bility of the existence, not only of pelvic cellulitis, but pelvic he matocele and extrauterine pregnancy was considered and discussed.

The verdict then, as stated, was pelvic cellulitis, with possible pregnancy. The cellular inflammation might explain all of the localized swelling, but the pronounced symptoms of shock and great pelvic pain were suspicious of either hematocele or extrauterine pregnancy.

No doubt the faradic electrical current killed the fetus, for its size at the time of its expulsion corresponded to its development at the time the agent was so vigorously employed.

Cases of interstitial tubal pregnancy no doubt exist; and it is also true that an ovum so located may be forced within the uterine cavity, and be delivered in the natural way. A number of such instances have been reported, some of them being reliable. But as the conclusive proof, in some of them at least, is wanting, the true condition remains a matter of dispute. It is not unfair

to say that not a few of these cases have been mistakes of diagnosis, the ovum all the time having been within the uterine cavity.

Dr. Lenox Hodge suggested, and successfully put into execution, the plan of dilating the uterine canal in a case of recognized interstitial uterine pregnancy, and then breaking the intervening wall with the fingers, so that delivery was effected in the ordinary way. Whether this case of Dr. Trush was one of tubo-interstitial pregnancy, I think, is very doubtful, and I believe my friend does not feel positive with his diagnosis. That position taken is largely assumed on account of the lateral pelvic tumor or swelling, which remained for awhile, and then disappeared.

May not all this be explained on the ground that it was inflammatory, and that it subsided in time; the treatment, even the electricity, assisting in the favorable change?

Dr. Palmer added that his criticism of the diagnosis proposed was based upon a full history of the case as read by the essayist. He had no intention of criticising the treatment, which necessarily was based upon the diagnosis of the case at the time it was instituted. Under the same circumstances, he himself might have used the electrical current.

In reply to some of the remarks made, he would say that it is by no means impossible for intrauterine pregnancy to continue, the fetus in the mean time developing, when uterine hemorrhage, more or less severe, does occur at irregular intervals from the beginning. Quite recently he had delivered a woman of a fetus of over five months' development, wherein hemorrhage, at times quite severe, had continued since the second month of gestation. There was no disease of the cervix.

Again, it is said that the pulsation of the lateral tumor was indicative of conditions other than inflammation; but a peritoneocellulitis does at times pulsate most distinctly.

Notwithstanding the symptoms at the onset were suspicious of a hematocele or extrauterine pregnancy, they were not inconsistent with the ushering in of a pelvic inflammatory attack.

DR. GILES S. MITCHELL said he could not agree with the opinion expressed by the last speaker, that the case reported was simply one of intrauterine gestation. All of the symptoms of pregnancy were present save absence of menstruation. The patient continued to menstruate regularly and copiously. Normal pregnancy

always arrests the catamenial flow. He was well aware that cases are reported of women who menstruate regularly during pregnancy, but in all such cases the flow is scant, and continues only during the early months. However, in the case reported, the woman was the mother of several children, and during all previous pregnancies menstruation was arrested. Extrauterine gestation during the earlier months is extremely difficult of diagnosis. The case, as reported this evening, however, manifested all the signs, both objective and subjective, of tubal pregnancy. The essayist was certainly to be congratulated upon the happy result of his treatment. The method of faradization employed was simple, safe, and efficacious.

DR. WRIGHT confessed that, although the case was not devoid of interest, it did not strike him very forcibly as an instance of extrauterine pregnancy. In his opinion it was simply a case of ordinary intrauterine pregnancy, complicated with either a pelvic cellulitis or hematocele. There was nothing extrauterine about it. DR. WENNING remarked that, although there were some points about the case which rendered the existence of extrauterine pregnancy doubtful, he was not so willing to exclude this possibility so peremptorily as the previous speaker had done. The gentleman who had reported the case was sufficiently well known to the members that he did not jump at conclusions very hastily, and some of the symptoms, especially in the latter part of the history, were of such a character as to render the existence of an extrauterine pregnancy at least probable. Perhaps it was just the lucky termination of this case in an accident which ordinarily is of exceeding gravity, that led others to doubt the correctness of diagnosis. The speaker would admit that he had always looked upon the conversion of an extrauterine pregnancy into an intrauterine one, by the application of the faradic current, as highly problematical, and yet it seems that in the case reported just this point was brought out with the greatest clearness. The essayist stated that "the right horn and its vicinity were decidedly flat and devoid of all abnormal sensibility," whilst on the left there was "a tumor, firm, indistinctly elastic, and about the size of a fetal head." This asymmetry of the uterus disappeared after the repeated applications of the electric current, and the right side then showed the same degree of development as the left side of the uterus. The essayist assures us that this difference in contour was not apparent, but real. It must also be remembered that with the appearance of the outline of the ordinary, symmetrical form of a pregnant uterus, the symptoms of extrauterine fetation disappeared. The earlier symptoms in the case might just as well have been due to a pelvic cellulitis or an hematocele, as suggested before, but this fact of subsequent swelling of the right side of the uterus would prove most conclusively that the fetus had descended from near the tube into the uterus.

