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CAMBRIDGE HOSPITAL, ALDERSHOT.
HOSPITAL MEDICINE AND SURGERY.
was admitted on May lltb, 1887, suffering from haemoptysis. The patient stated that he had suffered from winter cough for several years, and during the previous three months the sputum had been constantly tinged with blood. He had never suffered from syphilis, and there was no family history of consumption. Condition on admission.-A finely built but much emaciated man; height 72 in.; chest girth 40 in.; weight 9 st. He suffered from constant hacking cough and night sweats. Toe expectoration, a mixture of bright red blood and a little mucus, amounted to between ten and twelve ounces in the twenty-four hours. Right lung 8pX: resisting dulness on percussion ; increased vocal fremitus and loose subsrepitant atid gurgling xhies beard on auscultation down to the third rib; base normal. Left lung normal. The treatment consisted of ice internally and locally, ergot, gallic acid, acetate of lead, &c., and for a time the heamoptysis ceased. During May, June, and July the disease in the right apex steadily progressed and was attended by repeated attacks of haemoptysis; on several occasions the patient became collapsed from los of blood. On Sept. 1st McH- was seized late in the evening with a severe attack of dyspnoea and great pain close to the right nipple. On examination next morning,11 flit dulnesl’," feeble vocal fremitus, and distant bronchial breath sounds were detected On Sept. 3rd the apex of over the right base and axilla. the heart was found displaced and beating half an inch outside the left nipple line, and on the needle of a hypodermic
the left side; the facial and lingual vessels on both sides were divided and tied. Mr. Heath now pulled the tongue, with the piece of the jaw and the submental tissues, forwards, and removed them by dividing their attachments to the hyoid bone, without i’njuring the epiglottis. The bleeding was arrested, the cautery being applied to some of the bleeding points. The wound was ducted over with lOdoform, the indiarubber tube was passed into the cesopbagus, and the upper end was brought out at the angle of the mouth. The wound was adjusted with silk sutures, and a dressing of iodoform wool was applied. Cblorotdm The plug was administered through the tracheotomy tube. in the pharynx prevented any blood passing into the air passages. Four ounces of brandy were given before the operation and two ounces and a half directly after it, and afterwards two drachms were given hourly. The patient On the eighth was fed by means of the cesophageal tube. day after the operation he was taking about five pints of beef-tea, four eggs, and six ounces of brandy in the twentyfour hours. With the exception of an attack of pneumonia, be made a good recovery. On the seventh day bronchitic rules were heard at the left base; on the ninth dulness with tubular breath sounds were detected on the left bide as high as the angle of the scapula; on the twelfth the tubular breath sound had disappeared and moist rates were heard. From this date the patient improved steadily, and on the fifteenth day he was !ed for the firt time without employing the oesophageal tube. He lefthis bed three weeks after the operation, and went home a week latter. At that time the glands along the bc,rder of the left sterno-mastoid were enlarging. He was in good health, and able to go about and enjoy himself after he left the hospital, but about three months and a half afterwards he was found dead in bed, probably from suffocation dependent on a large growth which had formed in his neck. CASE 2. Epithelioma of tongue ; removal of entire tongue by scigsorsfrom the mouth; recovery.-J. 1-1 --, a man aged sixty-one, was admitted on March 27th, 1888. He first noticed a lump in his tongue fifteen months ago. On admission, the whole of the tongue was indurated as far back as could be felt with the finger; its surface was very irregular and glazad, and there was a sloughy ulcer on the left border. No enlarged glands could be felt. On March 28tb, an enema of brandy having been given, and the patient being placed under the influence of chloroform, which was then administered through a nasal tube, Mr. Heath removed the entire tongue by means of scissors in the way recommended by Mr. Whitehead. The lingual artery was seen and secured before division ; the other was divided, clamped, and tied. After the bleeding had been stopped aud a comparatively dry surface secured, the floor of the mouth was painted with Whitehead’s varnish. An cesophageal tube was introduced through the mouth, and the upper end of it secured by a bandage passing round the forehead. After the operation the patient was given a drachm of brandy, with two ounces of beef-tea and milk alternately, every half-hour. On the following day eggs and oxtail soup were added to his diet. 011 the second day after the operation the brandy was given in double doses every two hourf, and on the fifth day it was given every four hours. All food was given through the oesophageal tube, but on the ninth day after the operation the patient found the tube troublesome, so it was removed. It was necessary to replace the tube on the following day, as the patient was not able to swallow. The tube was finally removed on the fifteenth day, and from that date the patient succeeded in feeding himself. His general condition was good and the floor of his mouth was healing well. It was frequently washed with Condy’s fluid, and was dusted over with iodoform powder daily. The highest temperature was 1084° on the fifth dy; after that, date it was normal. The patient was discharged on the seventeenth day after the operation.
