gans," and clearly proves the close relationship existing between these remote organs.

DR. JAMES R. CHADWICK discusses "Peristalsis of the Genital Tract;" DR. THEOPHILUS PARVIN contributes a paper on “Facial Paralysis of the New-born Caused by the Forceps;" DR. HENRY F. CAMPBELL writes at length on the "Genu-Pectoral Posture," showing the value of this position in impeded uterine reduction, and in the prolonged nausea and vomiting of pregnancy; DR. JAS. B. HUNTER enters into the causes, and, in particular, the prevention of "Mural Abscesses Following Laparotomy; DR. WILLIAM H. PARISH gives a clinical picture of "Pelvic Abscess in the Female," and its Treatment; DR. CHAS. JEWETT reports "Two Cases of Laparo-Elytrotomy," one of which was successful, and incorporates in his paper a sketch of the twelve operations of this nature thus far performed, with the result of six mothers and seven children saved.

Such are the contents of this volume. Our readers cannot afford to remain without a volume which contains so many contributions of interest and of value.

EGBERT H. GRANDIN.

cases.

ABSTRACT.

1. Kehrer: Cesarean Section (Archiv f. Gyn., XXVII., 2).—In a previous number (XIX., p. 177), K. reported two cases of Cesarean section after his method (for these cases and method, see this JOURNAL, Supplement, July, 1882), and in the present paper he reports two additional In one of these cases, the mother died of sepsis on fifth day, the child was saved; in the other, both mother and child saved. In the first instance, K. admits that the Porro method would have been preferable, because the woman had been long in labor, the membranes long ruptured, there was fever and foul discharge. Under such circumstances, the conservative section is contra-indicated. In general, however, he has reached the conclusion from his four cases that in every uncomplicated case the improved conservative section is indicated, whilst, where there are complications (fever, metritis, multiple myomas of fundus), the Porro method should be preferred. The conservative Cesarean section has now been performed seventeen times, by one or another modification (in six, Sänger's), with seven deaths. Of the seventeen cases, one (Frank's) ought not to be counted against the method, because the operation was performed on a patient already under deep shock from severe burns, There remain, therefore, sixteen cases with a mortality of 37.5%, and only four (25%) died of sepsis. The cases are few, but the figures are far better than from Porro. K. then proceeds to describe his method in detail (vide this JOURNAL).

E. H. G.

Attending Physician and Surgeon to the Woman's Hospital of Chicago.

THE still existing difference of opinion as to the origin, and especially as to the advisability of surgical interference in pelvic hematocele, induces me to report the following cases:

Mrs. Mary S, a well-formed, medium-sized negress, 30 years of age, applied at the Woman's Hospital, March 14th, 1886, suffering with a retro-uterine hematocele. She had been married twice; the first time six years ago, the last time about a year ago. No children. Had one miscarriage September 10th, 1885, at six weeks, brought on by heavy lifting. Passed several clots with what the attending physicians recognized as the ovum. Was in bed three weeks. She then got up, but was taken two days later with pains and hemorrhage, and went to bed for another four weeks. Flowed continuously, sometimes more, sometimes less, for three months, and afterwards intermittently up to the time of admission to the hospital. Had been subject to pain in back and both iliac regions, principally the right. Bowels obstinately constipated from the first. Defecation painful. Sensation of pressure or straining in the rectum, as from hemorrhoids. A book canvasser, she has been unable to attend to her business until the last three weeks, and since then so unsatisfactorily, and with such discomfort, that she was ready to undergo any operation that would afford relief. She had been treated by a number of physicians, each for a different disease, and wanted no more temporiz

1 Read before the Chicago Gynecological Society, June 18th, 1886.

ing. Her husband was clamoring for offspring, and wanted the tumor removed.

The general condition of the patient was quite good, and if she could have been kept idle and off of her feet for a year or two, she would probably have outlived the tumor, without an operation.

Upon examination but little tenderness was found, except in the left iliac region, where a few lumps the size of a walnut could be felt. A large, highly elastic body was felt per vaginam, reaching down nearly to the pelvic floor, and forwards so as to push the cervix up behind the symphysis. Uterus three and one-fourth inches. Per rectum the utero-sacral ligaments were felt to be separated, so that one reached straight, and the other diagonally across the pelvis. The mass could be pushed up until they were put upon the stretch, without causing much complaint to be made. Uterus and tumor were felt above the symphysis. The lumps in the left iliac region seemed continuous with the tumor. On the 18th of March, assisted by Dr. Frances Carothers, I attacked the cavity of the hematocele at what seemed its softest spot behind the cervix uteri. Getting no fluid with a hypodermic needle, I introduced a fine curved bistoury. Still getting nothing, I introduced a pair of dressing forceps into the minute opening, and tore the vaginal wall by expanding the blades, until I could introduce two fingers. But little hemorrhage resulted. Introducing the forceps into the puncture made in the cyst wall, I likewise tore it open until the middle finger easily passed through it. Still no fluid escaped. I introduced the finger, encountered an organized blood clot, broke it up all around the opening, and for a couple of inches above it, and brought out half a cupful of small black pieces. A copious injection of hot water brought away quite a quantity of the same débris, but nothing else. The resulting cavity was then washed out with a two-percent carbolic acid solution and a carbolated vaginal tampon introduced. At 5:30 P.M. the pulse was 72, and temperature 99° F.

March 19th, 9 A. M., pulse 72, temp. 99° F. Removed the plugging from vagina; 2 P.M., pulse 66, temp. 993° F. Irrigations of cavity with carbolic acid, two per cent, ordered to be used twice a day; 8 P.M., pulse 87, temp. 1014° F. 20th, 9 A.M., pulse 78, temp. 98° F. Ate oatmeal, milk, jelly and cracker; 1:30 P.M., pulse 84, temp. 99° F. Took rice, crackers, butter, and milk; 5:30 P.M., ate crackers, milk cake and sauce; 8 P.M., pulse 84, temp. 99° F. Able from this time to urinate without catheter. 21st, took a laxative, and thereafter had no more trouble with constipation. Temp., A.M., 984° F., and P.M. 99%° F. Ate turkey, potatoes, tomato, and ice-cream.

