much as I was delegated to this congress by the minister of public instruction, the only minister, that has authority to make such an appointment. Prof. Semmola's appointment is not from the government, but from one minister, that of the interior, as an expression of personal regard. The plea that he is a senator of the kingdom should not be considered in this matter, as this is a medical and not a political congress. In view of the foregoing and of the personal affront, I hereby withdraw from the medical congress aforesaid. FRANCESCO DURANTE. Prof. Semmola of Italy delivered his address on "Bacteriolgy and Its Therapeutical Relations" at the general session of the medical congress to-day. The foreign contingent was well represented in the audience, as most of the foreign delegates understood French, in which language the address was delivered. Prof. Semmola's connection with the unpleasant episode in which Dr. Durante of Italy figured and felt affronted and withdrew from the convention because he was not permitted to respond to Secretary Bayard's address of welcome to the foreign guests,heightened curiosity and attracted a great many home delegates to see the cratory and to listen to an address delivered in a language which they did not understand. Happily, the trouble has all been explained Away, and Dr.Durante was on the stage just beforeProf. Semmola began his address;at the request of President Davis, he occupied the presiding officer's chair and listened attentively to the address of his distinguished colague. Prof. Semmola upon being introlaced to the audience stepped forward and delivered a brilliant and interesting discourse, dealing principally with the influence of modern discoveries in bacteriology, as bearing on the physio-chemical phenomena of bacterial life in the causation of disease. At the onclusion of his discourse he was loudly apHanded. When the applause had subsided Dr. Sayre of New York rose and proposed a vote of thanks to Prof. Semmola for the eloquent and instructive address which he had just delivered. Dr. Hingston of Montreal seconded the motion, and it was carried unanimously. A resolution was passed directing President Davis to appoint a committee, composed of an equal number of delegates from each nationality represented in the congress, to select a place of meeting for the next congress in 1890, the committee to report to the congress on Friday. The general session then closed for the day. Dr. Garnett, chairman of the committee on entertainment, announced in the general session to-day that owing to the fact that a number of tickets to the banquet to-morrow night had been surreptitiously or improperly obtained by many persons who are not delegates, the committee had decided to cancel all banquet tickets already out and issue new ones only to those entitled to them. This would be done in order to avoid a recurrence of the humiliating spectacle presented at the conversazione last Monday night, when the doctors and the delegates, as he said, "were engulfed by a mob." Dr. Durante, the delegate to the medical congress who withdrew from the convention because of the precedence accorded Prof. Semmola in allowing him to respond to Secretary Bayard's address of welcome, has addressed a note to Dr. Hamilton, the secretary general of the convention, in which he says: I thank you for your explanatory and very kind letter, and, although I feel that my position as the representative of the Italian government would, under the circumstance, suggest my withdrawal from the medical congress, the kind disposition of yourself and of the officers of your committee toward me and my country, overcome my sense of offended dignity and lead me to respond to your kindness by remaining and participating in the proceedings of the congress. Dr.Cyrus Edson, of New York city, read a paper before the section of diseases of children entitled the "Milk Supply of Cities." Dr. Henry Day of London read a paper on "Headaches in Children and their Relation to Mental Trrining." He held that public-school children should be separated into classes by medical experts and their studies regulated according to physical conditions and tempera ments. Dr. M. Richardson of Boston read a paper before the section on surgery on "The Possibility of Operations on the Esophagus Through the Stomach as Shown by Dissections." A number of papers of a technical character were read by distinguished surgeons. Dr. Whitmarsh of London, in a paper before the section on general medicine, expressed his well known views in opposition to the Pasteur treatment. Dr. J. A. Ochertony of Kentucky read a paper on "The Natural History of Disease," before the section on general medicine, and Dr. Crothers on "Inebriety as a Disease." Dr. Titus Coan of New York city, before the Climatological section, read an elaborate report on American mineral waters, the geographical distribution of mineral springs over this country, and a comparison of their characteristics with those of European springs. Dr. Murphy, the Irish physician, who wrote a letter tendering his resignation as a member of the congress, has withdrawn the letter in view of the explanation given by Dr. Hamilton. PHYSIOLOGICAL ACTION OF GASEOUS INJECTIONS.