but it was not my privilege to watch the progress and termination of these cases after leaving the hospital, and not hearing of any unsatisfactory results, I concluded that the results must have been very gratifying to the operator as well as to the patient. After entering practice, when cases of this nature presented themselves to me, the first operation that suggested itself to me was that of rapid dilatation, and after meeting with cases where, after dilatation to the maximum extent suggested by enthu. siastic advocates of the operation, and carrying out the after treatment in the manner advocated by them, the contraction was as marked as before the operation, if not to a greater extent, I have concluded that the operation does not overcome to a permanent degree the contraction of the cervical canal.

The cases in which we are called upon to do this operation, generally are dysmenorrhea and sterility. When I say dysmenorrhea and sterility, I do not mean to say that all cases of painful menstruation are due to a constriction of the cervical canal, or that all cases of sterility are due to this condition; I have only reference to those cases where every other reason is excluded and a stenosed condition of the cervical canal exists. When called upon to treat a case of sterility, I think we are justified in operating, if this condition is found to be present, although a history of dysmenorrhea is not associated with the case,- —a condition not at all uncommon,-in fact, the only successful case of sterility I treated by rapid dilatation was in a patient who presented herself for treatment to me. She had been married eight years; was twenty-four years of age when married; had never any serious sickness; she was very anxious to have children, and stated that if the fact that she had not was due to any condition that could be corrected, she wanted to have it done. She menstruated regularly, and never had severe pains immediately before this or during period. There was no ulceration around the external os. On passing the sound it met with considerable resistance at the internal os, and was forcibly passed through. The uterus was found to be in its normal position. The only condition about her, that I found, that her sterility could be attributed to, was this apparent constriction at the internal os. I dilated this rapidly under ether, passed a sound at short intervals for a month, after which I did not see her for four or five months, when I was called to treat for some of the disagreeable symptoms of pregnancy, and in a year from the time of operation I delivered her of a twelve pound boy.

Of the forty cases I have operated on, ten were for sterility, and thirty for dysmenorrhea. On the first ten cases that came under my observation for dysmenorrhea, I operated by rapid dilatation, and of these but four were permanently relieved. The condition of six others, after periods varying from three months to a year, was as bad, and in two cases, worse than before operation. They underwent a secondary

operation by incision, and after a period of from one to two years I have yet to hear of an unfavorable result. Of the remaining thirty cases operated on by incision, permanent relief followed in every instance. Within the last six months I have operated on three cases, which I have not included in my statistics, as I do not regard a case permanently relieved until they pass a period of one year without a recurrence of the trouble. Of the ten cases operated on for sterility, six underwent the rapid dilatation operation. This operation proved effectual in but one case, and that as I reported. After one year's time the contraction was as marked as before the operation. They underwent a secondary operation by incision. Two of them have borne children, and one other is well advanced in pregnancy, and in one the constriction is as marked as before operation. The other patient passed from under my observation about six months after the operation; she was not pregnant at the time. On four patients I have done the operation by incision, during the past year two are now pregnant,— -one two months after operation, and the other four months. On two I have operated within the last three months, and are still under my observation.

The constriction, in every case that came under my observation, has been at the internal os. In not a single case have I met with any resistance with the ordinary sound, until I came to the internal os; and in every instance the constriction has been so marked that an ordinary probe could not be passed unless considerable force was used. What we accomplish on rapid dilatation is a paralyzation of the sphincter muscle surrounding the internal os, but it is only a temporary paralysis, and will gradually resume its function again in the same manner as the sphinterani after forcible dilatation for diseases peculiar to the rectum. The great tendency for this muscle to contract again after dilatation is not at all surprising. Very true, the muscular fibres that are ruptured by the dilatation, lose their power of contractility, but it is almost an impossibility to rupture them all with the instruments devised for rapid dilatation, and I doubt whether we will rupture any of the fibres if only carried to the extent advocated by some authors. When we reflect and consider how soon after a labor, where the muscle encircling the internal os is put upon a stretch to an extent about six times as great as can be accomplished by any of the dilatating instruments now in use, and how soon after it resumes its power of contractility, it is inconsistent to expect to deprive the same muscle of its function under the force of the instruments devised for that purpose.

The operation by incision is not attended with any more danger than that by rapid dilatation. A number of instruments called hysterotomes or metrotomes, have been devised to do the cutting. The objection to these instruments is, that they do not incise deep enough. In my hands

the long, blunt pointed bistoury has accomplished the desired result without any trouble.

Pelvic peritonitis or cellulitis, is a contra-indication for the operation; in fact, it is essential that any inflammatory trouble peculiar to the pelvis should not exist to have the operation successful. If the operation is done and any inflammatory trouble exists, the operation is certain not to be a success, and the inflammatory condition aggravated. This does not refer to endometritis, but on the contrary when this disease exists, which it does very often as a consequence of the stenosed condition of the internal os, the cure of it is facilitated by the opening of the os.

The operation should be done as soon after a menstrual period as possible. This will give the tissues sufficient time before the next period to completely heal over. If the tissues are in an inflamed condition at the subsequent period, contraction is very apt to follow; for this reason a patient should not be operated on close on a period.

