pregnant uterus with sloughy myoma extirpated supra-vaginally. He then spoke of THE PROPHYLAXIS OF OPHTHALMO-BLENNORRHEA NEONATORUM. Referring to the favorable results of Credé's method, the speaker inquired whether the successes were due to the primary disinfection of the eye or to the general cleanliness, and whether the same successes could be secured by a milder procedure. Stress is always laid exclusively on infection during labor. This is not strictly correct; he holds the danger of infection during the passage of the child to be not very great; even if the gonococcus is present, infection need not ensue, since the eye of the child is provided with a number of protective apparatus (closure of the lids, the covering of vernix caseosa). A second point in support of his view is the slight morbidity in private practice; he did not believe there were an equal number of infected women in maternity institutions. The examination by different hands, and the transfer from case to case are responsible for the infection in institutions. The examining finger brings the secretions to places where they become dangerous for the eye. Accordingly, primary disinfection should not be accorded the first place. The fact that Credé's method had removed all the primary and subsequent affections is due to the whole system of cleanliness. That silver nitrate alone does not suffice is shown by the varying results at the institutions. Nor is this drug alone a specific; sublimate is equally effective. He was convinced that the same results were obtained by prophylactic sublimate irrigations of the vagina during labor, and washing of the eyes with distilled water. From April 1st until now, no case of ophthalmo-blennorrhea had occurred in more than two hundred deliveries. The advantage of this procedure lies in its simplicity and freedom from irritation. The eyes are bright and clear, not in the least injected; he would not expose all children to an artificial catarrh of the eyes. Ophthalmologists do not hold two-per-cent solutions of silver nitrate to be indifferent. Schroeder likewise had expressed himself against the obligatory introduction of the disinfection. DR. ZWEIFEL, Some years ago, had instituted quite similar experiments; during this time, no eye became affected; later the disinfection was performed by the nurses, and an epidemic ensued. This shows that the protection is not perfect. He then again introduced Credé's method, and since that time had had no more cases. He had witnessed a blennorrhoic catarrh of the eye after the use of silver nitrate. DR. OLSHAUSEN did not agree with Dr. Kaltenbach in some points. If K. considers primary infection to be comparatively not so frequent as transfer in the institutions, this is undoubtedly correct. Nevertheless, we have in the time of onset a proof of the fact that infection occurs primarily during labor. The great majority of the cases become affected at the end of the third or the beginning of the fourth day. He, too, had had the vagina regularly irrigated with carbolic acid, and then the eyes washed first with one-, then with two-per-cent carbolic solution. Although the improvement was marked, he had still better results with the application of silver nitrate. He considers the latter drug a sort of specific; he had not had equally good results with the use of sublimate, and had again come back to silver nitrate. One serious obstacle to the obligatory introduction is presented by the frequent occurrence of catarrhal inflammations of the eye. DR. WINCKEL remarked that not one child had been affected since the introduction of the prophylactic disinfection of the eye. DR. SCHATZ thought that, if silver nitrate were continued, it would be impossible to secure a more general employment. Sublimate did not produce the same results, while silver nitrate is a specific. He did not believe that sublimate had a specific effect on gonococci. DR. LEOPOLD expressed great satisfaction with Credé's method. When first introduced, there had been several pronounced symptoms of inflammation, some of them even quite purulent. This was traceable to a careless carrying out of the directions; the treatment should be in reliable hands. Kaltenbach's advice to irrigate the vagina with sublimate he thought would prove objectionable in private practice. He had but very rarely seen irritation after the instillation of a two-per-cent solution of silver nitrate. DR. MUELLER (Berne) looks upon vaginal irrigations as the chief remedy for blennorrhea; he gives them every one or two hours during the second stage of labor. This can be done also in private practice. DR. PROCHOWNICK.-Before the introduction of silver nitrate for this purpose, he had had about nine or ten cases in private practice. Since the establishment of Credé's method, he had seen no more instances of blennorrhea. He no longer uses prophylactic vaginal irrigations, and holds them to be superfluous. DR. HOFMEIER.-It is of importance for us to determine definitely which is the effective step in the procedure. In Berlin, the results had been quite as good with antiseptic agents, but less favorable with the use of distilled water. DR. BUMM.