to the learned societies and listen to their discussions, we are surprised at the diversity of opinion. As there is no fixed plan of treatment, the practitioner can follow almost any course which strikes his fancy and find respectable authority to confirm him.

The radical and the conservative methods in the treatment of the retention of the placenta and membranes have their advocates in every country. It is seriously considered by some that the safety of the patient and the comfort of the physician is best served by the immediate removal of the secundines after the expulsion of the ovum; in every case where it can be done without force sufficient to injure the woman. The curette, in skillful hands and with the proper patient, is a means of good after abortion; yet under other circumstances it is an instrument of danger. In the text-books we find remarkable unanimity in recommendation of the expectant plan, while the recent contributions to medical literature favor immediate removal.

Symphyseotomy During Parturition.—(An. de Gen. et d'Obs.) Dr. Spinelli says a well-developed fœtus at term can be delivered after symphyseotomy has been performed, through a contracted pelvis, whose true conjugate diameter is only 2.5 inches. At present embryotomy or Cæsarean section is almost invariably practiced for this measurement; the mother does not suffer any permanent damage if strict antisepsis be enforced and the divided pubic bones unite by first intention. The essential features of the operation do not jeopardize the child, the dangers incurred by them being solely due to the maneuvers needed for extraction. He describes twenty-four cases in which division of the symphysis pubis was resorted to during labor. In these, all the mothers and twenty-three of the children were saved. Dr. Spinelli strongly favors symphyseotomy during labor in cases of contracted pelvis.

Chronic Endometritis-Treatment.-(Med. Sum.)-Philippeau treats this disease by drainage and the application of mild caustics and astringents to the endometrium. Iodized phenol may be used at the beginning, though tincture of iodine is to be preferred. Both of these remedies are to be applied by

means of an applicator and cotton; this is allowed to remain in the uterine cavity a minute or longer and then carefully withdrawn so as not to displace the eschar in process of formation. A tampon of cotton saturated with tannin and iodoform may now be placed against the cervix and the application is complete. The patient should remain quiet the remainder of the day, and after the tampon is removed the next morning, a vaginal injection of water at a temperature of 113 F. should be used. These applications should be repeated every four days of iodized phenol until the uterine discharge nearly or quite ceases, when tincture of iodine should be substituted and continued for weeks, or even months. The cause must be removed if discoverable and the cervix must be freely permeable.

The Menopause is discussed by Theophilus Parvin (Am. Lan., April). He says it is rare for a woman to pass through this period without some suffering or physical derangement. Celibacy lessens the liability to disorders. The chief troubles have their origin in blood plethora and nervous derangements, but it is not a dangerous period as popularly believed.

The Habitual Use of Opium in the Pelvic Troubles of Women. (Md. Med. Jour., March.)—The general practitioner is accused of making opium slaves by so frequently resorting to its use. Marie Werner (Ann. Gynec. & Ped., Feb.) also protests against its use, urging the more rational procedure of treating the cause in cases of painful menstruation. Its use after pelvic operations should be discouraged. It produces and increases constipation, and thereby eventually increases the pain which it temporarily lulls. In patients of the uric acid diathesis, opium tends to store up the acid.

The following are selected from the Section on Obstetrics, A. M. A., at Detroit:

A Report of Experiments Germane to the Subject of Abdominal Supporters after Laparotomy.-By Robert T. Morris of New York. The author gives the results of his experiments upon rabbits, going to show that in laparotomy operations the structures should be united separately. It took only seven days

for the united peritoneum to become as strong as normal; about fourteen days were required for complete repair of muscular and fibrous walls; the skin becomes of full strength at the end of eighteen days. He argued that it was absurd to apply abdominal supports after laparotomy to prevent hernia if the surgeon had done his suturing aright. Dr. Currier had long thought the ordinary abdominal supporter of little value after laparotomy. He applied, however, a broad strip of rubber adhesive plaster, and believed it gave greater security against hernia.

Colpo-Perinneorrhaphy.-A paper read by Dr. Edward W. Jenks of Detroit. He gave some general considerations of tears of the perineum and their repair, and then described the method of operating he had practiced for fifteen years or more. He said four important things were to be attained in secondary operations upon the perineum (1) To repair the loss of power and function of the lower part of the rectum and vagina. (2) To restore the normal sustaining quality of the posterior vaginal wall for the anterior vaginal wall and bladder. (3) To provide as much support for the uterus as the perineum naturally gave. (4) To cure the many distressing symptoms of which these patients complained. Any surgical procedure which did not accomplish these results was not successful.