PREPARATIONS.

A mild cathartic is given the night before operation. If this does not prove effectual by time of the operation, the bowels are unloaded by a rectal enema. A vaginal douche is given the morning of the operation; this leaves the parts in a proper condition for the operation. The various steps in the operation are as follows:

The patient is anæsthetized and placed on the table, and a bi-valve speculum introduced, or a Sims, whichever is preferable to the operator. The cervix is grasped by the forceps tenaculum and held in a fixed position. A dilator is passed to open the os up to a degree large enough for the bistoury to enter. After passing the bistoury, the next step is to make the incisions. I resort to the crucial incision, one anterior and posterior, and two lateral incisions. A blunt pointed, double edged bistoury has been devised to simplify the operation by avoiding turning the instrument. I use the single edged one, and do not experience any difficulty in turning it from one wall to the other. The depth of the incision is governed by the experience of the operator. The danger of a deep incision lies in the severing of the circular artery. As near as I can determine, the depth of the incision I usually make is about three-eighths of an inch. The hemorrhage is controlled by compression with absorbent cotton passed into the canal on an applicator. Occasionally I have found it necessary to resort to applications of the persulphate of iron to control the bleeding. A douche of hot water is again given, a stem pessary introduced and held in place by tampons saturated with a solution of glycerine and carbolic acid, ten grains to one ounce; hypodermic is then given, and cold applications are kept over abdomen for about four days.

AFTER TREATMENT.

A vaginal hot douche is given once a day for about ten days. If symptoms of pelvic inflammation develop, the pessary is taken out, and a sound or dilator passed every few days, and hot applications are to be made instead of cold. It is the exception for inflammatory symptoms to develop. The patients generally make an uninterrupted recovery, and are able to be around on the tenth day. The pessary can generally be left in for three weeks before removing. If the period is due before that, it will be essentially necessary to remove it at the expected time. The patients are instructed how to place tampons themselves. If the operation is for dysmenorrhea, sounds should be introduced a few days before the expected period; if for sterility, I generally wait until after the period before their introduction. If the patients are not carefully observed and dilatation kept up for a year after operation, it is certain not to prove effectual.

THE PROMISCUOUS USE OF OPIUM IN VERMONT.

BY DR. E. W. SHIPMAN, VERGENNES.

Mr. President and Gentlemen :

After receiving the invitation of our worthy Secretary to present a paper at this meeting, the first subject which came to my mind was the indiscriminate use of opium by the people of Vermont; or perhaps I would do better to say by the people in some parts of Vermont, for I intend to deal only with what has come directly under my own observation. I have been particularly impressed by the loose method in which this drug is handled in the Green Mountain State, and I feel perfectly safe in making the statement that her population of 332,000 consume as much if not more opium and morphine than the same number of people any where in the United States-I believe I am not making a wrong statement when I say that there is no restriction whatever upon the sale

of opium and morphine in Vermont. Now is this right? Is it right for us to stand by and see our fellow creatures commit slow suicide without uttering a protest? For the opium habit once formed, may, with very few exceptions, be justly designated suicide. I do not wish to pose as a moralist, but after some investigation I have come to look upon the habit as a crying evil of the day, for what sense is not undermined and degraded by the continued use of this narcotic. It has been well said by an eminent writer that any habit which makes one contented with his lot by dulling the senses and producing weird hallucinations, is a baneful one; and is not this especially true of the opium habit? And why not? For the slight prick of the hypodermic needle or a taking into the stomach of a portion of the drug transports the habitue from deepest despondency to that elysium from whose observatory life's greatest cares seem of hardly trifling importance.

The opium eater who is a hod carrier, despite the fact that he may possess qualifications fitting him for a far higher station in life, will continue to be a hod carrier-at least until he becomes too weak to carry his hod; for should he have a melancholy moment in which to bemoan his lot, he can quickly throw a cloak over reflection and see himself in the future a capitalist surrounded by all the luxuries heart could desirefood, drink, clothing and lodging he sees in a few cents worth of the product of the poppy.

I do not presume to say that a pharmaceutical restriction forbiding the sale of opium, except on a physician's prescription, would do away altogether with its being indiscriminately dispensed by the druggist, but it would certainly hold its sale in check to some extent. I have seen five victims of this habit enter a drug shop in the town in which I live and purchase what opium and morphine they desired, within less than two hours time and no questions were asked.

On one occasion I heard a man ask a druggist for ten cents worth of corrosive sublimate, to use, he said, for rat poison. After questioning him rather closely the druggist refused to let him have it, for the reason, as he afterwards told me, that it was a deadly poison and too dangerous a drug for people to handle loosely, and he was fearful lest some wrong use might be made of it; and yet a few moments before he had sold a drachm of morphine to a woman whose family I knew to be in want of food. If asked which of the two should have been sold without question, one would almost be tempted to say the corrosive sublimate, for it done its work quickly and not by a slow tedious process. From whence should come the protest against this lawless traffic in a poisonous drug? Who can better recognize its dangers than the physician? It seems to me that it is our duty as guardians of the public health, and members of this Society to do all in our power to influence the passage of a law to mitigate this evil.