duce it as far as possible, then, by stretching the part it occupies, the contraction above (the stricture), yields sufficiently to allow of the introduction of the blades of the large dilator. To make sure of no recurrent retraction, I carry the dilation to the fullest extent or capacity of the instrument. If following the operation there is considerable soreness; a suppository of opiam introduced into the rectum will allay it and all pain.

Many gynecologists in operating for rapid dilation prefer the left side for position of patient; I prefer the dorsal position, unless it be for partial dilation the former position then offering many advantages.

When is the operation indicated?

In dysmenorrhea when the condition is due to stenosis of the cervical canal, or flexion, or flexion and stenosis combined.

It seems to me impossible to differentiate these conditions by subjective symptoms. We understand, and it is stated that where stenosis alone exists, before the flow the pain is excessive; and as it becomes established the pain gradually ceases; but in flexion the flow comes in gushes, cansed by the pent-up fluid straightening out the canal. There being excessive pelvic and ovarian hyperemia, all subjective symptoms are unreliable. This condition of hyperemia is consequent on the obstruction and tends to mask the naturally concomitent symptoms of stenosis alone, or when combined with flexion. Where obstruction exists the vaginal portion of the uterus usually becomes elongated, somewhat pointed; and often, in fact nearly in all cases, the os externum is exceedingly small, the fundus is enlarged, and measurement by sound is from three to three and a half, sometimes nearly four

inches.

Different writers tell us that "the eat of the obstruction is generally at the os externum," and where obstruction exists at the os internum, "it is due to flattening of the walls by flexion." I am not prepared to say whether this is true or not, but, in either case, experience has taught me that where the conditions of stenosis and flexion are both present, rapid dilation will cure both conditions—i. e. the operation to cure the flexion will per necessity cure the stenosis. The condition or result of obstruction are "(1), congestion and enlargement of the body of the uterus, causing uterine colic and spasm, menorrhagia; (2), a similar congestion of the fallopian tubes; (3), congestion, enlargement and inflammation of the ovaries; (4), as an ulterior result continued obstruction may entail, through the action of inflammation or long interference with function, atrophy of the ovaries and extinction of the menstrual phenomena.”

This being the case, and when we realize the serious consequences which must follow a long congested uterus, the fallopian tubes being in the same condition, and the ovaries in even a worse; when we think of the terrible suffering of those in whom these obstructions exist, can we laud too highly a treatment that will afford relief beyond all peradventure of failure, a treatment that we are bound to use by every consideration of humanity? Thanks to science the operation of incision of the cervix to overcome stenosis, and the various cutting instruments invented have been relegated to the past and rapid dilatation is fast taking, if it has not quite taken, the place of the knife, scissors and the metrotome.

Nothing will overcome sterility where it

is due to stenosis or anteflexion so quickly and surely as dilatation. If the fundus, upon examination, is found resting upon the bladder, it would be almost impossible to introduce a probe on account of the flexion. In such a case you gain two ends by rapid dilatation; first, you widen out the cervical canal and thus facilitate fecundation; and second, you will straighten the flexion and thus as a consequence overcome the obstruction to pregnancy. In numerous cases it will be discovered that the obstruction is of many years standing. Here the general disorganization in the lining membrane of the uterus, fallopian tubes and ovaries, resulting from the long continued hyperemia, renders fecundation doubtful, even after the removal of the cause. But by securing a channel which will give the menstrual fluid free flow, curing the cause of the dysmenorrhea there is every reason to expect that pregnancy will ensue as time and nature will rectify other conditions with the beneficent aid of the properly selected Homœopathic remedy.

In the use of intra-uterine medication dilatation is absolutely necessary, not only for proper and efficient treatment, but for intelligent examination and diagnosis. It is very necessary often to make a digital examination of the interior of the uterus, and the operation of rapid dilatation makes the effort of examination easy; especially is it so in comparison with dilatation by tents. And then, too, where there are strong suggestions on account of the menorrhagia and other symptoms of a foreign growth in the interior of the uterus, the operation of rapid dilatation gives us the means and a condition of things is created which makes it possible for a correct diagnosis. If a growth of

any kind be discovered, the laxity of the tissues of the cervix (especially if there has been continued menorrhagia) resulting from depletion, renders so easy the operation of dilatation that usually the cervix can be dilated and the substance or growth if present removed at the single operation. This fact, in comparison with the old and excessively tedious and often painful to an extreme, dilatation by tents, should be argument enough for rapid dilatation. As for its facilitating and making efficacious the use of intra-uterine applications, inspections, etc., the using of the curette, etc., rapid dilatation offers every advantage over any other means. Immediately after menstruation should be chosen as the time for operation, as the danger from hemorrhage is much less. The best aftertreatment is quiet, hot water injections and the indicated remedy.

