As to the remarks concerning the size of the catheters, the speaker stated that he had not yet had the advantage of working for twenty years on his instrument, as Nitze and others have had. Possibly with longer experience, some features would be further remedied. Increasing the size of the catheters was one of the points that he had in mind to carry out with his instrument.

As to the point raised by Dr. Jacobson concerning the funnel-end of the catheter, he had cut that off his catheters to enable him to withdraw the cystoscope while leaving the catheters in the ureters. The Nitze instrument does not enable one to withdraw the cystoscope after double catheterism; that instrument must remain in the bladder as long as the two catheters are draining-which must be very uncomfortable for an inflamed bladder or urethra. It is undesirable to catheterize the ureter on one side on one day and wait three days to catheterize the other side, because of the probable changes occurring in the urine in the meantime. There are marked changes in the character of the urine at different times of the same day even.

He acknowledged that air is slightly more irritating than water when the bladder is distended. Yet, the members of the society had seen how little irritation there was in the case before them, which was a case with a badly inflamed bladder! The use of air is disagreeable, but not enough to prevent catheterization or to be a very weighty objection. On the other hand, there was the ability to drain comfortably without the presence of the cystoscope in the bladder. If it is necessary to drain for half an hour with a straight tube like a Nitze cystoscope in the bladder, he thought that the irritation would be greater than it was from the temporary use of air.

Dr. Lewis stated further that he had noticed some points about this work that were new to him, and he could not state positively how they would all turn out; one thing particularly, was the marked benefit that followed in tuberculous conditions after this catheterization. He could not understand this. He knew that tuberculosis of the peritoneum is of ten cured by simply opening up the abdomen and closing again, without anything else being done. The question arises whether the introduction of air into the bladder does not cause the same improvement in tuberculosis of the bladder as it does in the case of tuberculosis of the peritoneum. In reading on tuberculosis of the bladder, it is common to see the advice given that the less instrumentation carried out, the better for the condition. Tuberculosis of the bladder was only diag nosticated by this procedure and the operation was not repeated, yet improvement was noticed in some cases. In one case in which a double catheterization was performed one year ago, tubercle bacilli were found in the urine from both kidneys. This observation was confirmed by Dr. Gradwohl, who made the guinea-pig test. Last week, the essayist got clear urine from both sides, and no tubercle bacilli could be found. The evi. dence of improvement in other cases consisted in marked lessening in the amount of pus.

In other words, as Dr. Meisenbach stated, catheterization is going to do a great deal of good. Infection is avoided by careful sterilization of

No. 3. The Bransford Lewis Operating and Office Table: In position for cystoscopy or ureter catheterism. Patient's pelvis elevated. legs flexed and comfortably supported by crutches, placed at any angle or hight desired; hands grasping handles. Foot-stool present if desired. No strain in the posture. Willbrandt Surg. Mfg. Co.

No 2. The Bransford Lewis Operating and Office Table: In position for cystoscopy or ureter-cathe terism, further illustrated in photo No. 3. The Emil Willbrandt Surg. Mfg, Co., St. Louis.

all parts of the instrument, as well as by sterile applications. Dr. Lewis quite agreed with one of the speakers who advised against the indiscriminate employment of this procedure just as he would decry the indiscriminate use of morphine or other medicinal agents. He only carries out this procedure in cases where it is necessary to make a diagnosis, or apply treatment. It requires some practice in order to perform the catheterization. The more inflammation in the bladder there is, the more difficulty there is in doing this work.

Dr. Lewis stated that he had been lately working on some additions to the instrument, one a prism-telescope which was inserted directly through the cystoscope, and enabled the observer to "look around the corner" and see the conformation of a prostatic outgrowth, etc.

The Nitze and the Casper instruments help somewhat in this diagnostic work, but it is not possible with these European instruments to get as good a view of the prostate as is desired.

The speaker was also having made a cystoscope for purely operative work within the bladder. By working through air distension, he expected to be able to accomplish much more than is possible through a fluid medium. Any active bleeding into the latter medium would immediatey stop any operative procedure, which would not necessarily be the case with the air medium.

