* FRENCH ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE.

Congress of Nancy, August, 1886.

In regard to the use of the intra-uterine chemical galvano-cautery in the cure of chronic metritis and endometritis M. Apostoli said:

Gynecological intra-uterine therapy is constantly gaining strength, and with good reason tends to replace the old external treatment by way of the uterine cervix. The new process, which I instituted four years ago in the electric treatment of fibromas, I have applied for

the same period with the same advantage and equal success to the cure of chronic metritis, and I find it especially serviceable in the relief

of endometritis.

To a lesion which begins in the mucous membrane and fixes itself there, involving eventu

weakened only after many successive operations, and which may furnish, with a small number of cells (thirty on an average), a high intensity of one hundred to two hundred mil liamperes. The best cabinet cell is certainly the Le Clanché; a good transportable cell of small volume remains yet to be found, but at present a cell whose elements are arranged for immersion in bisulphate of mercury may suf fice for practical wants.

(c) An intra-uterine electrode of sufficient

length to enable the operator to command the entire uterine cavity. It should be of platinum or of some other material free from the sheath to protect the vagina; a tube of celluaction of acids, and guarded with an isolating loid best answers the purpose.

(d) A neutral or indifferent electrode which,

I apply a treatment altogether intra-uterine, namely cauterization of the uterine mucous membrane.

For the modern process of scraping, liquid injections, and purely chemical cauterization, I substitute a galvano chemical treatment, which is less violent, more easy of application, agreeable to the patient, and not followed by any inflammatory reaction when properly applied.

The immediate chemical action, which consists in the progressive destruction of the mucous membrane, is shortly followed by a process of regression and disintegration, which favors resorption of the exudate and newly-formed hyperplasias.

In order best to cary out this operation the following electrical apparatus must be provided and its action and necessary qualities carefully

studied:

(a) First, a galvanometer for intensity, divided into milliamperes, which I have devised. It is graduated up to two hundred, and gives the only exact measure of electrical yield, which has hitherto been obtained only in a vague and empirical way, by judging the intensity of the current by the number of cells (a cell that has been used never gives the same yield as a new cell) in use at a given time.

(b) A battery of sufficiently large volume to sustain long usage and to become moderately

tense current to pass without pain, heat, or danger of cauterization; the best material for this purpose is fuller's earth, as proposed by me in 1882.

(e) Flexible rheophores, strong enough not to break easily nor to make interruptions in the current, which are painful to the patient.

The physician with such an outfit must conform strictly to the technique of the operation,

which should be conducted as follows:

1. Make a lukewarm antiseptic vaginal injection, and place the woman exactly in the position required for examination with the speculum.

2. Arrange the battery for working, place the galvanometer in position, apply the abdominal pole of fuller's earth, apprising the woman always that it is cold.

3. Introduce the platinum electrode gently

and gradually into the uterine cavity, having

it well washed and disinfected; isolate completely the vagina and vulva.

4. Use the positive pole in all hemorrhagic cases, and the negative in all others.

5. The principle which ought to dominate all interference is never to surprise the uterus, and never to make an application too painful. But it should be known that there are some very irritable uteri (a small number, it is true, three to five per cent), such as those of hysterical patients, which bear the current

badly, even though it be of very little intensity;

in such cases only mild doses should be given. 6. The current should be delivered gently, very gently, and stopped before any excessive sensibility is aroused, in order to habituate the patient to its action and overcome all mental or physical resistance.

7. For two or three sittings the intensity should be progressively increased till we reach in the majority of cases one hundred, one hundred and fifty, and with care two hundred milliamperes; the intensity ought at first to be proportional to and regulated by the tolerance of the subject, and the gravity and chronicity of the lesion.

8. The duration of the application, like the intensity, should be regulated according to the response of the patient and the effect desired.

9. The sittings should take place every week or every two days, according to requirements, and the physician should regulate their number and proximity by the urgency and necessity of the intervention.

10. An enforced rest of at least several hours, ought to be required of all patients who have been operated upon; this rest is necessary to the safety of the method and its efficiency.

11. Antiseptic vaginal injections of corrosive sublimate or carbolic acid should be prescribed, to be used morning and evening. This simple and inoffensive treatment, a truly hysterometric therapy, is nothing more than a galvano-chemical molecular curetting, acid or basic, according to the case, which leads to the formation of a new mucous membrane; it is an intra-uterine stimulant, whose action may be prolonged and varied at will.