CAMBRIDGE
HOSPITAL,
ALDERSHOT.
A CASE OF PHTHISIS COMPLICATED BY RECOVERY; REMARKS.
Under the care
EMPYEMA ;
of
Surg.-Major W. H. HORROCKS.) of following phthisis treated in this boqpital presents many points of interest, and illustrates the arrest of phthisical processes by means of fluid pressure. Private MoH——,age thirty-one (twelve years’ service), THE
case
1247
I possible
I
syringe being passed into the pleural cavity a syringeful of pus was withdrawn. On considering all the details of the case, and how the patient was rapidly being exhausted by the constantly recurring haemorrhage from the cavity in the right apex, it was determined to allow the fluid toaccumulate in the right pleural cavity, in the hope that by its pressure the diseased lung might be so compressed as to practically close the cavity in the upper lobe of the right lung, at the same time carefully watching for any signs of congestion in the sound lung or interference with the heart’s action. Accordingly day by day, with the increase of fluid in the right pleura, it was noticed that the sanguineous expectoration gradually diminished in quantity, and in a little more than fourteen days amounted to only three ounces of muco-pus, without a trace of blood. On Sept. 26th, the left (the sound) lung beginning to show signs of congestion, and the dulness on the right side having mount,ed to the third rib, aspiration was performed in the right axilla, and twentysix ounces of pus removed. On Oct. 13th aspiration was again performed, and on the 19th a drainage tube was inserted between the seventh and eighth ribs in the midaxillary line. After this operation there was no return of haemoptysis, and the secretion of pus from the pleurat cavity gradually diminished. On Dec. 12th no ra!es could be heard over the right apex, the physical signs being harsh breath sounds and resisting dulness on percussion. On Feb. 9th, 1888, the secretion of pus having ceased, the drainage tube was removed, the wound rapidly healed, and no reaccumulation of pus took place. A month later the patient was discharged, having regained his former weight of twelve stone; the physical signs present in the right lung indicated a bealed cavity surrounded by induration of lung tissue in the upper lobe and pleural adhesions over the middle and lower lobes. Remarks.-The influence of serous effusions in temporarily arresting tubercular lucg disease is often seen in practice, and had the fluid in this cafe been simply serous there could have been no doubt as to the propriety of adopting the line of treatment detailed above. But a purulent effusion has infective as well as pressure effects; consequently, it was only after considering how rapidly the patient was being exhausted by the beemoptysiq, the imminence of a fatal result, and the futility of all drugs, that it was considered right, as a last resource, to risk the remote possibility of infection in order to obtain the immediate benefit of fluid pressure. After producing decided intra-pleural pressure, it seemed advisable to aspirate two or threr times and slowly diminish the pressure before introducing the drainage tube, so as to obviate the disastrous results of rupture of lung tissue and cardiac syncope, which have been reported as occurring when a large quantity of fluid has been suddenly removed from the pleural cavity. Lastly, with regard to the origin of the empyema in this case, it appeared most probably due to the giving way into the pleural cavity of a small patch of caseous softening 13 u2
OBSTETRICAL SOCIETY OF LONDON.
1248
situated just under the visceral pleura, the patch of softening being isolated, and having no communication either with a bronchus or the cavities previously formed, for there was no evidence of the formation of a pyo-pneumothorax.
LINCOLN COUNTY HOSPITAL. A CASE OF TARSO-CHEILOPLASTIC OPERATION FOR
TRICHIASIS.
