nephritis. In the latter, neuro-retinitis albuminurica; in the former, choroidal tubercles were demonstrated.)

3. So-called hemorrhagic retinitis, or the simple hemorrhages with or without white centre, occur in sepsis as well as in other diseases. (B. has reported on four cases belonging under this head: anemic retinal hemorrhages after difficult detachment of the placenta, retinal apoplexies in a puerpera with cervical carcinoma and in a phthisical patient, finally a hemorrhage into the choroid during typhoid fever in the puerperium.) When sepsis has been positively demonstrated, these hemorrhages are generally of unfavorable prognostic importance.

4. Retinitis septica, consisting of flocculi and so-called flakes of Roth, is pathognomonic of sepsis only after all other diseases which could present similar appearances, such as nephritis, diabetes, and leukemia, have been excluded. It has never been observed with typhoid fever. It occurs both in the phlebitic and in the lymphangitic forms of puerperal fever, and prognostically is not absolutely unfavorable.

5. In ordinary panophthalmitis, there is always purulent choroiditis, but the latter does not invariably spring primarily from the choroid. We must distinguish :

a. Purulent choroiditis which produces first symptoms on the anterior pole of the eye, such as chemosis, keratitis, iritis, synechiæ of the iris, hypopyon, protrusion and impaired mobility of the globe. Secondarily only is the process propagated to the retina. Whenever the affection is not the sequel of a trauma or an operation, of a perforating corneal ulcer, or a suppuration in the cranial cavity, it certainly indicates septic disease, and in many cases ulcerous endocarditis. (B. saw a case in which the process developed in a patient suffering from cervical carcinoma and bilateral salpingitis, occurring acutely after a simple exploration; the intermediate step was ulcerous endocarditis.)

b. Purulent retinitis which affects the choroid secondarily, and thus leads to panophthalmitis, or remains confined to the posterior pole of the eye. It begins with embolic inflammation of the retina (in one case perhaps embolism of the central artery; in the other, obstruction of one of its branches), leads to suppuration in it, and from there extends to the vitreous and the choroid. It always indicates sepsis, and, possibly without exception, ulcerous endocarditis.

OLSHAUSEN (Halle) holds that it is very important for us to advance to the point of applying ophthalmoscopic indications diagnostically. He has, in former times, often convinced himself of the frequency of retinal hemorrhages, especially with anemic patients, in the puerperium. Some of them are remarkably large, and are followed by defects in the field of vision and serious disturbances of sight.

FEHLING (Stuttgart) read a paper on

HABITUAL DEATH OF THE OVUM WHEN THE MOTHER IS AFFECTED WITH DISEASE OF THE KIDNEY.

The most frequent and best known cause of the death of the ovum is syphilis of the parents. More rarely, it can be traced to uterine diseases, such as metritis and endometritis. Thus far it had not been known that kidney diseases of the mother may likewise be followed by intrauterine death and premature expulsion of the fetus, and even a repetition of this accident in different pregnancies. The speaker has observed several similar cases. The first case was that of a woman in whom, when near the thirtieth year of life, menstrual disturbances had appeared, especially retarded onset of the periods. Six times premature expulsion of the ovum, which had died in utero, occurred. Each time, in the fifth or sixth month of pregnancy, edema of the entire body took place; albumin could be demonstrated in the urine. Symptoms of the death of the ovum, such as cramps of the stomach and chills, having shown themselves, the birth did not occur until eight weeks later. All the placenta were remarkably small, atrophic; the deciduæ thickened. The family physician had formerly instituted an antisyphilitic treatment, but without avail. The second case was that of a primigravida. About the middle of the pregnancy symptoms occurred which pointed to the death of the ovum. The urine contained large quantities of albumin. This diminished under appropriate treatment. Still the child was expelled after a few weeks. It was mummified. The placenta presented the same appearances as in the preceding case. After labor, the albumin disappeared from the urine.

