previously he had been engaged in railroading in the Mississippi Valley, where he was much exposed to the night air and dampness of that malarious locality.

His habits as to food and drink have been bad, and he has also made use of tobacco too freely. His diet has been immoderate and composed of rich articles of highly-seasoned food. He has often indulged quite freely in the use of wine, whisky, champagne, and beer. He served in the war of the rebellion for three years, and while there endured many hardships and privations incidental to the life of a private in the ranks.

His family history is bad, as his father and several relatives died of consumption, and one brother and two sisters are now sick of the disease.

Three years ago he had hemorrhoids and fistula in ano, and while afflicted with these troubles he had two hemorrhages from the stomach. Six months since he had some inflammatory disease of the bowels, which was followed by an abscess.

On examination I find the lungs are free from disease. There is a distinct murmur with the first sound of the heart. The liver is enlarged, percussion dullness extending down three inches below the margin of the ribe. There is much tenderness under pressure, and some swelling may be observed from the ensiform appendix along the cartilaginous margin of the ribs on the right side. The pulsations are 110 per minute, and the temperature in the axilla is 100.2° F.

The disease appears to be hepatic abscess, and the use of the exploring needle is suggested with a view of confirming the diag nosis, but this end can not be accomplished. Treatment. Believing that the swelling was due to an effusion of serum, and that the pus stage had not been fully reached, a large fly blister was applied over the affected parts.

The patient was directed to take internally every third hour two drams of a mixture containing potass. acetat. 3i, spts. ether. nitrosi f3i, tinct. digitalis fgii, and elixir simplicis f3ii, and to keep the bowels in a healthy condition he was directed to take effervescent seltzer aperient every morn

ing. Under this treatment the temperature did not exceed 101° F., but the pulse increased in frequency until it reached 124 per minute. The blister relieved the swelling and pain but the tenderness under pressure still continued. At the end of the third day the patient became sleepless and irritable; a hypodermic injection of one fourth grain of morphia sulph. was given him at night which enabled him to get some sleep. The injection of morphia was repeated once only, and on the fifth day the temperature in the axilla was found to be normal. On the seventh day the patient ate some custard which caused emesis, and subsequently blood to the extent of a teacupful was vomited. Hot water was prescribed for the patient in small quantities, and no more hemorrhage ensued, but his appetite, that up to this time had been reasonably good, failed.

On the ninth day quinine was added to the internal medication, and of this he took five grains three times daily for the next. four days.

On the tenth day some swelling and soreness under pressure still remained, and another fly blister was applied as before. The relief following the use of the second blister was most marked. Two days later the swelling and tenderness under pressure had entirely disappeared. The area of the percussion dullness below the margin of the ribs had diminished. The urine, which up to this time had been highly colored, now became clear and increased in quantity. The digitalis mixture and the quinine were now discontinued, and the patient was given fivegrain doses of iodide of potassium three times daily. Six weeks have passed since the treatment of this case was begun, and the patient has resumed his occupation. The diminution in the size of the liver has been going on steadily, and he is almost well.

In concluding this brief account of the case I trust it may be found that the diagnosis has been correctly made, and, if so, it may serve to renew the importance of the old adage, "An ounce of prevention, etc.," in cases of abscess of the liver.

LOUISVILLE.

PROGRESS IN OBSTETRICS AND GYNECOLOGY IN FRANCE.

BY E. 8. M'KEE, M. D.

con

Massage during parturition is productive of four beneficial results, according to Dujardin-Beaumetz. It excites uterine traction, rectifies vicious positions, favors delivery by expression, and arrests hemorrhage.

Hemorrhage during pregnancy due to varicosity of the veins of the genitalia, has been reported by Pinard, Boisard and Mougeat. In cases of hemorrhage occurring during pregnancy it would be well to remember this as a possible cause.

A new symptom characteristic of cancer uteri has been brought out by Petit, Troisier, and Raymond. Each of these gentlemen found the existence of an enlarged lymphatic gland above the left clavicle in cases of cancer of the cervix uteri.

Cracked nipples are treated with great success by Pinard, as follows: As soon as there are any appearances of cracks, or even tenderness of the nipples, a compress folded in four and steeped in boracic-acid solution, three or four per cent, is applied. Oil silk is placed over the compress to prevent evaporation. Over this a layer of cotton wadding, and the whole secured by a bandage.

