could not be positively determined to what extent the same water and towels were used by several children in succession. An interesting fact was that boys who were exposed to the same source of infection escaped, showing the greater susceptibility of the female genital tract.

The gonorrhoeal nature of the discharges was proved by the finding of the characteristic gonococci, which persisted in sixty preparations after ten weeks' treatment. The latter consisted in daily vaginal injections of chloride of zinc (one per cent.), bichloride (one to five thousand), alum (one per cent.), sulphate of zinc (one to four hundred), and nitrate of silver (one to three thousand), none of which seemed to have any marked effect. Iodoform-pencils were also used with negative results. In conclusion, the writer calls attention to the importance from a medico-legal standpoint of examining suspicious vaginal discharges in children, with the view of determining the presence of gonococci, especially in cases of supposed rape.

THE ABUSE OF CATHARTICS IN GYNECOLOGICAL TREATMENT. LOEMER (Centralblatt für Gynäkologie, 1891, No. 46) calls attention to the fact that the excessive use of laxatives by women leads to paralysis of the muscular coat of the intestine. This condition can be overcome in time by careful regulation of the diet, sufficient exercise in the open air and massage, with the use of both the faradic and galvanic currents. In one case the writer suspended all laxatives and enemata, and persisted with this treatment for eleven (!) days before a movement of the bowels occurred, but after that they moved spontaneously and the patient's health began to improve.

RETRO-PERITONEAL TREATMENT OF THE PEDICLE AFTER SUPRA-VAGINAL AMPUTATION.

BESSELMANN (Centralblatt für Gynäkologie, 1891, No. 47) reports a successful case operated upon according to Chrobak's method. With the patient in Trendelenburg's posture the adnexa were first removed, and the broad ligaments were ligated and divided. The peritoneal covering of the corpus uteri was incised at the middle of the organ and was dissected off as low down as the vaginal fornix. The uterus was then amputated at about the level of the os internum, and the cervical canal was disinfected with a solution of bichloride, one to one hundred. In order to check oozing from the stump, the latter was transfixed and tied with silk, the cervical canal being avoided and the peritoneum not included. The canal was then tamponed with a strip of iodoform gauze, the end of which was pushed through into the vagina with a sound. The edges of the peritoneum were then united by a continuous silk suture, completely covering in the stump. The abdominal wound was closed in the usual manner without a drainage-tube.

Recovery was rapid and uninterrupted. The gauze was removed per vaginam on the third day, a small quantity of odorless discharge following. The patient was discharged on the twenty-third day. The writer claims that suf ficient drainage is obtained through the cervical canal, and that if suppuration of the stump occurs, the discharge is evacuated better than when the stump is treated according to Schröder's method.

[We have already called attention to the independent work of Dr. Goffe, of New York, in connection with this ingenious method of treating the stump.-H. C. C.]

INTRA-PERITONEAL TREATMENT OF THE PEDICLE IN MYOMECTOMY.

ZWEIFEL (Archiv für Gynäkologie, 1891, Bd. xli., Heft 1 u. 2) contributes a valuable paper on this subject, clearly illustrated. His method is as follows: The tumor is lifted out of the wound, and the broad ligaments are ligated in the usual manner, with this exception, that the lowest ligature is placed as close as possible to the uterus. The cervix is then temporarily constricted with a rubber cord; the peritoneum above it is divided and is dissected off with the finger-nail so as to form a cuff, as in a circular amputation-stump. The mass is then excised just above the ligature, the cervical canal is thoroughly cauterized, and the eschar is then excised with a wedge-shaped piece of healthy tissue. The edges of the stump are sewed together with catgut, and the peritoneal edges are united over the stump by a Lembert suture. The writer has operated upon fiftyone cases by this method, with a mortality of only 4 per cent., the last twenty-seven patients recovering.

REEVES (Medical Press and Circular, 1891, No. 25) concludes a lengthy article (well illustrated) on the intra-peritoneal treatment of the pedicle, with a description of his method of operating, which consists essentially in securing each broad ligament with two pairs of long compression forceps, dividing the ligament between them, applying ligatures to the distal portion, and securing each uterine artery separately by a ligature carried with an aneurism-needle through the fornix vaginæ, close to the cervix. A rubber cord is then applied, the mass removed, the opposite surfaces and edges of the stump are sutured, and it is dropped back with the cord in situ. If desired, it is an easy matter to remove the cervix per vaginam, in which case the writer prefers to suture the peritoneum over the vaginal opening.

