substance. Such a pedicle, in the experience of Dr. Keith, never gives trouble from oozing. The wound was closed with fine silk sutures which had been boiled. Ten or fifteen pieces of silk were threaded at each end with very finely tempered needles nearly three inches long, which were introduced on either side from within outward. Very small margins of peritoneum and skin were included in the sutures. Dr. Keith thought it a very common fault among operators to draw the stitches too tight in tying. The long fine needle used in closing the wound is superior. It makes a very small puncture which never bleeds, and is so fine that it is easily pushed through by means of finger and thumb without needle forceps. In the AMERICAN JOURNAL OF OBSTETRICS, April, 1880, Marion Sims had given a remarkable description of the Keith operation, which has exerted a powerful and beneficent influence upon the operation in America. Dr. Dudley could add little except the gentle handling of the adhesions with the sponge, the ligature forceps, and the peculiar long straight needles already mentioned. The wonderful success without antiseptics recorded by the great Scotch ovariotomist, by Dr. Bantock and by Mr. Tait, who have reduced the mortality almost to zero, must have great influence in fixing the value of Listerism so far as it relates to abdominal surgery. At any rate, incompetent operators can no longer venture with impunity upon these capital operations under the dangerous impression that, in some mysterious way, antiseptics will deprive a crude surgical performance of its greatest perils. Evidently it was not so much a question of Listerism as of removing the tumor with the least possible amount of operating and in the shortest time consistent with careful attention to detail, and in the most gentle manner. Dr. Dudley, however, raised the pertinent question whether Listerism should be placed on trial before a court of abdominal surgeons, and whether, if found unnecessary in peritoneal surgery, it could be fair to condemn it in general. He thought that such a verdict could not be sustained by the facts, but that the antiseptic principle in surgery was destined to stand. Even the most violent opponents of antiseptics agreed that perfect cleanliness was essential. He knew of no other method by which cleanliness could be rendered so nearly absolute. Nor did the seeming ability of two or three of the most dexterous operators to do without antiseptics prove that it might not be a useful aid to others. Clearly, the man who removes a tumor with the least operating and handling of the parts will require fewer preventive measures against inflammation and sepsis. Antiseptics, therefore, might be most valuabie for an inexperienced operator, and, to say the least, an additional safeguard for any one. Some American operators were now having about as good results as could be shown in Great Britain, which seemed to indi cate that our former high mortality in this American operation had been due in reality to bad operating, and not, as many supposed, to climatic causes. The minor gynecology of Great Britain had apparently made but little progress since the days of Bennett and Simpson. The general impression prevails that on this side of the Atlantic we are going wild in the minor gynecological surgery. In response, we may now congratulate our English brethren that many of their leading gynecologists are already commencing to comprehend, to appreciate, and to perform the American operations of perineorrhaphy, elytrorrhaphy, and trachelorrhaphy, and at the same time to lay aside, in a measure, the old porte caustique. DR. H. P. NEWMAN said that there were other reasons for the brilliant success of foreign laparotomists than those referred to by Dr. Dudley. Aside from the facility and expeditious manner of operating, acquired by large experience, a prime factor is the justifiable self-confidence of the operator and a responsive confidence inspired in the patient. DR. W. W. JAGGARD thought that minor gynecological operations, as Dr. Dudley termed them, were less frequent in the United Kingdom and the Continent than in America. Dr. Dudley had made this general assertion, and he agreed with him. He did not, however, think the operative skill of British or Continental surgeons inferior to that of their American confrères. The indications for operative procedure do not exist in the United Kingdom and the Continent as in America. Lacerations of the cervix and the perineum are of much less frequent occurrence. The cervix uteri is usually effaced, and the external os is fully dilated before the application of the forceps. Manual dilatation is less frequently practised. The bag of waters is not prematurely ruptured. Greater care is taken with the preservation of the perineum. In a word, obstetricians are better