The variations of the number of electrical dosages, even in same class or character of disease, were partly due to the peculiarity or idiosyncrasy of the patient, but mostly to the difference of the resistance which the current meets in each pathological case. Some were firmer, denser and less vascular than others, and required longer, steadier electrical stimulation-without injuring the healthy organ. But just as soon as an electrical force was sufficient to induce a decided hyperemia in either case, osmotic action took place, which deprived the parasitical cellular substance of nutritive support, which resulted in

their death and ultimate chemical absorption. Indeed, it is a histological fact that cells of low formation have greater resisting power than the cells of rapid growth. And that which I have said in a former paper is true now, "that as abnormal structures of fibroid character possess in no small degree the tenacity of the natural fibrous tissue cell-both consisting of a homogeneous mass of wavy interlacing fibers of ultimate strength and vitality-it is reasonable to suppose that a greater intensification of electrical fluid is required to disturb their functional capacity than those constituting the myxomata, myomata, papillomata, adenomata, etc., because their conductivity is not equal." Hence it is difficult, yes, impossible, to approximate a uniform system of quantitative electrical treatment. We have to determine from actual clinical experience the amount of electrical force required to establish chemical changes in the pathological lesion. Hence no rule can be laid down for either the inexperienced or experienced, though the latter, from much wider observation, can detect its primary impressions sooner, and utilize its resolvent properties to better and safer advantage.

Now this tabulated report may seem rather exaggerated to some of you, inasmuch as it shows that during this time I had treated by electrolysis five hundred and sixty-six cases, and all suffering from the various pathological conditions enumerated, with results defying any other system of treatment in like compari

son.

But I assure you it stands correct; and that each case was studied with a careful measure of observation, with the view of determining its true osmotic and chemical absorbing qualities, and the comparison I might draw from its clinical effects with what other medical electricians obtained. I am truly conscious of the import of my remarks. I am sensible of its intended significance, that of bringing to your minds the importance and careful study of the peculiar phenomena which electricity displays in diseased tissue. And though too much caution cannot be exercised in its use, yet I am justified in saying we have in it a weapon which is a most powerful destroying agent, but fortunately when curbed. by the hands of those experienced in its manifestations in organic structures, becomes a harmful and useful engine, possessing the essential property of osmotic action and chemical absorption.

ECTOPIC PREGNANCY, WITH REPORT OF CASE.*

BY ARTHUR BENNETT, M. D., DETROIT, MICHIGAN.

I PRESENT this case for you, to-night, hoping that it will, with the discussion, materially aid you to a timely diagnosis of the most grave, most horrible and painful condition that female human flesh is heir to. That many skillful physicians have made a mistaken diagnosis in this trouble is beyond question. The death certificate has been signed, the patient buried beneath the ground, and the whole subject of ectopic pregnancy forgotten. Happily the spirit of chivalry is not entirely gone, and such men as Price, Tait, and others, have laid this subject so plainly before us that it is now a much easier task to make a diagnosis than in former days, and with the light already thrown on the subject it behooves * Read at a stated meeting of the DETROIT MEDICAL AND LIBRARY ASSOCIATION, and published exclusively in The Physician and Surgeon.

us as general practitioners to look about us and become familiar with the symptoms, diagnosis and treatment, for who knows what hour or minute they will be ushered into the presence of this fearful condition. There is no condition in which the life of the patient is in so much danger, yet nowhere in the whole realm of surgery or medicine have the results been so brilliant and satisfactory in cases where the diagnosis has been made and proper treatment instituted in time.

I will not take up valuable time in discussing the cause of this trouble or in describing the various kinds of ectopic pregnancies, unless it be to state that the case I report to you to-night was considered by me and those that saw it an excellent example of ovarian pregnancy, and that this is a condition considered by many authorities as next to impossible. There is a difference of opinion between Price and Tait in regard to the existence of the intra-ligamentous variety, which is supposed by Tait to be a tubal pregnancy rupturing into the broad ligament. Price has operated some sixty-two times and says that he has never met with this intra-ligamentous variety but that he rather considers that all extrauterine pregnancies are tubal, and that when rupture takes place, they rupture directly into the peritoneal cavity, and that the intra-ligamentous variety of Tait's is only inflammatory membrane or capsule surrounding the foetus. The foetus, he thinks, grows after this rupture surrounded by the inflammatory exudate or capsule.

It does not concern us materially which of these views are correct; what is wanted by the general practitioner is to be able to recognize the trouble and treat it; if not to get some competent surgeon in time to treat it for him. It is an easy matter to understand that it is next to an impossibility to make an absolute diagnosis of extra-uterine pregnancy before a rupture takes place, and the best thing we could do, if we could bring ourselves to think of a sure case, would be to make an exploratory operation to clear up the diagnosis, or submit the case to some specialist for this purpose.

After rupture takes place and the hæmorrhage has gone on to an alarming extent we have not time to theorize or to guess at a diagnosis. We cannot say we think, or we are positive the patient has a severe case of colic, and give an opiate. We must be positive. We must act and act immediately. We must either operate ourselves, immediately, or get some one to do it for us; and to do this we must ever be on the watch for the alarming symptoms which will never fail to present themselves. Now, to enable you to glean a little more light, I will report two cases, one my case that died, and one Dr. Price's case, reported by Dr. Cordier, that lived.

