WASHINGTON NOTES.

The

The last meeting of the Clinico-Pathological Society was held on Tuesday, May 21. next meeting will take place in October. Dr. W. Sinclair Bowen presented "Two Ovaries and Tubes" that had become discolored and removed a few days before. The discussion of Dr. E. L. Tompkins' paper was continued from the last meeting. The subject of the paper was "Cerebral Hemorrhage." It was discussed by Drs. Mitchell, Bishop and Glazebrook. The paper of the evening was by the President, Dr. Wm. M. Sprigg, on "Post-Partum Hemorrhage." He also delivered the Presidential Address. The paper on post-partum hemorrhage was discussed by Drs. Bowen, Kelley, Beatty, Bishop and others.

The regular meeting of the Medical Society of the District of Columbia was held on Wednesday, May 22. The programme of the evening was as follows: Dr. Swan M. Burnett: "Clinical Contribution to the Study of Nuclear Paralysis of the Ocular Muscles." Presentation of a patient. Dr. J. H. Bryan : "A Contribution to the Study of Suppurative Disease of the Accessory Sinuses, with Report of Cases."

It is with regret that we hear of the sad accident that has befallen Dr. Julian M. Cabell, Assistant Surgeon of the United States Army. In jumping from a moving train he fell and had one leg crushed off at the knee and a portion of the other foot was also hurt.

Dr. J. Ford Thompson has improved enough to go to Atlantic City.

PUBLIC SERVICE.

OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF MEDICAL OFFICERS.

UNITED STATES ARMY.

Week ending May 27, 1895. Captain Robert J. Gibson, Assistant Surgeon, will be relieved from duty at Fort Sam Houston, Texas, by the commanding officer of that post, and will report in person to the commanding officer Fort Thomas, Kentucky, for duty at that post.

Major William H. Gardner, Surgeon, is relieved from duty as attending surgeon and examiner of recruits at Headquarters Department of Dakota, and ordered to Fort Reno, Oklahoma Territory, for duty at that post, relieving Major Henry M. Cronkhite, Surgeon.

Leave of absence for four months, on surgeon's certificate of disability, with permission to leave the Department of the Missouri, to take effect on being relieved from duty at Fort Reno, Oklahoma Territory, is granted Major Henry M. Cronkhite, Surgeon.

Leave of absence for ten days, to take effect from the date of the conclusion of his examination for promotion, is granted Captain Louis W. Crampton, Assistant Surgeon.

BOOK REVIEWS.

URINALYSIS; Including Blanks for Recording the Analysis and Microscopic Examination of the Urine. For Medical Practitioners, Life Insurance Examiners and Specialists. Arranged by Joseph C. Guernsey, A. M., M. D. Philadelphia: J. B. Lippincott Co. 1895.

This book has the advantages of great simplicity and great usefulness. It opens with a short list of apparatus and chemical reagents needed for ordinary urine testing, then there come simple rules for the tests, a short article on diet and the remainder of the book is made up of blanks for the recording and preserving analyses. It so often happens that the physician makes a series of tests in a patient's case which he wishes to preserve for reference and comparison, and this book with its alphabetical index for the names of persons and the blanks offers all that could be desired. It is eminently practical and moreover when patients pay visits at long intervals it records the state of the urine each time it is examined. This book is recommended to all physicians. A separate pad of blanks is also issued by the same author in case it is desired to test urine for another physician.

THE PHYSICIAN'S GERMAN VADEMECUM. A Manual for Medical Practitioners for use in the Treatment of German Patients. By Dr. Richard S. Rosenthal. Volume I, Gynecology and Obstetrics. Volume II, General Medicine. Chicago: The Rosenthal Publishing Company.

