thalmo-blennorrhea occurs in the children, febrile diseases affect the mothers. These diseases in particular had confirmed him in his prophylaxis. He doubted that the gonococcus causes only superficial disease. How then could we explain the strictures in man caused by gonorrhea? He believed, on the contrary, that the gonococci penetrate into the depth of the tissues.

DR. BUMM thought it impossible to make the diagnosis clinically. Neither the history nor the discharge would be decisive. Two clinical symptoms alone could be utilized: inflammations of the vulvo-vaginal glands, and urethritis. A bacteriological examination alone could decide. The parametritic inflammations might be due rather to the Staphylococcus aureus or albus.

DR. ELISCHER.-The antipyretics disarrange the stomach. He had obtained the same results with cold ablutions as with baths. DR. SCHAUTA agreed with Dr. Runge. Puerpera bear alcohol very well; they burn it up soon; it supports respiration and fortifies the cells in their struggle against the invasion of micro-organisms. But we must also guard against the further introduction of microbes, especially through the uterus which, as it were, is a dead space. He called especial attention to the iodoform treatment (iodoform bougies).

DR. GUSSEROW.-The alcohol treatment is very old. He had not seen much good from antipyretics, and had all along given alcohol, but had always met with much opposition on the part of the patients. He would also like to know how the large quantities of nutriment are given to the patients; they usually refuse them. Alcohol can only be looked upon as an adjuvant.

DR. MUNDE.-In America, alcohol is given in the shape of cognac or whiskey, about one litre per day, together with drugs to improve digestion (pepsin), if necessary. Cold he applies by means of the rubber ice-coil applied to the abdomen. Besides, he gives antipyrine. In reply to Saenger he stated that he had seen salpingitis without gonorrhea in virgins.

DR. V. SAEXINGER had, long before Breisky, instituted the alcohol treatment, giving large quantities (one to two litres) of domestic wine per os and rectum, and had also attended to vigorous nutrition; yet he had never witnessed recovery after very grave diseases. Alcohol should only be looked upon as an adjuvant. He had not had much effect from antipyretics.

He was surprised at the high percentage of gonorrhea which Saenger had observed; he does not see the affection with a like frequency. The following he believed to be a reliable clinical symptom: in women affected with gonorrhea, he had observed, aside from the intense reddening and intumescence, especially a swelling of the papillary bodies on the surface of the mucous membrane, and on the eminences, through loss of epithelium, small ecchymoses which, in conjunction with the other symptoms, are pathognomonic. He had also seen in young girls two cases of salpingitis which were undoubtedly gonorrheal in character.

DR. FEHLING referred to Zweifel's investigations with regard to germs of decomposition in the living organism, and his success with the ice treatment after laparotomies. Immediately after the expulsion of the placenta, the speaker had ice-bladders laid upon the abdomen, in order to avoid the lesser wound fevers which so frequently give rise to the spread of the puerperal fever. The result was very satisfactory. After omitting the ice-bladder, he had again witnessed a series of slight rises of temperature. He

recommended the ice-bladder as a prophylactic against the lesser wound fevers.

DR. VEIT (Berlin) expressed surprise that nothing had been said about the value of local treatment of puerperal diseases. Owing to the movements associated with baths, he had frequently observed grave symptoms traceable to the detachment of thrombi. He had given antipyrine when first introduced, but he did not think it indicated, as it disturbs free observation. He rejects the iodoform bougies recommended by Schauta.

DR. KUESTNER expressed himself in favor of the local treatment recommended by Fischl which is likewise in use at Jena. He also advised the early vaginal diagnosis and treatment of puerperal ulcers.

DR. KRUKENBERG had also observed rigors after cold baths (16° R. = 68° F.), and, in one case, metastases at the autopsy. DR. FIRNIG (Cologne) recommended hydropathic packs, i. e., wrapping the patient in a wet sheet which is to be covered with a woollen blanket.

DR. WINCKEL thought, with reference to the opinion of Saenger and Noeggerath, that in Leipzig, owing to the great influx of strangers, conditions similar to those in New York prevail, and that in both cities opportunities for infection are frequent. In Dresden, among seven hundred autopsies, he had never found a case of death due to acute gonorrheal infection. In Munich, however, he had observed several very grave cases of gonorrheal infection with exudations. The speaker also made mention of cauterizations with liquor ferri sesquichloridi and their favorable effect. He had saturated some sterilized silk with the cocci of erysipelas and then dipped it into the iron solution. Later, when he employed the silk on rabbits, erysipelas either failed to develop or else did so very slowly.

