noticed, with deep fluctuation, which was supposed to indicate the presence of an exudate. Under treatment by warm baths, douches, and iodide of potassium ointment, the exudate disappeared, when it was found that an ovarian cyst as large as a man's head was present. Four days after this diagnosis was made, the patient suddenly collapsed with excessive pain. Laparotomy was performed, and an ovarian cyst was removed. It was found that the tumor had burst. The patient made a good recovery in two weeks.

PREGNANCY AND PARTURITION COMPLICATED BY CANCER OF THE

UTERUS.

VON HERFF (Centralblatt für Gynäkologie, 1891, No. 50) reports an interesting case of carcinoma of the cervix. Seven months later, conception occurred and pregnancy was normal. At labor, prolonged delay was noticed. The tissues about the os were so infiltrated with the carcinoma that dilatation was exceedingly difficult. Multiple incisions into the carcinomatous tissue were employed, but at first with little success, and preparations were made to perform Cæsarean section. A last resort to multiple incisions in the cervix was followed by an increased strength of the labor-pains and the spontaneous expulsion of the child. Mother and child recovered well. The mother perished later from the cancer, and the child died of meningitis.

THE MIGRATION OF THE OVUM.

HASSE, of Breslau (Zeitschrift für Geburtshülfe und Gynäkologie, 1891, Band xxii., Heft 2) gives the results of his investigations upon this subject. He finds that migration of the ovum is rendered possible by the development of pockets separated from the abdominal cavity surrounding the oviduct; the ciliated epithelia of the tube penetrate this pocket, and the serous fluid found in the tube and the ovum are forwarded by this means in a direction contrary to the usual passage through the abdominal opening of the oviduct. External migration of the ovum results when the diverticula upon both oviducts developing at the upper extremity of the uterus form a single capillary space in which both oviducts empty and into which the cilia of the epithelia dip. If in such a case the movements of the cilia of one tube are more vigorous than in the other, the ovum may be abstracted with the capillary flow of serous fluid from the oviduct of the opposite side behind the uterus and the median line to the abdominal opening of the opposite tube. If the formation of the diverticulum is defective, the ovum may escape into the abdominal cavity and develop there as an abdominal pregnancy.

GONORRHEAL INFECTION OF THE ORAL MUCOUS MEMBRANE IN THE

NEWBORN.

Continuing his researches, described in a previous number of the Zeitschrift für Geburtshülfe und Gynäkologie, ROSINSKI, in Band xxii., Heft 2, of this publication describes some interesting observations upon the immunity displayed in certain portions of the mouth and connected cavities against the gonococcus. The lesions caused by this germ in the mouth develop only

where the pavement epithelium has been removed. These cells are especially fragile in the young child, and hence the readiness with which infection occurs. It is interesting to note that, in gonorrhoeal ophthalmia, it is very rare to find that the lachrymal sacs become involved; it is also true that the cylindrical epithelium of the naso-pharynx seems also to resist successfully invasion by the gonococcus. Clinical observation shows that these cases develop usually between the fifth and tenth day of life, resulting often from infection occurring at birth from the genital canal, and oftentimes through direct infection at the hands of attendants. This is especially true where the epithelium of the mouth is destroyed through efforts at cleansing. These cases are remarkable for the fact that they affect the general health so little; the children nursed well and seemed free from pain. The lesions were yellowish plaques, surrounded by a border of pale-reddish tissue, in which the process of healing usually began upon the third day by a reaction zone of deeper color. The epithelium was renewed from the borders of the plaque, pus-cells being thrown off as the healing progressed. Scar-tissue was never developed in these cases.

A SUCCESSFUL OPERATION FOR UMBILICAL HERNIA IN THE NEWBORN. In a series of interesting cases reported by RUNGE at the Göttingen Clinic (Archiv für Gynäkologie, 1891, Band xli., Hefte 1 u. 2) is the account of a case of umbilical hernia operated upon sixteen hours after birth with success. The hernial sac was the size of a small lemon, its membrane firm in character, and of grayish-green color. Chloroform was given, and the antiseptics employed were a solution of salicylic acid, carbolic acid for the instruments, and iodoform. In dissecting out the sac and freshening the edges, it was found that the peritoneum was adherent to the upper layer of the peritoneum at the left lobe of the liver. These adhesions were separated, causing considerable hemorrhage, which was checked by the thermo-cautery. The abdominal walls were resected sufficiently to permit the easy closure of the edges; the wound was brought together with silver wire, the umbilical vein having been ligated with catgut. Iodoform gauze was used as a dressing, retained in place by adhesive plaster. The child was placed in an incubator and artificially fed after the operation. The stitches were removed on the twentieth day, the wound having been dressed first on the fourteenth day. Union by first intention was the result.