operators, and do not require socalled gynecological assistants. DR. E. J. DOERING said that, in 1874, he had been present at ovariotomy and other operations performed at the Samaritan Hospital by Sir Spencer Wells. He was particularly impressed with the extreme care exercised in admitting spectators to the operations, each visitor being required to sign a statement that he had not made an autopsy or attended a case of contagious disease for the two or three days preceding. He desired to know whether these regulations were still in force, and also if Mr. Lawson Tait and Dr. Keith required similar restrictions. THE PRESIDENT asked the following questions: 1. Was any treatment given to the patients to prepare them for the operation by any of the eminent gentlemen mentioned?" 2. "How were the patients covered during the operation, or was the whole abdomen left bare?" 3. How was the evacuation of the cyst managed?" 4. "Was the patient turned upon her side to accomplish this, as Dr. Thomas sometimes does?” THE PRESIDENT suggested that all who desired should ask questions for further light before the general discussion began. DR. CHRISTIAN FENGER replied to the question, raised by Dr. Dudley, that antiseptic precautions might be more important in surgery in general, than in abdominal surgery, where it looked as though more perfect methods of operating without antisepsis gave as good results as with antisepsis, as follows: He thought that the abdominal, or rather peritoneal cavity, in respect to the antiseptic precautions, occupies a peculiar position in surgery. The danger from absorption of the poisonous antiseptics is far greater in the abdomen than in wounds. The ability of the peritoneum to absorb serous fluid and blood before it decomposes, to encapsulate foreign substances not capable of absorption -ex. gr., rubber ligature-is perhaps somewhat greater than the ability of a wound in that direction, although it may be that there is some prejudice about this, as we have not as yet used silk ligatures extensively in general surgery. As to the question, whether more perfect methods of operating without antisepsis would improve the results, or rather prevent inflammation and sepsis, he could say that outside of the peritoneum this question must as yet be answered in the negative. In 1873, Volkmann, of Halle, introduced the Lister method of dressing and operating in his surgical clinics. In his report of the work done in 1873 (“ Beiträge zur Chirurgie," 1875), the antiseptic surgery had reduced inflammatory and septic complications fol lowing excisions, amputations, fresh penetrating articular wounds, fresh open fractures, to a minimum never before dreamt of, and all this in one year. In the broad field of surgery it is not possible that Volkmann or anybody else could improve the technique of operating to the extent of having the results change all of a suddenin that way. No surgeon would dare to-day to excise, for example, a knee-joint, without antiseptic precautions in all the minute details, even if he employed all the latest improvements in the method of operating. Abdominal surgery is the only branch of surgery in which, as yet, the heavy operating has been done without antiseptic precautions. TRANSACTIONS OF THE GERMAN GYNECOLOGICAL SOCIETY. SECTION XVIII. OF THE FIFTY-EIGHTH ANNUAL MEETING (REPORTED BY M. GRAEFE, M.D., HALLE A. S.) (Translated from the Centralblatt f. Gynäkologie.) SCHATZ (Rostock) read a paper on THE FORMS OF THE CURVE OF UTERINE CONTRACTIONS AND THE PERISTALSIS OF THE HUMAN UTERUS. He briefly touched upon the manifold difficulties associated with the examination of the phenomena of uterine contractions, the cause of which is to be sought in the smooth muscular apparatus and its peculiar structure. There is, besides, a second difficulty, namely, to learn to understand fully and to read the curves deineated by the intrauterine pressure. Thus the explanation of the different forms of curve was not an easy task to S. In many cases, the ascending part of the curve is exactly equal to the descending one; only the latter is more drawn out, similar to that with which we are familiar in the twitchings of the striated muscles. In most instances, the ascending portion is much steeper than the descending one, rarely the reverse. For various reasons, S. soon abandoned the view that the gradually declining curves are curves of fatigue. In like manner, he was forced, after years of experimenting, to again abandon another interpretation which he had accepted on account of analogous appearances with striated muscles, namely, that they were curves of tension and of shortening (curves of tension in difficult or impossible evacuation of the uterus, curves of shortening in evacuation by contraction), although he convinced himself that the labor curve was somewhat altered by the