tarded the progress of the labor, could it be expected to prove useful. B. inquired of Mueller whether the muscular structure of the uterus had been defective in the cases in which the constant current had given no results, and was answered in the negative. Perhaps, too, the method of application may have been the cause of the failure. B. has obtained especially favorable results since he opens and closes the circuit rapidly in the above-mentioned

manner.

LOEWENTHAL (Lausanne) read a paper on

THE THERAPEUTICAL EMPLOYMENT OF ELECTRICITY IN MINOR

GYNECOLOGY.

In a series of cases of chronic metritis, L. has first employed the faradic and then the mixed current. The effect, especially of the latter, was rapid and lasting. Uteri whose cavity measured thirteen centimetres in length diminished to seven or eight centimetres. At the same time the health of the patient improved visibly. It is worthy of mention that the internal os opened almost invariably; contractions, however, were not observed. Other favorable results were obtained by L. in genital neuroses, for instance, in a case of grave hysteria in the climacteric age. All the symptoms were made to disappear in the period from February till April. Another case was one of intractable anorexia. The patient vomited nearly everything she ate. The affection was of six years' standing. Nevertheless the constant current caused the vomiting to disappear. To be sure, at first repeated slight relapses occurred. But eventually the cure was complete.

As to the mode of application, L. always introduces the cathode into the uterus, while he places the anode, consisting of a large cushion, on the abdomen. It is advisable to commence with weak currents, to increase them gradually, and then reduce them to zero by degrees. In this way the application of the current is painless to the patient; the effect, however, is more powerful and lasting than when the current is broken suddenly. We must avoid bringing the electrode to the anterior fornix of the vagina where it causes intense pain. The sitting should last from five to ten minutes, but by no means be prolonged beyond fifteen minutes. The currents employed should be very strong. They are very well borne when used in the above manner. L. has had no result from the constant current; but, as stated above, very good ones with the mixed current.

Experiments made to act on displacements of the uterus by electricity, or to cure them, resulted negatively. Only the concomitant nervous symptoms were improved. For the present, therefore, L. believes the mixed current indicated only in chronic metritis and genital neuroses.

MUELLER (Berne) read a paper on

THE PROGNOSIS OF LABOR IN CONTRACTED PELVIS.

In order to form an opinion of the prognosis of labor in a con

tracted pelvis, it is necessary, not only to have a clear idea of the quality of the pelvis itself, especially the size of its diameters, but also to determine approximately the size, shape, and consistence of the infantile head. Even the former is connected with difficulties. Although the conjugata vera can be measured pretty accurately, this is not possible with the transverse and oblique diameters. In these respects we must be content with an approximate estimation on palpating the pelvis. It is no less difficult to inform one's self about the child's head in the direction indicated. Various methods are given for estimating its size directly or indirectly. The results of all these methods, however, are inexact if not false.

M. has endeavored, therefore, to get information as to the prognosis of labor in contracted pelves in another manner. He tests early in pregnancy the proportion of the fetal head to the maternal pelvis. In this procedure he first searches for the neck and the region of the occiput of the fetus by external palpation, which is easily done. Then he presses the head, put approximately in the median line, chiefly from the occiput in the direction of the pelvic axis into the pelvic canal. Then, for the purpose of fixation from without, he gives the head to an assistant, and personally ascertains from the vagina whether the head really descends, whether it passes the promontory, or whether only rotation occurs. Where serious obstacles are present, it is easy to prove that the head remains with the greatest periphery above the pelvis and even bulges out the region above the symphysis.

Such a determination of the relation of the head to the pelvis is of decided importance in settling the time for the induction of premature labor, especially where we are in doubt as to the stage of the pregnancy. In cases in which the induction of premature labor seems indicated, M. has the above-described attempts at engagement repeated every eight or ten days, and induces premature labor when the head can just barely be pressed into the pelvis.

