Department of Obstetrics and Gynecology.

In charge of Dr. P. MichinaRD, assisted by DR. C. J. MILLER, New Orleans.

POLYHYDRAMNIOS.-At a recent meeting of the Obstetrical Society of Philadelphia, Dr. E. P. Davis reported five cases of polyhydramnios and briefly discussed its differential diagnosis, its etiology and its treatment. In one case there were twins,

each fetus being in its own individual sae. One sac contained the normal quantity of amniotic fluid, the other two gallons. All fetuses showed defective development in one form or another.

The doctor said the pathology of the condition is not fully known. The placenta is often large and dropsical; Jungbluth's vessels enlarged, amnion and chorion thickened with extensive fissures in the epithelial layer of the amnion and fatty degeneration of the cells. He said that seven times more fluid passes through veins than through arteries of cord into placenta. "Any fetal condition causing venous engorgement tends to produce polyhydramnios." It is to be differentiated from ovarian cyst by duration of illness. In some cases cysts complicating pregnancy may be mistaken for polyhydramnios.

"Treatment by drugs is without value.' No treatment is required when the disease is slight, not increasing, and the woman's health remaining good. Otherwise gestation should be terminated; but great care should be exercised to avoid a rapid emptying of the sac. Patient should wear a close-fitting abdominal binder during and after delivery, which delivery should be accomplished slowly. Occasionally there is an absorption of the excess of amniotic fluid following an abdominal section.

THE CHOICE OF OPERATION FOR THE RELIEF OF RETRO-DISPLACEMENTS OF THE UTERUS.-Judging from the titles of the many articles being presented before the various gynecological and obstetrical associations during this year it appears that the time of reckoning has come for the numerous procedures that have been suggested for relieving displacements, and a com

parative study of the after effects of each operation affords some points of great interest. Dr. Joseph Taber Johnson (American Journal of Obstetrics, June, 1902) contributes a very valuable article which is more of a general summary than a relation of his personal work. He calls attention to Noble's review of the obstetrics results in 808 American cases of suspensio uteri and ventral fixation. Among the 808 were 56 pregnancies or 6.9 per cent. There were six abortions or 10.7 per cent.; 43 were delivered at full term or shortly before it. There were three deaths, of which two were not attributable to the operation, one dying of heart disease before labor, the other becoming septic before operation, due to a dead ovum. Therefore but one deathNoble's-Porro-a mortality of about two per cent. occurred as a direct result of the manipulations made necessary by the conditions consequent upon the operation. The complications in labor were: Forceps, 3; amputation of the pregnant uterus, 1; retained placenta, 2; sepsis before labor, 1; heart disease, 1; uncontrollable vomiting, 1; induced labor, 1.

The European statistics correspond closely to the American, according to the statistics collected by Gordon of Baltimore.

The conclusion of Jacobson, of Brooklyn, as to the influence of suspensio uteri and ventral fixation on fertility, are that apparently they reduce fertility, as only 56 became pregnant out of 808.

Polak declares there is no special tendency to induce abortions created by these operations. Kelly and Fry have both suspended the uterus during pregnancy without causing abortion. Johnson reports fifty of his personal cases, all treated by ventro suspension. Only one patient, so far as he knows, has been pregnant. She had a rapid and uncomplicated labor. All cases were successful, except one. In that case the displacement recurred and the operation was repeated recently.

TREATMENT OF INFLAMMATORY AFFECTIONS OF THE PELVIS BY BODILY POSTURE COMBINED WITH PRESSURE.-The Journal of Obstetrics and Gynecology of the British Empire, June, 1902, contains a lengthy extract of an article by L. Pincus, which appeared originally in Volkmann's Samml. Klin. Vortr.

The characteristic features of the method are moderate elevation of the pelvis and lower extremities and pressure internally

and externally exercised on the pelvic organs, as well as on the inflammatory exudations. Both forms can be used simultan-eously. In order to produce pressure from without, bags filled with shot and weighing from 4 to 8 pounds are placed on the. abdomen. It is not advisable to employ external pressure by itself, as the downward pressure on the pelvic organs might lead to increased congestion. This is prevented by using intravaginal pressure at the same time. An empty bag of gauze is introduced through a speculum into the vagina, while the patient is on the inclined plane, the bag is gradually filled with shot, then tied and pushed upwards.

The weight does not exceed two pounds. The newest method consists in exercising pressure by means of mercury; the pressure is more uniform.