These manuals are about as good as most works of this kind but it is doubtful if they do very much good, for it rarely happens that the patient answers as the book lays down and then to one who repeats parrot-like these sentences, the whole conversation becomes a babel of tongues. The sentences are on the whole good but rather more stilted and extended than one is accustomed to use in an ordinary conversation between physician and patient. Some of the German sentences are

verily alphabetical processions and are of the kind seen in conversation books but never heard in any conversation. These books, however, are not without merit and they may give a hint to one who already knows the German language. MANUAL OF GENERAL MEDICINAL TECHNOL

OGY, INCLUDING PRESCRIPTION WRITING. By Edward Curtis, A. M., M. D.. Emeritus Professor of Materia Medica and Therapeutics, College of Physicians and Surgeons. Third Edition. Pocket size (Wood's Pocket Manual Series), 245 pages. Price, $1.00.

This is an extremely useful little book and has a fund of information between its small covers. With the rapid increase of special preparations prescription writing is rapidly becoming a lost art and too many men cannot write a grammatical prescription. This book has reached its third edition and that is sufficient to recommend it. In this edition the text has been changed to conform to the revision of the Pharmacopeia.

REPRINTS, ETC., RECEIVED.

Fourth Annual Report of the Sharon Sanitarium, Sharon, Massachusetts.

Circular Insanity. Report of Three Cases. By William F. Drewry, M. D., Petersburg, Virginia.

Treatment of Insomnia. By Samuel Wolfe, A. M., M. D., Philadelphia. Reprint from the American Therapist.

Sanitary Climatology. Circular No. 4. Information Relative to the Investigation of the Influence of Climate on Health.

Remarks on the Treatment of Inevitable Abortion. By Charles P. Noble, M. D., Philadelphia. Reprint from the Codex Medicus Philadelphiae.

A New Method of Examination and Treatment of Diseases of the Rectum and Sigmoid Flexure. Howard A. Kelly, M. D., Baltimore. Reprint from the Annals of Surgery.

Celiotomy for Puerperal Septicemia and Peritonitis. By Charles P. Noble, M. D., Philadelphia. Reprint from the American Gynecological and Obstetrical Journal.

The Diagnosis of Pregnancy During the First Three Months. By Charles P. Noble, M. D., Philadelphia. Reprint from the Transactions of the Philadelphia County Medical Society.

CURRENT EDITORIAL COMMENT.

OPTICAL SCHOOLS.
The Refractionist.

AS AN outgrowth of the recent advances in refraction work and the accompanying idea that there is a mint in it, a class of persons, evolved from the old-time opticians, also jewelers and others acting on the principle that fools rush in where angels fear to tread, are claiming that refraction is a department like dentistry, and that one need not be a physician to master it. This delusion can be suppressed only by an enlightened public and the vigilance of the medical profession.

FOUR YEARS' MEDICAL COURSE.
Medical Record.

THERE is no doubt that four years is not too long a time to study medicine, yet there are many cases in which four years of college study are not needed. If a young man has spent four years in getting a degree of A. B. or B. S., if he then studies medicine three years, and at the end of that time enters a hospital for a year and a half he should be as well equipped to practice medicine as educational institutions can make him. There is developing a kind of four-year-course fanaticism among some of those who are in the propaganda for higher education. A previous college training and a year and a half in a hospital ought to entitle a man to get off with only three years of lecturing and reciting.

VACATION.

Atlantic Medical Weekly.

WITH the doctor his work is never done, his day never completed, his nights never his own and his vacation, although sometimes badly needed, something to be looked forward to for months and then to be foregone because, forsooth, he cannot in safety leave a patient dependent upon his skill and care. Every man should have a vacation. Every man would be better for one, and none would be the poorer in the long run by throwing aside his cares for a few weeks each year, even if he did lose an occasional family, even if he did cease the eternal grind for a livelihood and thereby lose a few dollars, but the busy doctor needs more than a vacation; he needs something to which he can turn his mind every day or at least as often as he feels the responsibilities of his business oppressing him.

WHOLE NO. 741

IT has now been some eleven or twelve years since Apostoli claimed attention for his method of ameliorating and symptomatically curing fibroid tumors of the uterus by the use of electricity. After the lapse of such a time, and in view of the accumulated experience and testimony of many investigators, it is quite possible to draw conclusions of average correctness as to the true value of the method and its applicability to the different varieties of the affection.

