case is mentioned where such notched teeth were hereditary in a family, the effects occurring in pairs, and never affecting the whole row. these words "The day is seemingly not far distant when we shall speak of pneumonic fever in precisely the same way as we use the term enteric fever at present; that is, to signify a zymotic or SULPHUR IN CHLOROSIS.-Schutz and Strübing specific blood disease, manifesting itself after the have drawn the following conclusions (Med. Chron.) lapse of a certain time-the period of incubation as to the treatment of chlorosis by sulphur-by physical phenomena, objective and subjective, connected in this instance with the lungs." 1. In cases of simple chlorosis, in which iron has no effect, the general condition is markedly improved by sulphur. 2. After sulphur has been given for some time, treatment with iron could be started and continued successfully. 3. Sulphur is not borne in cases of chlorosis complicated with catarrhal, inflammatory conditions of the digestive THE ONTARIO MEDICAL LIBRARY ASSOCIATION. -The secretary of the Ontario Medical Library Association has received a letter from Dr. Hodge, of Mitchell, Ont., donating to the library the entire collection of medical works of the late Dr. John Rolph; as also from Dr. H. C. Wood, of Philadelphia, making a large number of donations from his private library. It is gratifying to know that the interest in the scheme is general throughout this Province, and it is to be hoped the gifts so far offered, are but an earnest of many more to follow. PNEUMONIA. Dr. Moore, of Dublin, concluded his paper before the late International Congress in POT. IODID. IN ASTHMA.-Dr. Cozenave de la Roche says (British Med. Jour.) that the above remedy is very efficient in asthma if given in cow's milk. His formula is aq. dest. 150 grammes, pot. iod. 8 grammes. A tablespoonful in a cup of milk twice a day. BROMO-SODA.-W. C. Deane, M. D., 727 Lexington Avenue, N. Y., says, during my voyage on the steamer Arizona I cured at least twenty-five cases of sea-sickness by giving Warner & Co.'s preparation of "Bromo Soda" in large doses. I heartily commend it, as from personal experience it afforded great relief when other remedies failed. SACCHARINE. A New York druggist announces (Med. Rec.) that he has just received an invoice of anhydroorthosulphamidobenzoic acid (CH, (2) N H), or saccharine, one grain of which is sufficient to sweeten a cup of tea or coffee. DOSE OF ANTIPYRINE.-Dr. Ostrander, of Lansing, Mich., writes (Med. Rec.) that he has always succeeded in getting the desired result with five grain doses of antipyrine, repeated each hour for three hours. He believes it useful in migraine, and to relieve the pain of rheumatism. DR. JOHN WILLIAMS has such faith in antiseptic treatment, says Junius C. Hoag, that he would not hesitate to attend a patient in labor, although he had, on the same day, visited another patient suffering from puerperal fever. PROFESSOR BARTHOLOW recommends a three grain pill of iodoform three times a day, for the flushings and other morbid sensations occurring about the climacteric. The London (Eng.) School of Medicine for women has sixty students. RICHARD QUAIN, the great anatomist, died recently, aged 71 years. Books and Lamphlets. PATHOLOGY AND TREATMENT OF GONORRHEA AND SPERMATORRHEA. By J. L. Milton, Senior Surgeon to St.John's Hospital for Diseases of the Skin, London. Octavo, 484 pages. Illustrated. Price, bound in extra muslin, $4.00. New York: William Wood & Company. Toronto: Carveth & Co. This work is intended for the practitioner and not for the college student, as it takes for granted an acquaintance with the elements of the subject. Some of the statements contained in it are pretty sweeping, and will be read with some surprise by the majority of medical men. As an example, we may quote the following: "In men who have reached the age of three or four-and-twenty, anything beyond one (nocturnal) emission a month, requires attention." Besides the pathology and treatment of Gonorrhea and Spermatorrhea he includes, in the present work, chapters on the pathology and treatment of Impotence He is somewhat iconoclastic, but gives as his reason the fact that most of the remedies vaunted as curative in Gonorrhea Spermatorrhea and Impotence have not fulfilled the expectations which the first accounts of them were calculated to raise. He says, "Nothing has been recommended by myself in this work but what has stood the brunt, not merely of experience, for that I rate rather low, but that of special observation." The book is, we believe, invaluable as a consultation book, filled with sound doctrines, and what is of more importance to the busy, general practitioner, practical and concise directions as to treatment. The publishers have done their part of the work well. of the lungs, will be studied with profit by both classes of readers. The author has here given, in a condensed and clear form, everything of importance in the " definition, pathology, causes, symptoms, physical signs, diagnosis, prognosis, and treatment," of the most important affections of the lungs, sixteen in number. The like, if not more and better, may be said of his synopsis of diseases of the heart. The illustrating engravings, numbering 93, will be more easily understood by the teacher than by his pupils. In truth they present sorrowful evidence of the consequences of the untimely removal of the author from earthly labour; but the student who has become well grounded in his anatomy, will be quite able to overlook those deficiencies and obscurities which must be presented to the beginner, or to the idle and careless, who are always promising to begin to study earnestly, but too seldom reach this herculean achievement. No book, however excellent its merits, can ever benefit this class of illusionists. LESSONS ON GYNECOLOGY. By William Goodell, A.M., M.D., Prof. of Clinical Gynecology in the University of Pennsylvania, etc. Third edition, revised and enlarged. Illustrated. Philadelphia: D. G. Brinton. 