To secure the best results it was necessary that the skin flap extend as high within the recto-vaginal septum as there were signs of slack or redundancy of the posterior wall. In his operation, unlike most others, the first two sutures were the longest and most important. The first entered half an inch from the commencement of denudation and came out where the denudation ceased above.

Ovariotomy During Pregnancy.-Dr. W. H. Myers of Fort Wayne reviewed this subject critically. Among the methods recommended were non-interference, puncture of the cyst, Porro's operation, and ovariotomy. Objections to all but the last method were given, especially to the first two.

Delivery Through the Abdominal Walls vs. Craniotomy.—Dr. Geo. J. McKelway, of Philadelphia. The author thought

craniotomy or embryotomy justifiable only when the child was dead or a hydrocephalic monster. The need for an early examination in pregnancy was emphasized. The paper was discussed by a number, most of whom agreed with the author. Dr. Rohe thought each case should be decided upon its own merits.

Impairment of the Voice in Female Singers Due to Disease of the Sexual Organs.-Dr. C. H. Legnard of Detroit. In a paper by Von Klein of Cleveland special stress was laid upon disease of the ovaries in causing change of voice, whereas the author thought disease of the uterus the principal cause either in itself or as productive of ovarian change. He attributed the laryngeal trouble to reflex action, tracing the connection through the sympathetic system supplying the uterus, to the pneumogastric, and finally to the spinal accessory supplying the larynx.

Hysterical Mania as a Complication of Gynecological Cases.Dr. Ely Van de Warker of Syracuse. The author believed ten per cent. of females under 45, inmates of asylums, could be restored to society by proper treatment and removal from the influence of the insane. Removal was essential on account of the imitative tendency of hysterics. He related some cases of hysterical mania cured or greatly improved by gynecology, and advocated reform in the appointment of asylum superintendents so that men who have a knowledge of gynecology and other specialties can give inmates the benefit of treatment from those trained in medicine aside from hospital experience.

Influence of Parturient Lesions of the Uterus and Vagina in the Causation of Puerperal Insanity.-Subject of paper by Dr. Geo. H. Rohe of Catonsville, Md. Four cases were reported. Two of the cases after laparotomy and removal of the uterine appendages recovered their normal mental condition. The other two cases, both of five years duration, in a condition of partial dementia, were very much improved. He concluded: (1) Puerperal insanity is in the majority of cases at least, an infective psychosis. (2) Without rejecting the influence of other factors, such as heredity, anemia, exhaustion, mental shock and distress, careful observation will show that few

cases of puerperal insanity occur without preceding or coincident puerperal infection.

The reasons for this opinion are summarized thus: (1) Puerperal insanity occurs in the great majority of cases within the first ten days after delivery, about one-half in the first five days, the same period during which puerperal infection usually occurs. (2) It is usually accompanied by elevation of temperature and other evidences of febrile disturbance. (3) The clinical form in which puerperal insanity manifests itself is, in the majority of cases, that of acute delirious or confusional mania. Depressive states are rare except as secondary forms; that is, the most frequent condition is one most closely resembling febrile delirium. (4) The death rate is much higher than in simple mania. Death occurs from exhaustion with high temperature and rapid pulse. (5) Post-mortem examinations have shown grave involvement of the pelvic viscera. (6) Examinations of the pelvic organs during life, show lacerations of the perineum and cervix uteri. As secondary conditions, are found intra-pelvic (peritoneal) inflammations and consequent abnormal locations, fixations and congestions of the uterus, tubes and ovaries. (7) The results of operations seem to show that removal of local sources of irritation increases the chances of recovery from the mental disease.

Officers elected for the ensuing year: Chairman, Dr. John Milton Duff, Pittsburg; Secretary, Dr. M. B. Ward, of Topeka; Executive Committee, Drs. Montgomery, Joseph Taber Johnson, and Eastman.

SPECIFIC IRITIS.

Read before the West Tennessee Medical and Surgical Association,

BY J. F. HILL, M.D., MEMPHIS, TENN.

It has been estimated by Noyes that at least fifty per cent. of cases of iritis are caused from syphilis. Iritis, from syphilis, may come in a few weeks after the primary lesion, or it may come among the later phenomena of the secondary stage. The case that I wish to report is a variation from the general rule; hence its interest to both the general practitioner and oculist.

Some time since I was out of the city to see a gentleman,