* **

CASES.-Out of thirty-two cases I have operated on by this method, I select but three from my note book; first, because this article is much longer than I first intended it; and second, because these are recent cases.

**

CASE I.-Mrs. F., aged 20 years, married two years, never pregnant. Some dysmenorrhea for several years before marriage, which increased to extreme severity after marriage. Health otherwise good. Came to me August, 1889. Examination revealed anteflexion and stenosis of cervical canal and external os. Operation-rapid dilatation and straightening of flexion. In order to more thoroughly complete the latter I withdrew the instrument and reintroduced it, and opened the blades opposite the flexion. At the next

monthly period there was much less suffering than usual, at the next none what ever. Eight months since patient became pregnant, expects to be confined latter part of this month. No remedies were prescribed excepting Belladonna 30th, immediately following the operation.

* *

CASE IL-Miss Kate G., aged 23. Came under my care September of this year. Has suffered so extremely for five years past from dysmenorrhea as to become nervous, irritable and mentally affected. As the case bas had the best of Homœopathie medication I refused absolutely to see it unless an examination is permitted. This is at last consented to. Examination in presence of married sister reveals the cervix very long, narrow and pointed, and the os externum so small that I can only introduce a fine probe. I found no flexion, but the fundus was much enlarged. Under the influence of chloroform I introduced the small and followed with the large dilator, the handles being very slowly brought together and kept there for fifteen minutes. The result showed that the uterus was shortened and there was an entire obliteration of the conical condition. She was kept in a recumbent position for five or six days and hot water injections used for three or four days. No medicine excepting Belladonna 30th for three days. She has since menstruated regularly and painlessly and is in perfect health.

CASE IIL-IS exceedingly interesting and rather peculiar; is a boom for Homeopathy here and is booming the writer also, as the lady is very prominent and does not hesitate to talk about her case to her lady friends. Modesty perhaps should

forbid my mentioning this case, and I should not do so if it were not for the fact that by reporting it in all its interesting detail some brother may thereby get a hint that may some day help him "out of the woods." Mrs. L., wife of the president and manager of one of our largest manufacturing interests, came to me by the advice of Mrs. Rev. Henry, wife of the rector of Grace Episcopal Church of this city, April 7, 1890. I copy from my note book, giving her own words:

"I have been married five years, am 26 years of age, commenced menstruating at fifteen; never had any trouble with my menses, came regularly and were neither scanty, too free nor in the least painful. As you see I am the perfect picture of physical health; weigh 184 pounds and do not have an ache or a pain excepting when I am unwell; then I suffer torments. The first month after marriage I suffered considerably, the second month intensely, the third month worse than ever, and the fourth month gave birth to a fully developed fetus which the doctor said was at least three months. My recovery was rappid; in sixty days I came uuwell again suffering as much if not more than ever; again, when twenty-eight days had passed, notwithstanding, I was under the care of one of the best physicians in Brooklyn, N. Y., I suffered as bad as ever. Immediately following this monthly flow I had every reason to believe I was pregnant, I was nauseated continually, and no food of any description would remain on my stomach. And now comes the strange part of my experience. At the time for my regular monthly sickness I came unwell as before, when pregnant, and for sixty-two consecutive days I continued to flow, some of the time slightly, much of the time excessively;

every three or four days I would pass large clots. My physician had counsel twice, still the flow was not stopped. I be came so sick and emaciated that my friends became alarmed. Counsel was again called and to save my life an abortion was produced. My recovery was exceedingly slow, my menses did not return for nearly a year; and then it was the same old story. Now my health is perfect with the exception of this terrible suffering every month. Pain commences two or three days before the flow sets in; then clots commence to pass and the flow is very dark and offensive." This in brief is the history of this most interesting case, a case that presented a perfect picture for the Homœopathic remedy. She would not listen a moment to any suggestion that indicated medicine, and the examination at once revealed a condition of things that only surgical interference could correct. The uterus was found to be very much hypertrophied, the fundus retroverted and enlarged, but there was no flexion. The cervical canal, notwithstanding the frequent miscarriages, was very narrow, so much so that it was with difficulty I passed a small sound, there being a complete stoppage at the os internum. I fully expected to find a polypus, but upon freely and fully dilating the cervix, with the patient under chloroform, I found no growth of any description. It was at once clear to my mind that the menorrhagia was due to hypertrophy consequent upon the stenosis.