1887. Toronto: Hart & Co. The new edition of Goodall's popular work shows careful revision. It is not a complete treatise on the diseases of women, but consists mainly of clinical and didactic lectures delivered to students at the University of Pennsylvania, and possesses the advantages and disadvantages of matter from such a source. Suffice it to say, that the work is practical, without much padding, and that the author goes straight to the point. The book is a very useful one both to the student and practitioner. A MANUAL OF THE PHYSICAL DIAGNOSIS OF THOR- This is a well printed book of 150 pages, on good paper, from the press of W. Wood & Co. In consequence of the sudden death of the author, "just after the manuscript had been placed in the printers' hands," the correction of the proof sheets devolved on his friend Lawrence Johnson, M.D. The work will most probably be more highly valued by the teachers of clinical medicine than by the students, though to both it will not fail to prove highly serviceable. Chapter VI, which is devoted to a synoptical exposition of the diseases MASSAGE, PRINCIPLES AND PRACTICE OF REMEDIAL TTEATMENT BY IMPARTED MOTION. By Geo. H. New York: John B. Alden. 1887. Taylor, M.D. This little book of 173 pages, will be useful as a to those ignorant of massage in the treatment of chronic disease. It is written for the general public, but will be found interesting and instructive to the general practitioner. Births, Marriages and Deaths. On the 19th Oct., Dr. T. H. Robinson, of Kleinburg, to Annie C. Hill, of Toronto. On the 24th Oct., Dr. J. F. Bell, of Toronto, to Jessie Brown, of Eglington. THE CANADA LANCET A MONTHLY JOURNAL OF MEDICAL AND SURGICAL SCIENCE, VOL. XX.] TORONTO, DEC., 1887. Original Communications. [No. 4. ELECTRICITY IN GYNECOLOGY. BY A. LAPTHORN SMITH, B.A., M.D, M.R.C.S., ENG., organ remains normal and the displacement is due to defective action of the muscles which should support it, owing to their being in a state of degeneration, then no medication can be so effective as that which tends to tone them up and develop them to their normal strength. In most of our text books this cause of displacement is slightingly dealt with. A year ago, at the meeting of the Canada Medical Association, at Quebec, in a paper which I had the honor of reading on Alexander's operation, I analysed the causes which lead to the uterus being held in place, and on my recent visit to Europe, the opinion I then expressed was fully endorsed by many of the leading authorities, whose views I obtained. Defective muscular tonus of the uterus and its muscular ligaments, and of the vaginal tube or column, and of the perineal muscles on which the end of that column rests, they all agreed was the cause of uterine displacements. This view is a rational one and is proven by the fact that they occur always in women whose muscular system is in a low state of development. Uterine displacements, I fancy, are unknown or at least very rarely met with in women living in a savage state, or among women of those countries where the manual labor is mostly performed by members of that sex. They are especially noticed among women of the higher classes, and among the lower classes living in a high state of civilization, whose muscular system, not only of the internal organs, but also of the limbs, is in a state of atrophy, amounting almost to wasting. In the dissecting-room we find cases in which the muscular system is so very much attenuated, that many of the muscles cannot be found. It is for this reason, doubtless, that in many cases for which the operation of shortening the round ligaments or round muscles has been performed, for the cure of retroflexions or retrodisplacements, the operator has been unable to find them. As women of very well developed uterine muscles rarely, if ever, have anything to complain of in that direction, it is, I fancy, rare to find these muscles well developed in cases of displacement. It was, therefore, with peculiar pleasure that I found Apostoli treating these cases by means of electricity. If we were called upon, for instance, to treat a case of lateral curvature of the spine depending upon the degeneration of the muscles of one or both sides, we If on the other hand, the size and weight of the would not be justified in trusting to artificial sup As the treatment of diseases peculiar to women, by electricity, has in the last few years attained a high point of perfection and is now attracting attention all over Europe and America, owing to the writings of Apostoli, of Paris, and having lately had the pleasure of spending some time at his clinic, I thought it might be of interest to your readers to be