394 which have been cut off, by bending and shaping them to the form of the capital letter T. The pessary retains its place, and being made of many wires, prevents union and gives better drainage than any other means. which can be used. No gauze is used as packing or as a means of maintaining an aseptic condition. Six hours after the operation, a carbolized vaginal douche is used and kept up three times daily, until the stitches are removed, which, as a rule, is about the twelfth day. As soon as possible the douche is given to the patient, sitting over some receptacle, instead of a bed-pan or anything else which requires a recumbent position. About the fifth day patients may sit up and even go about before the stitches are removed. I prefer, in every case, silver wire for suture; others may use silk or silkworm gut. One condition, however, that of sacculated pus, prevents surgical repair of a lacerated cervix. Therefore, the operator, before undertaking the operation, must satisfy himself by every means in his power, that there is no pus in the pelvic cavity. If there be pus present, the traction on the uterus and the manipulations consequent to the operation might cause a bursting of the sac, escape of pus into the abdominal cavity and the consequent results. If the case operated on has no pathological condition within the pelvic cavity which requires excision, the benefit obtained by a well performed repair of a lacerated cervix are marvelous. The return of the uterus to its normal size, the lack of pain at menstrual periods, the lessened uterine discharge, the loss of nerve pains, direct and reflex, in fact the placing of the patient in a condition to attain perfect health. Even in cases where there are inflammatory deposits, the patient is put in the most favorable position to gain benefit, if possible, from constitutional alterative treatment. In looking over the results of my experience, I may sum it up under the following heads: 1. Many cases of uterine troubles in women who have borne children, are due to an unrecognized laceration of the cervix uteri. 2. A slight unrecognized laceration may cause as much nerve ache and pain as one which is deep and easily detected. The early repair of a laceration will frequently avoid many dangerous and grave lesions which follow neglected or unrecognized ones. 4. The cases which require operation, are more numerous than is generally admitted. 5. The correct treatment of a true laceration is surgical; therapy is of no avail. 6. The presence of pus in the female pelvis alone forbids operative interference. In every other condition benefit may be hoped for, from repair. The Weekly Medical Review has been sold to Mr. O. H. Dreyer, formerly associated in its publication. J. H. Chambers, the founder of the Review, retires to quieter fields of business. Dr. L. T. Riesmeyer will continue as editor, and promises that a softening influence will be instilled into the warlike spirit which has heretofore characterized the columns of the Review. We wish success to the new enterprise. 395 DEPARTMENTS PEDIATRICS. IN CHARGE OF HUBERT WORK, M. D., PUEBLO, COL. The Etiology of Diphtheria and Pseudo-Diphtheria.-(Lennox Browne, Liverpool Med. Chir. Jour.)-The author discusses the predisposing causes of diphtheria under three heads: A. Climatic and Habitation-Surroundings.-Evidence upon this subject, although profuse, is extremely contradictory and uncertain. It is well known that it is more prevalent in regions in which the soil is clayey and wet. It is more common in temperate than in torrid or arctic climates. It is found in valleys rather than on the hill-tops, and prevails in those months in which the rainfull is greatest. Insanitation, the author believes, may be directly and primarily a cause. He holds also that in cases of diphtheria attributable to contagion or importation, the infectious element is highly influenced in its development by anti-hygienic conditions of individual or local surroundings; and lastly, that such anti-hygienic conditions are not only responsible for the development of diphtheria, but they do unfavorably influence the gravity of an epidemic or of an individual case. Among the reports of forty-five epidemics, evidence of defective sanitation was discovered in 93.3 per cent. The nature of these assigned causes may be classified as follows: Cases due to unsanitary or polluted water, 29; cases due to infected milk supply, 4; cases due to contagion in schools, etc., 11; cases doubtful, 1; total, 45. This proves that milk is not as common a source of infection as it is usually thought to be. B. Preceding or Concurrent Epidemics of Other Specific Fevers.