often profuse hemorrhage, and the necessity of dragging down the cervix with hooks, are great annoyances. In the application of the écraseur the bleeding, it is true, is avoided, but, as an offset for this, the adjacent tissues are dragged into the loop. Simon, it is true, essays to fix the spot embraced by the chain by needles, but they cannot be safely applied without pulling down the cervix. Even the bleeding cannot always be avoided in the use of the écraseur. In one case, for instance, such profuse hemorrhage ensued after the écrasement as to call for the tampon. All these disadvantages are avoided by the use of the galvanocaustic. The loop is applied as near as possible to the fornix of the vagina, a spatula-like instrument being used to support it in its application. It is not easy to heat the coil at the given place, owing to the ease with which it slips off. But if it is once successfully adjusted it will cut in the desired direction without danger to the adjacent tissues. In order to obtain a good result the coil should be allowed to get hot and cut through the tissues slowly. Neither marked hemorrhages nor severe pains ensue. Even the glowing heat is not perceptible, if a stream of cold water is allowed to play over the field of the operation during the procedure. The loop makes a smooth cut, which granulates very nicely, especially if there be no carcinoma. Where this is the case the operation will only be palliative, for the speaker saw relapses ensue even after this operation. As regards the intra-uterine galvano caustic treatment, taken all in all, the speaker is opposed to intra-uterine treatment in general. The uterine cavity does not tolerate foreign bodies for any length of time. Intra-uterine applications of astringents must, in order that they may quickly flow out again, be preceded by dilatation of the cervical canal. For this purpose the compressed sponge is most appropriate. at least one inch beyond the os tincæ. Speaker has seen predominantly metritis, parametritis, etc., ensue after injections of But its point must project alkalies and iodine, less frequently after injections of lunar caustic, and all those astringents which attack less the deeper structures. As superficial applications are better tolerated, the speaker tried, in blenorrhoea and hemorrhages in consequence of endometritic polypi, to cauterize the uterine cavity with a porcelain cautery, the cervix having been previously dilated. The porcelain cautery should be curved in the shape of a uterine sound. The current is interrupted as soon as the patient complains of pain. He saw no marked reaction in any case. In the first few days after the operation there is hardly any discharge; subsequently it becomes more profuse, and is often slightly stained with blood, but in the next fortnight it disappears completely. Lange confirmed Spiegelberg's experience in regard to the evil effects of the écrasement. In one case such profuse hemorrhage ensued after the écrasement, that it could only be arrested by the actual cautery. Hegar also discarded the écrasement, but prefers the knife and scissors to the galvano-caustic in amputation of the cervix uteri, for the reasons that they never fail, are always procurable, and promote healing by first intention. Hegar proposed to make the incision in amputations for infiltration and papillary exuberation obliquely funnelshaped, as otherwise some of the morbid tissues may be left behind. It is also easy to make this funnel-shaped incision in simple. hypertrophies of the supra-vaginal portion. For the purpose arresting the hemorrhage he makes use of the suture suggested by Sims, and for greater security covers the wound by stitching the mucous membrane to the fornix vaginæ. No other dressings are then necessary. The results of the operation performed in this manner were very satisfactory. Spiegelberg regarded the funnel-shaped incision with the suture as very appropriate in simple elongation, but not in marked carcinomatous degeneration: since the cervix uteri must either be pulled down, or the knife, guided by the finger only, must work in the dark. Relapses have also ensued where the oblique incision had been made. of Hegar rejoined that his method is also applicable in carcinomatous degeneration, by first cutting away the main tumor and then making a funnel-shaped incision in the cervix uteri. Although in carcinoma the suture is not capable of achieving union by primary intention, it is nevertheless a superior hæmostatic, and renders the tampon or other dressings unnecessary. Spæth (Vienna) also confirmed the disadvantages of the intrauterine treatment of flexions, although he has found in some cases a total insensibility and an absence of reaction from the wearing of intra-uterine instruments. He agrees entirely with Sims, that the uterus tolerates better the cutting than the bloodless operations. Although until now there are only favorable reports of the use of laminaria and such like measures, it is because the favorable cases only have been published.