KIKKERT (abstract of Inaugural Dissertation in Centralblatt für Gynäkologie, 1891, No. 47) reviews the different methods of treating the pedicle in hysteromyomectomy, and expresses his preference for the intra-peritoneal. Treub has operated thus with good results in fifty-seven cases, constricting the stump with a rubber cord and dropping it back, without suturing or covering it with peritoneum. Terrillon is the only foreign operator who has adopted this plan, which the writer favors, in spite of Zweifel's criticism that it is a dangerous experiment to which to subject a patient. He thinks that it is better not to cover the stump with peritoneum, since septic fluid collecting beneath the latter might force its way into the peritoneal cavity instead of escaping through the cervical canal. There is also danger of infection from the vagina. The danger of intestinal adhesion is small if perfect asepsis is maintained. The objection made against the elastic cord as a large foreign body in the cavity might be urged with equal propriety in the case of the stout silk ligtures with which Zweifel transfixes the stump. In conclusion, the writer shows the results obtained at the Leyden clinic, where this method is practised. Treub lost only five patients out of fifty-seven-two from intestinal obstruction. Mendes de Léon lost two out of eleven cases, and Meij two out of twenty-four.

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TOTAL EXTIRPATION OF THE UTERUS FOR MALIGNANT DISEASE. GUSSEROW (Berliner klin. Wochenschrift, 1891, No. 47) reports sixty-seven cases of total extirpation; in four of these laparo-vaginal hysterectomy was performed, with three deaths. He regards the latter operation as a dangerous one, to be undertaken only under exceptional circumstances, where the vagina is unusually narrow, or carcinoma is complicated with fibro-myomata. The Of fifty patients who had been operated total mortality was 10.4 per cent. upon over a year before, sixteen were free from recurrence (one after the lapse of eight years), eleven had died from the disease, and one from pyelonephritis; eleven had a recurrence, and eleven were not heard from.

The writer believes that statistics will only be improved by early resort to the radical operation, at a time when the diseased tissue can be thoroughly removed. He rejects cases in which the vagina and broad ligaments are involved. Limitation of the mobility of the uterus (the patient being anæsthetized) by indurations in the parametria should be a contra-indication, even if the operator is not positive regarding their malignant character. By operating upon such doubtful cases vaginal hysterectomy is brought into disrepute. His strict adherence to this rule led the writer to operate upon only five per cent. of the cases treated by him.

THE POSITION OF THE UTERUS IN THE HUMAN EMBRYO.

NAGEL (Archiv für Gynäkologie, 1891, Bd. xli., Hefte 1 u. 2) has made careful microscopical studies of embryos with the view of verifying the correctness of the prevailing view expressed by Bardeleben, that when the bladder is empty the uterus in the adult is normally anteverted, and in children and young girls is anteflexed. He found that in the youngest embryos there was present a marked curve in the urogenital tract at a point corresponding with the future corpus uteri, and that in some cases acute anteflexion might be regarded as a congenital condition, as affirmed by Schröder. It seems as if the intimate union of the genital tract with the bladder had something to do with this flexion, although this is not the only cause (as Kölliker believes), since the bend in the former occurs long before this union takes place. Neither is Tschaussow's view tenable-that the anteflexion of the uterus is due to the contraction of the pelvis in the embryo-simply because this condition is sometimes met with in cases of pelvic contraction in the adult.

THE ANATOMY, PHYSIOLOGY AND PATHOLOGY OF THE PORTIO
VAGINALIS.

DÜHRSSEN concludes an elaborate paper with this title (Archiv für Gynäkologie, 1891, Bd. xli., Hefte 1 u. 2) with these deductions:

The portio consists of two parts, a peripheral and a central, the latter terminating at the cervical endometrium. The peripheral is distinguished histologically from the central by its greater amount of connective tissue and excess of elastic fibres, the latter forming a superficial network beneath the squamous epithelium, and a deeper layer surrounding the vessels; both interlace with those of the vagina.

The function of these elastic fibres is to effect dilatation of the os during labor. The central part of the portio then remains unchanged, while the peripheral blends with the vaginal wall. This unfolding of the portio is due to two factors-the traction of the uterine muscle from above and the centrifugal pressure exerted by the bag of waters, and later by the presenting part. The deep layer of elastic fibres is absent in the newborn and in old subjects, and is poorly developed in women with infantile uteri, as well as in those who conceive late in life. This accounts for the rigidity of the portio in old primiparæ. Mechanical dilatation in such subjects is an unscientific procedure; if necessary to hasten delivery, it is better to make deep incisions. In consequence of the presence of elastic fibres amputation of the portio is followed by the formation of cicatrices which, occurring on the posterior lip, favor the development of posterior parametritis. The same anatomical peculiarity may account for the extension of carcinoma of the portio to the paracervical tissue.