SCHATZ (Rostock) would call M.'s procedure the relative measurement of the pelvis. He has been teaching it at his clinic for about eight years. As a rule, he proceeds to the induction of premature labor only when the head can be pressed into the pelvis no farther than to overtop the symphysis by rather more than one centimetre. According to his experience, at this time the power of configuration of the head on the one hand, and the parturient forces on the other, suffice to make the head pass the pelvic strait without material difficulty.

OLSHAUSEN (Halle) inquired whether the force exerted during the pressure must be very great, and how long it should be continued; also, whether rigid abdominal walls were not an obstacle. FEHLING (Stuttgart): Does not the lower uterine segment act as an obstacle to the descent of the head?

MUELLER (Berne). The duration of the pressure should be about one to one and a half minutes. The force need not be very great.

The resistance differs much in individuals. In many cases anesthesia is necessary. The procedure is absolutely devoid of danger. As to the appropriate time for the induction of premature labor, M. does not believe that the latter would progress easily when the head can be pressed no farther into the pelvis than to project one centimetre above the symphysis.

To this SCHATZ replied that, if we proceed earlier, premature labor will often be induced too soon. The lower uterine segment offers no obstacle.

BATTLEHNER (Karlsruhe) read a paper on

THE TOTAL EXTIRPATION OF THE UTERUS THROUGH THE VAGINA.

The author first gave a brief historical review of total extirpation of the uterus, and then proceeded to speak of his experience in regard to the operation. He has operated on nine cases. One patient died of collapse in consequence of grave anemia. In four cases a relapse occurred after six months. Up to this time the patients had remained free from symptoms. In these latter cases B. was unable to confirm Schroeder's observation, that the patients suffered less from sloughing, hemorrhage, or other accidents than if they had not been operated upon. The remaining four cases are still free from relapse, one now for more than two years.

In his first cases, B. inserted a large rubber drainage tube, in the latter he employed large glass tubes. In one case the omentum had penetrated into the holes of the tube, the removal of which caused serious difficulty. Still the patient recovered. B. had always made the observation that the secretion from the wound does not pass through the drainage tube, but by the side of it. He has now entirely given up drainage. He only loosely tampons the vagina with sublimate gauze, and lays a large pad of cotton on the abdomen to which it is firmly pressed by turns of the bandage. He does not elevate the patient's shoulders as Schatz recommends.

SCHATZ (Rostock) stated that he likewise had given up drainage, and had also abandoned tamponing of the vagina. Prolapse of the intestines need not be feared. He, too, had abandoned the elevated position of the patient's shoulders which he had formerly employed.

FROMMEL (Munich) would in future close the abdominal cavity. If no infectious germs have entered it during the operation, the patient will recover, drainage or no drainage.

FEHLING (Stuttgart) calls to mind the excellent results obtained by Fritsch without closure of the peritoneum. F. himself has operated after Fritsch's method in three cases with favorable results. He believes that there is some advantage in leaving the abdominal cavity open, in so far as the secretion accumulating in the first few hours can escape.

KALTENBACH (Giessen) read a paper on

STENOSIS OF THE TUBES WITH CONSECUTIVE MUSCULAR HYPERTROPHY OF THE WALL.

(Prof. Kaltenbach proposes to publish the paper in full in the Centralblatt f. Gyn.)

FROMMEL (Munich) has observed an hypertrophic tube similar to that described by K., with two malignant ovarian tumors, one of which was associated with pyo-salpinx of the opposite side. He did not find hemorrhages into the tissue of the tube in these cases. To K.'s question, what had been the state of the fimbriated extremity, he replied that in the case associated with pyo-salpinx of the opposite side it had been occluded, and open in the other

case.

SCHATZ (Rostock) has operated on two similar cases. In one of these there was pyo-salpinx on one side and on the other adhesions which he regarded as the result of ruptures. Gonococci could not be demonstrated.

KALTENBACH (Giessen) does not believe that in the case described by him there had been an accumulation of fluid before the hypertrophy occurred. The greatly contracted canal and the much thickened wall were against this view. The epithelium was short, cylindrical, flattened.