Dysmenorrhea in its most violent forms has been relieved by Meniere, by giving an enema consisting of bromide of potassium and chloral, thirty grains of each; one half of this amount to young girls.

A case of dystocia from persistence of the hymen has been reported by Charpentier. This is the third case seen by this writer, which, together with the amount of literature cited, would lead to the supposition that it is not so infrequent as supposed, or, as some believe, never present.

A needle holder which is certainly an improvement on its predecessors, and is quite a good instrument in perineal operations, has been invented by M. Pozzi, of the Hospital Lauricienne, Paris.

Palpation of the shoulder as a means of *Compiled from notes collected by the author during a recent tour abroad.

diagnosticating the position of the head in cases where this can not be readily made out is recommended by Riviere.

Incomplete inversion of the uterus, which resisted all attempts at reduction under chloroform, has been very nicely managed by M. Dumesnil, of Rouen, by means of the elastic ligature. It was applied with the object of ablating the procident portion. The ligature was an elastic band of rubber four millimeters in diameter, and was applied around the well-formed pedicle at the level of the neck. At the end of seventeen days to his surprise there was neither odor of gangrene nor expelled detritus. The cord came off, and he found the uterine cavity perfect. He thinks it possible that the constriction. provoked contraction of the uterine muscles, which, little by little, expressed itself from the ring formed by the constriction. The method merits trial, offering reduction, assuring section if reduction fails. M. Boucet, of Lyons, makes another favorable report.

The death-rate of La Maternite is shown by a chart, the preparation of Prof. Tarnier. This chart extends back to the year 1792, and is divided into three periods. The first, the period of inaction, the death-rate averaged 9.3 per cent. It ran some years as high as 20 per cent (murder !). The second period, that of hygiene, the mortality descended abruptly to 2.3 per cent. This shows wonderful results through the use of

antiseptics in this hospital, which is a tumble-down old building, a convent of the sixteenth century.

Hysterectomy for cancer of the uterus has been held rather in disfavor by the French, possibly because it is in such high favor among the Germans. Its popularity in Germany is doubtless due in part to its disesteem among the French. Sauve, of Paris, thinks the operation does not deserve the disrepute with which it is regarded in France. It is capable of affording the patient a long period of ease, and if it returns after the operation it is attended with less pain. It is not less difficult than the other abdominal operations, and the statistics are

constantly improving. Colpo-hysterectomy should be the chosen operation, and laparohysterectomy reserved for cases where the body of the uterus is too large to pass through the vaginal wound. He recommends the most vigorous antisepsis. Iodoform, and especially iodoform gauze, is much more valuable than carbolic dressings. As a rule he prefers to apply sutures without drainage. Richelot considers the indications for vaginal hysterectomy to be carcinoma uteri, and particularly the primary carcinoma of the corpus uteri, carcinoma of the mucous membrane without visible border of the disease, carcinoma of the cervix uteri with extension on the posterior vaginal wall. In those cases in which it would seem possible to remove the disease entire by an extensive operation he thinks total extirpation should be performed, as by this means the lymph-vessels can be more thoroughly removed. He also thinks the total extirpation indicated in cases of severe retroflexio uteri, and in fibroids with serious symptoms and stubborn prolapse. As to the technic, Richelot thought the principal difficulty of the operation lies in the trouble with which a ligature is laid about a ligamenta lata in a secure manner. With the object of shortening the operation he recommends the application of long clamping forceps to the ligamenta lata, and allows them to remain twenty-four to forty-eight hours. This does away with the sutures and drainage. Duplony objected to the pressure on the rectum caused by this clamp forceps. In one case he had gangrene from it. He prefers the suture for simple cases, and reserves the clamp for the more difficult. Pean claims the priority of this preventive method of controlling the hemorrhage, and was the first in France to perform the total vaginal extirpation of the uterus. He claims the application of the clamping forceps to be unnecessary, and thinks it quite easy to draw down the ligamenta lata after the operation and ligate the bleeding vessels in loco. In complicated cases he allows the forceps to remain for thirty-six hours, and has never had any bad results.

