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that this disease in children not uncommonly starts in with high fever.

The chapters on nervous diseases are fairly written, but the prognosis of infantile spinal paralysis is made out much more favorable than the facts in the cases seem to us to warrant. The summary of contents given at the beginning of the chapters is an excellent feature of the bock, and adds to its usefulness as a work of handy reference. We think too many detailed case reports have been introduced for a work of the size.

On the whole, while the book contains much that is good, the reader will find in it little that is new, and not found in other textbooks, and when one can obtain Goodhart's book we can see no reason for buying that of Day.

L. EMMETT HOLT.

THE BRITISH GYNECOLOGICAL JOURNAL, being the journal of the British Gynecological Society. Edited by FANCOURT BARNES, M.D. Part IV. London: Smith, Elder & Co., 1886, pp. 150. This number comes to us water-soaked and dilapidated, a relic from the wrecked steamship Oregon," the bag which held it having been recovered after floating for five days.

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The most interesting paper which the number contains is one by DR. IMLACH, describing a new operation, oöphorraphy, which he has devised, and citing fourteen cases where it was successful. He asserts that, where the tubes are healthy, but where there is marked prolapse of the ovary with oöphoritis and severe ovarian pain which is not improved by ordinary treatment, a condition for which nearly all authors now advise removal of the uterine adnexa, a cure can be attained by his operation essentially as follows: Through a median abdominal incision two fingers are passed, uterine and ovarian adhesions are separated, the ovary is picked up and brought to its normal position on the posterior fold of the infundibulo-pelvic ligament and secured there by a single suture passed through its hilus, this maneuvre also tending to remedy the obstinate retroversion often found in these cases.

While oöphorrhaphy is in many respects a conservative operation when compared with oophorectomy, yet any procedure which necessitates the opening of the peritoneal cavity is of necessity a capital operation and should not be done without good and sufficient reason, no matter what statistics expert operators may show. As, in most cases where the symptoms are grave enough to demand laparotomy, the ovaries or tubes show evidence of structural degeneration, and as oöphorraphy can hardly be expected to relieve where there are marked organic changes, the indications for the operation of Imlach will necessarily be limited, still, especially in young women, where the indications are found, the operation should be tried, and, if future results bear out his representations, Dr. Imlach is to be congratulated for an important advance in the surgical treatment of ovarian disease.

DR. R. T. SMITH's paper on cervical laceration is of no interest to readers on this side of the Atlantic, save as showing the growth in favor of Emmet's operation in England, as it is merely a rehearsal of matter which has already been discussed here over and over again, substantially the same facts having been recorded by Emmet himself as long ago as 1874 (AM. JOUR. OF OBST., vol. vii., p. 442 et seq.) and by Mundé in 1879 (ibid., vol. xii., p. 117, which see for literature to that date). Dr. Smith is convinced that the operation is a valuable one, having closed more than fifty cervical rents

with good results. In the discussion of the paper, Dr. Aveling said that he treated all cases of ectropic erosion by the actual cautery, and got better results than by Emmet's operation: this same treatment was advocated by Dr. Routh, who said that, in the course of a large experience, he had seen but one case which could not be cured by "adustion;" he further stated that lacerations were much more common in America than in England, “because in the wilds of America there were often not only no doctors near, but not even midwives: women being delivered without proper aid by other ignorant matrons, it might be by their husbands, or the veterinary practitioner in the neighborhood." When will our English brethren learn that we are at least civilized, that our women are not attended by the village horse-doctor, and that we generally know what we are about, and do not advise or perform a surgical operation unless we have good reasons for so doing? The question of the relative merits of the old treatment of cervical tears by firing as compared with the modern method of closing and so removing the laceration and its consequences we cannot here discuss; the reader who is conversant with modern views regarding the healing of wounds and the formation of cicatricial tissue can easily answer the question for himself.

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DR. PURCELL asked, in a discussion on "Removal of the Uterus," whether it could not be detached and removed from the peritoneum covering it, as then it could be removed without entering the peritoneal cavity. As this question was answered, it may be well to state that the same point was broached by Dr. Mundé at the meeting of the New York Obstetrical Society, October 17th, 1876, and was answered in the negative by Drs. Noeggerath, Peaslee, and Thomas. Dr. Mundé afterwards found by actual trial on a number of uteri that the peritoneum could be easily peeled from the uterus up to about the level of the internal os in front and a little higher behind. Above this point the peritoneum was so firmly attached to the muscular substance of the uterus that it could not be cleanly separated even by cutting.

