A NEW TREATMENT FOR CHRONIC METRITIS AND ENDOMETRITIS BY INTRA-UTERINE CHEMICAL GALVANO-CAUTERY.

Dr. G. Apostoli (Can. Med. and Surg. Jour.) says. Intra uterine therapeutics tend more and more and with much propriety, to replace the old methods of application to the exterior of the uterine cervix. The new procedure which I instituted four years ago for the electrical treatment of fibroma I have employed with the same advantages and equal success in the treatment of chronic metritis, especially when the latter condition complicates endometritis. To a lesion, which, before invading the uterine parenchyma, commences in the mucosa and is confined to it for some time before involving the peripheral structures, I oppose a treatment which acts by cauterizing the whole of the more or less diseased mucous membrane; for the modern methods of curetting, intra uterine injections, and purely chemical intra-uterine cauterizations, I substitute a galvano-chemical treatment less heroic, easily localized, the dose easily regulated, well borne in all cases, and not liable to be followed by inflammatory reaction, if the remedy be properly ap plied. The immediate chemical action, which consists in progressive destruction of the mucosa, is soon followed by a process of regression and disintegration, which favors the absorption of exudations and hyperplasia. To properly conduct the operation it is necessary to be furnished with and understand the use of the following electrical appliances:

1. A medical intensity galvanometer, which I first had constructed to indicate 200 milliamperes. Only by this appliance may the intensity of current employed be exactly ascertained. The great advantage of this precission over the old method of estimating the intensity by the number of cells is obvious. Thus a new pair of elements is, of course, more active than one in use for some time.

2. A constant current battery of sufficient size of elements to last a long time and not grow weak to any great extent by use, and which can furnish from, say, 30 cells a current of from 100 to 200 milliamperes.

3. An intra-uterine electrode sufficiently long for application to the whole length of the uterine cavity of a material such as platinum, which is not acted on by acids and furnished with an insu

lating tube to protect the vagina, the best material for this purpose is celluloid.

4. A neutral electrode, which, applied to the abdomen, permits of the transmission of a very intense current without pain, heat, or the formation of eschars; the best is wet clay, which I proposed in 1882.

5. Conducting cords sufficiently pliable to be convenient of use and strong enough to prevent any danger of painful interruptions of the current from their being broken.

The physician being in possession of the proper appliances must strictly contorm to a technique of operation which may be definitely indicated as follows:

1. A tepid antiseptic vaginal injection should be administered and the woman placed in the dorsal position. the knees drawn up.

2. The battery being brought into action and the galvanometer interposed, the abdominal clay electrode is placed in situ, the woman being warned that it is always cold; and the rheophore attached.

3. The intra uterine electrode, previously warmed and disinfected, is slowly and cautiously introduced, with care that the vagina and vulva are protected by the insulator.

4. The intra-uterine galvano cautery is to be negative in the hæmorrhagic cases and positive in the other cases.

5. The principle which should govern all such intervention is never to surprise the uterus and never to make a too painful application. Now it is important to know that in a certain small proportion of cases (3 to 5 per cent.) the uterus is irritable. Such are certain hysterical subjects who bear the current badly, although of slight intensity, and in such small doses alone must be administered.

6. It is necessary in all cases to begin with a weak current, slowly increased in intensity, and to stop short of producing more than slight pain, to gradually accustom the patient to its effects and so overcome all physical and moral resistance.

7. Gradually in two or three sittings the intensity of the current is to be increased until in the majority of cases 100, 150 and if necessary 200 milliamperes have been attained. The intensity is to be proportioned and regulated by the tolerance of the patient and the extent, gravity and duration of the lesion.

8. The duration of the application, from five to ten minutes, must, like the intensity, be regulated

by the extent of effects it is desirable to obtain. 9. The sittings may be held weekly or tri-weekly, according to necessity, and the physician must regulate the number and intervals of the applications according to the urgency and necessity for intervention.

