DR. KUESTNER spoke of the annulus fibrosus which stands in close connection with placenta previa. In the case of the annulus fibrosus we have to deal, not with fibrous formations, but with coagulation necroses (Ackermann), perhaps also with hemorrhages which subsequently undergo alterations. The thick chorionic membrane which unites the cotyledo succenturiata is likewise due to coagulation necrosis, and not to detachment. The annulus fibrosus prevents the growth of the placenta beyond it. DR. BAYER found placenta marginata most frequently at the tubal angles, and gave a mechanical explanation of it. It is usually semilunar in shape.

DR. SCHATZ.-The idea that the placenta occasionally is unable to grow further may be correct; but we find placenta which have no ring, and still do not grow further; in proof of this, he cited the twin placentæ of a single ovum.

DR. VEIT (Berlin).-Kuestner has changed his view, as may be learned from the discussion at the Magdeburg meeting of German Naturalists and Physicians; in the formation of the placenta, the essential point is, how the white ring arises. Before a coagulation necrosis begins, other processes must be present; he believed that they are processes affecting the decidua; he laid the greatest weight on the white ring, and thought that the growth beyond of the placenta is possible. He inquired whether Bayer was basing on anatomical or clinical observations when he asserted that the placenta does not lie in the lower uterine segment.

DR. HOFMEIER spoke of the development of the lower segment in placenta previa, and would not admit that the lower segment does not expand; he believed that this question could be solved only by anatomical preparations. Thus, uteri which he had examined anatomically in placenta previa showed a lower uterine segment very well developed. Contractions of the lower uterine segment are not necessary for the arrest of hemorrhage in placenta previa, as Simpson's experience teaches. The question is mainly where the uterine vessels enter the muscular structure; in one specimen he found that the larger vessels entered at the point where the peritoneum is firmly attached. Hence contractions of the lower segment are not necessary.

DR. KUESTNER did not believe in primary inflammatory processes of the decidua, as there were not sufficient data at hand in support of it. The main point was a coagulation necrosis.

DR. BAYER.-The margo of the placenta marginata is a secondary feature. To Hofmeier he replied that he did not doubt that a lower segment forms; the question is only whether the lower segment develops during labor. As regards the site of placenta previa below the prominence due to contraction, he doubted whether in these cases a normal lower segment had formed.

DR. FEHLING (Stuttgart) read a paper on

THE RELATIONS BETWEEN THE QUALITY OF THE BLOOD IN THE PREGNANT FEMALE AND THE COMPOSITION OF THE LIQUOR AMNII. Looking upon the liquor amnii as a maternal transudation, the reader had asked himself the question whether it would not be possible to find relations between the chemical composition of the blood and the liquor amnii. To this end, the liquor amnii was analyzed quantitatively, also its dry residue, albumin, and ash.

In the blood of the gravida, the quantity of hemoglobin was ascertained by means of Fleisch's hemometer, and the number of blood-corpuscles counted.

Taking the quantity of hemoglobin, according to Fleisch, at 100 per cent in healthy men and at 93 per cent in healthy women, there were found variations of hemoglobin in gravidæ from 67 to 110 per cent; in two-thirds of the cases examined (about one hundred) it was less than 100 per cent. Repeate examinations of the blood of the same gravida showed generally an increase of the hemoglobin with the advance of pregnancy-a result which conflicts with earlier investigations by Andral and Gavaret, Nasse, and others.

The increase finds its explanation probably in the vigorous nutrition, in the same way as the decrease of hemoglobin usually found post partum is explained by the loss of blood during labor. The greatest decrease was to 41 per cent in placenta previa. The number of red blood-corpuscles amounted to between three and four millions, on the average, less than Ingerslev found. The rise and fall in the number usually corresponded with the increase and decrease of the quantity of hemoglobin.

No constant relation could be found between the quantity of liquor amnii and the amount of hemoglobin of the gravida; but it was found, as before, that the dry residue is independent of the quantity of liquor amnii. Hence the liquor amnii is not simply diluted towards the end of pregnancy. The dry residue of the liquor amnii depends directly on its albumin contents, the amount of ash remains nearly constant.