To the conscientious physician who is thoroughly informed on this question there is no conflict whatever between the claims of electricity and surgery in the treatment of two classes of these cases. There are cases in which electricity in expert hands can give a hundred per cent. of practical cures, not necessarily cosmetic cures, but completely satisfactory in the comfort and well-being of the patient. There are also cases in which electricity can only do harm, and in which ablative surgery is not only wise, but imperative. In a third class true conflict occurs, and I may specify this class at once as made up of large tumors causing much deformity and which are either subperito

neal and thus beyond the direct range of electrical treatment, or else so inertly fibrous as to resist prolonged efforts at electrically induced absorption. Some tumors in the latter portion of this class may be arrested in further growth, it is true, but electrical treatment is apt to be so unlikely to cause material retrogression in size as to raise the question whether the patient should not undergo the dangers of an operation rather than endure the deformity. In this class pain and pressure symptoms are apt to have ceased since the emergence of the tumor from the pelvis into the abdomen, but if not, such symptoms are generally amenable to permanent relief by electricity.

Foremost among the cases that are too often operated upon though they clearly indicate electrical treatment are all small tumors in the initial months or years of their growth, often mistaken for painful displacements, ovarian disease, etc. In these cases a complete and permanent cure can be confidently anticipated. Hemorrhagic tumors of all sizes should always be placed under this treatment. I have never seen a failure in the cure of hemorrhage and pain, and the size will frequently be re

duced. Of the larger tumors clearly amenable to electricity the interstitial, multinodular growths are most promising, particularly when the tumor is somewhat symmetrically developed about the uterine cavity. Of this class I have had cases of actual disappearance by absorption, notably one as large as the adult head.

The class in which electricity is not indicated embraces all cystic or degenerating tumors, quickly growing tumors in which malignancy may be suspected, and all tumors associated with purulent inflammations of the appendages.

The prevention and cure of tuboovarian disease by arresting catarrhal affections of the uterine tract is one of the most important services of electrotherapeutics to gynecology. By tuboovarian disease, I mean chronic catarrhal inflammation of the Fallopian tubes, which by contiguity of structure has involved the ovarian periphery or stroma, resulting in infiltrated and enlarged tubes and ovaries. Clinically, the condition is manifested by almost continuous pelvic or sacral pain and by tenderness, aggravated by catching cold and at the menstrual periods. In a considerable proportion of cases the general health is more or less affected, nervous prostration and gastro-intestinal torpidity being frequently an accompaniment of the local condition. A bimanual examination will reveal an enlarged and fixed uterus, with boggy masses in one or both ovarian regions, and in some cases prolapsed appendages. The uterus will invariably be found affected, and at all stages of the disease.

In making a diagnosis of such a case we have been taught of late with much vigor not to neglect the conditions external to the uterus, the presence of which greatly modify the effect of our therapeutic efforts. So great has been the solicitude for this portion of the affected organs that scant attention is paid to the uterine trouble itself, in spite of its importance in the chronologgical order in which the parts are af fected.

From the point of view of the prevention of tubo-ovarian inflammation atten

tion to the condition of the uterus is most essential.

There can be no doubt that these attacks are all primarily catarrhal in origin, having an original focus of infection in the uterus, if not in the vagina. The vaginal seat of infection may be wanting, as in virgins, in whom a catarrhal affection may take its origin in the uterus from disordered menstruation, but in all cases it is in the uterus in which the lingering catarrhal condition remains long after its disappearance from the vagina. A subacute ascending inflammation of the mucous tract attends and follows the uterine catarrh in many cases, making an endometritis always deserving of our most careful attention, for it is while the disease is yet confined to the uterus that its cure constitutes a virtual prevention of tubo-ovarian catarrh. This is apparently a self-evident fact, yet a much neglected one.