M. B. FREUND (Breslau) spoke of a paper read shortly before in the dermatological section on the infectiousness of chronic gonorrhea. The demonstration of gonococci is very difficult in chronic cases. They are seated very deeply in the mucous membrane and come to the surface only when there is an inflammatory swelling of the mucous membrane excited by irritants and can then be demonstrated even in cases where the discharge is still slight. Accordingly there is nothing wonderful in the fact that no cocci could be found in the secretion taken from diseased tubes.

Other

KALTENBACH (Giessen) stated that it was not alone the presence of gonococci which led to the formation of pus in the tube. excitants entering there might have the same effect. Should it happen that suppuration took place in the ligated portion despite an antiseptic ligature, it was the consequence of the presence of infectious germs in the tube. The importance of the germs might be very variable.

W. A. FREUND (Strassburg) accepts Kaltenbach's explanation of the thickening of the tube, according to which it is to be regarded as a hypertrophy of activity. In the Strassburg collection is a specimen, in one of the broad ligaments of which there is a multilocular ovarian cyst in the ala vespertilionis. Here we find a hypertrophy of the tube with stenosis of the uterine ostium, in the base of the other broad ligament there is an ovarian tumor and the hypertrophy of the tube is absent.

SCHATZ (Rostock) admits that in the case of hypertrophy of the muscle it may be due to increased activity. But he is of opinion that in spite of this condition a dilatation by accumulation of fluid may have taken place. In the case mentioned by himself, this condition is still found on one side, on the other it has disappeared, and S. suspects that the uterine end of the tube had been occluded at the beginning of the affection by the greatly swollen mucous membrane, and had again become patulous after the swelling had subsided.

BAYER (Strassburg) exhibited

SOME OBSTETRICAL INSTRUMENTS.

Their only purpose was to save the soft parts of the mother.

a. Modification of Tarnier's forceps (old model). The instrument has a very slight cephalic curve, the posterior ribs are well rounded and slightly bent inward.

b. Forceps with movable blades. When the soft parts are narrow and rigid, and the head oblique in the pelvis, the ordinary forceps frequently cause laceration of the vagina because the posterior rib of the blade, pointing backward, does not lie close to the head. In order to avoid this and make a close adaptation of the blade to the head possible, the blades are made to turn. The forceps are on this account liable to slip, and therefore they must be controlled during the extraction, and the handle firmly compressed. The extraction is often more laborious than with ordinary forceps, because when the latter produce a lesion of the vagina the tension is at the same time reduced. With these forceps B. has in many cases obtained very good results as regards keeping the soft parts intact.

c. Perforating instruments. A pair of small Naegele scissors, curved on the flat and sharpened only near the end. They make a comparatively small opening. Also a pair of bone forceps with narrow branches. B. no longer uses the cranioclast. He perforates, removes the bones of the head as far as necessary, and extracts by traction with the fingers or the bone forceps. The operation done in this manner is rather tedious; it may last two hours; but its results are very good as regards avoiding injuries to the cervix and wounds by splinters of bone.

ZWEIFEL (Erlangen) read a paper entitled

ARE THERE GERMS OF DECOMPOSITION IN THE HEALTHY LIVING

ORGANISM?

The view is pretty prevalent that, should germs of decomposition exist in the healthy living animal body, this fact could not be brought into harmony with Lister's doctrine of antisepsis. Z. does not share this view. Although he has succeeded, by a series of experiments, in demonstrating the presence of micrococci in the living organism, he does not look upon antisepsis as altered thereby in its essential points.

The experiments of Tiegel, Billroth, Burton-Sanderson, Nencki, Giacosa, and Pasteur are well known. None of them succeeded, despite the greatest care and the employment of different methods, in preventing decomposition in portions of organs taken freshly from the body and at once withdrawn from the influence of the air. Z. himself first experimented with arterial blood. This, to his surprise, remained free from decomposition. But when he repeated Nencki's experiments with the heart, decomposition always occurred. The author then suspected that it was the oxygen contained in the blood which kept it from decomposition. He