Furthermore, there was found a proportional relation between the amount of hemoglobin in the blood and the quantity of albumin in the liquor amnii, the albumin in the liquor amnii increasing with the rise of hemoglobin contents in the blood of the gravida, viz., with a quantity of hemoglobin averaging 106 per cent it equalled 0.21 per cent; and of hemoglobin 80 per cent it equalled 0.15 per cent. Finally, the amount of albumin in the liquor amnii seems to be somewhat larger in ripe than in premature ova. In these results the reader finds a further support for the view that the liquor amnii is to be considered in the main as a maternal transudation.

DR. KRUKENBERG.-The increase of albumin in the liquor amnii may be due to alterations in the fetal blood, and need not depend on the increase of hemoglobin in the maternal blood. To be sure, according to his investigations, there were no urinary casts in the liquor amnii, while they are present in the fetal urine. His experiment of tying the uterine vessels to cause uterine stasis had been barren of results as regards the source of the liquor amnii. He held that Fehling's explanation, that the liquor amnii was chiefly a maternal transudation, was possible, but not proven. DR. GUSSEROW remarked that he no longer as strictly maintained his former standpoint. Ultimately the liquor amnii cores, of

course, from the maternal blood; for although the fetus really adds its urine to the liquor, this portion was likewise derived from the maternal blood.

DR. PROCHOWNICK.-The chemical processes do not suffice; he would recommend, besides, physico-experimental investigation. He had recently experimented with the fetal membranes, allowing a current of fluid to pass; nothing had penetrated.

DR. SCHATZ pointed to the condition of hydramnios in the case of some twins, and expressed the belief that nature here showed the source from which the fluid was derived.

DR. FEHLING had not yet examined the hemoglobin contents of the fetal blood. He did not intend his statements to be demonstrative, but merely to support his view. In reply to Prochownick, he remarked that dead membranes gave different results from living ones.

DR. WIENER.--According to the investigations of Zuntz and Cohnstein, the hemoglobin contents of the fetus steadily increase with its progressive development; hence the larger quantities of albumin in the liquor amnii during the later months of pregnancy might also be derived from the fetus. At all events, it had been proven experimentally that the membranes are more pervious in the later than in the earlier months of pregnancy. This fact might perhaps explain the larger amount of albumin in the liquor amnii în advanced pregnancy, but proved nothing against an admixture of fetal urine. In this respect, we dare not deny some influence due to the activity of the fetal kidney which has also been proved experimentally. Moreover, the cases of urinary stasis accompanying occlusion of the urinary passages of otherwise healthy ova indicate a regular activity of the fetal kidney, in other words, an admixture of the urine to the liquor amnii.

DR. RUNGE stated that Alex. Schmidt, who had examined the blood of the child at the moment of birth, had not found any material alteration of the hemoglobin contents of the fetus during labor.

DR. PROCHOWNICK said in reply to Fehling that the membranes which he had used were quite fresh and as like the living ones as possible.

DR. SAENGER (Leipzig) read a paper on

PALPATION OF THE URETERS.

He referred to his paper recently published in the Arch. f. Gyn., XXVIII., 1, and gave the previous history of the subject, in which Hegar and Chrobak take a prominent part, and in connection with palpation of the ureters in diseases of the urinary organs he stated that case 2 described in that paper (cysto-uteropyelitis duplex) had meantime died, and the diagnosis made during life, of greater implication of the right side, was fully confirmed at the autopsy. He spoke of making the diagnosis of diseases of the bladder and kidneys from the vagina, of palpating the ureters in the pregnant female, with healthy and morbid sexual, but normal urinary organs. He also discussed the frequent occurrence of epithelium from the renal pelvis in the urine from inflammatory and thickened ureters, and finally contrasted the sounding of the ureters (perfected mainly by Pawlick and his

ingenious method) with the brief ligation of the ureter, not according to Hegar after exposure of the ureter by a vaginal section, but without the latter operation, after having marked the ureter through Simon's speculum under the direction of the eye. Palpation of the ureter, however, will certainly restrict this procedure and even the necessity for the separate collection of the urine from one kidney.

He exhibited three gravida and two gynecological patients in whom the ureters could be felt in a most satisfactory manner.

DR. WINCKEL remarked that Hildebrand had previously demonstrated the protuberance of the ureters in retroflexion of the uterus.

DR. HIRSCHBERG.-It is not possible to distinguish the epithelium of the renal pelvis from that of the bladder; therefore it cannot be decided whether catarrh of the renal pelvis or of the bladder is present; sounding likewise gives no information in the case of calculous kidney.