THE HISTOLOGY OF PUERPERAL ENDOMETRITIS.

BUMM (Archiv für Gynäkologie, 1891, Band xl., Heft 3), from a histological study of five uteri from cases of puerperal endometritis, divides this affection into putrid and septic varieties. The first is characterized by the presence of saprophytic bacteria, septic germs being absent. The superficial layers of the decidua are involved, and the chemical products from the bacteria absorbed by the lymphatics produce fever and the other phenomena of intoxication. The peculiarity of this form of endometritis is the foul odor which characterizes the discharge. These cases are not at all uncommon, happening frequently after abortion. After the uterus has been washed out or curetted, the odor rapidly disappears and the fever falls. Pathogenic bacteria are not

often found in these cases. A zone of infiltrating cells is found beneath the decidua, through which bacteria do not often penetrate. The infectious material in these cases is apparently the chemical product of the bacteria.

In septic endometritis, streptococci are the most frequent infective agents. This form of endometritis is found as localized, or endometritis followed by general infection. In the first the bacteria are shut off from the circulation by a layer of connective-tissue cells in the localized lesion; the streptococci do not, as a rule, penetrate this layer; after disinfection of the uterus recovery usually follows in these cases.

In cases of general infection the lymphatics are the usual conveyers of bacteria. Occasionally the infective material is carried by the venous channels of the uterus, thrombosis developing, followed by puerperal pyæmia.

[The practical conclusion of these researches is distinctly in favor of the local treatment of puerperal endometritis. It should be noted that in the septic variety the rapidity with which infecting bacteria gain access to the general circulation renders the prompt disinfection of the uterus indispensable. When the practitioner is satisfied that a rise of temperature after labor is not due to lesions in the outer portion of the genital canal, he should at once disinfect the endometrium by the intra-uterine douche, accompanied by the use of the blunt curette and the intra-uterine antiseptic suppository.— ED.]

A SUCCESSFUL CESAREAN OPERATION FOR CARCINOMA OF THE

UTERUS.

PORAK (Nouvelles Archives d'Obstétrique et de Gynécologie, 1891, No. 11) reports a case of Cæsarean operation upon a multipara suffering from carcinoma of the uterus. The operation was performed at term, the patient being in the first stage of labor. Under careful antiseptic precautions the abdomen was opened, the infant and its appendages removed, and two injections of ergotin were given. The uterus was washed out with hot water, and a third injection of ergotin sufficed to check the hemorrhage. Eight deep and twelve superficial stitches of carbolized silk were put into the uterus. The uterine muscle was not resected, but the stitches were taken to the border of the mucous membrane. After the closure of the abdomen a dressing of iodoform gauze and borated cotton was employed. The patient made a good recovery from the operation and was transferred to a surgical ward for the treatment of the carcinoma. The radical operation was impossible, and the patient's health steadily failed. The child was jaundiced, ill-developed, and suffered from a general toxæmia.

THE TRANSMISSION OF MATERNAL SYPHILIS.

NUNN (Medical Press and Circular, 1891, No. 2742) describes the case of a woman nearly sixty, who had syphilis and had borne a syphilitic daughter. The daughter in turn gave birth to an infant manifesting symptoms of syphilis. The father of this infant could not be proved to be syphilitic. The case bore every appearance of a transmission of syphilis through the mother to the third generation. In his experience, the treatment of syphilis during pregnancy did not protect the child against congenital syphilis. When the

pregnancy was terminated, however, treatment was more successful, and its constant repetition even cured the patient.

THE IMMUNITY OF THE MOTHER WHEN THE FATHER SUFFERS FROM SYPHILIS.

DIDAY (Archives de Tocologie, 1891, No. 11) believes that the mother does not become syphilitic through the placenta, but through the blood of the fœtus begotten by a syphilitic man.

GYNECOLOGY.

UNDER THE CHARGE OF

HENRY C. COE, M.D., M.R.C.S.,

OF NEW YORK.