DR. EDIS, in an eminently practical paper on exploration of the uterine cavity in menorrhagia, enforces the necessity for what many are inclined to overlook-local examination and treatment after a fair trial of other means has been made and failed, the narrative being illustrated by a few typical cases where dilatation of the uterine cavity and the finding and removal of a small unsuspected fibroid or placental polypus had cured where other practitioners had failed or had pronounced the case hopeless.

DR. ALFRED MEADOWS, the retiring president, in a graceful and masterly address of some twenty pages, speaks of the wonderful growth made by the society in its first year; of its prospects of future success; of the amount and quality of the work done by its members; of its cosmopolitan character, etc.

This British society is, I believe, the first that has ever conferred a high official position upon other than a British subject, the names of Munde and Pinard being among those of its vice-presidents.

In addition to what has been noted, there is a description of an ingenious "pessary douche" devised by Imlach, the usual summary of gynecology and obstetrics, and a list of the fellows of the Society and of its officers for 1886.

This number completes the first volume, which, for artistic

effect, typographical excellence, and general make up reflects great credit upon its gifted editor, Dr. Fancourt Barnes.

BROOKS H. WELLS. TRANSACTIONS OF THE NEW YORK OBSTETRICAL SOCIETY, from May 17th, 1881, to March 17th, 1885. Reprinted from the New York Medical Journal for private distribution by the Society. New York: Appleton & Co., 1884. Vol. III., pp. 375.

The subject matter of this volume, having already appeared in the pages of the JOURNAL, needs no critical review to tell of its value.

Containing, as it does, an epitome of most of the obstetrical and gynecological work done in this city between the dates mentioned, we can only express regret that the volume has not been placed where it could be procured by the general mass of the profession interested in this important branch of medicine. By its exclusiveness in this respect, the Society greatly lessens the scientific benefit which should result from its work.

Further, we notice that the names of scarcely a third of its members appear as having taken any active part in its transactions, either in presenting original papers or material, or in discussing the subjects presented at its various meetings. It seems to us, after a very thorough acquaintance with the innermost workings of this Society, that its value and influence as a scientific body would be vastly enhanced if the Society were rendered more accessible to the members of the profession at large, and if the scientific features of the meetings were made more predominant.

Not until the New York Obstetrical Society follows the lead of the London, Philadelphia, and other prominent societies, and opens its doors to all reputable members of the profession, will it attain the position which the representative society of so large a city as New York should hold, and will it accomplish the object for which it was founded.

ABSTRACTS.

1. Lecorche : Diabetes in Connection with Uterine Disease, Menstruation, and Pregnancy (Annales de Gynécologie, October, 1885).-Diabetes is proportionately of most frequent occurrence before puberty and at the menopause. Thus, out of 114 cases, the disease was noted 70 times in women who had ceased to menstruate. Menstrual life would seem to carry with it a certain immunity against the disease. (Why this statement, is scarcely apparent, seeing that out of the 114 cases. observed by L., 37 were of women during menstrual life, whilst only 2 were of young girls before puberty.) The disease, however, when it occurs during menstrual life, is of a more virulent type than when it attacks women who have reached the climacteric. The most virulent form of all, however, is premenstrual diabetes. Indeed, the same rule holds for woman as for man—the acuteness and intensity of diabetes are in inverse ratio to the age of the patient.

The lesions, in general, impressed on the genital system by the disease

are:

A, Eczema of the vulva; B, Granular metritis, degeneration and alteration of the cervix; C, General uterine lesions.

A. Eczema of the vulva is of very frequent occurrence, in the proportion of about one-third, or, as noted by L., in 32 out of 114; of these 32 cases, but one was under 40 years, all the others beyond 40, 9 between 60 and 72 years. Frequently, eczema is the symptom which suggests diabetes, although, on close questioning, it will be determined that polyuria, great thirst, loss of flesh, and the like diabetic symptoms existed for some time before the appearance of eczema. Usually the disease has existed three to four years before the eczema. The amount of sugar in the urine will not account for the eczema, for L. has noted the disease in cases where from 105 to 400 grams of sugar were eliminated in the twenty-four hours, and also in cases where the amount was but 7 grams. The eczema is, therefore, partially constitutional, as witness the fact that coincidently with the vulvar eruption, the disease may appear on other localities of the body. The disease, hence, is in part diabetic, in part due to the local irritation of the urine. Is this local irritation due directly to the sugar in the urine, or secondarily to the fermentation products? Most likely to the latter. If the eczematous crusts be examined under the microscope, there are uniformly detected oval spores and the filaments of the saccharomyces cerevisiæ. These spores are not of themselves responsible for the eczema, but they provoke fermentation in the saccharine urine which is secreted, and thus make the urine an irritant. Whatever the cause, the main symptoms of vulvar eczema are itching, the eruption, abundant discharge from the diseased surface. (L. here describes the appearance of vulvar eczema and its complications, points on which it seems unnecessary to dwell here.) Whether vulvar eczema be accompanied or not by other general or local symptoms, pruritus is a symptom of undeniable value; for, often, in woman, the >ymptoms of diabetes are not at all marked, and then a persistent eczema which does not yield to local measures of treatment should ever suggest the possibility of diabetes as a cause, this being readily determinable through an examination of the urine.