(Under THE
the
of Mr. W. J. CANT.) reported by Mr. W. H. B. Brook,
care
following case was
house surgeon. -
-
-
-
I
abrasions of the cervix uteri; extra-uterine fcetation; fibroid tumours of the uterus; and cancer. The author then invited discussion on the relative merits of other caustics and modes of treatment employed in the affections mentioned as compared with their treatment by electrolysis. Dr. Lovrr L DRAGS read a paper on cases of Chronic Cervical Catarrh treated by Electrolysis. These cases formed In all, the healing an addendum to Dr. Steavenson’s paper. of abraded area was promoted. In one instance, where the chronic condition of the cervix was complicated by a Hunterian chancre on that part of the uterus, the beneficial effect of the treatment was well marked. No untoward effects were produced by the electrolysis, menstruation was not interfered with, nor was pain caused either at the time when the current was passing or subsequently. All the cases were of long standing, and other treatment had failed to give relief. Dr. Drage therefore contended that a claim could fairly be made for the recognition of electrolysis as a useful treatment in such cases. Dr. R. A. GIBBONS communicated a paper on Electrolysis in some Chronic Uterine Affections, and gave some illustrative cases. The cases had been under his care at the hospital, and were those of chronic metritis, endocervicitis, lupus minimus, caruncle of the urethra, and cancer of the uterus. The latter were accompanied by profuse bremorrhage, and were mentioned in order to call attention to the efficacy of the positive pole in arresting bleeding. After explaining the action of each pole on the tissues, the author dwelt upon the advantages derived from the use of the negative pole as a caustic in chronic inflammatory conditions of the body and neck of the uterus. The glairy discharge, so common in this class of affections, became electrolysed, and thus the lining membrane could be acted upon directly and thoroughly. The accuracy with which the application of electrolysis could be made was greater than that of any caustic. During manipulation the operator had no difficulty in keeping the electrolytic power under his perfect control. After giving technical details, Dr. Gibbons dwelt on the necessity of a reliable galvanometer. This method of employing electrolysis had never been described in any English
R. E-, a delicate girl, aged eighteen, was admitted into the hospital suffering from trichiasis of the left lower eyelid, the lower segment of the cornea being nebulous from the constant irritation caused by the lashes rubbing on its surface. There was free muco-purulent discharge with blepharospasm, the vision being reduced to perception of light. For a few days an antiseptic and slightly astringent lotion was ordered to be used, which diminished the discharge. On Jan. 23rd the patient was put under the influence of the A.C.E. mixture, and an incision 15 mm. in length and 4 mm. in depth made along the margin of the lower lid, just posterior and parallel to the lashes. On turning the lid down with the fingers, a gap was left between the edges of the incision about 3 mm. wide. Four silk sutures were then passed, one end of each through a fold of skin as near the lashes as possible, the other through a similar fold about 8 mm. down the cheek; on these being tied, the lower lid was drawn and the incision opened. All bleeding from the lid having ceased, a piece of mucous membrane was removed from the lower lip of the same shape as, but slightly larger than, the wound, into which it was accurately fitted with gentle pressure. No sutures were used to fix the graft, but the whole was dusted with fine iodoform powder, a pad of wool moistened with hot perchloride of mercury solution (1 in 2000) and a bandage being used to maintain the graft in position. The dressings were removed two days after the operation, when adhesion of the graft was found to havetaken place; work. on the fourth day the silk sutures were removed. At the Dr. J. SgAw read a paper on the Constant Current in the present time (Feb. 20th) the lashes are found to be in a Therapeutics of Gynaecology. The author described the normal position, without any tendency to in curve ; the appearances presented by a myonbroma when subjected, opacity of the cornea has greatly diminished, and the vision about twelve hours after its removal, to the prolonged is improving. The operation seems to afford a permanent action cf a constant current, and treated of the chemical cure for these most troublesome cases. and microscopical results observed in a subsequent experiment, also of certain attendant electrical phenomena. The different action on granulations of the positive and negative poles respectively was described, and the effects of the constant current in intra-uterine applications and punctures, on the circulation, temperature, sensibility to pain, and urinary excretion, were in turn detailed. From these obserOBSTETRICAL SOCIETY OF LONDON. vations, the author concluded that the constant current acts on a fibroid in a threefold