enous injection of serum or by the subcutaneous metho
jj^ * if necessary, to flush the peritonaeum with sterilized water 1
lethod of Bouilly, or reopen the abdomen to do it.

Cyst of Wolffian Body,
^\i^ ^^^-^T, Felix Legueu (Sefnaine gyn^cologique, April 7, 1896) repoi



4'^ * upon dividing the broad ligament in order to remove an intr
^t^^^^^entous cyst, he found attached to the cyst, and running upwa
^^ outward toward the lumbar region, a cord, or rather tube, wi
^^Goth and roseate internal surface. This structure did not fc



^^^^



the ureter, and yet, to be upon the safe side, it was stitched in



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4o8 Abstracts,



the superior angle of the abdominal wound after the removal of the
cyst. It healed without incident and without any discharge from
the divided end of the tube. This tube was found to open into the
cyst.

The pathological examination showed
of fibro-connective tissue, and covered b]
a single layer, which penetrated the fibre
consisted of fibro-connective tissue cover
Hum.

The canal communicating with the c
Gartner's canal running along the laten
vagina. It could only be the inferior part
the cyst had developed either in the cai
tubes*

BELGIUM.



Intra-uterine Fibroid infected by

Dr. Depla (Presse mid. Beige, Febru
following case : Patient thirty-seven years
a large fibroid. She suffered from profus
and followed by foetid discharge. At the
tient had been confined to bed for seven
140, and she ran an evening temperature

The operation presented no difficultie
the intraperitoneal method with a pedicle.

When the cervix was divided, a puruh
the cervical cavity. After the operation tl
and on the sixth day a large abscess, situ?
abdominal fascia, was opened. In the p(
was found ; this was drained by_ the vagi
any symptoms of peritonitis, died. The t
was almost necrotic. The bacleriologica
cultures of the coli bacillus. The author is
became infected from the rectum.



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Padiatrics,



409



PAEDIATRICS.



AUSTRALIA.



Diphtheria treated with Antitoxine in Comfari-
Hundred Preceding Cases treated Without.

ind W. F. Litchfield, Sydney (Australasian
D, 1896), report as follows: Both series, of one
ire treated in the same way with the exception
oxine ; in every case under consideration the
was found. The following table shows the
:ies :







Currd.


Died.


Death-rate.




59
41


19
30


40
II


67.7
26.8




100

48
52


49

29

48


51

19
4


51

39-5
7.6




100


77


23


23



e, the two series were pretty nearly alike ; the
very slightly more severe. While the ten ma-
I all died, two of the six in Series II recovered,
e done on admission, the child being brought
en the dyspnoea becomes urgent ; but in those
[1 permitted of delay, fewer tracheotomies were
the antitoxine, if given sufficiently early, will in
obviate tracheotomy. Of course laryngeal
itoxine does not always necessitate tracheotomy.
:oxine seemed to increase the dyspnoea, prob-
the membrane. The tracheotomy tube can
those treated with antitoxine ; in the tracheot-
as left in place an average of 7.7 days ; in
days. Though antitoxine should be used early,
ervice later; in the seventy- seven cases that
IS the average day of the disease on which it
enty-four hours after its exhibition, unless the
:, the child becomes much less apathetic ; this



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4IO Abstrc

is in marked contrast to the slow
disappearance of the membrane in
after ten days ; in Series II, after foii
ing up of the edges of the membn
but is not dissolved ; at the same t
wound diphtheria or reinfection ha
the antitoxine. In thirty-two cases
nine days after the injection of antitc
companying joint pains. The amoi
generally in direct proportion to the
during the rash there may be fever,
upon temperature and pulse is hard t
and reach normal when the throat ha
day. The occurrence of albumini
same in the two series ; but very li
have been diminished could the anti

Regarding bacteriology, when tl:
cases were usually mild, but the med
in mild, medium, or severe cases ir
disappear from the throat sooner un<
authors conclude that the associated
great importance, clinically or bactc
common in healthy throats, and (b) al
in which none of the severe sympto
they are frequently associated with i
well as with severe ones ; {d) the au
local or general abscesses, or erysip<
be expected ; {e) nothing in the clin
fection, the severe cases being mei
(/) diphtheria antitoxine always an
pathological destruction of tissue
true mixed infection may occur, but
rather than as an exaggeration of th
treated with antitoxine, two died o
malignant) of toxaemia, four (all sev
theritic heart failure, and fifteen of j
tracheotomy.