It is often useful to combine this treatment with other methods, hot douches, baths, plugs, etc., especially when we have to deal with very hard masses which resist absorption. Now and then treatment has to be interrupted, and finally given up, in consequence of pain and rise of temperature. These are mostly cases where pus is forming.

Suppuration must be considered a clear indication for abandonment of the weight posture treament. Operative interference then becomes necessary. Rise of temperature from half to a degree is no contraindication, but if there has been a considerable rise of temperature, then it is advisable to treat the patient for a time with hot douches, and begin the weight and posture later, when the condition has become chronic. In most cases it is sufficient to use the treatment at night only; the patient need not be kept in bed during the day. The author has treated 299 cases by this method. In about 10 per cent. the treatment had to be abandoned in consequence of acute symptoms supervening. In most of the other cases the treatment proved satisfactory, though in some, other methods had to be employed at the same time. Treatment occupied in each individual from five days to two months, the best results being obtained in cases of very hard pelvic exudates of old standing, which resisted other methods. Adhesions, on the other hand, are scarcely influenced. It also fails when suppurative foci are present.

Department of General Medicine.

In charge of DR. E. M. DUPAQUIER, New Orleans.

PATHOGENY OF THE SO-CALLED PARASYPHILITIC AFFECTIONS.The whole question of the so-called parasyphilitic affections must needs be revised. In the first place, the so-called parasyphilitic hysteria, neurasthenia, nervous and developmental disorders and changes are common affections pertaining as well to all other infections and intoxications as to syphilis. On the other hand, locomotor ataxia, general paralysis, leucoplasia lingualis, etc., are really syphilitic affections in origin and nature. They ought to be classed as atypical cases of syphilis. Is it not a fact that 90 per cent. of the cases of locomotor ataxia are seen in syphilitic subjects? Is it not probable that the others are directly due to conceptional, hereditary, ignored or dissimulated syphilis?

The absence of specific changes in locomotor ataxia is no proof against its syphilitic nature, since it is not fully demonstrated that all syphilitic changes to be regarded so, should have the character of those lesions formally recognized as typically syphilitic.

Again, the incurability of a lesion by specific treatment is no absolute proof that it is not syphilitic. Here lies the most important point in this question of parasyphilitic affections. For it is a certainty that a large number of tabetics are improved, at times cured, by mercury. It is probable that a larger number will be bettered when the specific treatment is carried out systematically in a continuous manner. Similar considerations can be propounded regarding general paralysis, leucoplasia lingualis, etc. Indeed, there is graded transition between the changes in these affections and the typically specific lesions of the brain, cord and tongue.-LEREDDE in La Revue Médicale du Canada, July 16, 1902.

DIAGNOSIS OF WHOOPING COUGH.-For obvious reasons, chiefly for isolation, it is most important to make a correct diagnosis as early as possible, a difficult matter by the way, in

many instances, unless during examination the patient is taken with a paroxysm and there occur in our presence the characteristic cough and whoop. Indeed, the information gathered from the usual questions and inquiry is uncertain. Examination itself is negative. The ulceration of the frenum linguæ is not constant, the puffiness of the face is hard to distinguish unless the normal appearance of the face is well known, the punctiform ecchymoses about the neck are often absent, auscultation reveals either nothing or simply the usual signs of a common case of bronchitis. There is only one way out of the difficulty: it is to cause a paroxysm of coughing in our presence and for that purpose many procedures are well known, viz.: tickling of the skin about the neck, light constriction of the thyroid cartilage, touching of the pharynx's fundus. But these and other physical or psychical exciting means usually employed are not always successful. The following never fails:

After disinfecting your forefinger, insert it in the patient's mouth, feel for the epiglottis at the base of the tongue, hook it up and enter the vestibule of the larynx, touch the superior vocal cords and quickly remove your finger. In no time this is done and in all cases of pertussis in which it is done, the characteristic paroxysm follows immediately. So, the diagnosis is safely made, safely by all means since the procedure is as harmless as it is reliable, while in the cases of young children a reflex is started which keeps the mouth opened as soon as the finger touches the epiglottis, and thus prevents it from being bitten.— VARIOT, in Journal de Médicine et de Chirurgie Pratiques, July 10, 1902.

Miscellaneous.

NEW WEARING APPAREL AND HYGIENE.-Dr. Heidingsfeld, of Cincinnati, remarks the observation of an unusual amount of cutaneous affection during the spring and fall. A close study will impress even the more unobserving that this pertains not only to the types which are generally classed with the infectious diseases, e. g., zoster, purpura, etc., which, like the acute infectious exanthemata, prevail more extensively during these sea