returned, as judged by the stools, was interesting. After a few weeks the number of daily stools was reduced to three; two occurring in the early morning and one at night. The stools were then thin and unformed. A few weeks later he had but two daily movements, night and morning, and the stools began to be partly formed. Later still there was no night movement, and formed stools became the rule. Up to the present time he has had one normal stool daily with a clock-work regularity. After sufficient time had passed to complete cicatrization all restrictions of diet were removed, and he has since eaten and worked as usual. His body weight has fluctuated between 150, his weight before operation, and 164, according to the season. He no longer has a hernia, and is in every particular in perfect health-JACOB R. JOHNS, M. D., of Philadelphia, in the Medical News, December 2, 1899.

GYNECOLOGY AND ABDOMINAL SURGERY.

Under charge of SOPHIE B. KOBICKE, M. D.,

Adjunct to Chair of Gynecology and Abdominal Surgery, College of Physi cians and Surgeons of San Francisco.

A Review of the Non-Operative Treatment of Certain Inflammatory Lesions.-Clark, of Philadelphia, reviews an extensive article (Zeitschrift fur Geburtshulfe und Gynakologie), in which C. H. Stratz considers the conservative treatment of inflammatory conditions of the pelvic organs. He does not definitely localize the inflammatory conditions under such names as perioophoritis, perisalpingitis, salpingitis, etc., but says that the treatment which he has instituted has been towards the relief of the inflammation in general. He says that of over 800 cases of disease of the adnexa, seen in his dispensary service, only 20 have been submitted to operation.

If Stratz's statistics have been carefully compiled, the method of treatment which he has employed in pelvic inflammation has given good results. During the operative era of the past decade, we have possibly come to look upon the removal of inflammatory affections, especially when there are purulent accumulations, a necessary life-saving measure. Certainly a more rapid convalescence may be secured in this way, but the question has arisen in the minds of many gynecologists as to whether good results may not also be obtained by more conservative methods. As we have learned through long observation, pyo

VOL. XLIII-48,

salpinx comparatively rarely causes a general peritonitis through rupture. So slight is the danger in this direction that we frequently permit patients to go several days before resorting to operation, in the hope that there may be some amelioration of symptoms before operation is undertaken.

Freund, who has been very active as an operator and therefore cannot be looked upon as unduly timid, speaks favorably of the possibilities of conservative treatment of even such a condition as pyosalpinx.

The employment of hot water to allay pelvic inflammations is not new, for such eminent authorities as Trousseau, Kiwisch and Emmet have recommended it in the past. Bertram, however, was perhaps the first to take up the subject in an extensive manner. Through vaginal douches of hot water, 38 to 40 C., he claims to have secured most satisfactory results in the treatment of metritis, endometritis, colpitis, and pelvioperitonitis. The duration of the treatment is from four to twelve weeks. Of 126 cases, 57 were entirely healed or markedly improved. A temperature of 40 C. can only be borne when it is very gradually brought up to this point and it is necessary to protect the external genital organs with ointments, because it is found that the vagina and cervix may bear, without pain, a considerably higher temperature than the external parts.

In order to prevent pain in the external organs during the injection of the hot water Stratz has invented a special douche apparatus, which delivers the stream of flowing water directly against the cervix and vaginal fornices, and in its recurrent flow does not touch the external surfaces. The instrument is of hard rubber and funnel-shaped, the conical portion of the instrument fitting accurately into the vagina and the nozzle which leads from it is of sufficient length to reach the cervix.

In order to obtain the best results, the douche should at first be given by a skilled person, preferably by the physician or a nurse. The temperature of the irrigating fluid is gradually raised from 48 to 50 C., and at least four quarts are used daily. It is possible to raise the temperature to 60 C., but this must be most carefully done. To obtain the best results, the pelvis should be slightly elevated. After the irrigation, a glycerine, or potassium with glycerine, tampon should be applied. While this treatment may be left in the hands of some patients, Stratz claims that the best results may only be obtained through sys

tematic treatment by the physician himself.-The Amer. Gyn. and Obst. Journ.

The Mensuration and Capacity of the Female Bladder. -Hunner and Lyon (Johns Hopkins Hospital Bulletin) have carried on investigations upon living women with practically normal bladders and with the women in the genu-pectoral position, the bladder, rectum and vagina being distended with air. Repeated examinations of the same bladder under similar conditions showed that the intra-abdominal pressure was nearly uniform. Diste ntion of the bladder by air with the patient in the genu-pector al position caused less discomfort than if fluid had been employed and the patient placed in the dorsal position and, therefore, the former method is less liable to error than the latter." The chief points investigated were: (1) The aver age atmospheric distention capacity of the female bladder, and (2) its actual internal measurement from the internal urethral orifice to certain chos en points on its walls."

For the first purpose the woman is placed in the genu-pectoral position and the three pelvic cavities filled with air. From a catheter in the bladder the air is conducted, on its expression, into a long bell glass inverted over water. This bell glass is graduated and the amount of water displaced is read off. This method was practiced on 25 women and the average atmospheric capacity of their bladders was found to be 303 co., the extremes being from 160 up to 545 cc. The fluid capacity was also measured upon 22 women and found to be 429.7 co., thus being greater than where air alone was used. The capacity, both air and fluid, of the bladder was found to be greater in nullipara than in parous women, probably due to the greater elasticity in the vesical walls in the former than in the latter.—The Montreal Med. Journ.

