is a signal for caution, but if at the indifferent pole it is a notice for a larger electrode and a better conducting surface. Consciousness of the current at the internal electrode shows the approaching limit of tolerance. The faradic current is best measured by the sensations of the patient; it should never be applied to the extent of causing pain. When stimulating currents are used it is better to stop abruptly; when the current is sedative, gradually reduce it to zero.

The following case will, in part, exemplify the method: Miss B., age 24 years, a bookkeeper, consulted me about four years ago. She had a retroflexion, and had previously been treated by a number of physicians with pessaries, tampons, etc., but with no permanent improvement. They had proposed a surgical operation, but this was not consented to. For the next two years the treatment was about as follows: I would insert a pessary which would make her comfortable for about a month; as she had to stand a great deal she would then feel uncomfortable, and tampons would be employed for a week or two and the pessary re-inserted. At the end of two years nothing had been gained but of a temporary nature, for as soon as the artificial supports were removed, the uterus would resume its retroflexed position. With the displacement there co-existed a thick leucorrheal discharge, an endometritis and dysmenorrhea; these were only partially and temporarily relieved by the treatment. No doubt, the character of the patient's employment was an important factor in the causality of these relapses.

At this time I resolved to try electrical treatment. In such a chronic case with muscular atrophy or degeneration, it would be needless to expect immediate results. For the temporary support of the uterus, therefore, I determined on the retention of the pessary. The office visits were irregularly made, as the patient's employment interfered. However, from one to four times a week the high tension induced current was applied, with considerable gain in the comfort of the patient, and a modification of the symptoms at the end of the first month. For the relief of the tenacious discharge and endometritis, two applications of intrauterine negative galvanization were made, followed by six applications of the positive pole. These were made about once a week, together with concurrent faradio treatment as before mentioned. This brought us to the end of the third month of the treatment, with an all around improvement.

I then changed the character of the electrical treatment to a more stimulating one, and the slowly interrupted induced current of quantity was selected. This treatment was kept up for nine months, making in all one year of electrical treatment. During this time the pessary had never been removed, except for the purpose of applying the current, when it was immediately replaced. It was now removed and the treatment by the current alone continued for three months more. At the end of fifteen months of treatment it was found that the uterus maintained its position, being slightly inclined backward, and the symptoms had permanently disappeared.

Dysmenorrhea.-In a large majority of these cases there exists a hyperesthesia of the endometrium, especially at the os internum, and this is often combined with stenosis and flexion; not uncommonly there exists imperfect development with induration or degeneration. Painful menstruation may be due to endometritis, and this may or may not take on the form of the membranous variety. Disease external to the uterus may coexist or be the cause. The pain may be accompanied by profuse or scanty menstruation.

In the electric current will be found an effective means of combating the evils. Positive or negative galvanization, or the faradic current of high tension, or the faradio current of quantity being indicated according to the symptoms and their causes, although some of the cases are relieved by external or vaginal applications, yet the intrauterine method will generally be required.

The following case will illustrate the procedure: Miss B., aged 18 years, had been menstruating for six years, during three of which she had suffered great pain, being confined to the house and even to the bed for two or three days at every period. When she came to the office she said she wanted electrical treatment for the pains, but refused to be examined. The high tension faradic current was applied externally three times a week. On next menstruation there was no apparent improvement. When she returned she was willing to submit to any treatment in order to get rid of the pain. This was commenced by vaginal dilatation by means of a small speculum, which was sufficiently accomplished in one week. As the menses were scanty the method of electrical treatment selected was intrauterine negative galvanization. Placing the positive electrode

over the abdomen, and introducing the vaginal speculum, the intrauterine electrode was gently pressed against the os, which it barely entered, then carefully turning on the current, it was gradually raised until marking 10 milliamperes; continuing the pressure, the electrode slowly passed to the internal os; as at this point the patient complained of pain, I carefully reversed the controller to zero, withdrew the instruments, and inserted a tampon of boro-glycerine. Two days afterwards, at the next sitting, the electrode entered freely to the internal os, and the current being made, it was raised to 15 milliamperes, and after a few minutes the electrode with slight pressure reached the fundus. The intrauterine applications were made twice a week, alternating with vaginal bipolar high tension faradization up to next menstrual period. Afterwards irregularly for one month more. The menses are now more profuse and without pain, and the patient is happy.