DR. RUNGE reiterated that his method simply invigorated the organism and rendered it more capable of resistance. The alcohol alone did not do it; it must be given in conjunction with baths, but very freely, then the appetite also improves. The majority of his nine cases belonged to the so-called lymphatic form, with very weak pulse, peritonitis, etc.

DR. SAENGER said that his material comprised persons of every station, residents and strangers, but no prostitutes. Gonorrhea is a universal disease, and there can be no city to which it might impress a special stamp, as Winckel maintained. If physicians were to make it a point to look for gonorrhea in every gynecological examination, they would throughout obtain figures similar to his own. According to Kaltenbach's view, there would have to exist a parametritis gonorrhoica. Clinical demonstration had always sufficed formerly and does so still. If Bumm thinks it impossible to make, he should first bring forward the true coccus, and not ever new forms of cocci. Where else could the frequent diseases of the adnexa and the pelvic peritoneum come from? Some etiology should be named. He would adhere to his opinion, and did not believe that catarrhal inflammations of the tubes can cause pyo-salpinx, nor that injuries could lead to it. Pyo-salpinx is always due to infection; but the gonorrheal form is the most frequent.

Halle was chosen as the next place of meeting.

Second Day Afternoon Session.

President, DR. WINCKEL.

DR. ELISCHER (Budapest) read a paper on

THE USE OF IODOFORM IN SEVERE LAPAROTOMIES.

He related a case of double ovariotomy in which both pedicles and a portion of the mesentery had been dressed with iodoform; in the pedicles were gaping vessels which were ligated. During the first two days, the patient felt very well, but there was absolutely no thirst. On the following day, uterine hemorrhage, great restlessness, sopor, slight icterus; temperature normal, pulse increased in rapidity. On the next day, the icterus was more intense, urine dark brownish-red. When the patient was touched with a cloth dipped in ice-water, deep respirations were evoked. Gradual return of consciousness, temperature normal, pulse still frequent. The patient recovered. After other operations, too, in which iodoform had been used, the speaker had witnessed remarkable symptoms (excitement, bilious vomiting, spells of weeping, immobility of the pupils, restlessness, etc.). All these he ascribed to the effect of the iodoform. He advised to close all gaping vessels by the ligature, since they might absorb the iodoform. Besides he keeps up the activity of the skin. His experience warned us to consider to what extent iodoform should be used.

DR. FROMMEL had not introduced iodoform into the abdominal cavity under normal conditions, but had used the drug extensively in two cases of tubercular peritonitis. The temperature of the first patient sank to the normal immediately after the operation. In a third case of ovarian tumor with ascites he found small papillæ all over the peritoneum and introduced iodoform in large quantities into the abdominal cavity; in this case it was likewise very well borne.

DR. SLAVIANSKY (St. Petersburg) had also observed a case of intoxication after a myomotomy in a fat patient in whom carbolic acid and iodoform had been used. Delirium and death ensued. The autopsy showed all the appearances of septicemia. Thus far we did not know the clinical picture of iodoform intoxication; it can easily be confounded with septicemia. Hence we must be very careful to diagnose iodoform intoxication. He had not observed any ill effect from iodoform.

DR. SCHAUTA had introduced as much as six grams of iodoform into the uterus in a case of puerperal endometritis, without any ill effect; he also referred to Ehrendorfer (Arch. f. Gynaec., Bd. 22), who had used still larger amounts of iodoform without unfavorable results. On the other hand it must be admitted that our best antiseptics are violent poisons. Possibly Elischer's cases were iodoform intoxications, perhaps not; possibly, too, the point of application might not be indifferent.

DR. HIRSCHBERG had succeeded in completely curing a case of peritonitis with tubercular nodules by corrosive sublimate. Hence iodoform is not the sole specific for tubercular peritonitis; in old people and fat persons it should either not be used at all or at most in small quantities.

DR. MEINERT agreed with the last speaker that it is not iodoform alone which will cure tubercular peritonitis; a like result can be obtained by other measures (tapping, incision).

DR. GRAEFE Confirmed these statements by a case observed by himself. He had also seen two cases of tubercular peritonitis completely cured, though the patients died of phthisis. This form of peritonitis is not always of a tubercular character; sometimes nothing but granulation tissue can be found.

DR. KALTENBACH had witnessed three cases of iodoform intoxication. The most prominent of the symptoms was great itching of the skin. Iodine was regularly demonstrated in the urine. When the pedicle is treated extra-peritoneally, he uses, instead of iodoform, tannin with salicylic acid.