-Bergeon read another interesting note before the Paris Academy (June 20) on the important question of gaseous injections per rectum. (World's Medical Review) Car bonic acid gas introduced through the rectum finds its way quickly into the circulation, and can be found in the products of respiration. This absorption very probably takes place in the lower portion of the large intestines, as no distention of the abdomen can be noted, even if a quantity of 2 to 3 litres is forced up rapidly; in ten to fifteen minutes, f.i., the gas produces a complete ventilation of the lungs, a sort of "respiratory diuresis." The carbonic acid gas appears to play a similar rôle in respiration as water in the urine. Pass of the economy, and in this manner purifies both the circulatory and the respiratory channels. But the gas is to be absolutely pure, otherwise it will accumulate in the intestines, produce meteorism and colic, and will fail to reach the lungs. Hence the chemicals and apparatus used must be of an undoubted purity, the latter preferably of glass. At THE STRUCTURE OF THE UTERINE ARTERY.-The phenomena of sexual life in woman necessarily involve frequent variations in the blood-supply to the uterus and ovaries. Professor Thoma has already noted the development of connective tissue in the tunica intima of arteries in relation to the mechanical conditions of the circulation. Dr. Westphalen, of Dorpat, (Brit Med Jour.) has recently examined the uterine artery in order to see how the intima is arranged in that vessel. He discovered that in childhood the intima consists of endothelium and of an elastic membrane which forms folds like a ruff when the vessel is empty. Between these layers, he found in place some elastic and muscular fibres, but very little connective tissue. the height of sexual life, however, a very distinct and thick layer of this tissue could be detected in the intima. It increased in thickness as the vessel neared the uterus, and was most marked in women who were not very young and had borne children. Similar histological conditions were detected by Dr.Westphalen in the intima of the ovarian artery, but in a much less marked degree. much less marked degree. This disposition of the connective tissue in the intima must depend upon the physiological peculiarities of the part which is supplied by the uterine artery. A similar histological condition has been already noted in the splenic artery, a vessel which is also distributed to an organ subject to periods of physiological engorgement. Dr. Westphalen's researches appear in the form of a short note in the 106th volume of Virchow's Archiv, pt. ii. THE INTRA-UTERINE-GALVANO-CANTERY.ing through the tissues, the gas becomes Dr. F. H. Davenport, in his report in the impregnated with the products of excretion | Bost. Med. and Surg. Jour., gives the views of Dr.Londowski concerning the use of the electro cautery in membranous dysmenorrhea. Londowski thinks the uterine disorder is frequently a cause of the general cachexia and debility which we usually find in women suffering from this disease. He has applied the galvano-cautery in two cases, after thorough dilatation of the os, the time chosen being five or six days after the cessation of menstruation. In one of the two cases the result was a complete cure; in the other the pain was relieved, but a small piece of membrane the size of a penny continued to be expelled at each menstrual period. This was, in his opinion, due to a small portion of the uterine wall having escaped the action of the cautery. M. Apostoli has also employed the intrauterine cautery in a large number of cases of chronic neuritis and endometritis, with great success. It is not necessary to confine the patient to bed during the intervals between the applications, and improvement, as a rule follows after a few sittings. He prefers this method over that of scraping with a sharp curette, as being capable of exact graduation, of being more easily localized, and of not being so instantaneous. The result of the cauterization is to cause the formation of a new and healthy mucous membrane. CORRESPONDENCE. NEW YORK LETTER. NEW YORK, Sept. 1, 1887. EDITOR REVIEW.-The foreign medical delegates have been coming in upon us with every steamer arrival. A local committee has received them at the Hoffman House and been their guides to the various places of interest. They have "done" our schools and hospitals and expressed themselves well pleased thereat. They are commencing to journey Philadelphia-ward en route to that for-the-time-being medical Mecca--the national capital. It is still too early for a renewal of activity in local medical circles. None of the societies have yet commenced work. The student still shuns the halls of learning and the wellto-do practitioner still lingers in his summer abode. Another month however will see a renewal of the usual activity. In the mean time a few noteworthy matters are occurring round about us. One or two yellow fever cases have crept up in vessels to our quarantine station, but have been detained there and not the slightest fear is entertained of the appearance of the disease in the city. Of more importance however is the appearance of pleuro pneumonia among cattle kept within the city limits. There are about three thousand cows kept in stables, mostly in the extreme northern limits of the island and it is estimated that fully one quarter of them are affected with the