-The carriers of infection are only sparsely present during labor, but increase materially in the next few days. Examinations of gravida show this very well; their milky secretion contains but few carriers of infection. During the delivery the number becomes somewhat larger: in the first days of the puerperium, when the secretion becomes sanguinolent, it is very great. Therefore, the infection does not take place during the passage through the parturient canal, but subsequently. The onset of the disease on the third or fourth day does not negative this view; the blennorrhea may be manifest already after twelve hours. DR. FIRNIG (Cologne).-At the School for Midwives in Cologne, in a portion of the cases (head presentations), the region of the eyes had been washed with ether, and touched with iodoform, immediately after the face had been delivered; and after the birth of the child, the eyes rinsed with water that had been boiled. This treatment simply failed, while no blennorrhea occurred after Credé's method. DR. KALTENBACH defended the greater disinfecting power of sublimate; he had decided on his procedure only after testing other methods. DR. CREDE.-In the last two years, among more than one thousand labors, he had had but one case of catarrh, and one slight at tack of blennorrhea; all the other eyes remained healthy. He had never employed sublimate for instillation or irrigation. Symptoms of irritation after the instillation of silver nitrate are exceedingly rare, and occur mainly in premature children; they may also be due to the incorrect execution of the method. He injects only a minute drop from a glass rod. Before he had resorted to silver nitrate, he had tried milder measures, all of which proved unreliable: hence there must be some specific power in this drug, which he saw no reason to abandon. According to his experience, disinfection of the vagina alone does not suffice. He is averse to giving sublimate into the hands of midwives. The question whether the state should take the matter in hand he thought was not yet ripe for decision; further test was necessary. DR. ZWEIFEL maintained that solutions of carbolic acid and sublimate, of corresponding strength, were equivalent. DR. MUELLER (Berne) asked Credé whether the number of eye affections had not greatly decreased since the introduction of the disinfecting method (vaginal irrigations). DR. CREDÉ was unable to give reliable figures on this point. PUERPERAL ECLAMPSIA. He reported two cases of typical eclampsia at the beginning of the tenth month. In the first, the Cesarean section was performed in the death agony; the second died eighteen hours post partum. In both were found, besides the usual lesions, the signs of acute yellow atrophy of the liver, and terminal icterus. No trace of urea was found in the organs. In the first case, methemoglobin was present in the fresh blood obtained by venesection, and in the scanty amount of urine; besides, large quantities of tyrosin and leucin were found in the liver and urine. It the second case, the same conditions were present, with the exception of methemogoblin, inasmuch as no venesection was performed and no urine was present. Ammonia was not found in the blood, but intense acute nephritis in the kidney; complete anuria in the second case. The speaker believed, as regards the absence of urea, even in the liver, that the processes of decomposition had not extended to the urea, and that intermediary products of tissue metamorphosis had been retained in the body and produced the symptoms of intoxication. Judging from experiments made with a patient recovering from eclampsia, he thought that this supposititious substance is not nitrogenous. Hence there could be nothing like ammonemia and uremia. The changes in the liver, the speaker thought, were terminal phenomena in the group of symptoms. The urine, like that of all eclamptic patients, contained acetone. He had, besides, found sugar in the urine of all eclamptic patients. It is uncertain whence the poisonous substance in the body is derived. It is possible that the child is the source, in reference to which supposition the speaker pointed to the rigor mortis and muscular rigidity in the new-born children of eclamptic patients, which had been observed by Dohrn and himself. This rigidity should have been retarded or even prevented by the surcharge of the blood with carbonic acid and the asphyxia due to it, as in his case. DR. WIENER inquired whether the urine had been examined for biliary constituents. (Answered in the negative.) We might suppose a condition of cholemia which likewise produces coma, spasms, and acetonemia. Possibly the kidney affection had hindered or prevented the excretion of the biliary constituents retained in the blood, and thus caused their accumulation in that fluid-a condition indicated among others by Spiegelberg in the icterus of gravidæ. DR. STUMPF rejected the theory of cholemia, since the icterus did not occur until the very end. DR. SAENGER.