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816 BOSTON: VAOIHTAL DOUCHES, ANTE-PABTUM AND POST-PARTUM. [N. Y. Med. Jodr., anatomy and physiology of the bronchial and vesicular elements of inspiration and expiration, their character, intensity, pitch, and relative duration. So it is with the voice. One may be able while in practice to detect signs of disease in certain derange- ments and modifications of the voice, and yet may be unable to make an analysis of the attributes of that voice or give any technical description of it that could be recognized by another. VAGINAL DOUCHES, ANTE-PART UM AND POST-PAETUM. By L. napoleon BOSTON, M. D., BACTERIOLOGIST TO THE PHILADELPHIA HOSPITAL ; INSTRUCTOR IN OBSTETRICS, MEDICOOHIRURalOAL COLLEGE, PHILADELPHIA. In the past, and even buy hoodia online at present, it is extremely common to find obstetricians and general practitioners who are especially fond of giving vaginal douches, and use them as routine treatment instead of dealing with the douche as with forceps, premature labor, and abor- tion, having certain distinct indications for its use. Douches may order hoodia be divided into three varieties: Hot, cold, and Scotch (hot and cold alternately), any of which may contain certain chemicals which render them more or less antiseptic. The lining membrane of the vagina is in many re- spects similar to that of other mucous surfaces, despite the views of Pretti, who states that it is merely an invagination and contains none of the essential proper- ties of mucous membrane. It is therefore fair to con- clude that any interference with its normal condition can do no good, and may do harm. The vagina is usually well lubricated by a rather tenacious secretion of acid reaction, probably due to the action of the bacillus of Doderlein. With few exceptions the vaginal secretions are increased during the latter months of gestation and after labor — a physiological provision against infection during delivery and the puerperium, since the ordinary pathogenic bacteria can not reach the uterus without first becoming entangled within the meshes of the vaginal secretion, which by its tenacious property prevents their reaching the uterus, and hoodia 57 by its acidity and selective antiseptic property arrests their fur- ther development. Given such a physiological antisep- tic, if not possibly germicidal lubricant of the vagina, with the additional provisions of its walls being con- stantly in apposition and a phig of mucus in the cervix, it is cheap hoodia fair to conclude that a woman rarely, if ever, be- comes infected except that such infection is conveyed from without, either by the doctor, the nurse, or by the vaginal secretions having first been washed away by means of douches. Bacteriology has contributed so liberally to medical science that it is scarcely possible to find a doctor of medicine who does not thoroughly cleanse his hands be- fore attempting to make a vaginal examination; yet almost as rare as this is it to find an accoucheur who first cleanses thoroughly the external genitalia and adja- cent parts of the patient. While asepsis has markedly lessened the percentage of septic cases after delivery, it is unfair to expect a hand perfectly free from germs, after proper cleansing, to pass over unclean skin and hair — two of the common sources from which infection may come — and yet carry no micro-organisms with it into the vagina, cervix, or uterus. The question of when and when not to douche before delivery of the child is one deserving of consideration. Various authors advise douching where leucorrhoea is pronounced; others, where it is alkaline in reaction or highly irritating; others, where it contains patho- genic bacteria, or where unclean instruments have been introduced into the vagina, as in abortion. A profuse discharge is no indication whatever for vaginal douching, except that bacteriological examina- tion has shown such discharge to contain virulent patho- genic organisms. I have repeatedly seen a marked leu- corrhoea continue for weeks or even months, yet re- peated bacteriological examinations failed to detect the presence of any pathogenic bacteria. When the dis- charge is alkaline, or faintly acid, the varieties of bac- teria found are many; yet it is likewise rare to find organisms pathogenic in character. Kronig, in about two hundred examinations, decides that the vagina contains no pathogenic organisms except those of gonorrhea and the thrush fungus. He further found that hoodia p 57 if, an hour after the infection of the vagina, an antiseptic douche of lysol were administered, the micro- organisms were not destroyed, and that it took the vaginal secretions from nineteen to thirty-six hours to destroy these microbes; but when no douche was given, the same bacteria would disappear in from eleven to twenty hours. Doderlein in a hundred and ninety-five purchase hoodia online exami- nations found streptococci in eight. However, he was unable to show that this organism was pathogenic in but five cases. Williams, in a report of the study of ninety-two cases, in connection with a general survey of the literature, agrees with Kronig that " the vaginal se- cretion hoodia buy does not contain the usual pathogenic cocci," hav- ing found the Staphylococcus epidermidis alhus twice, Kelly, in his late work on gynascology, states : " If staphylococci alone are present, especially the compara- tively harmless citreus, albus, or epidermidis albus, the danger to the health of the patient is much less than in the case purchase hoodia of the streptococcus, which tends to produce gen- eral infection."

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