furnished with some observations on this treatment. And although Apostoli himself is an enthusiast and therefore more inpressed than anyone else with the advantages of his methods over all others, still there is so much reason in what he teaches, and his views are so thoroughly borne out by actual results, that no one can spend very much time under his tuition without becoming almost as much impressed with its advantages as he is himself. Certainly the treatment of diseases of the uterus by electricity, either galvanic or faradic, has this in its favor, that it is the rational one for all diseases of that organ. Take, for instance, displacements; these all depend either on the womb being too heavy for its supports, or its supports being too weak to bear even a normal weight. In the first case the stimulating influence of a current applied to the muscular tissue or organ will have the effect of contracting its muscular fibres and consequently of diminishing its size and the calibre of the vessels supplying it with blood; for the muscular coats of the blood-vessels are made to contract, and the active and passive congestion is thereby diminished. ports, such as iron stays, but rather we should, by electrical applications, exercise, good food and good air, develop those muscles, rather than make them more lazy by doing their work for them by means of supports. And as, every time muscles contract, they become larger and stronger (witness a blacksmith's right arm), so the best way of enlarging and strengthening the weak muscles would be to make them go through a course of gymnastics. It is within the experience of every doctor that displacements of the uterus have come on suddenly after an effort of some kind, while, in my own experience, some cases occur every summer regularly on the return of warm weather, when everything and everybody seems to be relaxed. Cases of displacement often come to us with a history at tributing them to nervous shock or sudden fright. This could hardly be the case if the uterus owed its being held in proper position to ligaments instead of muscles, as only the latter depend upon the nervous system to any extent. Again, there is a large class of cases in which the disease consists of instability or disorder of innervation, in which the nervous system seems to act viciously for the want of proper control. During my stay with Apostoli, I have over and over again seen women come to his clinic complaining of agonizing pain in the ovarian region, which was so real and so severe that they could not endure the weight of my hand. After ten or fifteen minutes' application of the faradic current passing through a long, fine wire, the disorders, under its influence, seemed to be so controlled as to no longer produce the manifestations of which the patient complained, and I could then press my hand deep down upon the ovaries without causing the slightest pain. With regard to the sort of electricity; one should be able to distinguish the properties of galvanic and faradic currents, and even to accurately apply the different kinds of the latter, exactly in accordance with the requirement of each case. Thus, the current from the short, thick wire is suitable for putting the muscles through a course of gym nastics, and is, therefore, the peculiar remedy for muscular atrophy wherever it may be; while the current from the fine, long wire is especially adapted to disorders of the nervous system, being sedative and tranquilizing in its effects. The galvanic current is to be applied to disorders of nutrition, and the effect varies according to the pole used. Thus, the negative pole has a caustic action similar to alkalies, such as potash or ammonia when used in sufficient strength, and leaves less tendency to retraction, while the positive pole, around which acids accumulate, has a coagulating and retracting action, and is especially suited to cases of hemorrhage. It is, however, in the treatment of fibroids of the uterus that Apostoli has achieved a world-wide and well-deserved reputation. The former treatment in vogue has been to remove the tumor, always a dangerous operation, or the removal of the appendages which is not without the danger common to any opening of the abdominal cavity. In these cases Apostoli uses a constant current, and for this he requires a good battery consisting of about 60 Leclanché cells, which have the advantage of working a long time without being refilled or cleaned, and only using themselves up while they are in actual use. 2nd, and perhaps the most important, a good galvanometer, by which he is able to measure out the exact dose of electricity suitable to each case. The importance of this instrument will be understood when we remember that the outflow, of electricity from any good battery varies from time to time and from day to day, so that what would be a suitable dose to-day would be a quite useless and weak one to morrow. 3rd, a collector, by which he is able to bring in the circuit, one by one, as many cells as are necessary to produce the proper dose. And as the first cells are used up, he is able to bring into the circuit the middle or last ones which still remain fresh. 