on a dog. The blood pressure remained stationary during the narcosis. On spectroscopic examination of a few drops of bloodtaken from the animal, the two lines characteristic of the absorption of oxyhemoglobin were found. Hence the oxygen, with this mixture, remains in its normal combination in the blood, and the nitrous oxide circulates possibly in a loose chemical combination by absorption in the plasma.

ZWEIFEL (Erlangen) calls particular attention to the practical value of this communication. The chemical preparation of the gases is not so difficult as might appear. The cost, too, is proportionately small. The price of two hundred and fifty litres-a quantity sufficient to keep a parturient woman anesthetized for several hours-is five marks (about $1.25). Z. likewise lays stress on the prompt effect, the freedom from danger, the rapid return to complete consciousness, generally after three inhalations of ordinary air.

WINCKEL (Dresden) calls attention to the fact that the statement made by the author of the paper that Klikowitsch's experiments had thus far not been imitated are not borne out. He (W.) had employed nitrous oxide in more than fifty cases at the Dresden Maternity (see "Sitzungsbericht aus der Dresdner gynäkologischen Gesellschaft," Centralbl. f. Gyn., 1883, No. 10). Dr. Tittel had reported on it at the time. The results then obtained quite corresponded with those of the author of the paper. He does not think it necessary that the gas should be inhaled through a mouthpiece covering the nose likewise. The ingress of atmospheric air through the nose does not diminish the influence. The parturients prefer a simple mouth-piece. W. has also tried the mixture of the gases in town practice. For the transportation he made use of large rubber cushions imported from St. Petersburg. But they soon became defective after the gas was stored in them, and could not be repaired.

The

DOEDERLEIN (Erlangen) observed in reference to the last remark that bad material in the cushions was probably the cause. balloon employed in Erlangen was now in use for more than a year and a half without having become defective.

NIEBERDING (Würzburg) read a paper on

POSTERIOR PARAMETRITIS AND ITS SEQUELS.

The author expressed his surprise that so little had been published during the last few years about parametritis posterior-a disease which is so frequent that he has met with it in ten per cent of his private practice, and which is followed by grave sequels. He thinks that the reason therefor is to be sought in the growing operative tendency of gynecologists, and their greater interest in that branch.

As regards the source of parametritis posterior, he shares the view of Schultze, namely, that it is rather frequently of puerperal and still more frequently of non-puerperal origin. The first onset of the affection is usually not readily elucidated, since it is not marked by either violent symptoms or high fever. The beginning is more subacute, the whole course insidious. The symptoms in

crease but gradually, and may, indeed, become very intense, as for instance, the sacralgia and violent attacks of pain during defecation.

In the puerperium, parametritis posterior arises probably by infection of lacerations into the recto-vaginal septum, although the patients claim to have observed the first symptoms a long time after the confinement. In non-puerperal cases, the subjects are usually girls or women who have suffered for years from grave anemia, menstrual anomalies, sacralgia and abdominal pains, and obstinate constipation. N. would not decide whether the irritation here by the accumulated feces, and infection possibly of rhagades caused by distention of the rectal mucous membrane, or a primary disease of the uterus, and especially of the endometrium, is to be looked upon as the first cause. As regards the sequels of the atrophy of the folds of Douglas on the uterus and its posi tion, the author does not agree with Schultze as he does with reference to the etiology. While the latter writer holds that the fixed, acute-angled anteflexion is the most frequent result of the atrophy of the folds of Douglas, N. thinks that there is quite as often a retroposition with a more or less marked retroversion-a condition which S. declares to be rare. This requires a fixation by larger masses of exudation, which reach high up on the posterior wall of the uterus. The retroverted position may be aided by a certain rigidity of the uterus, due to chronic states of infiltration.