Mrs. H., aged thirty-two, mother of three children, youngest about three. She had been always regular in her menses until lately when she flowed between times. Felt first-rate up to three weeks from the date I was called, when getting out of a carriage she felt a sudden tearing pain in her right side which almost made her faint. She, however, got over this in a little time, but she noticed she had a little discharge of blood at times, and occasionally profuse hæmorrhage and bearing-down pains in bowels. About a week from this date she was out walking with her husband and when going up the high stone step into her home she was seized with the horrible pains again and swooned on the floor. Her husband got alarmed and sent for a physician. When he arrived she was somewhat better and

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he prescribed for colic, and all danger was averted for this time. She went on for another week, and one night her husband was wakened by his wife's moans who said she was dying and to send for a doctor quickly. My office being close at hand I was called in and found the woman very pale and weak and almost pulseless. She complained of pains, which I took for those of a miscarriage, but on examination the os was quite firm and I could discover no show, but the womb was pushed forward and a large mass in the posterior cul-de-sac which seemed to be quite firm and resembled a full-grown placenta. I gave a hypodermic of digitalin and atropine and immediately sent for Dr. Jennings. He thought the case very serious and Dr. Jenks was called in. Dr. Jenks pronounced the case one of pelvic hæmatocele probably due to extra-uterine pregnancy, but thought the patient too weak for an operation. She lived twenty-four hours after with great pain most of the time. On post-mortem we found the tissues, on cutting, bloodless, and the peritoneum black and bulging. There was a great quantity of clotted blood-not all clotted-and the prior inflamed condition of the right ovary or tube, so close to the ovary, was ruptured and the fœtus, about three months, floated over to the left side.

I report Dr. Price's case as a similiar case with operation and patient still living, and leave you to draw conclusions.

(Case reported by A. H. Cordier, M. D., in February number of Annals of Gynecology, 1892).

Mrs. A., mother of one child, five years old. Has been regular in her menstrual periods up to ten weeks ago when she had an inter-menstrual flow of blood lasting two days. The same irregularity was noticed the following month but accompaied by more pain than usual. She has had no subjective signs of pregnancy; more or less pain on right side was noticed for the last four weeks, but no acute suffering until one week ago, when a most severe tearing pain developed in the region of the right ovary lasting until unconsciousness was induced one-half hour later by an attack of syncope. She was placed in bed in the recumbent position and ordered to keep quiet by her doctor. This injunction she did not obey longer than two days, as she was free from pain and had recuperated from the previous prostration to such an extent that she thought it would be folly to remain in bed longer. She resumed her duties as housewife two days later which speedily brought on another attack of pain and prostration. This time she remained in bed a week barely alive part of the time. At this time Dr. Joseph Price was called in consultation to see the patient and recognizing the seriousness of the case recommended an immediate operation. She was placed in his private hospital (it being near by) and the operation was performed at once. At the time of operation she was pulseless from loss of blood, the heart beating at the rate of one hundred and sixty per minute. She was sighing frequently and having fainting attacks often; skin was cold and clammy, face blanched, and the lips had the appearance of an unpainted wax figure. Her condition was one of most desperate character from loss of blood, making the prognosis extremely grave with an operation, and certain death without it. Very little ether was given or required during the progress of the operation. In cutting through the distended and tense abdominal walls the knife cut through the exsanguinated tissues as through a piece of cold tallow, not a drop of blood escaping from the divided capillaries or arterioles, so empty

were they from the vast amount of blood lost from the circulatory system. On reaching the peritoneum the serous membrane was seen to bulge through the incision and present the peculiar and characteristic appearance seen in these cases, which of itself makes a diagnosis warranting you to carry your investigation further and seek the source of the fluid (blood). This appearance told the operator that the patient had a dark fluid in the peritoneal cavity which with the history of this patient was certainly blood, and the blood was from a ruptured tubal pregnancy. On opening the peritoneal membrane a stream of pent-up blood found an exit through the incision, spurting fully two feet high and in a stream the size of the abdominal incision, deluging the operator and his assistant. The pedicle was quickly secured by a Chinese silk ligature, the bleeding controlled and the appendage removed. The abdominal cavity was irrigated with a large quantity of hot water and many clots removed, drainage tube introduced and bandages applied, etc. As expected her recovery was slow. She is now perfectly well.

SUGGESTIONS IN THERAPEUTICS.*

BY G. A. WILLIAMS, M. D., BAY CITY, MICHIGAN.

THERAPEUTICS, we understand, is the use of medicine in the treatment of disease. To be a good therapeutist, a man must be well versed in every department of medicine and capable of observing and reasoning well. The object we wish to accomplish in the use of medicine is to cure quickly, safely, and pleasantly-curare cito, tute et jucunde. The first thing in therapeutics is the prescription with the formula for compounding the medicines and the directions for administration. Heretofore prescription-writing has not received sufficient attention in medical schools and the matter of correct dosing has also been very much neglected. In administering medicine, the teaspoon, desertspoon, tablespoon and wineglass are generally used, but when exact dosing is required all these measures will be found very variable and unreliable. At the present time many of the druggists furnish graduated medicine-glasses to all their regular customers, and these glasses can also be ordered by the physician on the bottom of the prescription. As many of the medicines corrode metallic spoons, this is a matter to be considered as well as the exactitude of dosing. Many people suppose that a drachm of any mixture in the fluid form usually contains sixty drops, but to show the discrepancy we might mention the following preparations: Liquor potassii arsenitis, fifty-nine to sixty-three drops to the drachm; castor oil, fifty-five; diluted sulphuric acid, forty-nine to fifty-four; alcohol, one hundred and twenty to one hundred and forty-three; aromatic sulphuric acid, one hundred and sixteen to one hundred and forty-eight; chloroform, one hundred and eighty to two hundred and seventy-six. Any difficulty in this way can be obviated by the use of some of the various medicinedroppers.

It has always been customary for physicians to write prescriptions in Latin, the abbreviations not only being more convenient and comprehensible to both the physician and druggist, but a little mystery in this respect has always a * Read at a stated meeting of the BAY CITY MEDICAL SOCIETY, and published exclusively in The Physician and Surgeon,