the occurrence of earthquakes, because philosophy has not yet been able to give a satisfactory explanation of their cause.

DR. S. C. BUSEY, of Washington, believes that there is some relation of cause and effect between maternal impressions and fetal deformities, and in support of this belief submitted the following propositions: first, any prevalent and current belief must be based upon an element of truth; second, in the physical world there is no effect without a cause, so it is likewise true in the world of life, that there can be no effect without a cause.

If there is one single case in which there is no probable doubt that an impression did produce the effect, the inference must be clear that similar cases may follow. And if there is precise correspondence between these impressions and the deformities, the affirmative of the question must be accepted as presumptively proven.

All the cases may be divided into four groups: 1. Those which come under the head of coincidences. 2. Impressions in which there are fetal marks, blemishes, with absence of correspondence. These two classes are constantly urged as showing that there is to relation of cause and effect, whereas Dr. Busey would regard hem as simply demonstrating that Nature does not always give us positive evidence.

The third class was that in which there was no previous mental impression and correspondence between the observation and fetal deformity.

The discussion was continued by DR. JOHN S. BILLINGS, of Washington, honorary member, who concluded his remarks with the statement that the best thing was to recognize our ignorance on the subject, to make experimentation where experimentation was available, and to collect such facts as might exist, and be content to admit that on this subject, as on many others, we do not know. The discussion was further continued by Dr. Goodell, of Philadelphia, who related a most remarkable case of deformity produced by maternal impression, and the discussion was closed by Dr. Barker.

On motion of DR. CHADWICK, of Boston, a committee of three was appointed to investigate and report on this subject at some subsequent meeting of the Society.

Second Day Afternoon Session.

DR. JOHN BYRNE, of Brooklyn, read a paper on

THE TREATMENT OF PROCIDENTIA UTERI BY GALVANO-CAUTERY.

Of the forms of uterine disorder of place, from which a large number of child-bearing women suffered, there is perhaps none which more urgently calls for relief than that of downward displacement. During the last fifty years especially, gynecologists have nearly exhausted the resources of surgery and mechanics in devising measures of relief with reference to laceration of the

perineum. It may be a very remote and indirect cause, but that the two conditions, laceration and prolapsus, can be etiologically associated in any other sense than simply to render the tissues less elastic and more passively yielding to the weight of the heavy uterus, cannot be admitted. Moreover, in quite a large proportion decensus uteri does not exist to any greater degree with laceration of the perineum than is commonly observed in most multiparous women. This injury, for other and obvious reasons, should be repaired; but the restoration, however perfect, can have no positive influence so far as uncomplicated prolapsus of the uterus is concerned, but vulvar protrusion will be retarded and the patient's condition to this extent improved, in case the displacement exists to a partial degree.

He was unable to admit that the perineum in health was a support; but, on the contrary, was fully in accord with Dr. Emmet on that point. It is not unreasonable to conclude, first, that kolpo- and perineo-plastic operations can affect uterine prolapsus only in so far as they create obstacles to vulvar protrusion; and, secondly, that only when amputation of a portion or of the entire cervix is added to such measures can we look for permanent or satisfactory results. The main object of the amputation is to lessen the size of the suspended organ and to reduce its weight. This is not, however, the whole or the most important gain obtained, or by any means a satisfactory explanation of the modus operandi by which the desired result is obtained; but to the inflammatory processes which necessarily follow such operations, and the tension of parts directly engaged in supporting the uterus, and in part often the whole pelvic diaphragm, are we to attribute the success met with by many surgeons, notably August Martin.

