Robert L. Dickinson

Endocervicitis and eversion and the nasal cautery tip

Abstract Thin, deep cautery lines (or punctures) heal and inroll the granular, everted cervix, and furnish a successful substitute for operation in a considerable number of cases. This is the treatment of choice with patients who are poor operative risks. Also when deferring repair until childbearing is overpast. For the cystic cervix it is the chief remedy. With rebellious discharges from an enlarged canal, linear cautery does well. This, an office treatment, with the delicate nasal cautery tip, entirely replaces the old Paquelin technic.

The technic of timing human ovulation by palpablechanges in ovary, tube, and uterus

Summary Under specified favorable circumstances bimanual palpation inwomen can detect changes in the ovary and uterine contraction whichpoint to the time of ovulation or omission of ovulation. The tendernessis often such as to suggest ovaritis or salpingitis. Varicosity ofa broad ligament may be present only, or accented only, at the midinterval.In one patient with a five–year report, symptoms, Mittelschmerz,spotting and self-detected tenderness, were scattered fromday ten to day twenty–three. In another the nonpregnant uterus ofthe midinterval copied her six weeks’ pregnancy findings.

The “safe period” as a birth control measure

Abstract 1. 1. There is no time in the month at which conception has not occurred in some women. 2. 2. The premenstrual week constitutes the relatively “safe period,” or “low-risk period,” when the average chance of pregnancy is less than one in ten. 3. 3. A “safe period” or sterile part of the cycle is present in every woman, but is a matter for individual tests, and such successful tests are not yet effectively transferable from animals. Nor has any series been studied that is made up of adequate case records of women with known “safe periods.” 4. 4. The height of fertility belongs to the week or ten days following menstruation. 5. 5. Fertility is relatively high during menstruation. For the four days that make up 14 per cent of the average menstrual cycle, conceptions from isolated coitus have amounted to 13 per cent. 6. 6. Abdominal operations point to ovulation between the fourteenth and nineteenth days from the beginning of the period—rarely there-after. Coitus may possibly free the ovum earlier. 7. 7. Alterations in rhythm of tubal contractions and in the tube lining point to passage of the ovum subsequent to the above days and up to the twenty-second day. 8. 8. New evidence shows coincidence of maximum sex desire and maximum well-being with minimum chance of conception, in the premenstrual week; also a secondary wave of desire at the time of greatest fertility.

Contraception: A Medical Review of the Situation

Summary 1. Our search discovers no investigation of “birth control” made in a scientific and ethical spirit and approaching the subject without bias. Review of the literature discloses a library of argument that condenses to a pamphlet of case histories. 2. Wide divergence of opinion exists largely owing to the meagerness of clinical evidence and to prepossession on the part of observers. For example, opinions gathered by questionnaire from 64 gynecologists vary greatly from the experiences published by the three birth control clinics of London and New York. 3. The committees investigation carried on in Holland demonstrates that this much quoted paradise of birth control is without clinics or clinical reports or consensus of opinion. Our English interviews show divided counsels, with no checking up of the returns from the two clinics. German authorities urge us to conduct a thorough-going inquiry. Russia is reported as starting some investigation. 4. The medical profession is not yet cognizant of any guaranteed contraceptive. In the very large number of cases where contraception works securely, as well as harmlessly and happily, we shall expect to find a choice rightly adapted to the particular couple, often with two measures combined or in sequence, and above all with attention to detail. It is our business to discover and define such conditions. 5. Sterilization by removal of the uterus prevents future pregnancies. Removal of the ovaries produces a surgical change of life. Both entail definite hazard, particularly to those most needing protection, such as patients with active tuberculosis or rheumatic hearts. Operations on the tubes are under question since the new insufflation tests snow reopenings. This test is now essential after all such operations. The simple, “non-operative” cantery sealing of the tubes is on trial. 6. Irradiation of the ovary calls for further experiment on dosage, on possible damage to future progeny, and risks of abortion. 7. Among ordinary contraceptive devices, some that are found reasonably efficacious among the intelligent are said to fail in half the clinic patients. Yet it is among these that the need is greatest In one outstanding report from 1000 educated American women, 730 believed in the rightness of regulating pregnancy and practiced it without unduly lessening the number of progeny; in a dispensary series 41 per cent of the women had some knowledge of preventive methods, the restriction (above 4.7 children) being in proportion to their knowledge. 8. The one contraception experiment supposed to be carried out on a national scale (the French peasants withdrawal) has not yet been subject to medical case study regarding its elect on health and reciprocity. The forty year community experiment with coitus reservatus at Oneida was medically studied and the method apparently exonerated. 9. Dependence on the plain douche and any douche alone is largely discredited. 10. Doctors and educated couples in America rely largely on the sheath. One large group shows failure in 12 per cent, whereas among else poor two clinics report 50 per cent failure in extensive series. 11. The use of the sheath calls for testing, lubrication, and ready access to a medicated douche in case of accident. 12. Among chemicals, suppositories make a lesser showing of protection than jellies and pastes and effervescing tablets with chinosol and acids, for which only 3 per cent failulre is claimed, covering 837 cases in one clinic report. 13. Infection from stems within the cavity of the uterus is not infrequent. 14. The chief measure which puts the womans care into her own hands, and is the main recommendation of students of birth control abroad and in this country is that form of soft rubber cervix cup distending the upper vagina which was originally devised by Mensinga, but is not sold here. This device, fitted by a doctor, used for the occasion, and in proper cases, (best combined with a medicated jelly) claims minimal failures and offers case histories. It should receive careful clinic tests—with patients who fall within the law—that is, where contraception is required temporarily or continuously “to prevent or cure disease.” 15. In all methods details of technic are found to be of great importance. 16. Where permanent prevention of pregnancy is required, trial should be made of the relatively simple method of sealing the tubes by the stricture that results from cautery burns of the minute intrauterine openings of the tubes. 17. The data should be collected under competent supervision, the physical questions by properly qualified members of the medical profession. The doctor is the person to select and instruct, because the need must be proved and the recommendations fit individual requirements and particular physical findings. 18. The Committee on Maternal Health, as part of a study of fertility and sterility, has carried on several steps of the investigation of contraception and has under way clinical, chemical and laboratory studies. These, in due time, with proper supervision and adequate professional collaboration and sufficient funds, should secure the facts. 19. The subject is susceptible of handling as clean science, with dignity, decency and directness.

