A DEMONSTRATING VAGINAL SPECULUM
1
1046 A DEMONSTRATING VAGINAL SPECULUM. BY H. MACNAUGHTON JONES, M.D. &c., EXAMINER IN OBSTETRICS, ROYAL UNIVERSITY OF IRELAND, ETC. THE desirability of having such a speculum as would enable the surgeon to demonstrate to a studentorstudents the os uteri and infra-vaginal cervix, in a different manner from that now adopted, and without exposure of the patient, often struck me in hospital work. By such an appliance as that made for me by Messrs. Maw, Son, and Thompson, this can be perfectly achieved. The drawing (Fig. 1) shows the FiG. 1. One-fourth size. appliance attached to a speculum. It consists of a nickel- plated steel bracket with three joints, as shown in the figure, which are so constructed as to enable the mirror to be placed at any angle or plane to the orifice of the speculum, from which it is twenty-five centimetres distant. A ring with a groove receives the mouth of the speculum, and will fit any large-sized speculum. The ring is clamped by means of a screw. (This clamp I am having im- proved.) But this may be so arranged that any sized ring can be applied so as to embrace a smaller speculum. FiG. 2. One-fourth size. At the other end of the bracket is a mirror, which works in a universal joint. It is three inches in dia- meter. If it be wished to get a magnified image, B a slightly concave mirror i can be attached. The entire appliance is shown folded in Fig. 2. It fits into a leather case, and is ’, quite portable. By means of this instrument the lips of the os uteri can be 1 seen, either by sunlight or artificial light, several feet away. The patient need not be in the least exposed during the demonstration. The teacher having introduced the speculum and having caught the reflection of the uterus at the plane required, turns the mirror so that anyone standing behind him or at the side, and looking into it, can see both the os uteri or any application which is made to it. It is not 4 necessary to expose more than the orifice of the speculum. J Harley-street, W. _______________ I ON NERVI, NEAR GENOA, AS A WINTER HEALTH RESORT.1 BY EDWARD HAUGHTON, M.D., B.A., &c. NERVI is situated about seven miles and a half east of Genoa, just at the head of the gulf, and is well sheltered on the north and east against cold winds. In Cook’s Guide to the Riviera it is spoken of as having "come into repute recently as a winter residence owing to its mild climate and sheltered position." It is also briefly described by Dr. C. T. Williams, in his " Climate of the South of France," in the following words: " Nervi, on the Eastern Riviera, about an hour’s drive from Genoa, stands on a ledge of level ground which descends in rocky masses into the Mediterranean, here affording boating, bathing, and tolerable fishing. The place is well sheltered to the north and east by wooded hills, on whose sunny slopes the orange and lemon flourish. Olive-grovei besprinkled with villas and picturesque hamlets rise about the village, and the view from this spot of the 1 Read at the last meeting of the British Medical Association in the Public Health Section, August, 1884. Bay of Genoa and the Col de Tende range is exceedingly beautiful. A good hotel and boarding-house (H6teld’Angle- terre) with well-sheltered grounds, pleasant walks and rides, and its short distance from Genoa, render Nervi attractive to invalids, many of whom have safely wintered here." For some unexplained reason the number of English visitors seems to have diminished, and their place to have been supplied by Germans, the proprietors of several of the hotels and boarding-houses being of that nationality. Not being satisfied with getting accounts at second-hand about the climate and capabilities of Nervi, I determined to pay a personal visit to the place, which I did about the middle of last February, leaving snow and sleet behind me in Basle and Lucerne and several of the northern Italian cities. I also made a point of visiting Pegli on the same day, and then returning to sleep at my hotel in Genoa, so as to make a really satisfactory comparison of the amount of shelter from cold winds afforded by the three localities respectively. The result was that the wind, which was bitterly cold at Genoa, was much milder at Pegli, especially in the valley behind the town, whilst it was perfectly calm and even warm at Nervi, so long as the headlands which protect the place were not rounded by the visitor, who literally has a haven of refuge there, which he should remain within so long as the wind blows persistently from the north or east, It is probable that Nervi remains, so to speak, in an un. developed state as a health resort from one or two causes which are not likely to be permanent. In the first place, the through traffic to and from Rome goes past it without stopping, or at inconvenient hours for alighting, and the sanitary arrangements of the place, although it has been hitherto absolutely free from epidemics, will need a little overhauling before they are quite agreeable to noses and eyes polite. The scenery