Douches should be given every day after the drainage is removed. I prefer 1 to 10,000 bichloride douche. Just a word regarding the application of acids and various chemicals to the uterine cavity for the treatment of endometritis, that word is, "Never use any of them." We have in curetting all that could be wished, and the introduction of chloride of zinc, nitric acid, carbolic acid and the lunar caustics are dangerous and unscientific. With proper care it is seldom that the operation need be repeated, except in septic endometritis. Here we have present possibly a decomposing placenta. It requires unusual skill and persistence to clear the entire cavity of this mass and the temperature will not always abate after one currettement. In these cases there is nothing like diligence to save the patient's life. I recall one case where for four weeks it required intra-uterine douches every four hours night and day and a currettement every other day before the patient recovered. I regard the sharp curette as preferable to dull as very little good can be accomplished with the latter. As to the dangers, if the novice should ask, if there were any danger in using a curette, I should say about the same there is when a fool handles a shotgun. If a man assumes the uterine wall to be a barn door he will no doubt be successful in pushing the curette through that wall, but fortunately for him even that will not kill the patient, unless perchance he hooks a loop of intestine into his curette and pulls that into the uterus. It is possible then that he may have an obstruction of the bowel unless his patient dies before symptoms of obstruction manifest themselves. There is on record the statement of a case where the operator pulled out a loop of intestine through the uterus and vagina under the impression that he had a retained placenta. There is a condition where it is very easy to push the curette through the uterine wall, and that is in acute septic endometritis following parturition or abortion. In such cases if the inflammation has been severe and prolonged the uterus has lost its tone, disintegration of muscular tissue is about to take place and but little resistance is offered to approach of the curette. In such cases only the most gentle manipulation should be made. I am well aware that some European authorities are beginning to condemn the use of the curette, but it seems more from a desire to institute a change of treatment than any valid objection. However in practical America where we are working for results and not theories, the curette holds a stronger place than ever. I would not give strength to the thought that I do not believe in remedies for the treatment of this class of affections, for I certainly. do and particularly the homoeopathic remedies, but the scope of my paper was the surgical or mechanical treatment of endometritis and my summing up of the treatment from that standpoint is the curette. AN ORIGINAL PLASTIC OPERATION FOR THE REPAIR OF COMPLETE RUPTURE OF THE PERINEUM. By SIDNEY F. WILCOX, M.D., New York. OPERATIONS for the repair of complete rupture of the female perineum are often liable to be followed by unfavorable results, which do not follow attempts to repair the incomplete variety. These unfavorable results, in my opinion, arise from the fact that most of the operations which have been devised for the repair of complete rupture, are finished with a line of intra-rectal sutures, or, in other words, with a seam which is inside the rectum, and conse quently exposed to the infection from the bowel. If either one of two conditions could be maintained this would not matter; that is, if the rectum could be kept in an aseptic condition, or if the suture line could be kept tight and proof against the admission of gas or fœcal matter for a few days no difficulty would be experienced in getting primary union. In most rectal operations it is considered advisable to dilate the sphincter-ani in order to immobilize the parts, and assist healing; but with a sphincter muscle torn in two it is impossible to stretch it before the operation, and it is certainly not advisable to do so after it has been united for fear of tearing out the sutures. After the operation therefore the sphincter is likely to be tighter than usual, and to offer unusual resistance to the passage of gas, thereby bringing greater pressure upon the suture line. Having these facts in mind I was led to devise the operation described below, and in the few cases in which I have had the opportunity to try it, it has been followed by perfect results. The method is a simple one, and consists in marking a flap on the mucous membrane of the anterior surface of the recto-vaginal septum, and in this flap, including the covering of all the perineal body which it is desired to denude, as shown in Fig. 1. This flap is then dissected from above, downward to the edge of the cleft, and turned down so that the mucous surface which consisted of a portion of the posterior vaginal wall, now becomes a part of the anterior rectal wall. Fig. II. shows the flap turned down, and the sutures inserted. The sutures in the vagina are of catgut, while those on the outside may be of wire or silkworm gut, as the operator sees fit. The raw surface of the flaps presents forward and is included in the wound which now becomes like that made after the usual denudation for an ordinary incomplete laceration. Fig. III. shows the operation completed, and is similar in appearance to the ordinary operations. The only other method for accomplishing the same result as the above is Tait's, which consists in pulling down the anterior rectal mucous membrane, as in the operation for hæmorrhoids, where the "pile bearing inch" has been removed; but Tait's operation is only suited to cases where the cleft is not deep. Editorial Department. EUGENE H. PORTER, A.M., M.D. } EDITORS. Contributions, Exchanges, Books for Review and all other communications relating to the Editorial Department of the NORTH AMERICAN should be addressed to the Editor, 181 West 73d Street. It is understood that manuscripts sent for consideration have not been previously published, and that after notice of acceptance has been given will not appear elsewhere except in abstract and with credit to the NORTH AMERICAN. All rejected manuscripts will be returned to writers. No anonymous or discourteous communications will be printed. The Editor is not responsible for the views of contributors. TWO UROLOGICAL MYTHS. Not long ago a gentleman handed a specimen of urine to a physician, with the remark, “Do not be frightened if you find phosphates in this. I have had them for a long time and they do not trouble me any." Inquiry developed the fact that the patient had been under treatment in a distant town for "phosphaturia," the said phosphaturia being evinced by a white precipitate that appeared in the urine on boiling and disappeared on the addition of an acid. As far as the urinary phosphates are concerned, distance from the metropolis bears no relation to diagnostic acumen, because a distinguished metropolitan consultant in renal diseases, in the case of a man dying of Bright's disease, has been known to make report after report of an alleged quantitative urinalysis in which the phosphates were invariably declared "normal." A real quantitative analysis of the same urine demonstrated that these salts were diminished to one-third of the normal quantity. The first blunder, the supposition that a heavy heat-precipitate of phosphates indicates an excessive excretion of those salts, is a myth that is firmly fixed in many medical minds. How it got there is a mystery; certainly no chemist originated it. Like myths in other fields, it was probably born of a little knowledge and a great deal of imagination. It is difficult to understand, however, how |