Dr. Henry Jacobson demonstrated a new instrument which is a modification of the Bottini-Freudenberg electro-incisor for prostatic overgrowths. It has a dial which can also be placed on a cystoscope and enables one to tell just where the cutting is taking place. Every time the instrument is turned, an indicator on the dial turns with it, pointing to the place where the knife is situated. So if the cauterizing blade is not burning the channel where the cystoscopic picture determined, it can be changed to the proper angle.

TUBERCULOSIS IN GERMANY.-Germany has special hospitals for the accommodation of 30,000 tuberculous patients. The statistics of these institutions for the years 1896 to 1901 showed that of 100 cases treated 87.7 were dismissed as cured or improved, 8.8 as unimproved, 3.1 as worse, and that 0.4 died. The imperial health office of Berlin has reported concerning the destructiveness of tuberculosis in Germany as follows: Of 1,000 deaths of persons between the ages of fifteen and sixty, 316 die of tuberculosis. Persons under sixteen and over sixty are seldom affected with the disease.

Dr.

FRESH AIR HOSPITAL FOR INFANTS.-Some philanthropic citizen whose name is withheld is cooperating with Chief Dispensary Physician Scherck, through Dr. E. W. Saunders to provide a fresh air hospital for the treatment of intestinal and other summer diseases in infants. Scherck tells us that sufficient funds are in sight and that the hospital will probably be an accomplished fact by another summer. It is purposed to locate it on the Bluff overlooking the river north of the city.

The Bossi Method in the Treatment of Puerperal Eclampsia-Report of Two Cases.

BY W. H. VOGT, M. D.

ST. LOUIS.

N presenting this paper I do not propose to bring up anything new, but simply to call attention more closely to the method above mentioned, which has been practiced in Europe for several years, but for some reason or other has not been extensively used in this country, and to my knowledge only twice in this city, namely, on the two cases herein reported. Although many hypotheses have been advanced concerning the etiology of eclampsia, yet we are still in the dark as to the true causative factor. We have, however, by experience learned to recognize a few facts. regarding the general course of this disease, and one of these is that in the great majority of the cases the convulsions cease either immediately or soon after delivery. According to Duhrsen and Ohlshausen in 93.73 per cent and 85 per cent respectively. It is, I believe, for this reason that most obstetrical authorities are of the one opinion that in cases of eclampsia, during pregnancy, as well as in labor, whenever an early delivery for some reason is not to be expected, the woman should be confined as early as possible, and by that method which seems at the time the proper one and the one offering the best chances for the recovery of the mother and the delivery of a living child, with the least danger of inflicting injury.

Concerning the method which should be used, opinions vary greatly. Some prefer to treat the case medicinally and expectantly, while others urge the rapid emptying of the uterus, and I believe the latter class are in the majority. To lay down any one rule to follow in treating these cases would be ridiculous, for each and every case deserves special consideration, and no two cases can be treated exactly alike.

Halbertsma, in referring to the treatment of this condition in the Centralblatt fur Gynakologie asks the question, "Should we, at the end of pregnancy, or at the onset of labor, wait or hasten delivery I agree with him when he says that the obstetrician should act when the prognosis for the woman seems very poor owing to the severity of the attacks, or in cases of absolute anuria, or if we have no way of knowing whether the pains will soon begin or not, or if we have reasons to believe that the pains when once set in will be of long duration, as in primipara, in the case of a narrow pelvis, or in twin pregnancies. To wait so long until the pulse becomes frequent and weak he holds absolutely wrong, although he admits that even under such circumstances favorable results are sometimes obtained. There is on the other hand no doubt that a number of cases of eclampsia get well, irrespective of what we do or what method of treament we adopt.

The prophylaxis, as well as the medicinal and expectant treatment deserve a high rank in the management of these cases, but owing to the great amount of space the consideration of these methods would consume, I