This last-mentioned clinical point was the sole object of the paper to which he would direct attention. He then related an illustrative case in which, three years subsequently, there was no perceptible change in the condition of the pelvic organs from that which was present when she was discharged cured. The woman had remained in good health, menstruation was normal and regular, and she was able to pursue her laborious occupation-that of a laundress-with perfect comfort. The entire womb and vesico-vaginal wall protruded before the operation. The remarkable improvement in this patient's condition, namely, double disappearance of both vesical and uterine prolapsus, was a direct consequence of amputation of the cervix with galvanocautery, and seemed to open up a wide field of inquiry as to the most probable and rational explanation of such results. He was well aware that a great many would promptly dispose of the question by attributing all that occurred to the combined influence of periuterine inflammation and cicatrization of the cervical stump, but with a total absence of every physical or rational symptom by which such pelvic inflammation was usually recognized, this explanation could not be admitted.

The whole number of cases of procidentia uteri so far treated by this method has been uine, and in three of these only has the cervix been removed-two on account of peripheral hyperplasia, and one with hyperplastic elongation. Of the other six, two required linear cauterization on the vesical, and one on both vesical and rectal walls.

Were he to venture an explanation, he would say that following partial amputation by galvano-cautery, some process analogous to ordinary inflammation is brought about through the agency of radiant heat, by which a permanent shrinkage of some, and perhaps complete obliteration of both blood-vessels and lymphatics for a considerable distance beyond the line of actual cauterization is caused, that a condensation of cellular tissue must necessarily also take place, and in this manner dynamic forces, which in health help to maintain the uterus and other parts in normal position, become completely restored or greatly modified. DR. GEORGE J. ENGELMANN, of St. Louis, then read a paper on

ELECTRICITY IN GYNECOLOGICAL PRACTICE.

With the exception of the work effected by a few specialists, notably Dr. Skene and Dr. Byrne, of Brooklyn, electricity in gynecology is in an almost chaotic state, and it has never presented any definite features. He wished in this paper to call attention to the faulty practice which had regulated the use of electricity heretofore; the false method, if method it could be called, which had caused the failure of electricity as a therapeutical agent in gynecology. The greatest errors which had been constantly made, and which give rise to failure, are an insufficient knowledge of the various instruments employed, lack of localization, concentration, and total want of doses and measurement, and also determination of the force and limitation of the intensity of the current by the sensations of the patient. The lack of exactness in the application of electricity was a feature which would strike almost any one in seeing the reports of cases. Operators had been in the habit of gauging its use by the number of cells, and the currents used had generally been too weak to be effective in gynecological practice. In a recent paper on this subject, written by Dr. Mundé, of New York, that acute observer had said that, so far as therapeutical results are concerned, the chief thing is to apply the poles in the proper spot, and not to use too strong a current.

Dr. Engelmann then gave a resumé of Apostoli's method of using electricity, and exhibited electrodes, battery, galvanometer, etc. He believed that the only definite contra-indication to the use of electricity was severe acute inflammation. He also made mention of a great variety of gynecological affections in which he had employed the agent with benefit.

Third Day-Morning Session.

DR. W. H. BAKER, of Boston, read a paper on

ELECTROLYSIS IN GYNECOLOGICAL SURGERY,

in which he restricted his remarks to the use of the galvanic current. The first topic was its use in the treatment of uterine fibroids. The method was first suggested by Dr. Gilman Kimball, of Lowell, who was aided in his work by Dr. Cutter. Dr. Baker employs needles very much smaller than those employed by Dr. Kimball, and has employed the galvanic current according to the following rules, and with marked benefit in many cases:

1. It should be used about a week before the menstrual period; 2. The patient should be under the influence of an anesthetic; 3. Electrolytic needles for both positive and negative poles should be used; 4. They should be sharp and thoroughly clean; 5. The needles should be buried in the tumor sufficiently near to each other so that when the current is introduced it will not be diffused to other parts. 6. The needles should not be too nearly approximated; 7. When both needles are properly placed in the growth, it matters not whether the positive or the negative needle is the internal one. 8. After insertion, a current of four to six cells is first used, gradually increasing to eighteen to thirty cells, the intensity being much more exactly regulated by the galvanometer; 9. The length of time from ten to twenty minutes, to be determined by the character of the pulse, which should be continually felt, and when found to be diminished in frequency below the normal, the current should be either discontinued or the number of cells decreased; 10. No interruption of the current during the application; 11. Gradual diminution of the current before disconnecting the electrode; 12. The current should be cut off before the removal of the electrodes; 13. The application should never be made at the surgeon's office and the patient allowed to go home after coming from under the influence of ether; 14. After the application, put the patient to bed, where she should remain for a week.