-Muscular rigidity of the child can also ensue in women who did not die of eclampsia, e. g., in fatal hemorrhage. DR. BATTLEHNER (Carlsruhe) believed that eclampsia is due to a substance resembling a ptomaïne, formed during life in acute yellow atrophy of the liver, perhaps also in the kidney, which presents similar conditions to those in the liver, i. e., fatty degenerations. Urea alone is not the cause. DR. STUMPF.-The ptomaïnes have hitherto been found only as the result of putrefactive bacteria; he would be disinclined to accept this view. DR. RUNGE (Dorpat) read a paper on THE GENERAL TREATMENT OF DISEASES OF THE PUERPERIUM. R.'s method consists of alcohol in very large doses, baths, ample nutrition, and avoidance of antipyretics. Especially the exhibition of alcohol must be very free. The baths should have a temperature of 22 to 24° C. (71.5 to 75° F.). Then, as in typhoid fever, we notice improvement in the pulse, deep inspirations are taken, and the appetite increases. Antipyretics at best influence the temperature, but they disturb the appetite. Of nine patients with grave sepsis, only one died under this treatment. This method strengthens the organism against the germs of infection present. DR. SAENGER (Leipzig) read a paper on THE RELATIONS OF GONNORRHEAL INFECTION TO PUERPERAL DISEASES. Gonorrheal infection is more frequent than was formerly stated. In order to make the diagnosis positive, there must be present reliable statements of the husband and the wife, ophthalmia of a child, diseases of the urinary passages and the vulvar glands; especially the latter are specific. He would avail himself only of the clinical standpoint. He had not made regular examinations for the gonococcus, because its presence is inconstant and its differentiation from pseudo-cocci had not yet succeeded. Among 1,930 cases in the last few years, S. had found 230 or twelve per cent due to gonorrheal infection, and in 161 additional cases of more recent occurrence, 29 or eighteen per cent. Far more than half of the cases are incontestably certain. In 100 of 389 gravidæ purulent discharge was noted, i. e., 26 per cent (Oppenheimer had calculated 27 per cent for Heidelberg); 40 children subsequently became affected with blennorrhea. It is remarkable that gonorrheal infection causes no puerperal infection. Persons infected with gonorrhea differ in no way from others not infected; still in the puerperium gonorrheal affections are very frequent and are not rarely taken for puerperal diseases. Ang. Macdonald called attention to the fact that gonorrheal infection may cause grave, even fatal diseases in the puerperium. Some of these cases, however, were of septic infection. The speaker then related a case of grave gonorrheal infection in the third week of the puerperium, in which he had found on the left side a parametritic exudation, and on the right side a pelviperitonitic exudation in Douglas' cul-de-sac. The suspicion that pyo-salpinx was present on the right side was subsequently confirmed by operation. It is the tubes affected with gonorrhea which in the puerperium give rise to pelviperitonitic exudations running a different course from septic inflammations which are nearly always fatal. Gonorrheal exudations usually run a protracted course and set in late in the puerperium. If we find in parous women recent or older perimetritic exudations associated with disease of the adnexa, then these diseases are nearly always of gonorrheal origin. The women affected are those whose tubes had been diseased before and during pregnancy, or else those who, soon after an abortion or labor, had connection with a man infected with gonorrhea. These cases furnish with special frequency pelviperitonitic inflammations with disease of the tubes. Of thirty-five cases of grave gonorrheal diseases observed by him in the time of the puerperium, these formed the majority. That the disease occurs so late is perhaps due to the fact that the gonococci are washed away or that menstruation again occurs, etc. The gonococcus acts only on the surface. For the puerperium, gonorrheal infection presents no very serious danger; hence gonorrhea appears comparatively harmless for the early lying-in period. On the other hand, persons seriously affected with gonorrhea must expect to suffer suddenly, some three to seven weeks later, without any obvious connection with the puerperium. In this way gonorrhea differs essentially from sepsis. These two infections do not concern one another, but mixed forms occur. DISCUSSION OF THE TWO PRECEDING PAPERS. DR. P. MUELLER inquired whether Runge's cases included peritonitis and diarrhea; also, how large had been the greatest quantity of alcohol. DR. GRAEFE.-As long as seven years ago, Schroeder had treated puerperæ successfully with large doses of alcohol. To Saenger's paper he remarked that he had observed a similar case in which disease occured in the puerperium; in another case he had observed the disease set in after twelve hours, but recovery followed very rapidly. DR. KALTENBACH.-It has often been noticed that where oph |