-Ziai (Graz) saw two cases terminate unfavorably from the use of laminaria. Hugenberger (St. Petersburg) saw pyæmic symptoms ensue in one case from the use of laminaria. In flexions he is an advocate of Simpson's pessary, which is tolerated very well and acts very beneficially when properly adjusted and retained a sufficient length of time. Prof. Von Mayrhofer (Innsbruch) presented a new movable uterine sound, invented by Dr. Sapolini, of Mailand, but whose introduction into gynecological practice will be prevented by its uselessness and expense. TRANSACTIONS OF THE PHILADELPHIA OBSTETRICAL SOCIETY. REPORTED BY GEORGE PEPPER, M.D., SECRETARY. MEETING OF DECEMBER 2D, 1869. DR. HARRIS IN THE CHAIR. DR. GOODELL related the following case:-A robust lady, who had a dark and livid tumor projecting slightly from the vulva, from which she had never suffered any pain or inconvenience. Hemorrhage setting in, her physician called Dr. G. in consultation. He found a smooth vascular tumor, originating one inch below the meatus urethræ, as large as a horse-chestnut, giving out a profuse hemorrhage in minute jets, from an apparently ulcerated surface. As ice, liq. ferri subsulph., and other styptics had failed, a double ligature was thrown round the mass. The hemorrhage was thus arrested, and as, from its unusual site, it was considered a benign erectile tumor, a favorable prognosis was given. The growth, however, soon increased so rapidly as to fill up the vagina, and the lady died one month afterwards, exhausted by repeated hemorrhages. An autopsy revealed a large cauliflower excrescence, springing from the anterior wall of the vagina, which showed under the microscope the characteristic cells of such growths. The womb, bladder, and rectum exhibited no trace of the disease, and all the other internal organs were healthy. Dr. G. said that the early diagnosis of a cauliflower excrescence is extremely difficult, owing to its resemblance to an erectile growth; indeed, Virchow asserts that the excrescence is at first a simple papillary tumor, which ultimately passes into the cancroid state; and that therefore all vascular tumors of the vagina and uterus should be looked upon with suspicion. Other members related their experience in regard to these cancroids, but had never seen one occupying the above site. CASE OF PREMATURE LABOR. DR. PEPPER related a case of a primipara, six months advanced, who fell into labor after a fall. The child presented by the breech, and for nearly an hour after the body was in the vagina, the head was grasped by the os uteri. All pulsation in the cord being arrested, traction was made on the legs, and after considerable delay a premature and apparently dead foetus was extracted. Some time afterwards he was attracted by a feeble effort at respiration, and found the child. breathing. The respirations were feeble-two or three to the minute; the pulsation of the heart rapid, and very faint. It was wrapped up and placed under the stove, where it continued to gasp for forty hours; no attempt at deglutition could be induced, although faithfully persevered in. DR. D. M. CHESTON related the history of a breech case, where, after a normal labor, the child was born apparently dead, and it was only after very prolonged efforts that respiration could be established. DR. DE FORREST WILLARD related a case in which a five and a half months fœtus continued to have respiratory movements for over two hours. DR. ROBERT HARRIS asked if the opinion of the Society was favorable as to development subsequent to birth, and entirely supplementing to the loss of a portion of intra-uterine life. A discussion arose, in which it appeared that the child was considered to be perfectly capable of replacing its lost uterine life; many cases in point being given to prove this fact. MEETING OF FEBRUARY 3D, 1870. DR. A. H. SMITH IN THE CHAIR. PROLAPSE OF ARM AND FUNIS. DR. A. H. FISH stated that he was called in by a midwife to see a woman in her eighth pregnancy, who had been in active labor for twenty-four hours. The left arm and a loop of the cord had descended in front of the head. No pulsation could be detected in it, but he tried unsuccessfully to replace it by the postural method. He therefore carried up the arm and hand, applied the forceps at the superior strait, and speedily delivered her of a large still-born child. PLACENTA PREVIA. DR. FISH also related the history of a case of placenta prævia. A primipara, seven months advanced, after a long walk, retired to bed. At midnight she was awakened by a sharp pain, and found herself losing blood very rapidly; about one quart before the doctor could reach her. He immediately passed up his finger, which the os barely admitted, and found a central implantation of the placenta. Calling in Dr. Goodell, anesthesia was induced, on account of the excessive restlessness of the woman, and the three sizes of Barnes' dilators were successively introduced. Their presence controlled the hemorrhage, but the very rigid and conical cervix uteri could not be dilated so as to admit the hand. Two fingers were therefore introduced, and a very large portion of the placenta removed. The head was in the first position of the vertex, but did not offer to engage. Ergot was therefore given, which forced the head upon the os, and plugged it firmly. There was no further hemorrhage; but as the woman became very exhausted and restless, whilst the os still continued rigid, the child's head was perforated, and delivered in a few minutes. The woman did very well until the fourth day, when symptoms of metro-peritonitis set in, of which disease she sank on the seventh day. DR. GOODELL remarked that he had never seen so rigid a condition of the os uteri, and likened it to the edge of the falci |