yet identified, or at least observers who claim to have discovered it do not agree in its description. Pfeiffer, the son-in-law of Koch, is the latest claimant, and the confirmation of his alleged discovery is looked for with interest, but if his claim is not confirmed, nor even that of any other observer, we may rest assured that the microbe is in waiting to be discovered.

Pfeiffer is connected with the Berlin Institute for Contagious Diseases. His conclusions are based on a careful study of thirty-one cases of la grippe, six of them being postmortems. His microbe is a minute rod or bacillus as thick as that of mouse septicemia and half as long. There is some difficulty about culture and staining, and this has misled other observers. Pfeiffer believes that other observers have seen the same bacillus but have described it as a micrococcus because it takes the stain at the ends. Kitasato has seen and described the bacillus, agreeing essentially with Pfeiffer. The microbic and contagious nature of the disease is admitted, but some work is needed to learn just how the contagium virum is conveyed from one to another. In all probability it is in the breath of the patient, and perhaps in the secretion of the skin.

Treatment. More than three-quarters of the cases of la grippe are treated at home in a variety of ways. A favorite method of treatment is to take a dose of pills and drink all the cider, made strong with red pepper, one can hold. The other quarter, or less, that the doctor sees are mostly complications and sequels and are to be treated symptomatically. There is no specific for the disease. It is a good plan, if the person is seen during the attack, to give a cathartic-say a dose of compound cathartic pills. The operation will materially relieve the intense pain in the head, and awaiting that, a dose or two of acetanilid will afford much relief. We ought, however, to select our cases for this treatment. The effect is too depressant sometimes for safety. Now and then a patient will sweat so profusely that it is really alarming. We should be very careful with acetanilid in la grippe. Still, I have given it to small children and once to a man eighty-two years of age, with excellent effect. Antipyrine, which was so extensively used two years ago, seems to have dropped out of focus. Beyond a doubt much harm has been done with that drug. That class of remedies, in such a prostrating disease as la grippe, ought to be used with great caution. After the bowels are evacuated opiates are to be preferred to them if the pain in head and back continues. Quinine is not a specific in la grippe. It neither shortens its course nor does it afford any relief so far as I have observed.

Notwithstanding treatment the malady has its course to run and the function of the doctor is to see that the course runs normally and to obviate, if possible, any threatened mischief. Avoidance of all exposure for a week after the disease subsides is of the utmost benefit to the patient. It is carelessness in this particular that makes work for the doctor.

TRANSACTIONS.

WASHTENAW COUNTY MEDICAL SOCIETY.

REGULAR MEETING, ANN ARBOR, DECEMBER 14, 1905. THE PRESIDENT, JOHN A. WESSINGER, M. D., IN THE CHAIR. REPORTED BY JOHN WILLIAM KEATING, M. D., SECRETARY. REPORTS OF CASES.

AN UNUSUAL CASE OF DYSMENORRHEA.

DOCTOR JAMES B. WALLACE: A single lady, aged twenty-one years, living at home, came to me March 18, 1905, complaining of severe attacks of dysmenorrhea. She is the second daughter in a family of four girls. Her mother, now aged forty-five, was troubled with severe menstrual pains when a girl and attributed the patient's affection. to an hereditary influence. The patient's sisters have no more pain at the menstrual periods than is considered normal. The mother is a healthy woman and her confinements were normal and easy. The family are all in good health except the patient, and she has never experienced any trouble except at the menstrual periods, and the fact that she is subject to a very obstinate constipation.

The patient has had the ordinary discases of childhood, and no other sickness nor disease. She was regarded to be perfectly well up to the age when she would ordinarily begin to menstruate. About the time she was thirteen or fourteen years of age her mother noticed that she was nervous and feverish, and oftentimes choreic. This she attributed to the approaching catamenia and did not pay much attention to it. The nervous disturbances did not disappear although the mother thinks they did not increase as time went on. Menstruation was not established, however, until the patient was seventeen years old, and at that time she was almost in convulsions from the pain. The girl had no medical treatment during the years of approaching maturity, except some patent nerve nostrum, Lydia Pinkham's vegetable compound, and Porter's pain king.