B. Granular degeneration of the cervix frequently accompanies the eczema, and frequently also there exist pharyngeal granulations. Here the irritating element contained in the blood of diabetics seems to attack, by preference, the mucous surfaces. A granular endometritis may rarely suggest a latent diabetes. The disease, however, complicates a late as well as an early period.

C. Every utero-ovarian lesion may exist in connection with diabetesL. has noted two cases of fibrous tumors, one cyst of the ovary, one case of métrite fongeuse (hyperplastic endometritis ?). Of course, we deal here not with cause and effect, but with pure coincidentals.

The further questions considered by L. are the influence of diabetes on (1), menstruation; (2), pregnancy and labor; and, finally, (3), the influence of pregnancy on diabetes. The menstrual troubles accompanying diabetes are variable. Occasionally it is dysmenorrhea, and then amenorrhea or suppression to the extent even of leading to a premature menopause. It is not likely that diabetes directly affects menstruation. More likely the menstrual derangements are the followers of the effect of the disease on the system in general, and, in case of menorrhagia, the

result of the local lesions, granular degeneration of the cervix and endometrium which frequently accompany diabetes.

Diabetes does not deprive the woman of the power of conception. If pregnancy in the diabetic is proportionately rare, the cause of sterility must be sought in the uterine lesions which have been indicated as accompanying diabetes. The course of pregnancy is not necessarily interrupted by the disease, but the fetuses are apt to be weak, and two out of four noted by L. were hydrocephalic. Although L. did not note serious trouble in the pregnant women affected with diabetes under his observation, in eleven out of fifteen cases collected by Matthews Duncan, death resulted from the disease within from three days to eight months after delivery; in two cases, at the end of fifteenth months to two years respectively-the one tubercular, the other of diabetic coma. Such gravity of the disease in pregnant women is not surprising, however, when it is remembered that diabetes developing before the menopause is especially virulent.

From the researches of Duncan, it is evident that pregnancy influences greatly for the worse the prognosis of diabetes. If the disease be not soon fatal, its phenomena are exacerbated. It should be noted, however, that in many cases diabetes disappears for a longer or shorter time after delivery. In a case recorded by Bennewitz, the disease appeared at the fourth, fifth, and sixth pregnancy, disappearing after each. In general, labor, even like menstruation, is followed by a diminution in the glycosuria. This effect, however, is purely transitory. The ultimate result is a marked aggravation in the symptoms, leading, frequently, to early fatality.

E. H. G.

2. Pritzl: A Case of Labor under Hypnotism (Wiener Med. Wochen., November 7th, 1885).-This case is unique, and offers a number of points of interest. M., æt. 26, of good family and personal history, admitted into Carl Braun's wards to await her confinement. The course of her pregnancy had been remarkably free from subjective nervous symptoms, but on the first examination it was determined that she could be readily hypnotized, the influencing agent being a bright thermometer case. Whilst hypnotized, she was perfectly senseless and anesthetic. Not more than ten seconds was required to hypnotize her; she did not react to needle pricks, rubbing of the cornea, irritation of the nostrils. Her appearance was natural, pulse and temperature unchanged. The upper eyelids were at times tremulous; the globes of the eyes rotated outward; pupil-reaction good; extremities relaxed; when patient placed upright no sustaining power in limbs. The fetal heart was not altered in the least during hypnotic state of mother. The spell lasted, at the will of the bystanders, from a quarter to half an hour. Patient readily brought to by massage, cold to the eyes, etc., when she would awaken, rub her eyes, look around with a dazed expression, say she felt well, and then sink into a deep natural sleep. Labor set in on the 30th of October, and but little progress was made by the evening of the 31st, owing to short ineffective pains. A narcotic being indicated, it was determined to test hypnotism. The external os barely admitted three fingers, although the membranes had been artifically ruptured some hours previously. With some difficulty, the patient was persuaded to glance at the thermometer case, when, instantly, she sank into the hypnotic sleep.

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