The patient in the third case had passed through two normal labors. During the third pregnancy Bright's disease was first discovered by the ophthalmoscope. Premature expulsion, in the fifth month, of a dead child free from signs of syphilis. In the succeeding year another pregnancy. During the latter, hemiplegia due to embolism of the arteria fossæ Sylvii. Again in the fifth month a putrid child was born. After that the albumin diminished. Both placenta were small and showed numerous white infarctions.

In the fourth case, abortion had suddenly occurred in the fifth month of the first pregnancy. During the second pregnancy, great edema of the lower extremities took place. The child was born dead. With renewed pregnancy symptoms of serious nephritis appeared. But slight improvement under appropriate treatment. The birth commenced with a profuse hemorrhage. The child was born dead. The patient did not react, remained unconscious, and died in an eclamptic attack. Here, too, the placenta showed the above-described alterations.

All these cases, therefore, have kidney disease in common. The disease had probably existed before the onset of the pregnancy, but had become worse subsequently. In January, 1885,

Winter had reported on premature detachment of the placenta in nephritis, before the Berlin Gynecological Society. The speaker has observed two similar cases. But he is no more able than Winter to give an explanation of it. As regards the premature death of the ovum in nephritis, it is undoubtedly the consequence of the placental disease. In all four cases observed by F. the placenta was smaller than it generally is at the corresponding period of pregnancy. There were present in it numerous nodules, white infarctions, partly wedge-shaped, partly roundish, which often contained vacuoles. According to Ackermann, the white infarctions consist of canalized fibrin, the increase of which causes atrophy of the villi, during which process periarteritis fibrosa multiplex occurs. As the villi perish, the child dies. The only remarkable circumstance remaining is the proportionately long retention of the placenta. The small-cell infiltration of the villi and of the vessels of the funis, which is characteristic of syphilis, was always absent; in fact, no sign of syphilis was ever found in the fetuses.

KUGELMANN (Hannover) read a paper on

A SIMPLE, SAFE METHOD FOR THE INTRAUTERINE TREATMENT OF CHRONIC CATARRH OF THE UTERUS.

The speaker had convinced himself on his own person that he could rapidly cure coryza by the introduction of iodoform into the nose, and thus prevent a laryngeal catarrh which usually succeeded it. This good effect on the nasal mucous membrane induced him to try iodoform also in the catarrh of the uterine mucosa. He injects the agent by filling with iodoform a slightlycurved metal catheter with solid beak, inserting it into the uterus -an easy matter-attaching to the proximal extremity a rubber hand-ball provided with a short piece of tubing, and insufflating the powder by compressing the ball. After this has been done, it is advisable to exert pressure on the uterus from the symphysis, in order to expel whatever air has entered. This painless and safe manipulation is repeated twice a week. The results obtained by K. were very good. The secretion always diminished or disappeared quite rapidly.

LOEWENTHAL (Lausanne) has for years employed iodoform in catarrhs of the uterine mucosa. But he makes use of very small pledgets of cotton dusted with iodoform to which a thread is fastened; these he introduces into the uterus with the sound. They do not cause any inconvenience.

KUESTNER (Jena), in connection with Kugelmann's paper, showed uterine dilators bearing a great resemblance to those of Hegar, but while the latter are made of rubber, the former are of copper. This material offers a double advantage. In the first place, they can be more easily rendered aseptic (after the method described by Kuemmel at the Surgical Congress), and secondly, the thinner numbers (up to 6 or 7) can be better adapted to the direction of the uterine canal, as they are flexible. K. has had

two sets of these dilators made, with different curvatures, one intended for the normal, the other for the retroflexed uterus. He stated that he employs them only preliminarily to minor manipulations. If he wishes to obtain greater dilatation, he always uses laminaria.

BUNGE (Berlin) exhibited

A CARRIER FOR CONVEYING A FILLET INTO THE GROIN IN EXTRACTIONS BY THE BREECH.

The instrument shown is a modification of the one formerly described by the same author (Centralbl. f. Gyn., 1881, No. 8). In the old model, it was difficult to remove the fillet from its metal sheath. This defect has been remedied by leaving a broad open space along the entire length of the latter. By virtue of this construction, only moderate traction is required to free the fillet from the carrier after it has been brought into the groin. (A fuller description of the instrument will appear in a subsequent number of the Centralblatt.)