DR. TRUSH, in closing the discussion, said he had already stated in the report that the idea of an interstitial pregnancy did not occur to him until after the second series of electrical applications, when he discovered those very marked changes both in the leftside swelling and in the right horn of the uterus. Being unable satisfactorily to account for these manifestations upon any other supposition, he concluded that this variety of pregnancy must have been present. The fact that no hemorrhage took place, and that the abortion did not occur until nearly three and a half.

months later, had seemed to him conclusive that for the time being the placenta had retained its original attachment, to be severed later by the gradual process of fatty degeneration. Once the entire ovum a foreign body, it was expelled. In the mean time the tubo-uterine orifice had doubtless suffered a progressive dilatation, which, however, judging from the phenomena he witnessed at the time of the abortion, need not have been very large, viz., the cervix had been just fairly passable for two fingers when the ovum came away, and he was much surprised at the occurrence with so limited a degree of dilatation; it was, of course, owing to the excessive flaccidity of the sac that the expulsion at this early moment was rendered possible. Something of a similar condition might have existed in the ovum at the time of the supposed transposition of its membranous portion and contents from the tube to the uterine cavity.

It had been suggested by one of the speakers that the changes alluded to might have been the result simply of absorption of an inflammatory exudation upon the left, and that the uterus, in consequence of such disappearance, had seemed larger than before. He could not accept this explanation as either satisfactory or probable, for, whilst it might account for the decrease in the leftside swelling, it failed entirely to explain the sudden enlargement upon the right; it should not be forgotten that he had repeatedly palpated the region of the right horn, and had found it flat and comparatively undeveloped prior, and very much larger after, the treatment mentioned. Neither should the fact be ignored that the patient had menstruated profusely in July, and that the flow was alarmingly profuse in August, and yet no abortion took place. He wanted to know if it were thought at all probable that these copious hemorrhages could take place and not result, at such early period of gestation, with a normal location of the ovum, in abortion. He thought not. After all, interstitial pregnancy_converted to normal, intrauterine was not such a rare event. Dr. Garrigues had been able to find, aside from the case already cited, ten others of this character in the medical literature.—Am. Gyn. Soc. Rep., 1882. Dr. McBurney had had such a case.-New York Med. Jour. March, 1882. Dr. Mundé had seen another.-AM. JOUR. OBS., vol. XII., p. 330, and in the same paper this writer referred to three more instances of this kind, viz.: one each by Poppel, Spiegelberg, and H. Lenox Hodge.

A GYNECOLOGICAL CABINET.

DR. WENNING exhibited a 'gynecological cabinet which he had lately devised, in company with Dr. Geo. E. Jones, and which he had found to form the most convenient, compact, and cleanly receptacle for instruments, medicines, etc., that he had thus far seen. In outward appearance it resembles a lady's writing desk, the upper portion covered by a roll top, concealing the bottles and jars which contain the substances for local medication, whilst the lower portion consists of four drawers and a side closet for instruments, cotton, basins, etc. When the roll top is thrown back, a number of small drawers and shelves, and underneath these three rows of bottles (one dozen tinctures and one dozen salt-mouths) with intervening space for jars, etc., are brought to view. The tiers containing the bottles, etc., may be drawn forward separately so as

to bring the latter conveniently within reach. Below these there is a large slide or table, covered with heavy French plate glass, which may also be drawn out to hold such instruments, etc., as are just then in use. The smooth, polished surface of the glass prevents any stain by blood or chemicals, and may be easily cleaned. The speaker added that he had now used this cabinet in his daily office practice for several months, and had found it to serve admirably the purpose for which it is intended.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF LONDON.