DR. BATTLEHNER had also seen a case of peritonitis with ascites and tubercles which recovered after tapping. He agreed with Graefe that the diagnosis could be formed only when the tubercle bacilli could be demonstrated. Otherwise he was of opinion that many a case of psychical disturbance is erroneously taken for iodoform poisoning. The speaker had had such a case.

DR. OLSHAUSEN had observed quite a number of cases of tubercular peritonitis. Tuberculosis of the peritoneum may be recovered from in many cases, or remain stationary for years; it may get well without iodoform.

DR. PROCHOWNICK had found in three cases extensive adhesions of the peritoneum to the pelvic wall which made the ascites clear to him.

DR. CHROBAK believed it had not been shown that Elischer's were cases of iodoform intoxication; he had also seen a case recover which might have been taken for iodoform poisoning. He could not recommend the abstraction of fluid which Elischer proposed. He had used iodoform in many cases, though not in excessive quantities, and had never seen any ill effects.

DR. V. ŜAEXINGER.-In a case of tubercular peritonitis with enormous ascites and countless tubercles, there had been no recurrence of the ascites after laparotomy and evacuation of the fluid; the operation was performed six months ago.

DR. FROMMEL disclaimed that he had recommended iodoform as a specific for these cases.

DR. ELISCHER said that in his case no septicemia was present (no fever, no swelling, etc.). To Schauta he replied that when iodoform bougies are introduced into the uterus, the quantity of iodoform administered cannot be definitely known, as a portion of the drug might drain away. He laid great weight on “dry diet."

DR. SCHATZ read a paper on

ULCERS OF THE BLADDER.

He had observed the following two cases. A woman, otherwise healthy, had very great dysuria during typhoid fever. Treatment by irrigation had no effect. After several weeks the bladder was palpated, and found velvety to the touch, except at the anterior wall, a short distance above the symphysis, where there was a spot, the size of a dollar, which differed from the remainder of the internal surface in seeming to be mounted on a firm wall. It was not depressed, but had an even surface which felt like dampened

glass. There was no swelling around it. There was some strangury; the urine contained blood and pus. Further treatment at the time proved ineffectual. Six months later, Dr. S. saw a similar case in a young woman. There was vesical tenesmus, together with the discharge of some drops of blood. On palpating the bladder, the conditions found were as in the former case, only the ulcer was seated more postero-superiorly, and was about five centimetres in diameter. Examination of the pus gave no information. The patient returned after several months. Irrigations produced no improvement. Meantime the ulcer had enlarged to thrice its former dimensions, its lower limit reaching almost to the trigonum of Lieutard. The question was, whether improvement could be obtained by a partial resection of the bladder. This operation was performed, similar to the high lithotomy. The incision was made immediately above the symphysis, and the bladder lifted up. After being opened, the ulcer became visible; the rest of the bladder was intact. The ulcer was seized from behind with a clampforceps; the mass within the grasp of the instrument was very thick, but it was ligated and cut off. The threads were allowed to remain, so as to let them hang out of a fistula. The vesical incision was stitched with catgut, the lower portion of the vesical and abdominal wounds left open. Through this fistula were passed the threads and a drainage tube extending through the urethra. By about the twentieth day the suture was so loose that it could be easily pulled out of the fistula; the same remark applies to the drainage tube. After three hours, the patient evacuated one-quarter litre of urine without any difficulty. The excised piece looked like a granulating ulcer; it contained tubercles, but no bacilli. After several months, during which she had no purulent urine, the patient returned with the remark that her urine was again turbid. It was always acid. The case, then, was a tubercular ulcer of the bladder. The reader had formerly seen two patients who had had vesical disturbances for a long time, and whose bladder was firmly contracted; internal palpation showed results which he would be most strongly inclined to term tuberculosis. The duration of tuberculosis of the urinary organs may occasionally be very protracted. The operation, therefore, was justified. The other question, whether it was correct to open the bladder from above, was answered by the reader to the effect that he did not think it good practice to enter from the vagina. The operation from above is not so grave; it resembles lithotomy. He had closed the bladder only to the point where the ligatures extended outwards, so that he could, if necessary, draw it upward, and in order to prevent the formation of a long fistula. He had found no similar case in literature.

DR. HIRSCHBERG said he would not readily decide upon a similar operation in the case of ulcers. The female urethra could be easily dilated. The high lithotomy is not quite simple and harm