quirements were satisfied in this case, and the diagnosis is clinched by the histological findings.

THREE NORMAL PREGNANCIES AFTER NEPHRECTOMY.

E. Tridondani (Ann. de Obstet. e Ginecol., July, 1896; Br. Med. Jour., November 9, 1896) Cases have been reported by Schramm, Fritsch, and Israel of pregnancy in women who had suffered the loss of one kidney. The author reports another of more than usual interest :

A patient, aged twenty-nine, came into the Maternity at Pavia suffering from symptoms resembling those of intestinal obstruction, accompanied with pain on micturition and scanty urine. She was in the eighth month of pregnancy; and to the left side of the uterus was a fluctuating tumor. Under treatment, the symptoms improved, and the woman was spontaneously delivered of a male infant. Three months later the abdomen was opened and a cystic kidney (the left) was removed. Recovery was complete. Since then the patient has had three pregnancies. In none of the three were there any abnormal symptoms. There was no edema, and the urine was normal in quantity and quality. The labors were at term and non-instrumental. The placenta and membranes in each case were healthy, and the puerperium was normal. The infants were born alive, were healthy, and had a weight and size above the average. The author concludes, from a study of this and the three other reported cases, that pregnancy occurring in a woman with one kidney does not interfere with her health; that the absence of a kidney does not disturb the progress of gestation, labor and the puerperium, and that the product of conception does not suffer. He does not, therefore, agree with Schramm, who advises that a, woman with a single kidney should not marry, or, if married already, should not become pregnant. It is noteworthy that in the above case the liquor amnii was increased in amount; but it is doubtful whether this was a consequence of the absence of one of the mother's kidneys.

GYNECOLOGY.

BY WALTER B. CHASE, M. D.

CONSERVATIVE GYNECOLOGY AND FUTURE PREGNANCY.

Mangin (Lancet, July, '96) publishes statistics on the afterhistories of cases of pelvic inflammation treated by the curette, scarifications, or amputation of the cervix. He admits that the

curette has been grossly abused, and it is only to be used by those accustomed to treat diseases of women. On the other hand, in many cases of old salpingitis there is no real obstruction of the uterine end of the tube, and it is not justifiable to sacrifice the appendages. Mangin includes in his tables 94 cases treated conservatively between 1888 and 1894. He rejects more recent cases, patients close upon or past the menopause, patients who have avoided the effects of impregnation, and all imperfect histories due to disappearance of the patients; 57 out of the 94 have been pregnant since treatment. Mangin divides the 94 therapeutically thus: (1) Simple curetting, 37, 24 since. pregnant. (2) Curetting and amputation of cervix, 37, 19 since. pregnant. (3) Curetting, amputation of cervix, and plastic. operations on the vagina to improve the position of the uterus, 20, of whom 14 have since been pregnant. Of the 57 patients pregnant after treatment, 11 have borne two and has given birth to three children; in this last case the patient had been treated for a mild double salpingitis; 58 of the 94 had distinct disease of the appendages besides metritis and discharges, 26 have been pregnant since treatment; 20 after unilateral and 6 after bilateral disease. Mangin concludes: (1) When the appendages are, to all clinical appearances, free from disease pregnancy follows treatment in at least 83 per cent. of the cases. (2) When there is disease of the appendages with metritis and probable permeability of the tubes, 44 per cent. may become pregnant; 60 per cent. after unilateral, 25 per cent. after bilateral disease. (3) When there is a collection of fluid in the pelvis which cannot be evacuated through the uterus, puncture through the vagina is followed by pregnancy in 10 per cent. of the cases. (4) Conservative treatment greatly diminishes the need of radical operations and often allows of subsequent impregnation.

THE BACTERIOLOGY OF VAGINAL SECRETIONS.

Hirst (American Journal of Obstetrics, July, 1896) having made a careful study of the recent German literature of this subject as well as numerous scientific observations himself, has embodied this knowledge in a paper read before the section of Gynecology, College of Physicians, Philadelphia, April 16, 1896.

His conclusions are certainly unique, and while we may not agree, are of interest to all physicians. He says: "From this mass of facts, the practical physician may draw the following conclusions, I think, to guide him in his work: The vagina be

comes infected almost immediately after birth, in normal conditions it contains no pathogenic bacteria; it has strong germicidal powers which serve to guard a woman against infection. These powers depend, as far as our present knowledge goes, upon the presence of a special bacillus and upon the products of its life processes; upon the leucocytosis due to chemotaxic action; upon phagocytosis; upon the germicidal powers, perhaps, of the anatomical elements of the vagina, of the cervical mucus, and of the bloody discharge during menstruation and the puerperium.

During and after labor mechanical safeguards of the most effective kind are furnished against infection. These are the discharge of the liquor amnii, washing out the vagina; the passage of the child's body; the descent of the placenta and membranes, and the bloody discharge which follows.

Moreover, should the vagina exceptionally contain pathogenic bacteria, they are likely to be in a condition of diminished or absent virulence, in which condition they will be productive of disease unless the tissues with which they come in contact are reduced in vitality.

