naria tents may be substituted for the cotton. By means of these tampons the cavity of the uterus is gradually distended, and at the end of the treatment the vagina and uterus form a single cavity. Vulliet has used this method in a number of cases of cancer, in three cases of sessile polyp, in two cases of large fibro-myomata, and in one or two cases of endometritis. The time requisite for full dilatation is very variable, in some three days, in others one month. E. H. G..

16. C. Braun: On the Manifold Utility of a Tri-form Forceps (Wien. Med. Woch., No. 9, 1886).-In Carl Braun's clinic, the forceps generally used is of the Simpson pattern, modified in certain particulars by B. himself. Under ordinary conditions, this forceps has been found to answer every requirement; but in difficult and high forceps cases accompanied by more or less pelvic deformity, it has often been necessary to terminate labor either by version or craniotomy. For a number of years B. has been accustomed to resort in the latter class of cases to one or another modification of Tarnier's axis-traction forceps, and with such favorable results that he has himself, by certain alterations, converted the typical Simpson into an axis-tractor, and this forceps he describes in the present paper. B. has become convinced that through recourse to axis-traction living children may be brought through deformed pelves in cases where, in the absence of an axis-traction instrument, craniotomy would be requisite. B.'s tri-form forceps-as he terms it--is 36 cm. long, the blades being 22 cm. At the lower angle of each fenestra are perfo

C. TIEMANN & CO.
FIG. 1.

rations where the handles are attached, making a double axis movable joint. The articulation is a perfect one, and the screws at the joints easily removable for cleansing. The hooks at the ends of the fenestræ

handles are for the insertion of a stirrup-shaped metallic plate which serves to fix the blades. The instrument, when used as in Fig. 1, is practically an unaltered Simpson, and may be used in typical forceps cases. Where high forceps are indicated, owing to the movable joints, the pelvic curve of the instrument may be altered from 7 to 10 cm. during the adaptation of the instrument, and later, during traction, this curve may

be reduced at will. The increase in pelvic curvature of the instrument is gained by (Fig. 3) linking the fenestræ handles under the lock. (It is

6.TIEMANN&CC.

FIG. 3.

sufficiently suggestive from the cuts how the pelvic curve of the instrument may be altered at will by lifting the fenestræ handles above or below the lock.) After use, the instrument may be readily taken apart by

GTIEMANN & CO.

FIG. 4.

removal of the two screws which articulate the fenestræ to the handles, and carefully cleansed. In B.'s opinion, this instrument will answer on every possible occasion when forceps are indicated.

E. H. G.

17. Blanc: Acute Hydramnios (Nouv. Arch. d'Obstet. et de Gynécol., March, 1886).—We record in abstract the following case on account of its rarity: C., æt. 23, of good family history and no acquired constitutional disease. One child at term, one miscarriage at six and a half months. In May, 1885, conceived for third time. In November, same year, acute bronchitis. The end of November, after working hard all day, experienced great pain in the lumbar region, extending to the abdomen. From this date the abdomen enlarged rapidly, and patient suffered from diarrhoea. She entered the service of Prof. Bouchacourt December 1st. Was badly nourished and weak. The abdomen greatly distended. Circumference at umbilicus 110 cm., above 98 cm., below 104 cm. Fluctuation very marked; palpation negative; fetal heart not audible; vaginal examination revealed no presenting part. Patient's urine loaded with albumin, no edema of lower extremities, heart hypertrophied--patient had hypertrophy of thyroid-respiration 60 ; temperature 40.3° C.; pulse irregular and 132; edema of the labia. In face of these extreme symptoms, labor was induced by perforation of membranes, and four litres liquor amnii, loaded with albumin, were obtained. Patient's condition immediately improved, and on palpation a presentation of breech determined. After a labor of moderate duration, a macerated fetus was delivered. Patient had an attack of septicemia, but eventually recovered.

The diagnosis of acute hydramnios is based on the group of symptoms-pain in abdomen, rapid increase in size of abdomen, accompanied by sudden rise of temperature, and increase of pulse rate and of respira tion. Ordinarily, in reported cases of the kind, vomiting has been a prominent symptom. In the present case, nausea alone existed. As for the etiology in the present case, hypertrophy of the placenta was the sole tangible factor. This organ was very large, distended with blood, thick to an unusual degree, weight of 1,200 gms., and 15 cm. in its longest diameter. Excess of pressure on the placental and umbilical vessels will account for the hydramniotic condition.