of Nervi is in some parts beautiful in the extreme. As for instance, if we climb the hill at the back of the town and look down on the valley beneath, or stroll along the sea shore, and listen to the murmuring of the waves amongst the rocks, which are here permitted to retain some of the wildness which constitutes one of the principal charms of the neighbourhood. It is to be regretted that the principle of laissez-faire is carried so far as to permit strangers to be annoyed by lazy mendicants, and to allow all kinds of refuse to lie about exposed to the sun amidst the very loveliest part of the walk by the sea shore. Various circumstances have convinced me that a bright future lies in store for this pretty watering-place; and I hope,. when sanitary zeal is really developed amongst its popula- tion, that its authorities may not copy too exactly or servilely the methods adopted in other fashionable localities. Warn. ings abound on every hand against such a course. First, we have sporadic cases of typhoid at Cannes, then an actual epidemic at Nice, just in the midst of an International Exhibition, and after an immense expenditure of money on "drainage" in both localities. It seems as though many engineers disbelieve altogether in the use of traps of the good old-fashioned S-shape ; whilst almost all are amicted with the superstition that it is only necessary to convey solid refuse into the sea, or even into a lake, in order effectually to get rid of it for ever. It is true that the shores of the British Islands are daily washed by a strong tide which dilutes, if it does not always remove,, the more noxious and offensive refuse which we continually pour into it. But to attempt to carry out the same idea on the shores of a Swiss lake, or even the Mediterranean sea, is likely to lead to more lamentable consequences than would be believed if we did not see them actually taking place. There is abundant and unimpeachable testimony as to ther horrible accumulation of sewage of the most offensive cha- racter in and around the harbours of both Toulon and Mar. seilles, the very’places which are now (August, 1884) en- during the scourge of cholera, and which will probably act as centres whence this vile result of inhaling concentrated filth will be propagated over a large portion of France, and pos- sibly even of Europe at large. Some of the most fashionable of the resorts of the Western Riviera have adopted wrong methods of disposing of their sewage; and it is only a question of time how long their popularity can possibly last, They are also intolerably dear, and treat the unhappy valetudinarian as though he were their natural prey. Are we to be accused of fickleness if we respectfully decline to be fleeced ? Those places which give the best value may reasonably expect the most custom, and there is no good reason why accommodation of a very excellent kind, witb
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Transcript of A DEMONSTRATING VAGINAL SPECULUM
1046
A DEMONSTRATING VAGINAL SPECULUM.BY H. MACNAUGHTON JONES, M.D. &c.,
EXAMINER IN OBSTETRICS, ROYAL UNIVERSITY OF IRELAND, ETC.
THE desirability of having such a speculum as would enablethe surgeon to demonstrate to a studentorstudents the os uteriand infra-vaginal cervix, in a different manner from that nowadopted, and without exposure of the patient, often struckme in hospital work. By such an appliance as that madefor me by Messrs. Maw, Son, and Thompson, this canbe perfectly achieved. The drawing (Fig. 1) shows the
FiG. 1.
One-fourth size.
appliance attached to a speculum. It consists of a nickel-plated steel bracket with three joints, as shown in thefigure, which are so constructed as to enable the mirrorto be placed at any angle or plane to the orifice of thespeculum, from which it is twenty-five centimetres distant.A ring with a groove receives the mouth of the speculum,and will fit any large-sized speculum. The ring is clampedby means of a screw. (This clamp I am having im-proved.) But this may be so arranged that any sized ringcan be applied so as to embrace a smaller speculum.
FiG. 2.
One-fourth size.
At the other end of thebracket is a mirror, whichworks in a universal joint.It is three inches in dia-meter. If it be wishedto get a magnified image,
B a slightly concave mirror
i can be attached. Theentire appliance is shownfolded in Fig. 2. It fitsinto a leather case, and is ’,quite portable.
By means of this instrument the lips of the os uteri can be 1seen, either by sunlight or artificial light, several feet away.The patient need not be in the least exposed during thedemonstration. The teacher having introduced the speculumand having caught the reflection of the uterus at the planerequired, turns the mirror so that anyone standing behindhim or at the side, and looking into it, can see both theos uteri or any application which is made to it. It is not 4
necessary to expose more than the orifice of the speculum. J
Harley-street, W. _______________ I
ON NERVI, NEAR GENOA, AS A WINTERHEALTH RESORT.1
BY EDWARD HAUGHTON, M.D., B.A., &c.