BAYER (Strassburg) read a paper on

THE INDUCTION OF PREMATURE LABOR BY THE CONSTANT CURRENT.

The author stated that he had published a paper on the same subject in Vol. XI. of the Zeitschr. f. Geb. u. Gyn. Since that time, he has had opportunities of testing the efficacy of the constant current in four additional cases.

1. Vpara, aged 28. In the four preceding deliveries, version was performed. Children dead. At the end of the ninth lunar month, application of the constant current. After the first application, pains commenced; after the sixth, there was complete dilatation of the os uteri. The child lived ten days.

2. Here pains likewise ensued after the application of the constant current. The child, which was born alive, died six hours post partum.

3. After seven electrizations, the os was fully dilated. Pains, however, ensued only during the continuance of the current, and ceased when it was interrupted. Patient discharged by request. After three and a half weeks, spontaneous premature birth of a living child.

4. After nine applications of the constant current, a grayishgreen ulceration of the cervix appeared. When the ulceration had healed, electricity was again employed, but without producing regular pains. Since it had been observed that frictions of the uterus always caused contractions, they were employed every five minutes, but the effect desired was not obtained. The cervix again elongated, the internal os closed. Renewed application of the constant current again caused dilatation of the os, and thus allowed delivery by operative interference.

It was therefore proved in these four cases that the constant current excited pains, dilated the os, and overcame strictures of the

cervix. But the speaker did not attempt to deny that the effect was not always uniform. The result will be most striking where the muscular structure of the uterus is well developed and the cervix not too rigid.

The mode of application has been altered by B. in so far that he opens and breaks the current at short intervals. To this end he raps on the abdominal integument with the anode-a procedure which seems to enhance the effect. He has given up the use of a double electrode to be applied to the cervix. The effect of the latter was very good, but its employment produced an eschar. In cases which require the long-continued application of the constant current, B. advises a specular examination from time to time in order to discover any incipient caustic effect, and in that event to discontinue the procedure.

HOMBURGER (Karlsruhe) had once employed the constant current in a IIIpara with a view to increase very weak activity of the uterus, but without result. But in two cases of uterine fibromas, the procedure had yielded favorable results. In one of these cases, treatment with ergotin had been ineffectual. The constant current caused decided diminution of the tumor and of the uterus; the menorrhagias became less. Of late, after the electrization had been discontinued for some time, they have again become more profuse. In the second case, likewise, a large tumor was gradually diminished. The uterus, too, which was much increased in size grew smaller, and resumed its anteflexed position.

SCHATZ (Rostock) has for the last eighteen months devoted special attention to the agents influencing uterine activity. He has used electricity in but few cases, and, therefore, is unable at present to express an opinion as to its value for the inductionof premature labor. He thinks it very probable that the uterus, like the heart, is provided with nerves not only for the excitation, but also for the retardation of contractions-a circumstance which deserves careful consideration. Moreover, he called attention to the fact that toward the end of pregnancy contractions occur periodically. Should any of the various agents for the induction of premature labor be employed at one of these periods, it would act more surely and rapidly than at any other time.

He

MUELLER (Berne) has often had opportunities to induce premature labor on the obstetrical material at his disposal. has frequently changed the method, and has also experimented with the constant current. In one case the effect was brilliant; in the succeeding five cases, however, it was not satisfactory. No direct effect ensued. After the constant current had been employed for some length of time, other means had to be resorted to. There was not even any preparatory effect. The oxytocic agents which were subsequently employed did not act otherwise than they did when the constant current had not been used before. Although the current usually produced dilatation of the cervix, it did no more. The labor did not progress, despite continued and intensified application of the current.

BAYER (Strassburg) corroborated, with reference to the case mentioned by Homburger, the statement that the constant current was ineffectual as a rule even during parturition. Only when there are cramp-like pains, or when a stricture of the cervix re