10. The patient must be made to rest in all cases several hours after the application. Such rest is necessary for the safety and efficacy of the method.

11. Antiseptic vaginal injections of corrosive sublimate or carbolic acid are to be prescribed for administration morning and evening.

This simple and safe treatment, a true therpeutic hysterometry (veritable hysterometric therapeutique), is none other than a molecular galvanochemical curetting, acid or basic, according to the case, which excites the formation of a new mucosa and constitures a kind of intra-uterine issue, the action of which we may prolong or vary as we please. Its beneficent effects which I have verified in a large number of patients are speedily obtained from the first sittings, become rapidly more marked, and soon lead to a cure: Confinement to bed or any additional treatment is unnecessary. As compared with surgical curetting, it has the advantage that it can be localized and regulated as regards dose or amount, at pleasure, according to the necessities of the case.

[For the Summary.] LOBELIA.

BY J. C. FEAR, M. D., WAVERLY, KAN.

I wish to call the attention of the readers of the SUMMARY to the action of lobelia in small doses I use it in doses of gtts. 1 to 2 every hour where we have dyspnoea and oppression of the precordia with very marked relief. I have just dismissed a case of pneumonia of right lung with hypertrophy of left ventricle of heart in which lobelia in connection with aconite and cactus grandiflorus played a very active and useful part in the treatment. In labor with rigid os and perineum it acts nicely combined with gelsemium given in small doses and frequently repeated. If given in too large doses it seems to act as an irritant on the stomach and is not taken up as well as in smaller doses at short intervals. In doses of 1 to 2 drops it is a powerful vital stimulant. It improves innervation and strengthens the circulation. As an emetic, of course, larger doses are needed.

CASE OF SUCCESSFUL ENUCLEATION, AFTER LAPAROTOMY, OF A FI BROID ATTACHED TO THE FUNDUS UTERI.

BY JOHN S. DICKSON, M. D., PITTSBUrg, pa.

Mrs. R, Pa., æt. 24, married, had given birth to two still-born children, one at full term and the other at an earlier period of pregnancy. She was sent to me from near Cornellsville (by Dr. Phillips, of that place) September 1, 1886, and was taken to Mercy Hospital after being examined by Dr. James McCann and myself at my office.

History. For three years patient had been suffering from an abdominal tumor, which, during the last few months previous to her reporting to me, had increased rapidly in size.

The diagnostic features indicated a fibroid growth attached to the fundus' of the womb on the right side. The os uteri was pulled up on the left side to an extent which made it impossible to use a sound or make a digital examination.

The patient rested quietly at the hospital until Tuesday, September 7, when laparotomy was performed. The incision made was about 13 inches in length, extending nearly from the symphysis pubis to the ensiform cartilage. The tumor was found to be a fibroid of a firm, elastic consistency, and intimately adherent to the fundus uteri on the right side. At first it seemed impossible to remove the tumor without the uterus, but eventually it was decided to enucleate the growth from its attachments. The peritoneal sac, from which. the tumor was enucleated, was very large, and the womb itself was about four times its normal size. This, at first, gave the impression that the growth was intra-uterine. The enlargement was found to be symmetrical and regular in form, however, and was then attributed to inflammation. It was considered probable that, after removal of the tumor, the womb would atrophy to its natural dimensions, and hysterectomy was therefore rejected. During the operation a great many ligatures (over forty) were required to control hemorrhage.

After the growth had been removed, the edges of the rent in the peritoneal covering or sac were approximated by sutures, and the whole let fall back into the abdomen. The abdominal wound was brought together by interrupted sutures of silver wire, eleven in number. A rubber drainage tube was inserted between the two last sutures, dipping down into the sac. The wound

was

then

dressed with lint, moistened in bi-chloride solution, and linen gauze placed over that. Scarcely any blood was lost during the operation, and the patient evinced no evidence of shock at any time. The tumor was weighed, and found to be eleven pounds, two ounces in weight. At the operation Drs. James McCann, Richardson and Davis and the hospital staff assisted.