E. H. G.

18. Obermann: Three further Cases of Cesarean Section after Saenger's Method (Archiv f. Gyn., XXVII., 2).—This method has already been described at length in this JOURNAL, wherefore we simply note the saving of both mother and child in these additional cases. The total number of cases operated on by S.'s peculiar method, up to date, is thirteen, with nine recoveries. (The range of usefulness of Porro's mutilating operation is being slowly narrowed.)

E. H. G.

19. Krysinsky: A Case of Cancer of Mucous Membrane of Uterus (Ztschrft. f. Geb. und Gyn., XII., I.).—The herein reported case presents the following points of interest: 1. Great hyperplasia of the uterus, in a nullipara, resulting from endometritis and superadded carcinoma. 2. A glandular cancer affecting the entire endometrium, and spreading throughout the entire body of the organ, was limited here, not having at all extended to the neighboring pelvic structures. 3. The patient, when admitted to the clinic, was highly cachectic, and yet by careful treatment she regained her strength. 4. The hemorrhage ceased, although the uterine cavity was filled with semi-solid purulent matter, and the cervical canal was patent for the sound. 5. Notwithstanding the retention of these purulent products in the uterus, there was no evidence of sepsis, and the temperature remained normal. 6. Without apparent dilatation of the tubes, the ampullæ were closed, and altered into thick-walled cysts.

In the reported case, owing to the excessively narrow vagina, kolpohysterectomy could not be performed. Freund's operation was resorted to, and the patient died in a few hours from shock.

E. H. G.

ITEM.

PROF. LUDWIG BANDL, of Vienna, has been appointed Professor of Obstetrics and Gynecology at the University of Prague, to succeed Prof. A. Breisky, who has been called to Vienna, to occupy the chair vacated by the retirement, through ill health, of Prof. Spaeth.

IN the July number of this JOURNAL I described a new instrument (an aspirating applicator) by means of which the uterine cavity can be washed and medicines applied to its lining membrane, apparently with perfect freedom from danger, without the necessity of previous dilatation of the cervix. I shall now try to make good my promise of a more extensive description of this and other instruments and their uses.

Up to a very recent date, I have been a pronounced opponent to the practice of intrauterine injections, in consideration of the many fatal and lesser accidents which resulted from it in spite of the greatest care and the many ingenious devices which have been brought forward to overcome these evil consequences.

Since I have used these improved means, my opinion and my practice have undergone a great change.

As a result of the studies which I made to understand the causes of the defects of pre-existing instruments, I learned, as others have before me, that the forcible influx and the defective efflux were the accountable factors; that the controllable force was wholly on

the influx side, with a total absence of control for the exit. Hence the double canula with the aspirating power attached to the inner or outflow tube, as described in my preceding paper, sprang into existence. This has since been considerably modified and improved by me, so as to be well adapted to the purpose for which it was invented.

Molesworth's "double canula and bulb syringe" is certainly the most perfect apparatus for intrauterine injections antedating mine that has yet come to my notice. Thomas' describes it thus: "When the India-rubber bulb is squeezed, the fluid which it contains escapes from holes in the end of the canula, and at once returns through another tube, which lies alongside of it. Then, as the compression of the bulb ceases, a vacuum is created which sucks back every superfluous drop." This may, at first sight, appear to fulfil every indication for which my instrument is proposed. Yet this is not so. Though Molesworth's syringe may, and possibly does, remove every superfluous drop of fluid, this does not prevent the damage which would probably be caused by the injecting force (which is the same as in any other apparatus), and not by the few drops of the fluid which may possibly be left in the uterine cavity.

This syringe lessens, but by no means obviates, the dangers incident to intrauterine injections. The effect obtained by the use of my instrument can scarcely be called an injection, as it merely draws a column of fluid through the cavity.

It is not my desire to argue here whether intrauterine injections, as a means of intrauterine medication, are admissible and useful, or the contrary. Opinions naturally differ, and in few fields more than gynecology, which goes far to prove that this branch is yet in its infancy. Some consider intrauterine medication of any description entirely useless, while others rely on it too exclusively; some put their trust in pessaries, other deprecate their use, etc. Yet opinions change with the advent and comprehension of new means, as fashions change with the coming season.

I hope, therefore, that the reader will give the instruments here to be described a fair trial, unbiassed by previous or preconceived opinions.

At the risk of incurring severe criticism by those who entertain contrary opinions, I shall proceed to describe the instruments 1 "Diseases of Women," fourth edition, p. 272.