NERVI is situated about seven miles and a half east of
Genoa, just at the head of the gulf, and is well sheltered onthe north and east against cold winds. In Cook’s Guide tothe Riviera it is spoken of as having "come into reputerecently as a winter residence owing to its mild climate andsheltered position." It is also briefly described by Dr. C.T. Williams, in his " Climate of the South of France," inthe following words: " Nervi, on the Eastern Riviera, aboutan hour’s drive from Genoa, stands on a ledge of level groundwhich descends in rocky masses into the Mediterranean,here affording boating, bathing, and tolerable fishing. Theplace is well sheltered to the north and east by woodedhills, on whose sunny slopes the orange and lemon flourish.Olive-grovei besprinkled with villas and picturesque hamletsrise about the village, and the view from this spot of the1 Read at the last meeting of the British Medical Association in the
Public Health Section, August, 1884.
Bay of Genoa and the Col de Tende range is exceedinglybeautiful. A good hotel and boarding-house (H6teld’Angle-terre) with well-sheltered grounds, pleasant walks and rides,and its short distance from Genoa, render Nervi attractiveto invalids, many of whom have safely wintered here."For some unexplained reason the number of English
visitors seems to have diminished, and their place to havebeen supplied by Germans, the proprietors of several of thehotels and boarding-houses being of that nationality.Not being satisfied with getting accounts at second-hand
about the climate and capabilities of Nervi, I determined topay a personal visit to the place, which I did about themiddle of last February, leaving snow and sleet behind me inBasle and Lucerne and several of the northern Italian cities.I also made a point of visiting Pegli on the same day, andthen returning to sleep at my hotel in Genoa, so as to makea really satisfactory comparison of the amount of shelterfrom cold winds afforded by the three localities respectively.The result was that the wind, which was bitterly cold atGenoa, was much milder at Pegli, especially in the valleybehind the town, whilst it was perfectly calm and evenwarm at Nervi, so long as the headlands which protect theplace were not rounded by the visitor, who literally has ahaven of refuge there, which he should remain within solong as the wind blows persistently from the north or east,It is probable that Nervi remains, so to speak, in an un.developed state as a health resort from one or two causeswhich are not likely to be permanent. In the first place,the through traffic to and from Rome goes past it withoutstopping, or at inconvenient hours for alighting, and thesanitary arrangements of the place, although it has beenhitherto absolutely free from epidemics, will need a littleoverhauling before they are quite agreeable to noses andeyes polite.The scenery of Nervi is in some parts beautiful in the
extreme. As for instance, if we climb the hill at the backof the town and look down on the valley beneath, or strollalong the sea shore, and listen to the murmuring of thewaves amongst the rocks, which are here permitted toretain some of the wildness which constitutes one of theprincipal charms of the neighbourhood. It is to be regrettedthat the principle of laissez-faire is carried so far as topermit strangers to be annoyed by lazy mendicants, and toallow all kinds of refuse to lie about exposed to the sunamidst the very loveliest part of the walk by the sea shore.Various circumstances have convinced me that a brightfuture lies in store for this pretty watering-place; and I hope,.when sanitary zeal is really developed amongst its popula-tion, that its authorities may not copy too exactly or servilelythe methods adopted in other fashionable localities. Warn.ings abound on every hand against such a course. First, wehave sporadic cases of typhoid at Cannes, then an actualepidemic at Nice, just in the midst of an InternationalExhibition, and after an immense expenditure of money on"drainage" in both localities. It seems as though manyengineers disbelieve altogether in the use of traps of thegood old-fashioned S-shape ; whilst almost all are amictedwith the superstition that it is only necessary to conveysolid refuse into the sea, or even into a lake, in ordereffectually to get rid of it for ever. It is true that theshores of the British Islands are daily washed by a
strong tide which dilutes, if it does not always remove,,the more noxious and offensive refuse which we continuallypour into it. But to attempt to carry out the same idea onthe shores of a Swiss lake, or even the Mediterranean sea, islikely to lead to more lamentable consequences than wouldbe believed if we did not see them actually taking place.There is abundant and unimpeachable testimony as to therhorrible accumulation of sewage of the most offensive cha-racter in and around the harbours of both Toulon and Mar.seilles, the very’places which are now (August, 1884) en-during the scourge of cholera, and which will probably act ascentres whence this vile result of inhaling concentrated filthwill be propagated over a large portion of France, and pos-sibly even of Europe at large. Some of the most fashionableof the resorts of the Western Riviera have adopted wrongmethods of disposing of their sewage; and it is only aquestion of time how long their popularity can possibly last,They are also intolerably dear, and treat the unhappyvaletudinarian as though he were their natural prey. Arewe to be accused of fickleness if we respectfully decline tobe fleeced ? Those places which give the best value mayreasonably expect the most custom, and there is no goodreason why accommodation of a very excellent kind, witb