DR. CHROBAK had also stated before that the ureters are palpable. Pawlick is likewise in the habit of palpating the ureters.

DR. SCHWARZ had repeatedly palpated the ureters and thinks the procedure easy. Where difficulty is encountered, he fills the rectum with the colpeurynter so as to have a foundation on which the ureter can be felt. He prefers the direct method (examination with Simon's speculum) to that of Saenger. In this way he had repeatedly seen turbid urine flow from one ureteral orifice, and clear urine from the other. Through Simon's speculum he had several times sounded the ureters; it is only necessary to fix the orifice with a tenaculum.

DR. OLSHAUSEN.-In order to determine whether one or the other kidney is diseased, we can omit ligation and content_ourselves with compression of the ureter; the latter can certainly be compressed with a clamp-like instrument from the vagina, and this can be done for some length of time without bad results.

DR. KORN (Dresden), among one hundred cases of pregnant women, had failed only once to palpate the ureters. In one case of chronic vesical catarrh he had felt both ureters to be as thick as a lead pencil.

DR. ELISCHER.-Palpation of the ureters is important, especially with reference to the extirpation of the uterus; he had made a ureteral fistula in his first extirpation. Sounding per se is not so difficult as the penetration beyond the angle formed by the vesical portion of the ureter with the upper part. He thought that ligation of the ureters was not free from danger.

DR. MUNDE doubted whether the ureters could really be distinctly felt, or whether other structures might not be mistaken for them. In chronic disease of the bladder the thickened ureters could be felt, as he had convinced himself in one case.

DR. ZWEIFEL.-Compression of the ureters had been spoken of already by Tuchmann and Simon; this he believed to be most convenient. The compresssion forceps are applied to the vesical orifice of the ureters.

DR. KRUKENBERG.-After ligation of the ureters nephritis may occasionally arise (Aufrecht).

DR. SAENGER.-Hegar only mentioned palpation of the ureters

in general, as did Chrobak.

Besides Hildebrand's statement, which seems to refer solely to retroflexion of the uterus, nothing is said anywhere respecting the almost regular palpability of the ureters and its applicability to the diagnosis of diseases of the urinary organs. Not the mere finding of epithelium from the renal pelvis, but its occurrence in large numbers and pronounced character, together with evidence of disease of the ureters, he believes to prove implication of the renal pelvis. In his paper he had already proposed compression of the ureters instead of the ligation, wherever possible. Ligation of short duration would hardly produce nephritis. Sounding of the ureters as practised by Schwarz he would characterize as antiquated hereafter, when contrasted with Pawlick's method. Mistaking other structures for the ureters is out of the question if we bear in mind the anatomical relations. Attention must be devoted only to those inferior portions of the urinary organs which are palpable from the vagina, then they will often be felt with surprising clearness both in health and disease.

DR. SCHWARZ did not intend in every case to dilate and use a tenaculum for the purpose of sounding the ureters; he had done so only in one case.

Afternoon Session.
President, DR. WINCKEL.

DR. ZWEIFEL (Erlangen) exhibited an

APPARATUS FOR THE FILTRATION OF LIQUIDS CONTAINING BACTERIA, in connection with the following paper:

When pregnant women suffer with infectious diseases, it is well known that the ovum does not escape the infection. Of course, there is a great difference in the several forms. While variola hardly ever spares the child, the ovum may escape the infection in some of the other diseases.

Nothing is known in regard to typhus fever, but with reference to measles and scarlatina, however contagious they may be otherwise, we know of no instances of transmission. To be sure, the last-named diseases cannot be properly compared with variola because they are mainly diseases of childhood, and a single attack nearly always secures immunity, and secondly, because it is possible for the fetus to pass through the entire disease in utero, but continue to develop and be born without showing a trace of having been affected.

There is, however, a disease which shares the special position of variola-splenic fever. Davaine inoculated pregnant animals with its infectious principle and the fetuses escaped the affection. Similar results have been published by Bollinger.

Up to a few years ago, this fact seemed to harmonize very well with our experience regarding the transition of solid, liquid, and gaseous bodies from the maternal to the fetal organism. The demonstration of liquid and gaseous bodies in the fetus succeeded,