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Related post: months while walking. After this she felt entirely well,
and so continued until she was three months and a half
pregnant (pregnancy occurred in June, 1896, thirteen
months after operation). Her bladder annoyed her con-
siderably, which was corrected by cannabis indica, a
quarter of a grain three times a day. Excepting drag-
ging pains off and on at the site of the buried sutures the
patient passed through a normal period of gestation,
without any tendency to abort.
Labor began at 3 a. ir.; pains slow and irregular; first
stage, seven hours and a half; second, an hour and a
half; and the third stage, five minutes. Child born
in L. 0. A. position at 13 a. m., weighing seven pounds.
Taking nine hours, tliis was seven hours less than her
first labor. The child was larger, according to the
mother's statement.
The iiterus contracted down firmly and could easily
be felt in contact with the abdominal wall. Vaginal
examination did not reveal the bogginess of the anterior
wall as in the first case. Post-puerperal period normal;
lochia ceased on the tenth day; patient up in fourteen
days, feeling very good; uterus well involuted and for-
August 14, 1897.J
RUBER: THE ABUSE OF MEDICAL CHARITIES.
207
ward, the fundus seemingly an inch and a half below
the abdominal wall.
In August, 1896, Dr. Noble, of Philadelphia, col-
lected and reported eight hundred and eight cases of
suspensio uteri from American operators, in some of
which one ovary was exsected. Of this number, fifty-
six became pregnant, forty-three were delivered at term
or shortly before, six aborted, seven were undelivered at
time of report, and four died. One of the latter,
who was septic before delivery, died after Porro's opera-
tion made by Dr. Noble where the hypertrophied anterior
uterine wall interfered with pelvic delivery; two died
from cardiac disease before term, and three from septi- Order Avana
cemia produced by retained dead foetus at seven months,
both of which were among Dr. Edebohls's cases.
The fourth was a similar case of Dr. Coe's. The pa-
tient became septic from retained dead foetus of long
standing.
Eeferring to the fatal cases, the operation proved to
have nothing to do with the deaths of three.
Eegarding the six cases of abortion, two occurred in
the same woman; the third, immediately after dancing;
the fourth was criminally produced, leaving two without
positive cause. Two cases have been reported in which
there was a slight disposition to abort, as in my first case,
but they were successfully carried over by rest in bed.
Even these cases fail to prove that ventrofLxation pro-
duces a tendency to abort, for they are common enough
in patients who have never had the uterus fixed.
Among the forty-three cases delivered at term there
were three in which forceps was used — the first low,
child weighed eleven pounds; the second difficult, child
weighed eight pounds; and the third for uterine inertia,
in case of twins, leaving forty normal cases.
Any one of the three above-cited cases, together with
cases of transverse and footling presentations, mentioned
in the foreign literature, more especially when pelvic
deformities are not uncommon, causing dystocia, are seen
in the everyday practice of the obstetrician.
Because these complications have occurred follow-
ing ventrofixation, is there any good and plausible reason
why their aetiology should be charged to Buy Avana this operation?
I believe that faulty technique may account for cases of
reported dystocia where above and below the pelvic
brim a bunch of uterine tissue, simulating a fibroid,
has been felt, which impeded the descending head. In
these cases the fundus and posterior surface of the uterus
were fixed, making a forced antefiexion, and giving the
posterior wall of the uterus almost the entire work to
accommodate the growing foetus. It is my belief that
the sutures should either be placed from before back-
ward through the anterior surface of the uterine horn
or transversely through the anterior surface of the body
near the fundus, but not including it.
This will allow the fundus to take part in the physio-
logical hypertrophy.
The possibility of a rupture in the posterior uterine
wall should be thought of; but, on the other hand, I men-
tioned a case of twins extracted with forceps, owing to
uterine inertia at term, which proves that if the uterine

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