disease. The sanitary department has directed that an examination be made of all cattle with reference to preventing the sale of milk or meat from any diseased animal. It takes the ground that recent investigations show that a number of diseases of an infectious or contagious nature are communicated from animals to man, and that in this instance it is preferable to err on the side of safety. The last week's report of the Summer Corps of visiting physicians shows that 29,344 families were called upon in 4359 tenement houses. Only 962 persons were found sick enough to need medical attendance. Of these 52 were suffering from contagious diseases. The work of the corps will be continued about two weeks longer. The inspectors have unearthed a small nest of variola in one of the densely populated districts. No spread of the disease is feared. Our present nine days wonder is the arrival. from the interior of Africa of two nondescript organisms, which are probably apes but which show a most marvellous resemblance to the human species. These beings rejoice in the names of "He" and "It." There was originally a third member of the group, "She," who died on the voyage. Naturally "He" and actually "It" are males. They come from Zambesi, and were brought over by a Mr. Reiche, a dealer in wild animals. During the rection be divided so that all the penal insti- SELECTIONS. past few days they have been visited by over one hundred naturalists and physicians. It is the universal testimony that no specimens of the monkey tribe have ever before been discovered with so many marks of the human species about then. Their backs and limbs. are marvellously human. It is only the prognathous shape of the head and the retreating forehead which suggest lower orders. They ON RUPTURE OF THE UTERUS DURhave been placed in charge of a nurse, have been auscultated and percussed, had their tongues looked at and pulse felt. As a result of all this professional attention, the morning journals report their illness. Two curious instances of poisoning have lately been reported here. The first relates to several cases of insanity which occurred in a town on Long Island. The patients were men employed in a rubber factory, and began to show signs of mental derangement, which gradually increased to an uncontrollable mania. These symptoms were ascribed to the constant inhalation of fumes of bi-sulphide of carbon used in making rubber goods. The second instance is that of a boy who contracted purulent conjunctivitis at one of the public baths. These institutions though valuable in their way are not entirely free from danger, and require constant supervision by medical men. Numerous cases similar to the above have been reported this summer. ING PREGNANCY. BY ARTHUR H. N. LEWERS, M.D., M.R.C.P. [CONCLUDED.] of the uterus during pregnancy, if we exclude Now, as regards the causation of rupture cases where there is a history of a violent blow on the abdomen, and cases where rupture has occured from attempts at criminal abortion, I would suggest that the accident is tion, that is, to a fertilized ovum having dne to the presence of an interstitial gestalodged and developed in that part of the Fallopian tube which passes through the walls of the uterus. In surport of this view, we have first the fact that in all the cases where the seat of the rupture is accurately described the rupture has been at the fundus or involved the fundus. Thus, out of the 17 cases of spontaneous rupture to which reference has been made, the rupture was at the fundus in six cases the position of the rupture is not or involved the fundus in ten; of the others, definitely stated, and in the remaining case the uterus was two horned. Now, the fundus The committee appointed to investigate is just the part at which tearing of the uterus the charges of mismanagement at the Ward's must occur when an interstitial gestation ruptures. A fertilized ovum lodging in the part Island Asylums has finally presented its reof the Fallopian tube that passes through the port. It finds that economy has been carried wall of the uterus may be compared to an intoo far for the good of the patients. The terstitial fibroid tumor that is growing. food has been poor in quality and insufficient Such a fibroid may grow toward the peritoin quantity. A kitchen with a cooking-plant neum and become a sub-peritoneal fibroid, or it may grow toward the mucous surface of to supply five hundred persons has been overthe uterus and form a submucous fibroid, or taxed to provide for nearly four times that it may remain interstitial, and as it increases number. The wards are found to be entire- in size form a projection both toward the ly too small for accommodating the city's in- mucous membrane of the uterus and toward sane population. The poor qualifications of the peritoneum. So it is with an ovum developing in the interstitial part of the Fallomost of the attendants are set forth in scath- pian tube. If, from its original position, it ing terms. Many of them were formerly bar forms a projection chiefly toward the peritokeepers, coarse, rough and brutal, and the last neal aspect of the uterus, then, at the time of persons to leave in charge of insane persons. rupture, the rupture will be most extensive on The principal suggestion is that the present peritoneal coat will be longest, that