4. I have been unable to determine the influence of nitro-glycerine upon the weight of the urine, the weight of the patients and on the dropsy.

5. With the exception of slight and transient headaches, the remedy does not give rise to any disagreeable symptoms.

GELOSINE. This is a mucilaginous principle extracted from the gelidinum corneum, of Japan. M. Guérin, the French surgeon, has employed it, and states that it is a colorless, amorphous, non-nitrogenous substance, a basis of vegetable jellies. It is easily soluble in warm water, and undergoes putrefactive changes very slowly. Guérin considers it adapted to poultices, suppositories, etc. Its cost is small.

HAY FEVER CURE.-Dr. Moorhead writes in the British Medical Journal that he has ob tained relief from hay-fever, his annual persecutor for thirty years, by hypodermic injection of one-twentieth of a grain of morphine and one two-hundredth of a grain of atropin night and morning. The relief was complete.

AMMONIA IN ACUTE CATARRH.-The inha

lation of a strong solution of ammonia will give relief in catarrh after exposure to cold, and limits the trouble to the nostrils. We order, as still more efficacious, the inhalation

of colorless tincture of iodine. Dr. Mullins finds that a dose from 25 to 30 minims of the tincture of belladonna, taken at the commencement of a cold, will abort it.

PRACTICAL SURGICAL HINTS.—In the Edinburgh Medical Journal, Prof. Chiene makes. the following suggestions:

In case of persistent epistaxis, plugging of the posterior nares should not be done until an attempt has been made to check the hemorrhage by firmly grasping the nose with finger and thumb, so as to prevent any air from passing through the cavity. By this means a clot may be formed, which, if not disturbed and moved by air forcibly rushing

by it in the attempts of the patient to the nostril, may consolidate and arrest the hemorrhage.

On dividing the frenum in tongue-tie only a slight nick of the anterior edge with the scissors is needed. The finger-nail should tear the remainder of the band.

Elongated uvula should be divided only after having grasped the apex and drawing forward to a firm tension. Simply grasping the uvula and attempting to divide it in situ is not an easy matter.

PILOCARPINE IN ACUTE ALCOHOLISM is ad

ministered by Dr. Josham (Med. Record) in one-third grain dose hypodermically. Its sobering effects are said to be remarkable. Sleep ensues and the patient wakes up a perfectly rational being. The tense, red, bloated countenance, the bleared, congested eyes pass away. The features become calm and easy, the skin clear and soft. Three ways of this therapeutic influence of pilocarpine in alcoholism are mentioned. 1. By lowering cerebral blood-pressure. 2. By eliminating alcohol.

3. By increasing the absorption of oxygen.

CHLOROFORM AS A HEMOSTATIC in such grave emergencies as uterine hemorrhage is don Medical Record, one Dr. Betz checked certainly a novelty. According to the London Medical Record, one Dr. Betz checked post partum hemorrhage and secured contraction of the uterus in two cases by plugging the vagina with a sponge or cotton soaked in chloroform. The hemostatic action is ascribed to vascular constriction.

PERMANGANATE OF POTASH IN BURNS AND FROSTBITE is employed by Zueboff (Meditz Obozrenie, London Med. Record) for the following reasons:

1. Permanganate of potash, applied on compresses in a solution of one or two grains to one ounce of water, is an effective remedy for frostbite of the first and second degrees and burns of the first degree.

2. In burns of the second degree, a lotion of one-half grain to the ounce relieves inflammation and pain and limits suppuration.

SOCIETY PROCEEDINGS.

ST. LOUIS MEDICAL SOCIETY. Stated meeting held Saturday evening, November 6, 1886. The President, Dr. Gregory being absent, the vice-president, Dr. Bremer, occupied the chair.