Patient showed but little disturbance from the anæsthetic, but complained of pain some two or three hours after the operation. She was relieved by morphia. She had considerable pain, and was restless during first night.

2nd day. Some uneasiness and pain. Relieved by small doses of morphia. She was catheterized every eight or ten hours; and this was kept up until she was able to be out of bed.

3rd day.-Symptoms gradually subsiding. Less pain and restlessness. Wound dressed and found doing well. 4th day. Some restlessness the most observable symptom. No undue pain or other trouble. Two or three upper and superficial sutures removed. Also drainage-tube. No discharge.

5th day. More sutures removed.

6th day.-Pacient complains of some pain in right side of abdomen. All sutures removed. Adhesive straps and moistened lint applied. Bowels opened by laxative and enema.

7th day.-Patient continues to improve, but is restless. Craves food. Sleeps quite well at night. Sleeps quite well at night. Is cheeful.

8th and 9th days.-Progressing favorably. 10th day. From that part of the incision whence the drainage-tube had been withdrawn, a black, offensive discharge, resembling tar, was provoked by retching caused by a dose of oil. The offensiveness of the discharge continued for several days. Previous to this discharge patient showed slight constitutional disturbance.

12th day. Patient taken out of bed, and put in a large chair for an hour. On each subsequent day she sat up for a little longer period. She is becoming less restless, and eats and sleeps well, Bowels move naturally.

During the period of eleven days intervening between the operation and the day on which she left her bed for the first time, the patient's diet consisted entirely of the J. P. Bush Manufacturing Company's bovinine with a little milk, and of stimulants. Other foods were tried, but she could not retain them.

October 20, 1886, patient had a miscarriage at her parent's home, in Mount Pleasant, Pa., and the foetus was supposed to have been of four months' development at the time of the abortion. The peculiarities in the size and shape of the uterus, which were considered at the time of the operation to be due to inflammation, were thus explained:

November 11, 1886, patient came to my office to show how well she was. She still had occasionally, a little discharge from the sinus, where the drainage-tube had been inserted. Extending down towards the right inguinal region, from the sinus, was a noticeably thickened and indurated condition of the parts. This was considered the source of the discharge, and tenderness was noticeable here when the flow was interrupted any length of time. The induration, however, according to the patient's statement, was gradually decreasing. Patient was otherwise stout and in good health,

It will be conceded that the above record of the case is a remarkable one as to results. The operation occupied 51 minutes, and necessarily subjected the patient to a severe strain. It certainly is remarkable that at no time the patient's pulse was higher than 96 nor her temperature higher than 101°. Many of the good results I attribute to the use of bovinine, which was practically the patient's only nutriment, during the first eleven days, and the careful employment, during the entire case, of antiseptic precautions.

The readers of the SUMMARY are respectfully invited to forward us original contributions on any subject which may be of general interest to the profession.

[For the Summary.] TREATMENT OF CHRONIC URETHRITIS AND CYSTITIS.

Editor Medical Summary:-Chronic urethritis and cystitis yield promptly to the cathode induced current while the mode is applied the whole length of the spinal cord over the bowels, stomach and liver. Dose, good strength, 12 to 20 minutes daily. My method of application, if a male, I introduce a male silver catheter; if a female, I introduce a female catheter, very carefully. I then take a piece of No. 18 insulated electric bell wire the exact length of the other wire, then I scrape off about two inches of the insullation and crimp it up a little just so I can introduce it inside the catheter as far up as to the point of soreness and start with a mild current increasing it to a good strength. After over twenty years' of constant use with the currents as directed and with a careful manipulator I am convinced there is no need of a failure. Yours, Aima, Mich.

MORRIS HALE, M. D.

PHYTOLACCA DECANDRA IN MAMMITIS.