This patient during the following ten days received treatment as follows:

Aconitum 3d for three days, then Belladonna 30th. Hot water injections twice a day until all congestion and soreness had disappeared. Then impaction of os ex

Signa-Apply every two or three days, commencing five days before the menstrual period. I prescribed Cimicifuga rac. 60th. She suffered some pain at menstruation; the next month none, and up to the present time none. She has not become pregnant, is anxious to become so and believes she will go to full term all right. So do I.

In conclusion let me say that the operation of rapid uterine dilatation should not be resorted to recklessly.

More blunders have been made in Gynecological Surgery during the past ten years, than in any other field of practice. Physicians who have never made a special study of diseases of women and their surgical treatment,attempt operations and even make applications that are ruinous and often make permanent invalids of what were curable cases. Supports are placed where there is no displacement, anterversion is held to be a pathological condition and a pessary is at once used. The uterus of many a woman is cauterized when there is no ulceration, and that double-dyed abomination, the pessary is inserted that there may be a show of doing something. And then, too, hardly a day passes but that some Eminent Gynecologist denies the assertions and the operations of some other Eminent Gynecologist. How long has it been since Noeggrath of Wiesbaden, entirely disapproved the theory and practice of Emmett of New York, that in the laceration of the cervix was to be found the true solution of so many of the obscure female diseases, and

that in the operation of trachelorraphy was to be secured the long sought for panacea. Soon, only too soon, gynecological literature was full of the success of this operation. Then came Prof. Noeggrath who disapproves Emmett's laceration of the uterus, says that does not conduce to miscarriage and that it increases the chances. of conception, etc., etc., ad infinitum.

Time and earnest observation and careful study will teach us which is the grain and which is the chaff.

Ophthalmology.

Texas Association, Fort Worth, May, 1891. WOUNDS OF THE EYE.

BY SYDNEY B. ELLIOT, M. D., LOUISVILLE KY.

[N removing foreign bodies from the eye, it should never be done with a sharp pointed instrument. As irreparable damage may be done. If no blunt pointed instrument is at hand, a tooth-pick will answer the purpose and when the particle has been removed, in most cases, nothing more need be done. This is not the case, however, when the foreign body has become deeply imbeded in the cornea or conjunctiva, here much skill is required, and must be followed up by after treatment when the body is successfully expelled. It will be necessary to put the patient under an anesthetic, or at least to use Cocaine. The lids being held apart by a speculum. A broad needle must be passed under the conjunctive or cornea and behind the foreign body. Then by pressing the body in this way from behind and using external manipulation the object

may be got rid of. If an attempt should be made, to expel the body without the precaution of getting at it from behind, when it has become deeply imbeded, it would be shoved forward into the inner part of the eye, the result would be disastrous. The after treatment should consist of

compress soaked in a solution of Aconitum and held in place by a bandage, while internally Aconitum should be given.

In some cases of injury the iris is reached and there may be a prolapsus of it, here, the protruding part must be drawn out and cut off. However, if the iris protrudes into the cornea, and not externally, don't cut it off, but use internal treatment. If it should be necessary to draw it out Atropine should be given to dilate.

In injuries from burns, and great trouble may result from creitrieal tissue drawing the lid down, this may be prevented by using sweet oil, or vaseline on the scars and keeping it on the stretch.

Injuries from seeds, the Bicarbonate of Soda or Potash in a weak solution, should be used to neutralize. In some very severe cases it will be found necessary to remove the eye if lime should get into it. Do not apply water but apply sweet oil, or cream; if nothing else, milk would do, then the lime can be removed. The adhesions which will take place must be broken up and the bed surfaces must be kept apart, if possible, or the surface would grow together.

An English quack was recently brought before a police court for practicing without due qualification, who, in defending the use of the characters M. D. and F. R. S. after his name said they meant "Money Down" and "Fosterer of Real Science." The individual's genius, however, says a contemporary, did not save him, for he was fined twenty pounds, M. D. -Ex.