As an instance how important the atrophic conditions of the folds of Douglas and the parametric cellular tissue surrounding them may become, N. relates the following case:

A young lady, aged 17, affected for two or three years with pronounced chlorosis, has suffered for the past year from increasing sacralgia and abdominal pains, obstinate constipation, and occasional amenorrhea. Uterus strongly retroverted, immovable, fixed to the posterior pelvic wall by a hard flat tumor, which crowded the posterior fornix downward, and gradually decreased at the sides of the uterus. Treatment produced no result. The patient died of marasmus in consequence of a supervening peritonitis. At the autopsy an exudation was found embracing the rectum high up, contracting its calibre to the size of a uterine sound, and drawing the uterus, the broad ligaments, and the ova ries strongly backward. The uterus was retroverted, but only by the extra-peritoneal adhesion.

KUESTNER (Jena) called to mind that Schultze likewise traced a portion of the retroflexions to parametritis posterior. When the acute stage has passed, the muscles of the ligaments have so deteriorated that they allow the vaginal portion to sink, and thus pave the way for the formation of a retroflexion. K. also explained the mechanisms, not hitherto known, by which retroversions and retroflexions arise. (The reader is referred to K.'s paper on the conditions causing the origin of retroflexion, etc., in the Zeitschr. f. Geb. u. Gyn., last issue.)

NIEBERDING (Würzburg) again briefly explained the origin of retroversions after parametritis. The exudation beneath the peritoneum extends upward. When it subsequently shrinks, the uterus is drawn backward and fixed.

SCHATZ (Rostock) thinks that Kuestner's and Nieberding's views are not opposed, but supplement each other.

FROMMEL (Munich) is of opinion that the processes described by N. are generally not purely parametritic, but also perimetritic, and, partly running their course in Douglas' pouch, lead to adhesions in the latter.

W. L. FREUND (Strassburg) holds that the case cited by N. was not one of parametritis posterior. This disease, with the formation of an exudation, can only develop laterally, but not so high up as in that instance. He thinks it absolutely necessary that in such cases the anatomical relations should be exactly determined, lest we retrogress again in our knowledge of these forms of disease. H. W. FREUND (Strassburg) read a paper on

THE MINUTE ALTERATIONS OF THE NERVOUS APPARATUS IN THE PARAMETRIUM DURING SIMPLE AND PARAMETRITIC ATROPHY.

When the father of the speaker recently elaborated the clinical and anatomical history of parametritis chronica atrophicans, he was allotted the task of examining the condition of the nervous apparatus as far as it entered into this question. The one here to be considered is the ganglion cervicale uteri or the ganglion of Frankenhaeuser. It forms a complex of sympathetic and spinal nerve-fibres passing to the uterus, of numerous ganglion cells, of peri- and endoganglionic connective tissue, and a pretty extensive vascular plexus. It is pre-eminently prone to become diseased by this variegated composition, but also by its exposed location, in the lateral walls of the vagina and in the connective tissue surrounding the sides of the cervix as far as the rectum, where it is liable to be injured by many processes starting from the neighboring large pelvic organs. Its macroscopic structure has been well described by Frankenhaeuser. Microscopically it appears as an organ with distinct outlines formed by a moderately thick envelope of connective tissue through which the nerve twigs pass to the uterus. Each of the polygonal ganglion cells, most of which have two processes, is surrounded by a fibrous ring, formed by the condensation of the connective tissue which is otherwise delicate and provided with numerous nuclei. In an ammoniacal carmine solution, the cells take a handsome stain. The nerves are to a great extent broad trunks with double contours, having a characteristic wavy course. Interspersed here and there are ganglion cells, but only up to a short distance from their entrance into the uterus.

The alterations found in the ganglion during pregnancy are briefly the following: augmentation of all the nervous apparatus, enlargement of the entire ganglion to from one and a half to two times the original size. The connective tissue in the adipose portion has wider meshes, and is otherwise more plentiful. The con

nective tissue envelope of the several ganglion cells approaches the latter more closely. The cells themselves are enlarged, thickened, increased in numbers. The nerve twigs, much widened and augmented, have more numerous ganglion cells than normally. The blood-vessels are broadened, multiplied, and well filled. Therefore, allt he constituents of the ganglion have undergone hyperplasia during pregnancy and have obtained a new accretion of substance-a condition which might have been expected, since the ganglion and its nerves, as is well known, grow during pregnancy to twice their size and beyond.