DR. STEVENS presented a very interesting specimen of femoral hernia including both the intestine and the omentum, which was removed from the body of Mary Dugan nearly forty years ago, since which time it has been in the museum of the St. Louis Medical College. Dr. Stevens stated that the woman had gone to a very prominent physician at that time, presenting a tumor in her right groin, about the size of a hen's egg. The symptoms, which might lead to a diagnosis were vague, but after a careful examination, it was pronounced to be a case of tuphlo-enteritis, or as it is now generally called, typhlo-enteritis, or inflammation of the caput coli. Another eminent medical man being called in, pronounced it to be a femoral hernia, and the dispute ran high, pamphlets being published on both sides to prove their positions. A lancet was finally introduced, and upon its removal was followed by a copious discharge of fecal matter, and the establishment of a false anus, though which the woman discharged feces for four years at the end of which time she died. Having given her body to the doctors for examination, a postmortem was held, which showed the case to be one of femoral hernia, and not tuphlo-enteritis. The next day a more thorough examination by Dr. Stevens showed the case to be one of femoral hernia, including both the intestine and the omentum, in other words, an enterocele and epiplocele. The historically interesting specimen was then presented to the society for examination. The hernial sac was found to have been punctured by the lancet, and at the site of the puncture so made, the artificial anus had existed. The specimen beautifully exhibited a knuckle of the ileum and a part of the omentum, resting within the crural canal, the point of the intestine engaged being three or four feet from the caput coli or cecum, was first thought to be the seat of the trouble.

which

DR. DALTON then presented two specimens without comment to the society for examination; one a specimen of lobulated kidney from an adult, a condition which exists nor adult life; and another, which he stated to be mally in the fetus, but rarely persists until an abscess of the anterior part of the tongue, in which case the epiglottis was gone.

DR. DEAN did not think it was a case of simple abscess of the tongue, the disappearance of the epiglottis pointing to some more serious trouble.

DR. BREMER Concurred in the opinion of Dr. Dean, that it was something besides a mere abscess, and thought it was most probably a small round-celled sarcoma of the tongue which had suppurated.

DR. HULBERT then read a paper entitled: "ELECTRICITY IN GYNECOLOGY."

In the beginning of his paper the doctor stated that he would deal more particularly with the galvanic or voltaic current, and said that his own work in electricity as applied to gynecology had been very satisfactory to him. Thought that electricity was now receiving a fairer criticism than ever before. Thought that electricity as a therapeutic means was a force or energy continuously exerted, and that all processes arising from its application could be attributed to changes in nutrition. Spoke of the frequent error of confounding the negative element with the negative pole, and the positive element with the positive pole, and mentioned the difference between the continuous and interrupted currents, stating that contraction of muscle took place at the time of passing of the current, and also at the interruption of it. Then gave many interesting details of the physics and physiology of electricity, showing how, when rationally applied, it leads to stimulation of function, which is equivalent to tone, but when the stimulation is carried beyond the point of equilibrium between waste and repair that it led to death of the part. Said that in cases of amenorrhea he had had marked success with the application of electricity, and thought this class of cases one which could be most successfully treated by agent, more especially those cases arising from imperfect development of the uterus and its mucous lining; that in these cases he applied the positive pole to the uterus, and the negative to the abdomen, with a general pelvic congestion resulting from the procedure that the effect was brought about by means of the sympathetic, and that there was no depression, but on the other hand, vigor and tone, or in other words the effect was that of tonic stimulation. Thought that the greatest benefits to be derived from electricity would be found in chronic cases; that the dangers and accidents, though not many, were such as to convince him that they arose from the use of the agent. All the patients that he had far treated had been hospital patients, under constant observation, and he had been very well satisfied with its results. Said that in

this

SO

electro-puncture of the uterus there was one danger, that of opening one of the large uterine venous sinuses and causing hemorrhage. Then related several cases treated by electricity, the first of which was a woman thirtyseven years of age, with pelvic cellulitis, and cancer of uterus; patient much emaciated, and edema of the legs and arms present. The uterine neck involved in the cancerous mass was removed, and the operation followed by parametritis; a large lump formed in the pelvic cavity, which was about the size of a goose-egg; this enormous exudate pushed the uterus far over toward the right side of the pelvic cavity, and the patient suffered with intense pain. Half hour seances of galvanism were made use of, and in a short time the exudate had decreased one-half, together with a rapid subsidence of the pain, which after the first two weeks ceased entirely. Electro-puncture was then resorted to, the needle being pushed through the vaginal wall into the exudative mass, with a which was indicated by twelve to fifteen deflections of the galvanometer needle. Under this treatment the patient improved rapidly, and general condition became much better; at present time patient has but little pain, the swelling has almost disappeared, and she is able to work.

current

CASE II.-Woman, æt. 26; had had three children and one miscarriage. Since the miscarriage has never been entirely well; pain in right iliac region, general condition very poor, abdomen tender. The vagina was quite short, measuring only one and a half inch, the cervix lacerated and fundus retroverted; a short distance up the vagina fluctuation could be detected; opened at the spot and seventy c.c. of pus removed. Under the application of electricity the parts regained greatly their normal condition; the uterus became mobile, the vagina normal, and menstruation occurred regularly; there was some thickening of the broad ligaments.