Bearing these facts in mind, it would seem that the common practice of relying upon vaginal douching for disinfecting the vagina before labor, or before some gynecological maneuver or operation, is faulty, not to say foolish. It has been clearly demonstrated that the injection of an antiseptic fluid in the vagina will not destroy pathogenic germs there, and will, moreover, rob the woman to a certain extent of the safeguards against infection that nature provides for her. If, therefore, under certain circumstances, it is desirable to disinfect the vagina, mere douching should not be depended upon, but the vaginal mucous membrane should be thoroughly scrubbed as well as douched, just as one would prepare the skin for an important surgical operation. This rule applies as well to obstetrical as to gynecological work. It has long been my practice in the former not to use objective antisepsis unless I see good reason for it, in microscopic evidence of a pathological condition of the vagina, but to confine myself to subjective antisepsis-that is, to the most thorough cleanliness of my hands, of my implements, and of the hands of the attendants who come in contact with the patient. When, in consequence of some diseased condition in the vagina, it is considered advisable to disinfect the lower genital canal, one should proceed just as though he were about to undertake some serious gynecological operation. That is,

he should scrub out the vagina with tincture of green soap, hot water and pledgets of cotton before using a douche. He should not depend, as so many practitioners do, simply on an antiseptic vaginal injection.

RETROPOSED UTERUS.

Stinson (The Therapeutic Gazette, May, 15) says:

"1. That in all cases of retroversion, without adhesions or disease of the adnexa, plastic work should be done on the cervix, vaginal walls, or perineum, if required; and the round ligaments should be shortened by Edebohl's modified Alexander's operation, with this exception-use kangaroo tendon as a buried suture for mooring the shortened ligaments and coapting the lips of the aponeurosis of the external oblique, the wound being closed without drainage.

"2. That in all cases of retroversion with adhesions, where one or other tube and ovary are diseased, plastic work should be done on the cervix, vaginal walls, or perineum, if required; an incision made into Douglas' pouch, and the adhesions separated; plastic work on tubes and ovaries, or one or other tube and ovary removed if thoroughly diseased; and the round ligaments shortened as above.

"3. That in all cases where there is retro-displacement of the uterus with bilateral disease of the appendages, vaginal hysterectomy should be the operation employed."

DISEASES OF NOSE AND THROAT.

BY WM. F. DUDLEY, M. D.

THE PATHOLOGY AND TREATMENT OF OZENA.

Capart (Jour. Lar. Rhin. and Otol., Dec., '96). The characteristic lesion is atrophy of the nasal mucosa of the inferior turbinated body, generally associated with hypertrophy of the middle turbinate, and accompanied by adherent crusts of dried mucus, having a distinctive odor. No ulceration or necrosis exists, thus excluding syphilis, tuberculosis, and sinusitis. The cocco-bacillus of Löwenberg is probably the result, not the cause, of the disease. Hypertrophy does not always precede atrophy, as latter may be found a few days after birth.

Primary atrophic inflammation is ascribed to scrofula, an impairment of general nutrition, and consequent abnormal secre

tion. The disease is possibly infectious. Heroic operative measures are deprecated. Mild detergent and stimulating washes may effect a permanent cure. As revealed by the microscope, the normal histological conditions may be restored.

Vibratory massage has not proved satisfactory. Electrolysis, especially bipolar, has given most satisfactory results. A current of twenty milliamperes for twenty minutes is employed. Ninety per cent. of the cases treated are permanently relieved. If the bipolar method is too severe, the negative pole may be applied to the arm or the thigh. To accomplish a successful treatment with children, it may be necessary to administer chloroform.

In 300 cases treated no accidents occurred. Delsaux claims that these diseases are preceded by simple chronic catarrh, not by hypertrophy. Its proper name is chronic atrophic rhinitis.

Grünwald claims that the atrophic process is traceable to "circumscript centers of suppuration" whose secretion has been suppressed by local irritation, or to empyema of frontal, ethmoidal or sphenoidal sinus, or to the presence of adenoid vegetations.

Tissier and Mayo Collier attribute ozena to an existing ethmoiditis.

Wingrave has found following histological changes :

1. Transformation of the ciliated epithelial and olfactory cells into stratified epithelial cells.

2. Disappearance of the hyaline basement membrane.

3. Disorganization of glands.

4. Obliteration of capillary blood vessels-atrophy of the venous cavities.

5. Lymphoid tissue diminishes.

Bone structure atrophies.

THE EXAMINATION OF CULTURES OF SUSPECTED CASES OF DIPHTHERIA.

B. Mead Bolton (Med. and Surg. Rep., June 27, 1896). Of 1207 primary cultures of cases showing clinical signs of diphtheria, a positive diagnosis was made by attendant in 557 cases. Of the 557 cases, diphtheritic bacilli were found in 90.2 per cent.

Of 148 cases in which cultures were made, but reported by the attendant as not diphtheria, the Klebs-Löffler bacillus was found in 40. The clinical and bacteriological reports agreeing in 72.9 per cent.

Cultures were taken from the throats of 214 persons who were exposed to the disease, but presenting no clinical symptoms.