Ovarian Cyst Infected by Eberth Bacillus.-A case of such rarity as to warrant mention is one of ovarian cyst infected by typhoid baci llus, reported by Wallgren in Archiv fuer Gyna ekologie, vol. LIX, Part 1, 1899. Bacteriological examination was made of the contents of the tumor. Werth, Sudeck and Pitha have published the only other undoubted cases. Wallgren's patient was thirty-nine years old. A small tumor was noticed in the hypogastrium in 1893. It grew slowly, and gave little inconvenience till an attack of fever in the summer of 1897. Since then the patient has never felt well; the tumor

became tender, and there were frequent rigors and attacks of feverishness. Ovariotomy was performed in September, 1898. There was a parietal adhesion of limited extent, but in separating it the cyst ruptured, and some cystic fluid mixed with pus escaped. The pedicle was secured without difficulty. After a slight pulmonary complication and high pulse and temperature the patient recovered. The cyst was dermoid, its fluid contents were purulent, and contained the Eberth bacillus, which were readily cultured.—Amer. Journ. of Surgery and Gyn.

Conditions Which Govern Success in the Sanger Cesarean Section.-Edward Reynolds (Obstetrics) states that the indications which render Cesarean section justifiable vary in accordance with whether the mother is or is not already infected with sepsis; exhausted by prolonged labor or by previous severe efforts at extraction of the child; or the subject of serious complicating disease. When her vitality is lowered by any of these causes, the maternal death rate of the Cesarean section is so enormous that it is justifiable only for the absolute indication, i. e., when the child cannot be extracted by any other method. In the absence of such unfavorable conditions, and under circumstances which render good operating possible, the Cesarean section is no more dangerous to the mother than any other simple abdominal operation; it is, therefore, (a) the operation of choice in cases, already at term, in which the ordinary intrapelvic operations are inefficient; and (b) may even be chosen in suitable cases in preference to the induction of premature labor, on accouut of its greater safety to the fetal life. Reynolds reports a list of 14 cases, all of which terminated favorably for mother and child, except in two cases the children died.—Amer. Journ. of Obstetrics.

Vaginal Celiotomy.-J. A. C. Kyroch (Ed. Mrd. Journ.), states that the advantages claimed for the vsg.nal over the abdominal route are: 1. Shorter convalescence. 2 No abdominal cicatrix, therefore no risk of hernia or subsequent forms. tion of intestinal or omental adhesions. 3. Less shock, on account of the peritoneun be ug less exposed. 4. Drainage, if necessary, is best carried out through the posterior fornix. Its drawbacks are: 1. On account of the limited space, dense adhesions are more difficult to inanage, and consequently greater danger of wounding the viscera. 2. Greater d ffi uity in rendering the vagina aseptic.

Cases suitable for the vaginal route, other means of treatment failing, are: 1. Mobile retroflexion, causing symptoms at or about the menopause. 2. Chronic ovaritis with adhesions. 3. Prolapse of the ovary with fixation. 4. Ovarian cysts, if small, whether dermoid, simple, or papillomatous. 5. Pelvic hematocele. 6. Unilateral, mobile tubal swellings. Cases unsuitable for this treatment are: 1. Large tumors. 2. Old standing tubal disease with dense adhesions, where the complete removal of the appendages is necessary.-Amer. Journ. of Obstetrics.

DERMATOLOGY.

Under charge of A. P. WOODWARD, M. D..

Professor of Dermatology, College of Physicians and Surgeons
of San Francisco.

Treatment of Eczema.-Jonathan Hutchinson, F. R. S. (Archives of Surgery, vol. I., p. 164.) "If I were required to name one remedy only for eczema I would choose tar; if two, tar and lead; if three, tar, lead, and mercury. Yet for a disease which presents so many phases and varieties, it may seem almost absurd to speak of single remedies. Making, however, allowance for such considerations, I yet hold to a strong belief that tar is the specific for all forms. The chief reason it is not accepted as such is that it is commonly employed far too strong. If weak enough, and used freely enough, tar solutions will almost invariably cure eczema. Common tar-water and solutions of carbolic acid are very useful, and come, perhaps, to nearly the same thing; but the solution of coal tar sold under the name of Liquor Carbonis Detergens, is the most convenient and most certain remedy. If I have been induced by lack of patience to prescribe any other remedy, I find almost invariably that I return to this. I use it, however, in extreme dilution. A teaspoonful to a pint of water is a common strength, but often it is prescribed much weaker. It should be so weak that it does not smart, and it should then be employed like water. The parts should be bathed with it, and rags soaked in it should be laid over them, and frequently rewetted from outside. Oil silk should not be used, at any rate not in large pieces. It soddens the part and spreads the eczema. A few small bits may be put here and there to prevent too rapid drying, but it is far better to do without it, and to rely upon very frequent rewetting."