of the the peritoneal aspect; that is the tear in the Board of Commissioners of Charities and Cor-muscular coat of the uterus not quite so wide, and the mucous coat will only be torn a little or hardly at all. My own specimen belongs to this variety. If, on the other hand, as the ovum grows, it forms a projection chiefly toward the cavity of the uterus, then at the time of rupture the tear will be most extensive on the mucous surface of the uterus, less extensive as re gards the muscular coat, and the peritoneal coat will be torn least. If, however, as the ovum grows, it forms a projection both toward the peritoneal aspect of the uterus and toward the mucous membrane (and this will be very likely to happen if rupture is delayed to a somewhat later period, such as the end of the fifth month), then at the time of rupture all the coats of the uterus will be torn to about an equal extent. When we consider that the interstitial part of the Fallopian tube is normally about one-half inch long, and that the ovum may develop sufficiently, as in my own case, to contain a fetus eight inches long, it will, I think, be evident that this explanation of so-called spontaneous rupture of the uterus during pregnancy is a reasonable and probable one. In the specimen shown, had the decidua, as might easily have happened, been detached and expelled (it is partly detached), and had the laceration toward the mucous surface of the uterus been more extensive, there would have been nothing to show that the fetus had not been in utero, and the case would have been set down as one of sponta neous rupture of the uterus during pregnancy. Again, to take up another point, spontaneous rupture of the uterus in pregnancy has been considered to be due to some pathological softening at the seat of rupture. Now, such pathological softening would no doubt furnish us with a satisfactory explanation of the accident; but in the group of cases I have collected there is no satisfactory evidence that any disease of the uterine tissue existed at all. The evidence, in fact, is all the other way. Thus, in four cases, including my own, the uterine tissue is specially said to have seemed quite healthy; in seven cases, nothing at all is said about the condition of the uterine tissue; in the remaining six, one was a case of two-horned uterus; in the five others, there is mention of pathological change in the uterine tissue, but the expressions used are exceedingly vague; for instance, in one it is stated, "structure of the womb rather softened;" in another, "body of uterus rather thinner and softer than natural;" in another, "uterine tissue healthy, except about the rent, where it was evidently softened," and so on. It will, I think, be admitted that such vague expressions rather suggest that the observer has perhaps persuaded himself that some softening, or other change, must have existed, in order to find an explanation of an accident that would otherwise have been inexplicable. As regards diagnosis, this must always be a matter of the greatest difficulty. Out of the series of seventeen cases referred to, a diagnosis seems to have been made only in three; and in only two of these, one in Trask's series and the other my own case, was the diagnosis thought sufficiently probable to just. ify opening the abdomen. In the histories we read that many of these cases were thought to be due to, for example, acute peritonitis, rupture of the liver, colic or lead poisoning, and so on. In regard to treatment, I think it is a point of much significance that the only case that recovered in all the seventeen cases, was one that was treated by gastrotomy two hours after the accident. In my own case, the operation was done eleven hours after the accident, and the patient had already lost a very large quantity of blood. The rupture was still bleeding a little at the time of the operation; had the operation been done several hours earlier, the prospect would have been very much better. On the whole, when the history, and particularly the sudden onset of symptoms, render a diagnosis of rupture of the uterus, or of rupture of an extra-uterine gestation, probable, I think an exploratory incision would be the best treatment to pursue. (3) To recapitulate.—(1) The expression "rupture of the uterus during pregnancy" should be limited to cases where the fetus has not reached a large size. Cases of premature labor should not be included, as then the causes producing rupture of the uterus during labor come in, which are of an entirely different nature. (2) Ruptures of the uterus from direct violence or from attempts at criminal abortion should be excluded, the cause of the accident here being evident. The evidence that pathological softening of the uterine tissue is the cause of so-called spontaneous rupture of the uterus in preg. nancy is altogether unsatisfactory, though it is not intended to deny that morbid softening of the uterine tissue, when there is proof that it exists, would be a sufficient explanation of the rupture. (4) It is here suggested that limiting the expression rupture of the uterus during pregnancy in the manner described, this accident is always due to the presence of an interstitial gestation. (5) That cases where the diagnosis is fairly probable should be treated by exploratory incision.-Braithwaite's Retrospect. |