CASE III.-Patient æt. 17; pain in the abdomen, nausea and vomiting; vagina very hot, broad ligaments thickened; large swelling in cul-de-sac. After five seances with the application of electricity, the needle being passed into the swelling through the cervix, the pain ceased, and later on there could be detected but a slight remnant of the deposit.

CASE IV.-Woman with hyperplasia of the uterus, dysmenorrhea and leucorrhea; uterine cavity three inches deep, broad ligaments thickened; under general treatment there was no improvement. Electricity applied, and after second application the pain which had been present ceased; short time after the

uterus was found to have a depth of two and a half inches, no tenderness, ligaments normal, and general nutrition good.

CASE V-Mother of four children, with uterus hard and large, both body and cervix. Under usual treatment there was no improvment, but after four applications of electricity the uterus regained its normal size and consistency.

CASE VI.-Woman, æt. 30, syphilitic. Uterus two and a half inches deep, and of stony hardness; pain and dysmenorrhea were present. After ten seances, the current being applied with needles, the consistency of the uterus was normal, as well as its size. Menstruated regularly and is perfectly well.

A

CASE VI. The patient said that short time before she had been attacked with a severe pain in the pelvis, accompanied by a sensation as of something having given away. pelvic hematocele was found behind the uterus, which did not undergo any change af ter the hot water treatment, but rapidly disappeared under the application of electricity, and in a short time no trace of the hematocele could be found.

CASE VIII.-Uterus very large, os patulous, the body of uterus extending to within an inch of the umbilicus; abdomen very tender; patient very weak and poorly nourished. Few hours after the first application of electricity, diarrhea set in, and the patient went into a state of collapse. After the diarrhea had been checked, the electricity was resumed, and patient rapidly progressed to a complete recovery. The doctor stated that in all these cases the negative pole had been applied within the pelvis, and thought it to be the proper method of making use of the agent. Said that he had had very satisfactory results in the treatment of menstrual irregularities by electricity. Had had two opportunities of examining the puncture track at post-mortems, in one of which the site of the passage of the needle could scarcely be detected, and in the other case which had died but a short time after the needle had been introduced, the sides of the track were agglu

tinated.

The paper was then briefly discussed by Drs. Hughes, Johnson, Engelmann and Dean, after which the society adjourned.

At the request of Dr. Etheridge, Dr. Sawyer narrated the following case, showing the shock and hemorrhage of acute inversion: I will state very briefly an experience which, no matter how long I may live, seems as if it would never become dim. I have never had any doubt that the determining cause of the acute inversion in this case was the enormous distension of the uterus due to the large quantity of liquor amnii. Before the woman was delivered, I was impressed with the fact that she probably had twins, but this was not the case. When the woman was delivered the bed was flooded, the liquor amnii flooding the room even. I put my hand upon the woman's belly, as is my custom, and at the first indication of contraction of the uterus, I substituted the husband's hand for mine that I might pay attention to the child. I am confident that the husband's fingers dimpled that uterus. I had no sooner detached the child than I gave the usual teaspoonful of ergot; was in a hurry on account of the flabby condi tion of the uterus, and for fifteen minutes my time was occupied in paying attention to the child, getting it to breathe. The woman, who had recovered from a small quantity of ether which I gave her, threw up her hands, and I saw she was pale. I put my hand under her husband's and felt the edge of the uterus like the edge of a saucer, I could define the mar gin of the crater, my finger in the vagina met the globe inverted and the truth flashed across me that I had an inverted uterus. Now fifteen minutes had not elapsed before that uterus was so firmly ergotized that it was im possible to replace it. I immediately resumed ether, and the woman began to snore, but that made no difference, the womb was ergotized, and the woman died from shock and hemorrhage with the uterus unreduced.

Dr. Jaggard has called attention to the enormous hemorrhage, and this reminds me of a case in which I removed a fetus from the abdomen of a woman, in the little town of Boulder. The fetus had been in the uterus for three and a half years. It was an adventitious uterus, the exact structure of which could not be ascertained, but the hemorrhage from the false uterus was enormous, and, I think, destroyed the woman. If the false uterus and adventitious sac could bleed to that degree and so early in pregnancy, the dangers of hemorrhage must surely be greater in the uterus at term containing a living fetus and an active placenta.