possible or impossible evacuation. After further laborious investigations, he had now come to the conviction that the different labor curves are only traceable to the circumstance that the uterine muscle does not contract simultaneously, but in a peristaltic manner. Beside the peristalsis, the form and the distribution of the muscles have a certain though subordinate influence. A peristaltic contraction of a cylindrical uterus will produce a curve of intrauterine pressure, the ascending and descending portions of which will be equal. But in the case of a conical or funnel-shaped uterus, the labor curve will first ascend steeply, and gradually decline, because during peristaltic contraction a greater intrauterine pressure will arise at the wide than at the narrow end. For during contraction of a wide zone, more fluid is displaced than in a narrow one, and inversely the displaced fluid finds greater resistance in passing into the narrow zone than in passing from the latter into the wider one. When the uterus is distinctly transverse or even bicornuate in form, the contraction, beginning at the two tubal extremities, and progressing from the narrow to the wide part of the funnel, will be followed by a curve ascending more gradually than it descends. The muscular apparatus of the uterus, by the varying thickness of its several muscular zones, in conjunction with their differing width, acts on the intrauterine maximal pressure, and thus on the form of the labor curve. When the zone, which by its thickness and circumference commands the greatest muscular bulk, and hence the highest power, is above the middle of the uterus-the usual condition-then the greatest intrauterine pressure, and with it the acme of the pain, occurs before its middle; its ascending portion is steeper than the descending one. When the most powerful zone lies in the middle or-a rare condition-below it, then the acme is likewise in or behind its middle. In addition, of course, the fact must not be lost sight of that the form of the contraction is influenced in a slighter degree by other factors, such as the possibility of evacuation, etc. As regards the direction in which the peristaltic movement extends, it passes, in the human as in the animal uterus, from the tubal extremities to the os uteri. The several proofs of this fact will be published subsequently by S. Very difficult of solution is the question with what rapidity the peristalsis passes over the uterus, as that movement cannot be seen on the round human uterus. S. has constructed an apparatus which, when introduced into the evacuated uterus, is said to represent graphically the contraction of the upper, middle, and lower portion, each separately, but all at the same time, and hopes to be able to give at some future time pictorial delineations of the peristalsis. For the present, he has calculated in another way the time in which the peristalsis travels from the opening of the tube to the internal os. It is said to amount to about twenty to thirty seconds, or, in proportion to the length of the pain, which lasts from sixty to ninety seconds, about the third part of it. Since the length of the pain is always equal to the length of the contraction of the single muscular fibre plus the peristaltic course, the former amounts to forty to sixty seconds, that is, double that of the peristaltic course. Therefore, when the contraction begins at the mouth of the tube, it takes twenty to thirty seconds until the internal os likewise begins to contract. The latter, indeed, is passively distended from the start; but its active tension does not begin until twenty to thirty seconds later. At this time, the muscles at the tubal extremities are in the state of highest contraction. When the internal os is in that condition, the tension has again disappeared at the tubes. Whether the peristaltic course takes place continuously as it does in the ureter, or intermittently, so that always entire zones would be in an equal phase of the contraction, S. is as yet unable to state positively. But he thinks he has observed this phenomenon on the animal uterus, and suspects the same to be the case with the human uterus. SCHATZ (Rostock) also read a paper on THE ETIOLOGY OF FACE POSITIONS. S. is of opinion that the various publications treating of the etiology of face positions have taught us a number of so-called predisposing factors, but have left us in doubt about the true origin. He has observed two cases of face position which, being in themselves sufficiently clear, might give more definite information in general. In both cases, the face position was due to an undeveloped form of the uterus. The latter is generally triangular, and may suffer different modifications. In a well-proportioned uterus the line of junction of the two tubal orifices is much shorter than that of |