Uterine Enlargements.-The two following cases will bear comparison: Mrs. J., age 39 years, had been operated upon five years ago, for lacerated cervix. She had been suffering from headaches, backaches, pain and heaviness in the lower extremities. With the exception of being "lighter on her feet," as she explained, there was no amelioration of the symptoms after the operation. These continued for two-and-a-half years when another pregnancy partially relieved her. Six months ago I was called and found her miscarrying at the third month. She had had irregular pains for three weeks with considerable hemorrhage. The uterine cavity was emptied and everything went well. About six weeks afterwards she consulted me at my office on account of excessive and prolonged menstruation. Examination showed the cavity of the uterus to be 3 inches in length, and escaping from the os was a profuse sanguineous discharge. She complained of headache and backache.

Positive intra-uterine galvanization was applied, and as she tolerated the current well, I allowed it to reach seventy-five milliamperes. During the next three weeks she received eight such applications, generally succeeded by the slowly interrupted induced current. The menstruation then due was normal, and at the succeeding visit the measurements of the uterus were also normal. The patient stated that she felt better than she had done since her first pregnancy. Irregular treatment was given for two more months, when she was dismissed as cured.

Mrs. R., age 28 years, had four children. After last confinement had felt miserable with pain and weakness in back, pain over bladder and ovaries, and headache. One year and a half subsequent to this confinement she had a miscarriage induced by her condition. When the menses next appeared she flowed for two weeks, and for this she consulted me at my office. Examination showed a unilateral laceration of the cervix involving the whole of the intra-vaginal portion. The ovaries and tubes were tender and congested, the uterus enlarged and giving exit to a bloody discharge. I gave her a positive intra-uterine galvanic application of thirty millamperes for ten minutes. Next day I repeated the application increased to seventy-five millamperes which stopped the blood entirely, and there was marked improvement in the general condition. The applications were then repeated every second day for the next week, and then twice a week until the next menstruation, which was rather profuse and lasted eight days. During the next month she received six galvanic intra-uterine applications, alternating with slowly interrupted induced current of quantity, when the menstrual flow became normal, the tenderness of the ovaries and tubes had disappeared, the uterus was of normal size, and the patient felt better than she had for two years. She is at this time seven months pregnant and feels comfortable and well.

In comparing these two cases it is found that both had laceration of the cervix. No. 1 was operated upon; No. 2 was not; both.continued to suffer. No. 1 was partly relieved by a subsequent pregnancy, but afterwards miscarried, and was entirely relieved by electrical treatment. No. 2 miscarried and was relieved by the same applications, and is now well advanced in pregnancy. I am not to be understood as advocating surgical non-interference in such cases, but I say this: that surgeons who operate for the purpose of relieving certain symptoms and fail, should understand that there is an infallible agent in electricity for accomplishing symptomatic cures.

The comparison also proves that the laceration does not directly cause pain, but may set up other conditions which produce the pain, and that although the first cause be removed the sequential pathological condition may remain. Further, that the electric current is capable of removing all the sequential pathological conditions and symptoms, and by strengthening

the parts, enables them to resist encroachment by the primary lesions.

An important consideration in connection with pelvic pathological conditions in which cervical laceration is a prominent feature, is that when the latter takes place, the parts are weakened and enlarged by pregnancy. The employment of electricity so as to bring about a proper involution will render the laceration harmless; this I have often demonstrated in extreme cases.

Diagnostic Value.-The suspected existence of cystic or cancerous degeneration will be confirmed by the absence of responsive symptomatic improvement when current applications are made, but in these conditions no distinct post-operatory disturbance will ensue. A pelvic pus collection contra-indicates the use of electricity, and will be announced by post-operatory symptomatic exacerbations Acute inflammatory action taking place in any part of the pelvic cavity will announce itself when large amperage is employed, and more especially by the intrauterine method.

It must be noted, however, in this connection, that intensification of the existing symptom, or even the creating of new ones, may immediately follow electrical seances at the commencement of the treatment, when the ultimate reactions are entirely beneficial, and when no contra-indication exists. An electrotherapeutist should not be discouraged in any case by the want of success of one or a few applications, as the fault may rest with the dosage, length of seance, mode of application or kind of current.

INHIBITION OF THE HEART AS AN AID IN DIAGNOSIS.

By ALBERT ABRAMS, A. M., M. D., San Francisco. (Abstract of Paper read before State Medical Society, April 17, 1900.) Physiologists have taught us that the inhibitory nerve of the heart is the vagus, stimulation of which op the heart in diastole. Stimulation of the sympathetic cardiac nerves has exactly the reverse effect, causing increase in force or rate of the heart beats; these are the augmentator and accelerator nerves. Czernak was able to press his vagus nerve against a little bony tumor in the neck, and by thus subjecting the nerve to mechanical stimulation, was able to slow or even to stop the beating of his own heart. This was the first demonstration in a healthy