Conclusions, — {a) Antitoxine mus
Of cases not thus early treated, the
greatest mortality, {c) Regarding t
tracheotomy cases, further observati



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Obstetrics, 4"



Treatment, — Antitoxine alone is not sufficient ; though it relieves

^Ae toxaemia, as is shown by the disappearance of the apathy, there is

^WJ in the laryngo-tracheal cases the danger of asphyxia, and in all

^^es the dangers of asthenia, heart failure, and paralysis. Nearly all

^^e cases had brandy and perchloride of iron. The throats were

^'t'abbed, at first every four hours, later twice daily, with liquor

^^6.2^ chloridi. In nasal diphtheria the nose was syringed twice or

^'itice daily with boric lotion. Watch was kept for the occurrence of

^^Ughing on feeding, which indicates some paresis of the muscles of

^giutition, and directly it appeared the child was fed by catheter

^rough the nose. This, as well as other paralyses, calls for strych-

ine. T* racheotomy wounds must be kept clean and aseptic, and the

^ ud ei:kc2ouraged to cough at the times when the tube is removed for

^a^nsir^g. It is a singular fact that trypsin, which formerly was often

^^^ssC"ully used in dissolving the membrane, had no effect upon it in



^ ^^s^s treated with antitoxine.



"^^ ^i^ht post mortems made upon cases in which tracheotomy was

^^ <^T^ admission, there was little, if any, membrane found, but in
most -f-i-fc. . .

. . ^*x^ bronchi and bronchioles were filled with a tough, tenacious,

tnii«' ^^*^"^^"P"™^^^^'^^^^^"S material. The lungs were emphysema-

^ hearts engorged with clots and dark blood, and the internal
ongested.



doae






OBSTETRICS.

IRELAND.

Eclampsia^ with Special Reference to its Treatment,

con^jlc* ^^- Tweedy {Dublin Journal of Medical Sciences, March, 1896)

tha.^ xito^ ^^ ^^ ^^^ aetiology of eclampsia as due to some toxine similar to

th^ ^^ ^^ich gives rise to uraemic convulsions. Owing to the fact that

ing ,^.^^ ^>^ters of nervous control are in a more unstable condition dur-

ptK^.^ ^gnancy than at other times, smaller quantities of toxine will

th^y. ^ e convulsions than in the non-pregnant state. Besides this,

^Yv^ ^^ an increase in the formation of toxines during pregnancy over

(^Vx\ ^^H-pregnant state. In the treatment of eclampsia he condemns

Cl\v\ ^^form, chloral, and the bromides as powerful cardiac depressants.

(;j^^ ^'^oforra, by limiting the amount of oxygen, actually increases the

^^Isions in some cases. Pilocarpine he considers a dangerous



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412 Abstracts.



heart sedative and attributes little advantage to profuse sweating as a
vicarious function. The depletion of the blood by sweating only con-
centrates the toxines. He claims that oedema of the lungs in convul-
sions is largely due to fluids of the mouth riocci'nrr Hnwn fii*» fro/«v>Ao oe
the oesophagus is closed and the glottis
proved by a nose tube which passes into th<
out of the tube during the expiratory ac
the air will come out during inspiration, d
the diaphragm. Hence patients should
the side, and mouth-gags should not be u
induction of labor — premature or otherwis
of treatment pursued by him for the past
Hospital has been the hypodermic inj(
doses, beginning with half a grain, to be
grain in two hours, and so on gradually u
ated or two grains have been given in
sets in, forceps may be applied after suff
dilatation is unjustifiable. He discredi
morphine, as in utero the child does
Bloodletting he favors, as a relief to 1
bronchial secretion. Nourishment shou
attack. Hot water, stimulants, or medici
tube or, better, by rectum. Purgative:
sparteine, and the nitrites are recommenc

BRITISH INDIi

Treatment of Placenta Prcevia in Ho\

with Cases,

Temulji Bhicajee Nariman, L. M
Review^ January, 1896), says that at the
there have been in the past seven years se
out of eleven hundred cases. These all <
dred and fifty cases ; none in the last foui
new Parsi Lying-in Hospital there has bei
cases. Of the first seven cases, three we
lateral y and two marginal (two os uteri
Vpara, aged twenty-eight years, in her s<
poned ; stillborn child ; no other aid.

The other case, an VHIpara, aged
Membranes punctured ; child stillborn ; i



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Obstetrics, 413



Of the two lateral implantations (partly over the os uteri), one was
^ JVpara, aged thirty-three years, at term. Placenta detached by
Alger ; version and extraction of stillborn child.