After the menstrual function was established, the patient felt better, except a few days before and during the menstrual week. Her nervousness and apprehension did not abate, but she began to await the dreaded period with feelings approaching hysteria. The pain just before the flow began was so severe that for a few months before the patient came under my observation, she had gone into convulsions at those times. She was quite irregular, sometimes going seven to eight weeks, and at other times menstruating as often as every two or three weeks.

The period in February, 1905, was the worst she ever had, and the mother told me that she had much more severe pain than any woman she had ever seen in labor. The reason she had never had treatment for her trouble was an implicit faith in patent medicines on the part of

her mother and a somewhat exaggerated dread of exposure on her part. On March 18, 1905, the mother came to consult me about her but did not bring the patient along. I obtained the facts of this history as I have given them, from her at that time. I plainly told the mother that she must bring the patient and be prepared to have her examined if need be, before I could tell her the cause of her trouble. Several days later they came to my office. The girl was a well-nourished, and healthy-looking lass, and did not show the signs of the nervous disturbances through which she had gone. A careful and extended physical examination showed that there was nothing wrong with any of the organs of the body except the site of the trouble, plus the chronic constipation, and a peculiar drawing or bearing down feeling during the act of defecation and sometimes also while passing urine. I then told the mother that unquestionably there was some abnormal position of the uterus and that I would make an examination. The patient consented and the cause of her trouble was soon apparent. The nymphæ were very long but as the girl was scrupulously cleanly there were no irritants lodged there. The hymen was normal but very tight, and I found much difficulty to introduce the finger even through the hymen without producing much pain. Finally this was accomplished and I found the vagina apparently smaller than the hymen. It appeared so small that I had to abandon the use of the finger and make exploration with the sound. The vagina was of normal depth and I could easily touch the os uteri with the sound. While attempting to withdraw the sound I observed that the point caught upon something which I could not make out. Examination per rectum showed a retroflexion of the third degree. A speculum could not be introduced into the vagina so I tried a branching ear speculum which showed the cause of the trouble. Just inside the hymen was a septum extending from the anterior to the posterior wall, the whole length of the vagina and dividing it longitudinally into two nearly equal parts. I advised its immediate removal. This was agreed to, but the girl would not permit my bringing another physician to give the anesthetic. The next day I went to the patient's home, where I made ready, gave the anesthetic, and dilated the vagina. I found that the os uteri was freely movable; a sound could be passed into it from either passage. The unusual part of this case consisted in the part of the septum near the os uteri. For about one inch in length, there was a wedge-shaped portion,-the base impinging against the os-the apex becoming continuous with the membranous septum. This wedge-shaped portion was firm and contained muscular tissue. I removed the septum, controlling the hemorrhage with spray of adrenalin; sewed up the wounds with chromacized catgut; replaced the retroverted uterus; packed the vagina with gauze; catheterized the bladder, and permitted the patient to come out from the anesthetic. When awake she said she had no pain and felt all right. I called again that night and there was no pain.

Patient recovered without suffering any inconvenience, her bowels.

became regular, and on the morning of the ninth day afterward she called her mother in alarm saying that the wound must have started to bleed. The mother telephoned for me and I went out and found that her period had come on and she had begun to menstruate freely and without a trace of pain for the first time in her life. That was in March. Since then she has menstruated regularly and has never had a symptom of pain. The uterus has stayed in normal position and she has no more need for the nostrums she formerly imbibed.

That wedge-shaped septum formed a cup-pessary which tilted the uterus backward, and when the organ became turgent and distended' with blood at the period, occluded the os, producing the pain and convulsions until the flux forced itself past the obstruction.

The girl is strong and well and is not so much afraid of doctors; the mother is pleased, and has lost a very large part of her confidence in patent medicines.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC.