Prof. J S. Todd, M. D., of Atlanta, Ga., in a communication to a recent number of the Atlanta Med. and Surg. Journal on therapeutic notes from practice among other valuable points, gives the following on polk root in the treatment of mammary abscess, which fully coincides with our own views as practical experience with the drug has demonstrated itself to us we know of nothing more reliable and sure to give satisfactory results, and in the only instance where it ever failed us was in a case where we had used an, unknown to us, inferior or worthless fluid extract of the poik root. Dr. Todd says I consider phytolacca decandra a true anti galactagogue. Being such, it rests the inflamed gland, and physiological rest is the greatest of all curative agents in a number of diseases. The surgeon's splints keep at rest the muscles that surround the fractured bone, and also secure their apposition; nature does the knitting; opium is the internal splint that quiets the bowels when they or the peritoneum are inflamed; belladonna paralyzes the muscles of accommodation about the eye, gives it physiological rest and repair uninterrupted, and ever ready does its

work.

When I have a case of threatened abscess, and I known it by the pain and swelling of the breast,

which are among the very first symptoms, for "ubi irritatio ibi affluxus," I give ten drops of the fluid extract phytolacca decandra and a brisk purgative. Sometimes I empty the breast and put on a bandage; never allow rubbing, handling and poulticing. The dose of phytolacca is re peated every hour for three or four times, then the intervals lengthened gradually pro re nata. True, I have once failed with this agent, but only once, but I count my successes in averting suppuration by the tens. When it becomes necessary to wean the child, or dry up the milk, or lessen its secretion in those who are weakened by its profuseness, and they are not few, because of the death of the infant or for other reasons, I have found it to be an unfailing and pleasant antigalactagogue.

Sig.--One every three, four or six hours, according to circumstances.

He adds: If these pills be commenced in the early stage of a common cold, i. e., when the affection is as yet confined to the nose and pharynx, the affection will be nipped in the bud. At starting, one pill should be taken every three or four hours, and later on every six. If a catarrhal subject has a box of these pills always at hand, he has, I believe, a weapon wherewith to meet and defeat his enemy. The longest time I have seen a cold last while the patient was fairly taking these pills was three days.

I think tannin is much superior for the treatment of inflammatory conditions of mucous mem branes than any of the other astringents, whether vegetable or mineral. It seems to possess some tonic properties as well as that of an astringent. It should be thoroughly dissolved or trituratedIsaac W. Chisholm, M. D., New Concord, Ohio.

Raw mutton can be safely eaten, according to M. Chatin, of Parls, since it never contains parasites, at least in dangerous amount. It is a safer raw food, therefore, than beef or pork.

The announcement of new discoveries in medical science should prove interesting reading to any physician. Look through our advertisements carefully.

The Liebig Coca Preparations have long been standard remedies for patients requiring tonic treatment. Scientific men are becoming more and more impressed with the necessity of supplying, by nutritive ingesta, the wear and tear of civilized life, and the Liebig Coca preparations are composed of materials well suited to fulfill the necessary requirements. The Coca Beef Tonic is looked upon with especial favor by med ical men for building up broken down constitutions.

During the six days' session of the Ninth International Medical Congress, the Medical Register, of this city, will be issued daily, and will contain a complete report of all the general session and of all the sections.

We are in receipt of a sample of compound iodoform powder prepared only by Griffith & Co., chemists, 146 Second Avenue, New York City. The iodoform in this powder is not "chemically changed," but simply mixed in proportion of one part in six with other antiseptic powders and oils of recognized merit, and their claim is that in this preparation the "very objectionable" odor of iodoform is nearly overcome, while its medicinal properties have not been impaired, but possibly improved by the additional antiseptic substances. The powder, aside from its use as a general antiseptic dressing, has been found useful in diphtheria, croup, syphilis of the larynx, tuberculosis of the larynx, nasal catarrh, eczema and various other skin diseases, &c. Send for sample.

In order to remove nitrate of silver stains dip the fingers into a strong solution of cupric chloride. In about a minute the silver will be converted into chloride, and may then be washed off with sodium hyposulphite solution,