Th.e other, a Illpara, aged twenty-five years, full term. Mem-
^^^axies ruptured ; vagina tamponed ; living child.

Of the three cases of central attachment, the first was a VIpara,
^Sed t:liirty-one years, at term ; placenta detached all round by finger ;
"^^rsion and extraction ; stillborn child. Second case, a IXpara, aged
^^irty— eight years, at term ; vagina tamponed ; placenta detached by
^Ji&^i' ; membranes ruptured ; version and extraction. Mother died
»D t-^ro hours ; symptoms of cardiac thrombosis. Third case, XVpara,
^ed forty-one years, at term ; Barnes' bags for dilatation ; mem-
branes ruptured; breech presentation; natural delivery of stillborn
chil<i_ The only case in the new Parsi Lying-in Hospital was a
^Pai^^, aged twenty-eight years, at term ; bleeding first occurred at
^^ ^^.-^th month, and at irregular intervals since. On admission there
^^^ ^'Ok.Kt bleeding; cervix would admit one finger ; /tfA?r«/ implantation
/ T>l^i-centa was recognized. Champetier de Ribes' dilating bag was
hs.^:b:-^^^j^ pains began, and, after the bag was expelled, the membranes
^^^^ ruptured and version done; a seven- and- three-quarter-pound
. ^^^"^ ^^ child extracted. Mother had normal puerperium. Five cases
^^^^"^ivate practice are reported under the sanie general management,
t^^mit one recovered, with two living children.

ITALY.

CcBsarean Section in Puerperal Eclampsia,

-ARLO Decio, of Milan {AnnaL di Ostet, e Gin.y January, 1896),

"^s the case of a primipara, aged twenty-three, in the seventh

Ti of pregnancy, who was admitted to the hospital suffering with

ptic convulsions which occurred in rapid succession. On ex-

5ition, the cervix was found to be undilated and rigid. Urine

*y and albuminous. Hegar's dilators were used up to the eighth

^la, the amniotic fluid was partially withdrawn by Meissner's

ge, and a Krause bougie left in situ for twelve hours. Convul-

continued, but at longer intervals, modified by the use of mor-

«. As the patient was growing stupid, and no dilatation of the

Sx could be detected, an examination was made under chloroform
osis and the presentation found to be transverse. The foetal
t was inaudible. Owing to the apparent impossibility to dilate

cervix, and the critical state of the woman, it was decided to do




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414 ^^^^ of Interest,



Caesarean section as the quickest method of delivery. This was done

in the ordinary manner by median abdon

the uterus was drawn out and the foetus
centimetre incision in the anterior wall
was quickly removed, the uterine incisioi
cular sutures and ten peritoneal sutures
closed ; whole time occupied was fifteen i
and under careful treatment recovered.
She left the hospital thirty-five days aftei
was dead and had begun to macerate. V
grammes and measured forty centimetres



ITEM OF INTE



AMERICAN ASSOCIATION OF
GYNiECOLOG]

Preliminary Press Notice of the Ninth A

Virginia.

The Ninth Annual Meeting of the A
stetricians and Gynaecologists will be 1
Richmond, Virginia, Tuesday, Wednesc
ber, 22, 23, and 24, 1896.

The proprietors of the "Jefferson^
Fellows of the Association, their familie
physicians who come to attend the me
pected that the railways will offer trans
of a fare and a third to all in attenda
Let all obtain certificates from their locj
nearest point where certificates are grar

Outline PROGRi

The Association will meet in executi
on Tuesday, September 22d, at 9.30 a.
Fellows. The open session for the rea(



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Item of Interest 415

^o A, Ki:. Recess for luncheon at i p.m. Afternoon session at 3
P. Af. ^jj evening session will be held Tuesday at 8 p. m.

^^^c>Tning session will begin Wednesday, at 9.30 a. m., for the read-
ing of scientific papers. Recess at i p. m.* Afternoon session at
^ ^" ^^«- Adjournment at 5 p.m. Executive session at 6.30 p.m.;
annu^sil dinner at 8 p. m.

-"- t^tu-sday morning the session will begin at 10 a. m.; recess at
.' ^* ^^<«^« Afternoon session at 3 p. m. ; final adjournment at 5 p. m. It
»s r^cj-uxested that a full attendance be present at the final session.



Papers promised.

-^^^i^TE. — No attempt is made to arrange papers in the order in
^ "-^^Ix they are to be read. That will be done in the permanent
P'^Srr-anime.