STATED MEETING, FEBRUARY 5, 1906.

THE PRESIDENT, JOHN J. MACPHEE, M. D., IN THE CHAIR.
REPORTED BY FREDERICK C. KELLER, M. D., SECRETARY.

READING OF PAPERS.

ACUTE PELVIC INFECTIONS.

DOCTOR JOSEPH C. TAYLOR read a paper on the above subject. He said, in part: It is but a few years since a woman's tubes and ovaries were sacrificed by an operator lest a future laparotomy should be required. Actuated by a sense of thoroughness, he deprived women of the function of menstruation, which is interwoven with their mental as well as physical life. It is better to conserve these organs, even if elaborate and hazardous procedures must be adopted to accomplish this end as well as to cure the patient. He did not advocate, however, the carrying of conservatism in connection with special organs so far as to endanger the constitutional condition of women. There is a broader conservatism, which seeks to restore the general health of the patient, even if special organs must be sacrificed to attain such an end. To this end he made an appeal for early surgical interference in acute diseases of the female organs. Conservative operations sometimes may fail; but even if they do, radical procedures must be adopted later without added risk to the patient. On the other hand, it is impossible to restore organs removed by radical work.

For many years it has been customary in most large hospitals to treat patients suffering from extension of gonorrheal inflammation to the tubes by hot antiseptic douches or perhaps by tampons and an ice

bag externally over the lower abdominal region. When the acuteness of the attack had somewhat subsided the tubes as well as the ovaries were frequently swollen and engorged to such an extent as to be designated as tumors and removal was advised; whereas, without apparent mutilation, the inflammation might have been checked in the beginning and the woman allowed to keep her organs, though somewhat damaged. The conservative work to be attempted is mainly that of evacuating the free pus in the culdesac when the operator is convinced by the bulging of the wall of the posterior fornix that purulent exudate is present in abundance. The gonococci, in an active state, after they have gained entrance into the uterine cavity, cause a destruction of the superficial cells, work their way into the deeper layers, and are the cause of an immense amount of purulent exudate, destruction and infiltration of the outer layers and edema of the deeper structures. Unfortunately, after gonorrhea has once become well established within the uterus, it invades by continuity of tissue the Fallopian tubes. The inner surface of the uterus may become such an active seat of inflammation in its deeper layers that the walls of the smaller vessels become involved, as do the surrounding lympathics, and the normal structure is almost entirely destroyed. The walls of the uterine cavity thus become suppurating surfaces, which later become sclerotic, and this is followed by a shrinking of the organ. This is frequently the case in mixed infections.

If the tubes are opened and drained during the onset of the disease, the woman may retain her organs, though somewhat damaged. The operation is very simple, but it necessitates a thorough knowledge of female pelvic anatomy and careful manipulation of special instruments. An incision is made on the posterior surface of the cervix at the juncture of the vaginal mucous membrane with the cervical, care being taken to keep close to the cervix. A pair of blunt-pointed scissors, curved on the flat, seems best adapted for this purpose. When the incision is made in the curve of the fornix, a painful scar is apt to result, the nearer the rectum is approached the greater being the sensory nerve supply. After incising the mucous membrane and retracting the divided edges, a small amount of loose alveolar tissue is encountered (most marked in women after the menopause). After incising this the peritoneum is easily divided or punctured. With the forefingers the opening can be enlarged. The uterosacral ligaments being pushed outward by the palmar surfaces of the fingers and the intestines carried out of the way by means of the Trendelenberg position and held there by pads, the tubes are easily brought into view by means of the proper instruments for retraction. If this procedure is adopted in the very early stages, as it should be, the tube will be found reddened, swollen, and with a tendency to sink into the culdesac. It should be grasped with a pair of blunt forceps, such as those of the modified Hunter type, on the dorsal surface, and pulled into the opening. It should be remembered that the tube, like the ovary, except at its uterine extremity, is