4th, an invention which is specially his own, and which has led to a revolution in the application of high currents (I refer to the clay electrode), consisting of a sheet of zinc about ten inches square, on the upper end of which is attached a wire, and on the under surface a cake of very moist potter's clay, held together by means of a piece of tarletan on its under surface, the piece of zinc being embedded on its upper surface. Before the application of this material to the purpose of an electrode, the highest dose of electric current which could be applied without cauterizing was from 40 to 50 milliampères; but with the moistened cake of clay, by which the point of contact with the skin is spread over such a large surface, and by which the electricity enters by thousands of doors, I have over and over again seen a strength of 250 milliampères administered without the patient com plaining of any sensation in the skin, or producing the slightest heat or redness. 5th, a uterine electrode, made of platinum, for the application of a positive current, for which, owing to the acids produced causing rapid oxidation, this metal is alone suitable. This platinum electrode is prevented from touching the sensitive vagina by means of a non-conducting covering for a considerable part of the length, otherwise the current would escape into the vagina, rendering the operation unprofitable. For this protecting covering he has found a celluloid tube the best. In all cases of uterine fibroids occupying a position in the uterus, such as to render a safe puncture impossible, he employs a positive current in the uterine cavity, as will do in cases of endometritis, and when it is not advisable to destroy a large amount of tissue by puncture. When, however, the fibroid is in the posterior half of the uterus, so that he can reach it through the pos terior cul de sac, he uses a negative current applied through an electrode made in the shape of a trocar. As much of his success is due to the observation of a number of little details which might be considered unimportant, I might describe the process of making a chemical galvanocaustic puncture : 1st. A thorough irrigating out of the vagina with a sublimate solution of roo, from which he has never had any ill effect. 2nd. Having introduced his right finger so as to touch the fibroid, pressing down the uterus against it with his other hand, he inserts the celluloid tube to the place he has chosen for his puncture. He then introduces the steel trocar (the length having been previously arranged, so as to project one-third to two-thirds of an inch beyond its covering) through the roof of the vagina right into the tumor. The current is then very gradually turned, a careful watch being kept on the galvanometer. When the woman complains of pain he diminishes her sensibility by, for the moment, increasing the current beyond her endur. ance, then gently reduces it by a few milliamperes, so that she is better able to bear it by comparison without complaining. This is what he calls establishing tolerance. He then carefully increases the current by successive stages, to one hundred milliamperes, for the first seance, but in subsequent seances reaching as high as two hundred and fifty. The woman is easily able to bear this high intensity without a great amount of pain, and also the short pain caused by the introduction of the short trocar. After from five to ten minutes the application of the current is very carefully and gradually reduced, as the sudden cutting of it off would cause a painful shock, owing to the induced current set up in the pelvis. The woman is then again carefully irrigated out and a small piece of iodoform gauze is introduced up to the wound, and the woman is then placed in bed for a few hours or for half a day, after which she returns to her home without any inconvenience. On her coming again a few days later, the gauze is removed with the slightest stain of blood or sometimes a little pus on it. The vagina is then again washed out and a fresh piece of gauze used, and after a week, or in some cases after two or three applications a week, the woman is able to return to her occupation. Apostoli does not pretend that this method will rapidly remove a large fibroid, but he does pretend to cure the patient symptomatically; that is to say, it is slightly reduced in size after each application, and the woman suffers no inconvenience from it. I did not have to depend, nor did Apostoli wish me to depend upon his word for the advantages of his treatment, as he invited me to walk about among the patients and to converse with them as to the kind of sensation they felt before treatment and as to the relief they experienced after, and with few exceptions their reports were exceedingly encouraging, while in cases of acute pain in the organs on pressure I could myself observe the relief. There is one thing which he does very thoroughly and insists upon his assistants doing, and that is a thorough cleansing of the hands and instruments before and after each application, or even examination. The hands have to be well washed and the fingers scrubbed with sublimate solution, and the vagina of every patient is thoroughly washed, while the instruments which are introduced into the uterine cavity are rendered scrupulously clean by being passed through the flame of a spirit lamp, and afterwards dipped in a strong carbolic solution. That he has never had any trouble from sublimate poisoning, may perhaps be explained by a little knack he has of pressing |