Ectropion may be distinguished from erosion by remembering that elastic fibres are absent in the vicinity of the cervical glands, but underlie the squamous epithelium.

PAPILLARY CYSTOMATA OF THE OVARY.

WILLIAMS contributes a paper on the histogenesis of these growths to the Bulletin of the Johns Hopkins Hospital, December, 1891. He arrives at the following conclusions regarding the origin of papillary cystomata :

1. They usually develop from the Graafian follicle, and will be lined with ciliated or non-ciliated epithelium according to the original condition of the cells in the membrana granulosa. The growth will be intra-ligamentous if the affected follicles grow between the folds of the broad ligament.

2. Superficial papilloma probably develops from the germinal epithelium only, and is often the starting-point for ordinary multilocular papillary cystoma.

3. It is possible that some cysts of this variety may develop from ingrowths of the epithelium of the tube into the ovarian stroma.

PELVIC MASSAGE.

DÜHRSSEN (Berliner klin. Wochenschrift, 1891, Nos. 44, 45, and 46) thus concludes an elaborate paper on Thure Brandt's method, in which he gives a detailed account of the treatment of eighteen cases: If endometritis is absent, the thorough application of massage will stretch or separate bands or adhesions. Organs which are fixed may be more quickly rendered movable by Schultze's method, practised under narcosis; massage should be employed subsequently in order to prevent the formation of fresh adhesions. Laparotomy is no longer justifiable in cases of retroflexion with fixation and chronic oöphoritis and peri-oöphoritis until massage has been thoroughly tried, provided that the trouble is not of gonorrhoeal origin. Systematic elevation of the uterus is often sufficient to cure retroflexion. Parametric exudations which were formerly purulent foci are unsuitable for massage; ordinary exudations are generally quickly absorbed.

STERILITY IN FAT SUBJECTS.

KISCH (Wiener med. Presse, 1891, No. 21) calls attention to the fact that while the proportion of sterile to fruitful marriages is one in ten, the sterility in fat women, as compared with others, is five to one. Excessive development of adipose in the male is often accompanied by diminution in the number of spermatozoa, or even by azoospermia. In the female, menstrual disturbances, especially amenorrhoea, and chronic metritis are common. Mechanical impediments to coitus are also to be considered. The prognosis is fairly good if the patient's weight can be reduced, for which certain baths are advised.

[It is important to remember that non-development and atrophy of the pelvic organs play an important part in these cases, and should render us careful about giving too favorable a prognosis.-ED.].

TUBO-OVARIAN CYSTS.

SCHRAMM and NEELSEN (Archiv für Gynäkologie, Band xxxix., Heft 1) from a careful study of these cysts (which they define as cysts the walls of which consist partly of the tubal mucosa and partly of ovarian tissue) arrive at the following conclusions: It is highly improbable that a tubo-ovarian cyst is ever congenital; this form has certainly never been observed. Burnier's theory is not tenable, viz., that in consequence of an inflammatory process the fimbriæ are inverted, closing the ostium abdominale and resulting in the formation of a hydrosalpinx, the cavity of which subsequently communicates with that of an ovarian cyst (to which it has become adherent), through a reopening of the closed ostium. The actual process is a gradual thinning of the septum between the cystic ovary and the distal end of the adherent tube, the dilatation of the latter being aggravated by the bend which always occurs at the junction of the ampulla and the pars isthmica, which is comparable to the development of hydronephrosis in consequence of a similar bend in the

ureter.

THE MEDICINAL TREATMENT OF UTERINE FIBROIDS.

ENGELMANN, of Kreuznach (Edinburgh Medical Journal, November, 1891), from an experience in nearly 700 cases of uterine fibroid treated at Kreuznach, gives the results of medicinal and hydro-therapeutic treatment. The mutter-laüge baths are prescribed for this condition, and compresses wet in the diluted mutter-laüge are kept on all night. If the tumor is growing rapidly, and hemorrhage is profuse, he gives daily injections of ergotin. These are never given during the menstrual flow, as they increase the hemorrhage. 304 cases were treated by baths alone; in 61 cases the patients were in poor condition from pain and hemorrhage: 38 cases were much improved, 11 recovered completely, and 12 showed no improvement. In 31 per cent. the hemorrhage was entirely checked, and in 50 per cent. it was diminished. Pressure-symptoms were partially or entirely relieved in 83 per cent. of these cases. In only 19 per cent. did the tumor diminish in size. Ergotin in addition was used in 96 cases, all of which were of the more severe type. In 21 of the worst cases there was entire relief from the hemorrhage in 17, from