THE TREATMENT OF ENDOMETRITIS.

KALTENBACH (Centralblatt für Gynäkologie, 1891, No. 44) disapproves of the application of caustics, which may cause atresia of the cervical canal. Forcible dilatation often repeated is also reprehensible, since lesions of the mucosa are thus produced, infection of which may readily give rise to parametritis through the medium of the lymphatics. Even if infection is avoided, repeated dilatation, irrigation, or applications to the interior of the uterus keep the patient in a constant state of nervous irritability, detrimental to her health, aside from the danger of causing toxic symptoms. Many cases of catarrh fail to improve because proper precautions are not taken to avoid fresh infection. The vulva and vagina should be thoroughly disinfected before any application is made to the endometrium. After this has been done, the uterine cavity should first be cleansed with sterilized gauze, followed by an application of strong tincture of iodine. In cases of long standing the thorough use of the curette should precede these applications, this treatment to be repeated only at long intervals.

MACKENRODT (Ibid.) does not hesitate to adopt the same treatment (injection of tincture of iodine after curetting), even when the adnexa are secondarily affected, provided that the presence of suppuration is positively excluded. It is, of course, not begun until the acute stage has passed. Forty-five cases are reported, in none of which were any bad symptoms noted. Seventeen patients were cured and twenty-two were improved.

THE ANATOMY AND ETIOLOGY OF ENDOMETRITIS.

DÖDERLEIN (Centralblatt für Gynäkologie, 1891, No. 44) confirms Olshausen as to the anatomy of the various forms of endometritis. These are readily differentiated microscopically by the examination of scrapings, although they cannot be separated clinically. The writer is firmly of the opinion that

benignant can always be distinguished from malignant disease of the endometrium in this way. He has examined numerous specimens in order to determine if simple non-septic endometritis is due to the presence of pathogenic bacteria, but always with negative results, an experience which is directly contrary to that of Brandt. It would seem as if Brennecke's theory was a plausible one-that hyperplastic endometritis is directly dependent upon disturbance of the ovarian functions.

THE ELECTRICAL TREATMENT OF IRRITABLE BLADDER.

GRAPOW (Centralblatt für Gynäkologie, 1891, No. 44) reports three cases of enuresis in young women between the ages of seventeen and nineteen years, in one of whom the condition had persisted since childhood. He used the faradic current, with the bipolar electrode introduced into the bladder. Ten séances were given, of five minutes each, the secondary current of moderate strength being used. In two cases the trouble disappeared after the first application; in the third it persisted only until after the following menstrual period.

HYDRASTININ IN UTERINE HEMORRHAGES.

CZEMPIN (Centralblatt für Gynäkologie, No. 45, 1891) uses the hydrochlorate of hydrastinin in doses of a quarter of a grain four times daily, usually administering it during the first two or three days of the menstrual flow. In cases of uterine fibro-myoma it is advisable to give the drug a few days before the flow begins.

Fifty-two cases are reported, good esults being obtained in twelve cases of menorrhagia due to disease of the adnexa. In twenty cases of chronic endometritis the result was very good in thirteen, and fair in six-that is, the hemorrhage ceased within from twenty-four to thirty-six hours after the exhibition of the drug.

The result in four cases of fibro-myoma was negative. Profuse menstruation following confinement was treated successfully, but hemorrhage after abortion was not affected. Menorrhagia in virgins from uterine congestion was relieved in about one-half of the cases. In general, in over fifty per cent. of the whole number of cases the hemostatic action of the drug was marked. It doubtless contracts the blood vessels of the endometrium, and hence is not to be compared with ergot, which causes contraction of the muscular fibres of the uterus, and hence is more efficient when the organ is in a state of relaxation. On the other hand, hydrastinin is a valuable remedy in all cases in which congestion of the normal mucosa is due to functional disturbances of the ovaries (as in virgins and women at the climacteric) or to disease of the adnexa, as well as in menorrhagia dependent upon hyperplastic endometritis. However, it is uncertain in its action, and may have no effect whatever.

GONORRHOEAL VULVO-VAGINITIS IN LITTLe Girls.

R. SKUTSCH (Inaugural Dissertation; abstract in Centralblatt für Gynäkologie, 1891, No. 46) had an opportunity to study this affection during an epidemic, in the course of which 160 cases came under his observation in the same institution. The infection occurred through the medium of baths, but it