, -*- - Principles and Progress in Gynaecology (President's address);
•'^^^X^li Price, Philadelphia,
pv ^^^- Vaginal Hysterectomy by the Clamp Method; Sherwood

^*^ *^, Los Angeles.
^.|-^^ Fiuther Experience with Appendicitis; A. Vander Veer,

^^-^*^y.
fjj^*^^- Relation of Malignant Disease of the Annexa to Primary

^^^ion of the Uterus; A. P. Clarke, Cambridge.
fj.,^^-^ - Treatment of Puerperal Septicaemia; H. W. Longyear, De-

Bg^^^^^- Treatment of Posterior Presentation of the Vertex; E. P.

^^^^^^rdy, Philadelphia,
fj^^.^^" - Relation of Local Visceral Disorders to the Delusions and

.J^'^ -acinations of the Insane; W. P. Manton, Detroit.
Ei^ '^^-^ Differential Diagnosis of Haemorrhage, Shock, and Sepsis;

^^'■^^ne Boise, Grand Rapids.
^^^^^ - Movable Kidney: Local and Remote Results; A. H. Cordier,

^^^^^as City.
•^^ «^^^' P^ithology and Indications for Active Surgical Treatment

^^ — contusions of the Abdomen; W. G. Macdonald, Albany.
c^^^l^^ I- Some Causes of Insanity in Women; George H. Rohe,
^^^sville, Maryland.

^ :2. Subject to be announced; John Milton Duff, Pittsburg.
^3. Shall Hysterectomy be performed in Inflammatory Dis-
^^5 of the Appendages? L. H. Dunning, Indianapolis.



^



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41 6 Item of Interest,



14. Subject to be announced; Rufus ''^ "**" r\^^\*^^^^\

15. Subject to be announced; Georg<

16. Dynamic Ileus: with Report of
mond.

17. Faradic Treatment of Uterine ]
Charles Stover, Amsterdam.

18. A Plea for Absorbable Ligature

19. Treatment of the Stump; J. F.

20. Limitations in the Teaching of (
as determined by State Medical Examin
ren Potter, Buffalo.

21. Subject to be announced; Walt

22. (a) The Philosophy of Drainage,
cle in Hysterectomy, or Hystero-myon
Method; George F. Hulbert, St. Louis.

23. Removal of the Uterine Append
sanity: a Plea for its more General ^
Columbus.

24. Albuminuria of Pregnancy; A. ]

25. Subject to be announced; Laws(

26. Subject to be announced; Waltei

27. Unnecessary and Unnatural Fix;
Results; James F. W. Ross, Toronto.

28. Sarcoma of the Urethra; Charlei

29. Appendicitis as a Complication
tion of the Uterine Appendages; Lewis

30. Gunshot Wounds of the Abdon
D. Griffith, Kansas City.



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THE

AMERICAN GYNAECOLOGICAL

AND

OBSTETRICAL JOURNAL



OCTOBER, 1896.



WOMAN AND HER DISEASES VS. GYNAECOLOGY*
By Henry Parker Newman, A. M., M. D., Chicago, III.,

Professor of Clinical Gynaecology, College of Physicians and Surgeons ; Professor of Gynae-
cology, Chicago Post-Graduate Medical School ; Attending Surgeon, St. Eliza-
beth's Hospital ; Gynaecologist, Chicago Post-Graduate and West Side
Hospitals ; Surgeon in Chief to Marion Sims Sanitarium ;
Vice-President, Chicago Gynaecological Society, etc.

In nothing is the trend of modern progress more strongly indi-
cated than in the well-nigh universal demand for the recognition
of prophylaxis as a factor in all efforts for the betterment of vital
conditions. Take, for an example, the programmes of the many con-
ventions of medical societies now being held in different parts of
the country, and compare them with those of a few years ago.

Then we had title after title relating to new operations and im-
provement in surgical technique. Often mechanical devices mo-
nopolized the attention of some of our best workers, and the atmos-
phere was rife with surgical activities and redolent of the fumes of
newly discovered anaesthetics and antiseptics. The man with the
feeble protest against radicalism was ingloriously sat upon and
silenced, and with some reason; for without the hardy battling of our
pioneers, and the unanimous and enthusiastic support of their follow-
ers, there could have been no such advance as we can boast in our
knowledge of disease and its treatment. But now, as is usual after
any season of great and prolonged activity, there is coming in a

♦ Read before the American Gynaecological Society, May 28, i8q6.
i8



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41 8 Henry Parker A

period of transition. We have opei
demands of suffering humanity, an<
for their performance. What folio
grammes and see. Instead of ess
studies in prevention; instead of ci
tire number of papers appearing on 1
representative gynaecologists nearly
sideration of abstract subjects. Tl
that branch of medicine which has
probrium of seeking financial emol
and humanity.