This good effect, which I have seen in a great number of cases, is not slow to manifest itself in the first essay, and the improvement is rapidly progressive until a cure is effected. It does not compel the patient to enforced rest for any long period of time, and requires no collateral treatment. Over surgical scraping it has the advantage of being localized accurately to the diseased part, of being applied without shock to the patient, and of being administered in broken doses at the will of the operator, and without discomfort or danger.

Reviews and Bibliography.

Meco-neuropathia. By C. H. Hughes, M. D. St. Louis, Mo. Reprint. 1886.

The Curette as a Diagnostic and Therapeutic Agent in Gynecology and Obstetrics. By B. Bernard Browne, M. D., Professor of Diseases of Women in the Woman's Medical Col

lege of Baltimore. Reprint. 1886.

Transactions of the American Surgical Association. Vol. IV. Edited by J. Ewing Mears, M. D., Recorder of the Association. 8vo, pp. xxiii and 339; cloth. Philadelphia: Printed for the Association and for sale by P. Blakiston, Son & Co. 1886.

First annual Report of the State Board of Health, and Vital Statistics of the Commonwealth of Pennsylvania. Transmitted to the Governor, December 7, 1885. Benjamin Lee, M. D., Secretary. 8vo, pp. 361; cloth. Harrisburg: Edwin R. Meyers. 1886.

The Surgery of the Pancreas, as based upon Experiments and Clinical Researches. By N. Senn, M. D., of Milwaukee, Wisconsin, Attending Surgeon to the Milwaukee Hospital; Professor of the Principles and Practice of Surgery in the College of Physicians and Surgeons, Chicago, Illinois. Reprinted from the Transactions of the American Surgical Association, April 29, 1886. Pages 129; 8vo, paper. Philadelphia: Wm. J. Dorman. 1886.

PROFESSIONAL SECRECY AND GOVERNMENT OFFICERS.-A certificate of disability, issued by Dr. A. Y. P. Garnett to a government employe, was returned by a United States pension officer with the demand that the doctor should strengthen it with explicit information. Dr. Garnett declined to furnish this information, on the ground that it would involve a violation of professional obligations. In this decision he is sustained by Secretary Lamar. The justice of the secretary's ruling will be conceded by every fair-minded man. What passes between the patient and his physician must be held by the latter as a secret inviolable; and it is gratifying to learn that the eminent Secretary of the Interior has given it the protection of high executive authority, since by so doing he has established a precedent which petty courts and government officers. will not presume in future to set aside.

Foreign Correspondence.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.}

It is generally supposed that typhoid fever, like the other eruptive fevers, never attacks a person more than once; but Dr. Deshayes, of Rouen, lately drew attention to two perfectly authenticated cases, observed by himself, of typhoid fever having occurred twice in two patients, an interval of three years having elapsed. In his communication to the Congress of Nancy, the author insisted on the fact that in neither of the two patients was it a case of relapse, but a bona fide recurrence of the typhoid attack. Hence, Dr. Deshayes concludes that one attack of typhoid fever does not confer immunity against subsequent attacks, as is generally the case with the infectious maladies, and observed that for some years past typhoid fever appears to have altered in character, adding, that at the present time there are a certain number of cases of this fever complicated with aphthæ.

Dr. Bérillon, of Paris, read a paper at the same meeting on symmetrical gangrene of the extremities of paludal origin. A case occurred for the first time in the ward of Prof. Verneuil, at La Pitié Hospital. The subject (a female patient), although living in a paludal district, and where different members of her family had had intermittent fever, she herself had never had any appreciable manifestation of paludism, when she was suddenly seized with symmetrical gangrene of the extremities, a malady first described by the late Maurice Raynaud. If the etiology of this affection is still obscure, it is not so in the present case, as, according to Dr. Bérillon, there was no doubt as to the paludal origin of the malady of the patient in question, not only from the distinctive character of the symptoms, but from the good effects obtained from the treatment by the sulphate of quinine and by arsenic. Moreover, Mr. Verneuil, whose great experience can not be doubted, did not hesitate, in spite of the absence of paroxysms of intermittent fever, to attribute this symmetrical gangrene of the extremities to impaludism.