On normal puerperal genitals, we find alterations of a decidedly retrogressive nature. The nerve twigs and ganglion cells are here and there, sometimes to a greater or lesser extent, filled with a blackish granular mass which a higher power resolves into dark granules or spherules. This is a development of fat. The centrally situated cells of the large main ganglion seem to remain free from the fatty metamorphosis. The latter evidently serves to remove the surplus of the nervous substance which became hyperplastic and new-formed during pregnancy; to restore the status quo ante. Herein lies, in part, the disposition to the simple so-called puerpéral atrophy which forms, not alone in the train of rapid wasting diseases, but mainly after a quick succession of deliveries and lactations and grave puerperal affections, and is frequently followed by hysterical disturbances. Aside from a more marked prominence of the peri- and endoganglionic connective tissue in bundles and cords, we find in this condition also a filling with fat granules of the ganglion cells which are diminished in size and number, and their polygonal shape changed into a round one. Nuclei and nuclear corpuscles are not always clearly demonstrable. Besides, we observe here and there glossy small flakes, perhaps the remains of cells or nuclei. The nerve twigs, too, which are decidedly narrowed, show depositions of fat. Here, therefore, the removal of substance by fatty degeneration has proceeded farther, much beyond the normal extent. The recovery from the affection we might imagine to take place in this way, that the physiological process of partial fatty metamorphosis of the nervous elements in the puerperium, under the influence of phthisis, lactation, puerperal disease, etc., first remains stationary, then advances, and leads to simple atrophy. There is nothing remarkable in the circumstance that nervous symptoms appear during the destruction of a portion of the elements belonging to a division of the nervous system which is in direct connection with the sympathetic and spinal systems.

It is altogether different with the nerve apparatus in a second form of atrophy of the pelvic connective tissue, the so-called parametritis chronica atrophicans. In this form, before the affection has attained its highest degree, we find within the cicatricial, sclerosed connective tissue the nerves narrowed and compressed,

the outline of the ganglion indented in many places, contracted throughout and drawn out. The interganglionic connective tissue makes the impression of a mass dominating the plexus almost uniformly. The ganglion cells are shrunken, have lost their polygonal shape, and are throughout pigmented a yellowishbrown color; in many of them the nucleus can only be recognized with difficulty. The emerging nerves are not seriously damaged in this stage of the disease, but they are in the following one, in which they are only sparsely present, narrow, devoid of ganglion cells, here and there disappearing as if broken off in the cicatricial tissue into which the peri- and endoganglionic connective tissue is transformed. In this extreme degree the outline of the ganglion is next to invisible; the ganglion cells are compressed, much sparser than normal, and invariably pigmented yellow. Here we have, therefore, a cirrhotic process-a condition which is of greater interest both in a patho-anatomical and in a clinical respect. The apparatus which supplies the bulk of the pelvic organs with nerves of every functional importance is affected with a grave progressive disease leading to the destruction of its most essential elements-the ganglion cells and a portion of the nerve fibres. It is very probable that the focus lies in the general nervous system which, first irritated by the proliferating connective tissue, becomes diseased, and finally destroyed, and by extending along direct routes causes symptoms in the spinal, sympathetic, and cerebral systems. For some definite forms of hysteria-namely, those occurring in the course of a parametritis chronica atrophicans (these have been minutely described by the father of the speaker), but for them alone-F. believes that disease of the ganglion cervicale uteri has been demonstrated as the In reply to the remark that quite recently in the psychiatric section doubt had been expressed as to the importance of the ganglion cells as central organs, and that when they were deprived of that rôle the correctness of the above explanation would be put in question, F. stated even in that event the above-mentioned alterations of the nerve fibres might well lead to the symptoms in other nerve regions.

cause.

(To be concluded.)

REVIEWS.

MANUAL OF THE DISEASES OF WOMEN, being a Concise and Systematic Exposition of the Theory and Practice of Gynecology. For Use of Students and Practitioners. By CHARLES H. MAY, M.D., Late House Physician, Mt. Sinai Hospital; Assistant to the Chair of Ophthalmology, New York Polyclinic, etc. Philadelphia: Lea Brothers & Co., 1885, pp. 357.

The title of this little book is a misnomer. Had the compiler