Dr. Baker also spoke of the use of the galvanic current in the treatment of chronic cases of inflammatory perimetric products. As long as there is any acuteness of the inflammatory process, it is hazardous to attempt manipulative interference. He believes that in electrolysis we have a valuable agent to assist absorption and promote cure. His experience, however, had been limited to a single case, but in which the result was so marked that he gave it in detail.

His conclusions were: First. That electrolysis is a useful agent in the treatment of certain cases of fibroid tumors of the uterus, as well as chronic circumscribed perimetric affections. Second. When applied to fibroid tumors of the uterus, electro-puncture is the most reasonable and efficient method. Third. In the treatment of fibroid tumors of the uterus by this agency, frequent applications are not necessary. Fourth. Cases of perimetric affections treated by this method should be selected with care in regard to the absence of all acute symptoms.

These three papers on analogous subjects, read by Dr. Byrne,

of Brooklyn, Dr. Engelmann, of St. Louis, and Dr. Baker, of Boston, were then before the Society for discussion, which was participated in by Dr. Chadwick, of Boston, Dr. Sutton, of Pittsburg, Dr. Hunter, of New York, Dr. Mann, of Buffalo, Dr. Byrne, Dr. Engelmann, and Dr. Baker.

DR. JAMES B. HUNTER, of New York, then read a paper on

PERSISTENT PAIN AFTER ABDOMINAL SECTION, in which he spoke first of causes of pain before the operation, referable, first, to diseases of the ovaries and tubes; and, second, to diseases of the peritoneum. He then spoke of cases where the pain was referable to disease of the ovaries and tubes, such as distention of the tube, prolapsus of the ovaries, etc. He then directed attention to the cases of persistent pain due to peritonitis, which may be acute and limited to the ovaries and tubes, and occur at regular intervals; which may be subacute, attended with constant pain, the patient passing rapidly into a state of neurasthenia, etc. In chronic pelvic peritonitis it has been stated that pyo-salpinx would produce pain, but that pain was not produced by hydro-salpinx. Pain might be produced by traction through adhesions, etc.

If after the operation there is no marked relief from the pain at the expiration of two years, the operation may be pronounced a failure, so far as pain is concerned. The causes of such failures may be, first, former peritonitis; second, peritonitis following the operation; third, some defect in the abdominal wall, such as ventral hernia, etc. Dr. Hunter believes that after Tait's operation many of the patients still suffer pain long after they have passed out of sight. It becomes a question as to whether disease of the tubes may not be secondary to local peritoneal inflammation.

His conclusions were, first, that all cases of abdominal section should be carefully followed up and made the subject of inquiry for at least two years after the operation. Second, that peritonitis present in any degree should be treated as much for its remote consequences as for its immediate dangers. Third, that secondary operations are generally of no avail, only occasionally afford temporary relief, rarely effect a cure. Fourth, that a guarded prog

nosis should be made in all abdominal sections for the relief of pain.

The paper was discussed by Dr. Skene, of Brooklyn; DR. Sutton, of Pittsburg; Dr. Wylie, of New York; Dr. Battey, of Rome, Georgia; Dr. H. P. C. Wilson, of Baltimore; DR. Mann, of Buffalo; Dr. Johnson, of Washington; and the discussion was closed by Dr. Hunter.

DR. JAMES R. CHADWICK, of Boston, then read a paper on

THE BLUE DISCOLORATION OF THE VAGINAL ENTRANCE AS A DIAGNOSTIC SIGN OF PREGNANCY.

It was based on the examination of four hundred and forty