Dr. Fauvelle, in a paper on the proximate causes of death of individuals in disease, makes the following statement:

"Life can no longer be considered the result of the reciprocal action of the lungs, of the heart, and of the brain. The human body is a compound of anatomical elements, of which the result is life. Among them, as regards importance, must be noted the nervous elements, which are the origin of influx. It is to them that should be ascribed all the functions of life, from the most humble function of vegetative life to the most elevated of the intellectual scale. Life is the consequence of the simultaneous action of oxygen, the destroyer, and of albuminoids, the elements of repair; when this action ceases death follows. Death is less certain when the circulation introduces toxic substances which directly alter the nervous elements or hinder the functions of decomposition and of reconstitution. All pathology can be put down to these three morbigenic causes acting on the nervous elements; the practitioner should never lose sight of the asphyxia, the inanition, and the intoxication of the nervous elements as the proximate cause of death of individuals in disease."

Dr. Ollivier read an important paper on hysterical hematemesis, or rather hematemesis in hysterical subjects. This form of hemorrhage may, according to the author, be met with in both sexes, and appears to be due to a special condition of the nervous system. It often led to an error in diagnosis, as it was regarded as symptomatic of simple ulcer in the stomach. The absence of any disturbance of nutrition, the suddenness of the onset, the presence of nervous disturbance, and the prompt re-establishment of health, would generally serve as indications of the true nature of the complaint. In women, these hematemeses occur at other times than at the menstrual periods, and are not to be looked upon as supplementary.

Dr. Bernheim, of Nancy, read a paper on hysterical amaurosis, which the author described as being, like the sensitive-sensorial hemianesthesia of hysterical subjects, purely psychical; the subject sees with her retina, she sees with her brain; the retina receives the impression, the visual cortical center perceives

it. But the hysterical subject unconsciously neutralizes the image with her imagination, she does not see with her mind's eye, she produces a negative illusion of the perceived impressions. Dr. Bernheim cites, in support of his assertions, two cases that came under his own observation in his hospital ward, of hysteria with sensitivo-sensorial hemianesthesia, with complete amaurosis of the left eye. The author considers that hysterical achromatopsia is as much psychical as amaurosis, and is the result of an unconscious auto-suggestion. Hysterical amaurosis has no anatomical localization whatever; it does not reside in the retina, nor in the optic nerve, nor in the visual cortical center; it is localized only in the imagination of the subject. The author concludes that he could easily show that hysterical hemianesthesia is a phenomenon of the same order, purely psychical.

Your readers are doubtless aware of the extraordinary theory set forth by M. Verneuil, the well-known surgeon of La Pitié Hospital, respecting the nature and pathogeny of tetanus, which he believes to be of equine origin. At the last meeting of the French Congress of Surgery, Dr. Blanc, of Bombay, stated that he not only believed in the equine origin of tetanus, but that its pathology partook of the nature of cholera, which rather startled the audience. He gave as reason for his assertion that tetanus was endemic at Bombay, that at certain periods it became really epidemic, principally during the hot season. This corres

Dr.

ponds to the recrudescences of cholera, and Dr. Blanc thinks that these two affections are propagated together by the drinking-water, that surgical tetanus is inoculated by the digestive tube, and not by the wound, just the same as medical tetanus, which is also frequent at Bombay, and during the same seasons. Blanc also observed that, in the surgical wards at Bombay, Lister's dressing has entirely eradicated pyemia, whereas tetanus has not diminished. I can not give here the various theories set forth at this meeting on the nature and origin of tatanus, some of the speakers considering the disease a modality of septicemia, arising from contused suppurating wounds complicated with foreign bodies. This asser

tion was made by M. Doyen, of Rheims, who does not believe in the vacillary origin of the disease. Dr. Vaslin considers the disease to be of neurotic origin, in confirmation of which opinion he stated that all medications based on the supposed infectious nature of the malady have always remained unfruitful, and that the medicines which succeed in tetanus are precisely those which are employed in the treatment of nervous affections. M. Thiriar regards tetanus as of parasitic origin, and that it is contagious. M. Sarger believes tenanus to be a malady esssentially infectious.

PARIS, November 3, 1886.

Translations.

THE SIGNIFICANCE OF SYPHILIS OF THE LUNGS IN LEGAL MEDICINE.-Dr. Hiller, of Kiel, says it is well known that most children suffering from congenital syphilis die before birth. The changes found in such cases are known. Among them is the change observed in the lungs by Weber, Virchow, Hecker, and Balse, described as white pneumonia.