I hardly need remind you that the present attitude of most specialists in the diseases of women is one of engrossing attention to tubal inflammation coupled with a practical neglect of its antecedent and initial lesion in the uterus. Completely occupied with the gross and harsh remedy for the former involved in their removal they call all attempts to intelligently direct the processes towards repair "tinkering," and present to us the spectacle of medical efforts only actively concerned in finishing the work of destruction rather than staying it.

No continuous muco-purulent discharge from the uterus should be neglected, particularly if it occurs in young girls. By early arrest of this process, in cases diagnosed as simple endometritis or endometritis associated with painful menstruation — menorrhalgia-I have had the satisfaction of restoring more than a score of girls and women to the enjoyment of full womanly health, in spite of the fact that some of the cases presented sufficient tuboovarian involvement already to induce other physicians to counsel an unsexing operation.

In the treatment of the uterine affec

tion nothing is equal to the positive pole of the galvanic current within the uterus, in doses from 15 to 25 milliampères. In cases that resist this remedy I have recently resorted to a modification of a method introduced by me zinc-amalgam cataphoresis, which adds to the microbicidal and alterative effect of electricity the effect of nascent oxy-chloride of zinc and mercury released by electrolysis in immediate contact with the diseased mucous membrane. If the affection has already reached the tubes and ovaries all intra-uterine treatment must be used with caution though still essential at intervals, the greater number of the applications being vaginal. If the general health has been affected by long continuance of the disease, or by a natural nervous erethism, we must conjoin with this treatment the main features of the rest cure and general electric treatment.

This method will be at times successful in cases that have reached the stage of purulent accumulations in the tubes, the curative process ascending from the uterus as the diseased process had ascended, resulting in a drainage of the tube through the uterus.

But the uterine route is by no means the only one to reach the tubal and ovarian mischief, whether the uterus

SARCOMA OF THE KIDNEY IN CHILDREN.-From a study of a number of cases of sarcoma of the kidney Dr. D. A. K. Steele concludes, in Medicine, as follows:

1. These new growths of the child's kidney are often congenital.

2. They are usually unilateral; when bilateral it is from secondary infection of the other kidney.

3. They are primarily extra-renal, and surround rather than infiltrate the renal tissue.

4. Round-celled is the most common form of these sarcomas.

5. They are of exceedingly rapid growth, and destroy life by exhaustion.

6. They are uniformly fatal when treated medically, the duration of life being from four to twelve months from the time the disease is first observed.

demands treatment or not. We can hasten absorption of effusions and infuse new tone into relaxed glandular and muscular tissue by stimulation of the lymphatics and sympathetic nerves of the pelvis. The clinical importance of these two sets of draining and controlling agencies is too often neglected. On them alone depends the practical restoration of organic and tissue integrity, and any method by which they may be directly stimulated gives us the means of initiating an active remedial process. The usual remedies now employed for this purpose are copious hot vaginal douches and application of tincture of iodine to the vault, both or either being at times of marked service. A more efficient stimulation of the lymphatics in chronic cases is the negative pole of the galvanic current, applied by means of a moist cotton-covered electrode. If this is properly placed to include the local trouble between it and the opposite pole the current bulk will traverse the affected structures, and in the tissues surrounding the electrode there will be a marked quickening of trophic processes. To lessen congestion, remove pain and tenderness and contract relaxed muscular tissue the fine faradic current should be used with a bipolar instrument, daily or thrice weekly.

7. Nephrectomy offers the only hope. of cure or prolonging life in these unfortunate cases.

8. More accurate early diagnosis and prompt operative interference has lowered and will continue to lower both the primary and secondary mortality.

9. The extra-peritoneal route is preferable when the tumor is small.

10. When large, a trans-peritoneal incision is imperative.

II. It may be either transverse or vertical; considering the nerve supply of the parts, the transverse would seem the better.

12. The operation of nephrectomy in these cases is justifiable, and we are not doing our duty as surgeons to our little patients if we withhold the only chance. they have for life.