The Wisconsin State Medical S<
proceedings of its fiftieth annual n
versary, by the way — to preventiv
their specialistic individuality as us
speakers treat of hygiene, sanitatic
alone true of medicine. In seculai
has taken first rank. Our popular i
established departments of hygiene
try, and physiology are all linked
new sanitation. Philanthropy is
bread and clothing to the hungry
know the causes of the pauper's d
be eliminated from prevailing socia
it is better to prevent evil than to <
is better to form a citizen than to r
taken the cue from medicine, whicl
only better but easier to prevent di
sequences; for there is no doubt t
intelligent people in this subject h
medical men. Notwithstanding the
ranks in public estimation with tl
greed, it is incontestably true thai
given to the cause of public healt
diseases which are supposed to be
reform ever came without self-sacri
invents a labor-saving machine thr
of work for a time, but he makes tl
the scientist in medicine. His com
ment of humanity physically. Foi



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Woman and Her Diseases vs. Gyncuology! 419

consideration of the elaborating and perfecting of modes of treat-
ment until he seemed to have reached the highest plane attainable
in theraj>eutics.

But, still unsatisfied and ambitious of more complete victory,

lie turns now to attack the enemy from another direction, as the

^gyptiatis thought to exterminate the hosts of Israel, in the cradle. ,

This is prophylaxis, and it is to our relation as gynaecologists to

this science that I ask a few moments' consideration. I have called

"ly paper Woman and her Diseases vs. Gynaecology not because

I have any indictment to urge against this branch of medicine, but

because I hoped thereby to emphasize one thought; and this, that

^n our devotion to the experimental and purely scientific side of our

^rt, We must not forget that we are dealing not with cold facts or

Interesting phenomena in wood or stone, but with the highest of

uman interests. We must take part in the present crusade against

prevailing evil conditions, and no mean part, but as conservators

nea.lth in women take front rank among social and sanitary re-

'Tners. None know so well the needs of woman as the profes-

. '^ "^^ho, for the better part of this century, have made the study

^^^^^le anatomy and female disease, its aetiology, pathology, and

T^*'^^^^*' ^^ chief consideration, and to this profession should the

, *^^ turn for enlightenment upon all that concerns woman's

^^H, There is room for abundant effort in this field as in the

. ^ ^^f mechanical experiment. The amount of ignorance of Na-

^ ^ x-equirements displayed by the average woman, intelligent

^ ^Srlx on other points, is appalling. Woman's sphere has widened

. .^^^^> until now her outlook is as broad as man's. The few re-

^^^^<^iis to her liberty which remain as reminders of her narrow

• ^'"^ in the past will probably soon disappear, and all barriers to

^'^tinre progress be removed. How is she meeting these new

^^^^i^tivinities with their responsibilities? Entering the race with

^j. ^» cloes she equip herself intelligently for the trial? Does she

-ry ^^ake herself free as he of all that would hamper and impede?

, ^ot look for an answer to our few higher educational centers,

^ ^^ co-education demands for girls the same routine and regimen

^^ining as for boys. These are the exceptions. But look about

\^ ^ti the streets, in the offices, in the great commercial and social

T^^^rs, and find the average woman. The stenographer sitting all

-y^^ at her instrument, the saleswoman and workgirl standing

^^ugh long hours at her nerve-exhausting occupation, the busi-



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42 o Henry Parker Newman ^ M, D,

ness woman and the shopper, tramping up and down the hard, dirt-
laden streets. Are not their bodies, upon whose well-being the suc-
cess of all their efforts depends, outraged by compliance with the
dictates of arbitrary fashion in food, drc
of dress no attention is paid to the ori
the female form. •Fashion has set u
beauty, and one must conform to it a
pressed and constricted waist are hung
facturer's fabrics, cotton, silk, and w
permanently injuring the viscera, whicl
form adjustment, plus motility. The
into molds curiously constructed of
fur and the next some airy gauze — s
the utter immolation of the function c
liver, and other abdominal and pelvi



Online LibraryJohn Duncan EmmetThe American gyna︠e︠cological & obstetrical journal. v.1-19, 1891-1901 → online text (page 40 of 79)