The operation was done in 1874. The bemorrhage was cavernous. We arrested the hemorrhage by seizing the edges and puckering them up and tying an enormous ligature

I

around the stump; for a moment that arrested it, but the woman subsequently died.

DR. H. T. BYFORD said: Like any other operation this one, supposing it to be an operation that has been performed, has its limitations. I think Dr. Jaggard's suggestion that a greatly contracted pelvis might afford sufficient difficulty to make the opera tion impracticable, is a good one, although I think that the uterus might be inverted through a pelvis too small or too much distorted for a safe craniotomy. Another lim itation would be an undilated condition of the cervix. The irritation produced by rapid dilatation would certainly render the cervix unfit to be left as a stump, and make the Cesarean or Porro operation preferable. If the os is already dilated, then Thomas' revised laparo-elytrorrhaphy must be given precedence, provided there be no contraindications. The difficulty of inverting the uterus is not an imaginary one, and it seems to me that the best way to overcome it would be to invert. the uterus, placenta and all, before the placenta is separated, and between pains. This would tend to still further limit the operation to cases without extreme contraction, and would bring it into rivalry with craniotomy. Its chief advantage over the Porro operation lies in not fixing the cervix several inches beyond its normal position; and here lies the germ which the author seems to be trying to develop. Should there be a condition of the uterus which would not favor the Cesarean operation as performed by Saenger and Leopold, should the size of the cervix or vagina render fixation of the stump in the abdominal too difficult, were the uterine walls not sufficiently relaxed to be inverted, or the pelvis not roomy enough to to allow inversion with the placenta attached, should the condition of the tissues about the vagina and bladder contra-indicate laparoelytrorraphy, and should the os dilate naturally and easily, then this operation would find its rare opportunity. The process of coning out, or rather slicing around the cervix, and inverting the cervix, is easier to talk of than to perform. Any one who has seen the uterus amputated, even in cases of fibroid tumors, will agree that the loss of blood, including that taken off with the amputated pregnant uterus, and the vascularity of the stump would make the process of inverting the sliced cervix very hazardous. The stump, thus turned down, would undoubtedly shrink rapidly, and become a hard one to manage. As to opening the uterus with the cautery, I think this would not possess much advantage unless complete constriction of the uterus and

broad ligaments could be made, so that bleeding would not interfere with the complete searing of the parts.

DR. BARTLETT in closing said: Some of the Fellows taking part in the discussion, as they have stated, have not had an opportunity of hearing more of the paper than the bare proposition; not needlessly to occupy time, I shall pass over such objections (all of which I recognize as forcible), as have been fully considered in the paper now printed.

Dr. Jaggard refers to the authorities quoted by me as "questionable;" so far as my knowledge extends, not a case cited rests upon other than unquestionable authority. The Doctor thinks the actual cautery would prove useless as a means of arresting hemorrhage from the uterine incision. Prior to the time of Ambrose Paré, the cautery was relied upon "to arrest all forms of hemorrhage."

Dr. H. T. Byford has dwelt upon the difficulty of dilating the os uteri by artificial means, and in my opinion he has not exaggerated the difficulties often encountered in practice, where the parts are not prepared for dilation.

In regard to the embarrassment felt by the Secretary as to the operation to prefer, whether the old or the Porro method, I might say, that in face of the several substitutes and modifications, he would be amply justified in preferring the old Cesarean section.

OBSTETRICAL SOCIETY OF PHILADELPHIA.

Stated meeting, October 7, 1886. The President, B. F. Baer, M. D., in the chair. RUPTURED FALLOPIAN PREGNANCY. LEFT

SIDE.

DR. JOSEPH PRICE exhibited the ovary and distended tube which had burst spontaneously. No fetus was discovered; a very free hemorrhage into the peritoneal cavity had occurred. In the vast majority of cases the rupture is fatal. The cause of death is invariably hemorrhage.

DR. PRICE also exhibited specimens from a case of double pyo salpinx, with cyst of the right broad ligament, and abscess of the ovary of the same side. The specimen consisted of both fallopian tubes and ovaries and was a good example of pyo-salpinx, both tubes being closed at the ends and distended with pus. The right tube was long and very much distended, and with a large abscess of the ovary, and a cyst of the ovary, as large as a base ball, occupied the whole of the right