March 22d. Dilated the opening into the abcess with the fin ger, and directed the house surgeon to pass a finger into it at every dressing. A large quantity of débris, mixed with pus, came away at each dressing, and a little between. There was quite a little odor at the time of each irrigation, but at other times it

was scarcely noticeable. As the carbolic acid was slightly irritating to the vagina, I ordered the biniodide of mercury, 1:2,000, to be used for two days, and afterwards alternated with a one-andone-half per cent carbolic acid solution, each once a day. Pulse 72, temp. 2 P.M., 100° F.; 5 P. M., 991° F.

March 23d, temp., A.M., 100° F.; P.M., 1001° F. 24th, temp. 983° F., 99° F. Ate heartily of beefsteak, potatoes, and ordinary table diet; some pain in the evening, after the irrigation; temp. 1003° F.; tinct. opii deod. 40 drops. 25th, highest temperature 993° F. Ate heartily. 26th, there was a sudden discharge of a half-ounce of pus, accompanied by a sinking of the uterus almost to its natural position; temp. 99° F. 27th, 28th, and 29th, highest temp. 99° F., 98% F., 991° F., 983° F., 99° F. Up and about the room on the 29th 30th, temp., A.M., 981° F., P.M., 101 F. Considerable odor. 31st, temp., 10 A.M., 983° F. A blood-clot the size of a small walnut was passed. Having just read, for the first time, the article of Apostoli and Doleris, in the Archives de Tocol., for Nov., 1885, I reproached myself for my timidity in not thoroughly curetting the cavity at the time of the operation, and thus getting rid of this foul-smelling mass in advance. Finding the patient up and feeling quite well, I ordered her to bed and proceeded to scoop out the abscess with Thomas' dull curette. I went over every part of it, carefully and gently, without eliciting. any complaint from the patient, and found it still to extend above the top of the uterus at the left side. Upon using a one-and-one-half per cent solution of carbolic acid, she suddenly experienced such acute pain in the left iliac region, where the lumps were situated, that I thought I had made an opening into the abdominal cavity. The lumps, which had almost disappeared, became more prominent, bloating commenced and tenderness became marked. Pulse 70, temp. 97° F. Was given one-fourth grain of morphia hypodermically. 2:20 P.M., pulse 90, temp. 973° F. Great tenderness and bloating in left iliac region; another hypodermic injection. Slight chills; 7:20 P.M., temp. 98° F. Ordered irrigations of a one-per-cent carbolic acid solution to be commenced next morning.

April 1st. Pulse 78, temp. at 7:40 A. M., 983° F.; at 2 P.M., 993 F.; at 5:30, 1001° F. Tender and bloated. 2d, temp. A.M., 983 F.; P.M., 993° F. Purulent discharge. 3d, temp. A.M., 98 F., P.M., 100° F.; 5th, pulse 66, temp. 983° F. all day. No more tenderness. Ordered one-and-one-half per cent carbolic acid irrigations, alternated with biniodide of mercury 1:3,000. But little odor. 6th, used the irrigation myself, fourteen hours after a previous dressing. Detected no odor. A trace of pus, but no bloody débris. Pulse 72 to 90, temp., A.M., 98% F.; P.M., 100° F. Wanted to get up. 7th to 10th, temp. A.M., 98° F. to 99° F.; P.M., 100°, 100°, 100°, 99° F. 11th, temp. henceforth normal. Odor entirely gone. Up and about the house. 21st, discharge consisted of a little mucus in

the morning, probably from the cervix. The irrigation, one-andone-half per cent carbolic acid and 1 : 3,000 hydrarg. biniodide, had been kept up, as she was content to remain at the hospital, where her food and bedding were better than at her home. Upon examination, I found a lump the size of a small hen's egg just over the right sacro-uterine ligament binding the uterus; uterus three inches; abcess cavity collapsed. Pressed the finger into the opening and encountered a small canal leading upwards-too small for the passage of the finger.

April 28th. Returned for examination. No discharge, no odor. Feels well. Uterus movable. Still a small lump behind it and to the right. Examined also by Dr. Frances Carothers. Has menstruated normally twice since the operation, a few days ahead of time. No trouble with constipation.

May 8th. Still a little induration over right sacro-uterine ligament. Menstruated again normally, but four or five days ahead of her time.

June 5th. Induration less on the side, and now occupies a slightly lower position in the pelvis, extending from the point of puncture to the right sacro-uterine ligament. Menstruated two days ahead of time. Is canvassing as formerly, on her feet nearly all of the time.

The following points are interesting as summarizing the characteristics of this case:

1. The length of time from the occurrence of the hematocele to the time of the operation, about six months.

2. The method of opening the cavity, viz., by first tearing the vaginal wall and afterward the sac wall.

3. The absence of fluid in the tumor.

4. The breaking up the mass with the finger, without any immediate attempt at thorough curetting, or removal of the entire contents.

5. The complete disintegration and discharge of all bloody substance in thirteen days.

6. The absence of high temperature, 102° F. never having been reached.

7. The small amount of anodyne required-one dose (except the two doses to relieve the direct irritation from subsequent unnecessary curetting).

8. The toleration of strong antiseptic solutions. The vagina was the first to become irritated.

9. The absence of the usual amount of odor of such decomposing masses. The husband, who visited her frequently, thought he detected a very little odor on two or three occasions. The other patients in the ward experienced no inconvenience.