-The fact that scarlet fever is frequently accompanied by true diphtheria is undoubted. The author believes that measles is also complicated by true diphtheria more frequently than is usually supposed. As a complication or recurrent disease of small-pox is most rare, it has, however, seemed to be more common during epidemics of enteric or malarial fevers, C. Constitutional Predisposition. The author believes with Sir William Jenner, that the influence of family constitution is decided in determining the occurrence of diphtheria. This is perhaps explained to a certain degree by the fact that obstruction of the naso-pharyngeal passages and the occurrence of adenoid growths are more common in certain families. The author is strong in his opinion that diphtheria rarely occurs in a child under seven years, who is not a subject of these glandular overgrowths. In many cases of diphtheria in young adults, tonsillar enlargement will be founp to have persisted. It has been particularly noted in nurses who have taken the disease. As to the exciting cause, the author accepts unhesitatingly, the KlebsLoeffler bacillus. He describes in detail this bacilli, and also the various forms of germs which may be found producing so-called mixed infection, 396 viz: díplococci, staphylococci and streptococci. In view of the action of these various micro-organisms, he divides diphtheria into three general classes: 1. True, pure, or simple diphtheria. 2. Pueudo- or false diphtheria. 3. Impure or complex diphtheria; or, as Chaillou and Martin have called it, "diphtheria with associations." The second and third classes are further divided, according to the complicating germs present, into ten sub-divisions. Although these complicating germs have a marked influence upon the prognosis, the fact of greatest importance in regard to the mortality of the disease is the age of the patients. LARYNGOLOGY AND OTOLOGY. IN CHARGE OF WILBUR W. BULETTE, M. D., PUEBLO, COL. Laryngologist and Otologist to Pueblo Hospital; to Pueblo Children's Home; to Colorado State Insane Asylum; Member American Medical Association; Colorodo State Medical Society; Pueblo County Medical Society; Honorary Member Philadelphia County and Northern Medical Societies, The Benefit to Ear Patients from Nasal Treatment.-Gradle, Chicago, (Journal American Medical Association) from observations on this subject, draws the following conclusions: I. Acute suppurative inflammation of the middle ear, if not treated (locally) has a tendency to become chronic, the tendency increasing with the age of the patient. 2. Chronic suppuration of the middle ear rarely heals without treatment. Neither acute nor chronic purulent otitis is influenced by nasal treatment, but the liability to relapse after their cure is decidedly lessened by the removal of naso-pharyngeal anomalies. 3. Acute catarrh of the middle ear will generally terminate in complete recovery under aural treatment, and sometimes even without it, provided there are no persistent nasal or pharyngeal lesions. But when these are present the disease is more likely to become chronic in spite of aural treatment, and in many instances can either not be cured, or if improved will speedily relapse unless the normal state of the nose and throat is restored. 4. Proliferation or adhesive disease of the middle ear is the consequence of retro-nasal catarrh, and its course is determined by the duration of the disorder causing it. Aural treatment alone is practically useless in this form of trouble, while nasal treatment, if successful as far as the catarrh is concerned, will also arrest the ear-disease. The restitution of hearing, however, depends on the length of time the disease has lasted, and is often aided by ear-treatment after the cure of the retro-nasal catarrh. Curious Malformation of the Pharynx.-Wolfanden (Transactions British Laryngological Society, 1895) reports two cases: First, that of a man, aet. 24, who came to him in November, 1894, complaining of slight sore throat. Examination of the throat revealed a very curious condition. From the posterior aspect of the soft palate to the posterior faucial pillars, 397 at each side, and attached below apparently to the glosso-epiglottic ligaments, was a fleshy septum completely cutting off the naso-pharynx from the oro-pharynx, hiding the posterior and lateral pharyngeal walls and almost cutting off the oesophagus from the pharynx, except that there was an arched opening just above the epiglottis which, though only wider than the epiglottis and only 3% of an inch from top to bottom, apparently allowed the passage of food perfectly. There was an opening from the pharynx into the naso-pharynx by a slit, vertical in direction, and in a state of repose constantly open, which lay behind the uvula. The membranous web was not apparently attached to the posterior pharyngeal wall at all. It was fairly thick and of the color and appearance of normal mucous membrane, smooth, moist, and red. The patient was robust, well grown, and in good health, and had no history of