Artificial impregnation: Essays in tubal insemination

Abstract In women presenting histories or pelvic findings pointing to the sealed tube following milder types of salpingitis, entirely quiescent, injection into the uterine cavity of active semen produced no results in twelve instances. Strong pressure was not deemed warranted. In women with no gonorrheal histories or findings, free from cervical inflammations and evident uterine, tubal or ovarian lesions or abnormalities, living semen of the poorer grades produced no results, in nineteen patients. No infection followed except in one possible instance and that of mild type. Several of these received three trials. With fairly normal pelvic organs and semen of good quality, five pregnancies followed and are believed to have been due to tubal insemination. The kneechest posture, the curved pipette fitting the internal os and carried nearly to the fundus, injection into the tubes, horizontal rest, and repetition three to six times—these are considered important. Trial of this method may well precede resort to operation—save those done for external obstructions.

Rubber sheaths as venereal disease prophylactics: the relation of quality and technique to their effectiveness.

The quality of available condoms and their effectiveness in protecti ng against venereal disease is discussed. The durability of condoms has been greatly improved through new manufacturing processes though manufacturers seem unwilling to institute adequate testing procedures to eliminate defective devices. The physician does have an apposite role in guiding the purchase of condoms and in providing instruction in their testing and use. This is primarily due to the reluctance of the manufacturer to implement careful testing procedures. Thus more reliable methods for testing condoms should be instituted. The fact of the relatively low quality of condom manufacture combined with the igno rance of the user in its correct use indicate that the condom has yet to fulfill its potential as an effective prophylactic device.

Tubal patency test and unsealing by simple air-filled pipette

Abstract The uterine pipette and bulb furnishes an apparatus sufficient to test tubal patency and expand closed tubes by the use of air, as a substitute for gas pneumoperitoneal methods.

Life Size Outlines for Gynecological Cancer Case Records

For sheer definiteness, no record of physical findings competes with the diagram or picture made to scale. Words cannot equal pictures for visualizing conditions or for forcing the observer to be exact in his statements. Therefore, such use should be fostered. Diagrams should be life size. Entries should be the result of measurements. Colored pencils make for clarity. Reductions do not give adequate values. They are unconsciously misleading in bulk and dimensions. They are abstractions. They are translations from large to small, requiring retranslation to full size every time they are looked at. (In the present article reduction to page width has been necessary, so that the illustrations serve merely to show the character of the work.) The diagrams prepared by the author fit the stock size of folder and file, 8 1/2 × 11″, though this has required some sacrifice of outlying parts, as hips and buttocks. For diagrams of larger areas, as of the uterus and pelvis of advanced pregnancy, a double sheet has been used, that folds to 8 1/2 × 11″. It has a flap at the median line, so that, when opened, the whole lies flat, after the fashion of the double page map in an atlas.