Electricity in the treatment of uterine fibroids has gained very much favor in the eyes of the profession of the world from the investigations and writings of that earnest worker, Dr. Apostoli, of Paris. He has supplanted the old and in many respects imperfect method of applying electricity by a procedure for which he claims greater precision-more energy, yet tolerable-better localized, thoroughly under control, and more scientifically exact. He considers the positive pole "the medicament par excel lence" in bleeding or hemorrhagic fibroids. Apostoli does not claim to entirely remove the fibroid tumors, but to reduce them in size and to relieve their symptoms until the patients no longer know they have a tumor. This cure remains permanent to those who carry out the treatment properly. The following is a short summary of the directions and precautions which he gives: Absolute and regular antiseptic irrigation of the vagina before and after the operation. Let the puncture be shallow, not more than one or two centimeters, and made by a small steel trocar, or needle. Make the punctures in the most prominent part of the tumor, when possible, in the posterior cul-de-sac. Be careful to ascertain the seat of pulsation, and thus avoid the puncture of an artery.

Apostoli's method has gained great credence in Great Britain by the advocacy of such authorities as Playfair, Robert Barnes, Macan, Sir Spencer Wells, and the Keiths, father and son. Especial praise is given by these to the treatment in cases of hemorrhage from uterine fibroids.

Keith has recently reported his hysterectomies for fibroid tumor of the uterus, and gives the mortality of all cases of all operators, if they have reported every case, at twenty-five per cent. This he thinks a terrible mortality. He says it may be higher. In comparing the electrical treatment of Apostoli, he remarks: "I say it deliberately, hysterectomy is an operation which has done more harm than good, and its mortality is out of all proportion to the benefits derived by the few." Keith accepts toto animo the teachings of Apostoli. In less than five.

months Keith and Son have applied electricity in strong and accurately measured doses more than twelve hundred times upon more than one hundred patients, the majority being cases of uterine fibroid. The labor of these operations was very great, but it opens out a field for study which daily increases in interest. Several patients came to them for hysterectomy for uterine fibroids. After treatment by Apostoli's method, these women have all gone home without operation, with menstruation almost normal, and improving after their return. In every case the tumor was gone; in one instance only has there been a return of hemorrhage. The tumor had gone down two thirds, and she was allowed to leave town too soon. Should these improvements remain permanent, and from the experience of Apostoli there is every reason to expect they will do so, the field of hysterectomy is reduced to the narrowest possible limits. "I would consider myself guilty of a criminal act were I to advise my patient to run the risk of her life before giving this treatment a fair trial."

The endometrium is nearly always extensively diseased in cases of uterine fibroids, hence the hemorrhage will be arrested by cauterizing it. In all cases of metrorrhagia the author places the positive pole within the uterine cavity, and uses the negative pole in other cases. This treatment has good results in neuralgias, especially those of the ovaries. Subinvolutions, versions, and flexions are successfully treated by the enthusiastic author. The system is so intricate, and requires so much time to properly master it, that few of the many who visit Apostoli's clinique find it possible to stay a sufficient length of time. In fact, it is largely the work of specialists.

CINCINNATI, O.

A LIBERAL GIFT.--The anatomist R. Quain, who recently died in London, left nearly his entire fortune-seventy-five thousand poundsto the University College, to be devoted to the furtherance of the study of modern languages and natural sciences.

THE TREATMENT OF MASTITIS.

BY J. S. WESTERFIELD, M. D.

Volume I, No. 2, of the AMERICAN PRACTITIONER AND NEWS contains an article by Prof. D. W. Yandell on the subject of compression in mastitis.

The treatment, though not new, was new to me, and having tried it in a few cases with favorable results I have thought it not improper to report my cases as briefly as possible.

Mrs. L., my first case, came under my care in January, 1886, a few days after I read Prof. Yandell's article. She was the mother of two children, the last one six weeks old, and had been treated for a right mammary abscess by another physician for three weeks prior to my visit.

The gland was indurated, painful, and discharging from three openings. She suffered from nervousness, emaciation, and loss of sleep, had no appetite, and was taking opiates freely. I applied the rubber plaster as directed in Prof. Yandell's article, after introducing horse hair for drainage. Results, immediate relief from pain and return of appetite. She took no more opiates, slept well the first night, and in two weeks the plaster came off; the case was discharged, being about well.