Essentially it is a filling up of the alveoli with degenerating cells, whereby the lungs are made large, white, and impervious to air. From this white syphilitic pneumonia of the still-born, which is essentially an alveolar disease, must be distinguished interstitial pneumonia. I have for a number of years found, in the abundant material passing under my observation, that exactly this change plays an important role as a cause of death in new-born and sucklings. My communication on this subject to the International Congress at Copenhagen has remained almost unnoticed. Microscopically such lungs appear more or less filled with air, distributed very irregularly and thick to the feel; the thick spots being dark grayish red, and presenting an outline even with the white tissue. Microscopically it is found more or less spread out, with sometimes inconsiderable, and sometimes extensive thickening of the inter-alveolar tissues.

The alveolæ persist, though more or less narrowed, and especially when life continues for some time, there is marked increase of capilla

ries, so that that form of lung disease due to affection of the heart is produced. In many cases are found gummata also, as likewise infiltration of the alveole as in white pneumonia.

The life of the new-born may be limited to minutes, hours, or even days and weeks, or longer, according to the extent of the process and its influence on respiration. The children, in whom these anatomical changes are found, die almost invariably asphyxiated.

They die as soon as the interchange of gas and air in the lungs sinks below a certain limit. In children who survive some length of time, a slight bronchitis supervenes, which adds to the intensity of the trouble. Such children may give no other, or, at most, small signs of disease; they only become quiet (the beginning of carbonic acid poisoning) and gradually die with brief attacks of spasms.

Since, for the most part, in these cases we have to deal with illegitimate children, the question often arises whether death is not due to neglect or starvation. Only a sufficient knowledge of these obscure cases can enable us to guard against erroneous conclusions and the consequent censure of innocent parties.-Deutsche Medical Zeitung.

Abstracts and Selections.

THE DIET OF CONSUMPTIVES. -The diet of consumptive patients should be ample, and should contain a larger proportion of the respiratory constituents of food than is required in health. The appetite of consumptive patients is very capricious, and daily grows more so if it be not sharpened up by exercise. When the food taken is not applied to the purposes of nutrition, it is better left untasted; for otherwise it lies undigested in the alimentary canal, and sets up a serious train of dyspeptic symptoms, nausea, and diarrhea. Kind friends often, with the most provoking and mistaken good-nature, thrust upon the consumptive relays of the most improper food, because the necessity for nourishment is so obvious. But the fact is, that when the lungs are acting indifferently digestion can not go on actively, since, as Arbuthnot well observed, respiration is "the second digestion." the quantity of food taken by the consumptive person should be small at each meal; but the meals may, if the sensations of the patient re

Hence

quire it, be more frequent than in health. Of animal foods, mutton is the best. Fatty and oily foods, which constitute the respiratory class, should predominate, and fresh butter with bread may be taken almost ad libitum, so long as it agrees with the stomach. Cream, too, is excellent, and the luxury of curds and cream is very suitable. Milk, whenever it suits, is advisable as a constant drink food, and good cows' milk, new, answers every purpose. There are, as far as I can gather from numerous cases in which I have seen them tried, no such specific virtues in asses' milk, and goats' milk as some have supposed. Tea may be taken in moderation with perfect safety. Fresh vegetable diets should not be omitted; and fruits, especially roasted apples, are always admissible, except in instances where they excite irregular action of the bowels. The Iceland moss has had a great reputation, as have jellies of different kinds, but these often are slow in digestion, and they have no specific value.Mr. B. W. Richardson, Popular Science Monthly for November.

ERGOT AFTER LABOR.-At the recent meeting of the American Gynecological Association in Baltimore, Dr. John Goodman, of Louisville, Ky., presented a paper under the above title.

In the absence of the author the paper was read by the secretary.

The administration of a full dose of ergot immediately after the completion of labor has become a general practice. It is claimed that it promotes involution, prevents after-pains, and tends to prevent post-partum hemorrhage. Some years ago the author administered a full dose of ergot after a perfectly normal labor. In fifteen minutes, severe pain appeared and increased. The tenderness of the uterus continued for a week. There was no milk; and the patient, previously prolific, never again conceived. The trouble was attributed to inflammation of the muscular coat of the uterus produced by the action of the ergot.

In a second case ergot was given after a forceps delivery. On the seventh day the patient had a chill, followed by a temperature of 104°. The next day a clot was washed out of the uterus and the temperature fell to 99°. Well-marked septicemia developed, and the patient died one week later. In this case the retention of the clot was attributed to the spasmodic contraction of the uterus preventing its escape. The author had seen other cases in which injurious effects were produced by the administration of ergot.

He claimed that ergot did not assist involution, which was a natural process and required