Wednesday, October 6th, 1886.

'J. B. POTTER, M.D., President, in the chair.

Specimens-The following specimens were shown: 1. Dr. Malins. A dermoid ovarian cyst.

2. Dr. Lewers. I. Microscopical sections of a uterus affected by malignant disease.

II. A fetus from a ruptured tubal cyst successfully removed through Douglas' pouch.

3. Dr. J. Phillips showed an ovum expelled thirty-four days after conception.

4. Dr. R. Boxall exhibited the thoracic viscera of a woman who died in childbed with symptoms of pulmonary thrombosis, due to dislocation of the heart into the left pleural cavity.

5. Dr. W. Duncan and Mr. W. B. Sutton showed the ovaries and tubes from a case in which there was a hematocele due to rupture of the left ovary.

Also a pair of ovaries removed for the cure of dysmenorrhea.

FOUR CASES OF RUPTURED UTERUS.

DR. G. SWAYNE gave four cases of ruptured uterus occurring in his practice. Two were incomplete and two complete cases of rupture. The first occurred about the middle of utero-gestation, and was not clearly traceable to any accident. The uterus appeared to have given way during the effort to expel a putrid five months' fetus. The woman died undelivered and a laceration was found in the anterior wall of the uterus, through which the child had passed, so that it lay between the uterus and bladder in a pouch formed by the peritoneum reflected from one to the other. In the second case, labor had been induced at eight months, and the rupture had apparently arisen from a transverse presenta

tion and the spontaneous expulsion of the fetus in a doubled state. In neither of these cases was the peritoneum torn. The third case was one of complete laceration, and the accident took place during the course of an ordinary labor at full term, in a woman with slight pelvic deformity. She was delivered by craniotomy, but died on the fifth day after delivery. The fourth case was one of complete rupture, and occurred in a multipara during an ordinary labor. The child, which had partly escaped into the abdomen, was delivered by turning. Laparotomy was performed, the abdomen was thoroughly cleansed, and the wound in the uterus united by several sutures. Death took place within an hour afterwards.

CASE OF RUPTURE OF THE UTERUS.

By RICHARD Cox, M.D.-A multipara, aged 38, was taken in labor at 8 A.M. on May 2d, and was attended by a midwife. Till 3 P.M. everything had appeared normal. Suddenly then the patient screamed out, and became faint and sick. The expulsive pains ceased, but an agonizing pain in the abdomen was complained of. Dr. Cox was sent for, and being from home arrived about 6:30 P.M. The patient was then moribund. After administering some stimulant, Dr. Cox passed his hand into the uterus, which was empty. Finding a rent of five inches in the anterior wall of the uterus, he was able to seize a leg and bring the child back from the abdomen, together with the placenta, and to deliver them pretty quickly. There was some difficulty with the head, which was arrested at the brim by a slight contraction. The patient died shortly afterwards. She had had previous natural confinements.

DR. BRAXTON HICKS said that so many points presented themselves that it was difficult to select, but he thought, when delivery had been effected and the uterus was found paralyzed, when the rent was so large that a prolapse of the intestines occurred through the rent, that in such a case the best plan was to perform Porro's operation rather than to leave the case to its almost inevitable fate.

DR. HORROCKS thought operations per vaginam difficult, if not impossible, to carry out, and that abdominal section seemed the only method offering any hope. The question between carefully stitching up the rent or removing the uterus should be decided after carefully examining the site and size of the rupture, and more particularly the condition of the torn parts. If the laceration was severe, as usually was the case, Porro's operation would be best. If the edges were clean cut, they might be carefully brought together by sutures.

DR. ROUTH said that, while agreeing with Dr. Braxton Hicks, there was another rule not one whit less important. When the case was ascertained to be one of rupture of the uterus, it was an unnecessary piece of cruelty or malpraxis to attempt to extract the child per vaginam, irritating the bowels with your hand, and running the risk of enlarging the tear in the uterus or increasing hemorrhage and shock. The rule should be to proceed at once to abdominal section. Whether in cases of the tear being very rag