In July, 1887, Mrs. G., mother of several children, the last one three months old, had a large abscess of right breast, which had been discharging for two or three weeks. She told me she would prefer to die at once rather than live and suffer another week as she had been doing for a week past.

Washed out cavity with antiseptic solution and applied rubber plaster. Result, early relief from pain and anxiety. The next day she was cheerful and expressed herself as feeling well. In ten days the plaster came off and she was discharged, being well.

In January, 1888, Mrs. McC., mother of three children, the last one six months old, called at my office. An abscess had a month before formed in the left breast, discharged and healed, but left an induration the size of a goose egg. At the time of her visit the gland had again inflamed and was intensely painful. I detected no sign of fluctuation, but it was

my opinion that pus could be reached by cutting deep.

I did not cut, however, but applied rubber plaster; and she sent me word several days later that I had entirely cured her abscess and that she suffered but little pain after the plaster was put on.

January 23, 1888, I visited Mrs. B., mother of one child, still nursing at the age of fifteen months. I found an abscess of the left mammary gland that should have been opened a week before. Cut abscess, and let out at least a pint of as offensive pus as I ever smelled. The treatment at this time consisted of antiseptic washes and support of the gland by bandage, together with an iron tonic. I saw the case again on February 10th, and learned that a neighboring physician had again lanced the breast a week prior to my second visit. At this time both openings were discharging. Pus was detected in another part of the gland and evacuated. I washed out cavities with a solution of carbolic acid and applied plaster. I have since learned that the cure was complete.

I think this plan of treatment for mastitis ought to be known to all practitioners, and for full instructions in its use I would refer to Prof. Yandell's article in Vol. I. No. 2, of the AMERICAN PRACTITIONER AND NEWS.

GREENBRIER, ARK.

Societies.

MEDICAL SOCIETY OF BERLIN.* At the meeting of March 7th, Dr. Siegmund in the chair, a patient was presented by Dr. E. Kuester. The operation of removal of the left kidney had been made on this man on account of tuberculous disease. The patient, aged thirty-six years, was descended from a healthy family; in 1886 he suffered from a fever, the exciting cause of which could not be ascertained. About a year ago a tumor of the left kidney was discovered, and it was finally determined to make a nephrectomy. The kidneys were drained, but the formation of pus did not cease. A second incision was made anteriorly and the kid*Reported by E. S. McKee, M. D.

neys were drained transversely; this second cut was made through the diaphragm without damage.

In October last when the patient came under the care of the reporter, he was excessively reduced in flesh. He had two fistula in the neighborhood of the kidneys, out of which poured quantities of pus. The reporter thought he had a case of simple pyonephrosis, the more because the urine which came only from the right side showed no abnormal condition. As the two fistulas were united by an incision, a number of cavities presented, out of which a cheesy mass could be pressed by the fingers. The question of tuberculous kidney immediately came up for consideration; as the other kidney was entirely healthy it was decided at once to extirpate the diseased organ. The speaker chose the incision which he was accustomed to use, that is the horizontal lumbar incision. Despite the fact that the operation was rendered difficult by the condition of things and the former incision of the peritoneum, recovery followed promptly and without accident. The patient has only two small fistula which scarcely secrete any thing; he has gained twenty pounds in two months.

Dr. J. Wolff read a paper on Arthrectomy of the Knee-joint on account of Arthropathia Tabidorum, and presented patients before the Society. So far the results from the operative treatment of the neuropathic affections of the joint have not been encouraging. Contrary to the general experience, Dr. Wolff has had the satisfaction of a case in which the result from operative interference has been most favorable. Patient, locksmith, aged forty-eight, in November, 1886, fell from great height and suffered a wound of the knee-joint, but could go about again after only four days. Three months later the knee-joint swelled again, became loose, and only after eighteen months' treatment was he able to resume his labors. One year ago he fell on this knee again. Swelling began, accompanied with pain and inability to hold the knee steady. At the end of last May the patient came under the treatment of the reporter. He found a decided swelling of the knee-joint and projection of the bones; the leg was shortened five centimeters, and quite loose at the