syphilis, diphtheria, or antecedent ulceration. There was no dyspnea or dysphagia, and never any symptom to attract his attention. He himself was inclined to think it was a congenital anomaly in the absence of any antecedent condition to account for it. The second case was a young girl, aet. 15, who had a membranous web extending right across the throat from behind one posterior faucial pillar to the other side, free above, but attached below to the posterior pharyngeal wall about the level of the epiglottis. The entrance into the œsophagus was quite free and so was that into the naso-pharynx, but the membrane formed with the posterior pharyngeal wall, a kind of pouch extending from one side to the other, into which a probe or tampon could be introduced. As in the preceding case there was no history of syphilis or diphtheria, nor of any antecedent ulceration of the throat. The author was disposed to think this case was also congenital. Tincture of Iodine in the Treatment of Chronic Suppurative Inflammations of the Ear.-At a recent meeting of the New York County Medical Society Dr. Hoover read an interesting paper on this subject, which was freely discussed by members present. The author concludes that the curative results of this treatment had been striking, as shown by a number of illustrative cases. The applications should be made two or three times a week with a probe wrapped with cotton. There is no pain attending the applications, and the burning sensation ceases entirely when the air is shut out by a pledget of cotton. (Medical Record, July 6, 1895.) The Presence of the Tubercle Bacillus in the Nostrils of Healthy Individuals. (Strauss, in Archives Kinderheilkunde.)-The author examined the secretion from the nostrils of healthy persons who had lived in close contact with the tuberculous, and found virulent tubercle bacilli. Guinea pigs were inoculated, and the presence of the bacilli proven. The nostrils of twenty-nine persons were examined, the tubercle being found in nine. 398 PATHOLOGY AND BACTERIOLOGY. IN CHARGE of E. B. LA FEVRE, A. M., M. D., ABILENE, KANSAS. GOUTY PAROTITIS. 'ESTREES reported to the Philadelphia Society for Clinical Research (University Medical Magazine, March, 1895) two cases of gouty parotitis which had come under his observation, the only two with which he had met in a large experience among gouty subjects since 1868, at the watering place, Contrexéville, France, but remarked that he had collected a dozen unpublished cases from various French and English physicians. The first was that of a gentleman 63 years of age, whom he saw in consultation with Dr. Buequay, of Paris. The right parotid was hot, red and swollen, and gave him intense pain. External applications bringing no relief, d'Estrees suspected its gouty nature, and remarked that "two days later the parotid was flat, and a regular fit of gout had invaded the left knee." Afterward the left parotid became involved, leaving the latter to invade the right knee. The second occurred in a man 54 years of age, and was preceded by an attack in the wrist of the same side. The attack yielded to gouty treat ment, and examination showed it to be loaded with the urates. CULTIVATION OF THE GONOCOCCUS ON ARTIFIVIAL MEDIA. Recently two articles have been published detailing the results of efforts having for their object the cultivation of the gonococcus on artificial media, and with apparently complete success in both instances. From this work it would appear that we will soon be able to readily and satisfactorily apply the culture test in determining the relationship existing between the gonococcus on the one hand, and some of the affections that are now believed to depend upon metastatic infection from the urethra on the other. Turro (Central fur Bakt. und Parasit., No. 1, 1894) found he could cultivate the gonococcus on the ordinary nutrient media of an acid reaction, acid urine being a favorable medium. As other bacteria will not grow in a medium so strongly acid, it is an easy matter to obtain a pure culture of the gonococcus from materials containing them. The gonococcus grown in this way was inoculated beneath the prepuce or within the orifice of the urethra of dogs and caused a severe inflammation of the mucous membrane, with a purulent discharge which extended upwards to the bladder and kidneys, and sometimes caused a general infection. From such cases gonococci were obtained like those in the original cultures from the human subject, but slightly smaller. The virulence for dogs was lost by changing the culture to a non-acid medium. Wright, (American Journal of the Medical Sciences, February, 1895) following the method of Steinschneider, grew the gonococcus from "seven cases of gonorrheal urethritis, eight cases of ophthalmia purulenta, four cases of pyosalpinx, and from one case of vaginitis in a child," on a mixture of |