manner-(I) to but a small degree by electrolytic action, the positive pole most affecting Electrolysis in Gynaecological Practice. the cellular and the negative the formed elements; (2) by A MEETING of this Society was held on June 6th, Dr. John the haemostatic action of the positive pole and the derivative Williams, President, in the chair. influence of the negative; (3) by increased arterial tension, Dr. W. E. STBAVENSON read a paper on the use of Electro- and so diminished nutrition, accompanied by some alteralysis in Gynaecological Practice. The author drew attention tion of the mutual relation of the fluid and solid elements. In the discussion which followed the reading of the above to the numerous cauterising agents used in gynaecological practice with the object of raising a discussion OR their papers, Dr. HoRROCKS noted the important admission of relative merits and values. Reference was also made to Dr. Steavenson that electricity possessed no specific virtues, the use of the actual cautery, Paquelin’s cautery, and the but acted as a stimulant, caustic, or cautery. A powerful galvano-cautery, but the paper was chiefly devoted to battery was expensive, ponderous, and hard to work and advocating a more extensive use of electrolysis. It was keep in order; hence, in general practice, it would hardly pointed out that this property of electricity is especially be preferred to acids, alkalies, the knife, or the thermouseful in the treatment of affections in parts difficult of cautery. In hospital practice he had found the battery to access, and perhaps finds its widest field for usefulness in the be of certain value, but he agreed to Dr. Steavenson’s admistreatment of those diseases of women in which local appli- sion. Even in the treatment of paralysis careful friction cations are necessary. It is a more efficient and elegant of the affected muscles proved as beneficial as electricity. way of applying caustic than any other that we possess; it Statements about the number of cells which were used in can be most accurately localised at the part it is wished to a given case were unreliable, for newly charged cells were affect ; the amount used and the extent of tissue to be de- stronger than the same cells charged for some time or not in stroyed can be regulated to a nicety, and its action can be perfect working order. A means of measurement was absocommenced and arrested at any moment at the will of the lutely necessary ; for this purpose a galvanometer answered operator. A brief account was given of the action and best, but that appliance introduced another complication and theory of electrolysis and of the batteries and instruments expense.-Dr. AusT LAWRENCE said that allowance must be to be employed. Its action and the method of employing made for rest in bed, purgation, and the other altered conit in the following affections were then given-viz,, stricture ditions to which a patient under treatment by electrolysis of the female urethra; stenosis of the os uteri or cervical was subjected. A highly trained electrician was not indiscanal; dysmenorrhoea and sterility, in the place of the pensable, as with a little help and study anybody could tents, dilators, or incisions that are often employed; master the details sufficiently to be able to employ electro-
Medical Societies.
was admitted on May lltb, 1887, suffering from haemoptysis. The patient stated that he had suffered from winter cough for several years, and during the previous three months the sputum had been constantly tinged with blood. He had never suffered from syphilis, and there was no family history of consumption. Condition on admission.-A finely built but much emaciated man; height 72 in.; chest girth 40 in.; weight 9 st. He suffered from constant hacking cough and night sweats. Toe expectoration, a mixture of bright red blood and a little mucus, amounted to between ten and twelve ounces in the twenty-four hours. Right lung 8pX: resisting dulness on percussion ; increased vocal fremitus and loose subsrepitant atid gurgling xhies beard on auscultation down to the third rib; base normal. Left lung normal. The treatment consisted of ice internally and locally, ergot, gallic acid, acetate of lead, &c., and for a time the heamoptysis ceased. During May, June, and July the disease in the right apex steadily progressed and was attended by repeated attacks of haemoptysis; on several occasions the patient became collapsed from los of blood. On Sept. 1st McH- was seized late in the evening with a severe attack of dyspnoea and great pain close to the right nipple. On examination next morning,11 flit dulnesl’," feeble vocal fremitus, and distant bronchial breath sounds were detected On Sept. 3rd the apex of over the right base and axilla. the heart was found displaced and beating half an inch outside the left nipple line, and on the needle of a hypodermic
the left side; the facial and lingual vessels on both sides were divided and tied. Mr. Heath now pulled the tongue, with the piece of the jaw and the submental tissues, forwards, and removed them by dividing their attachments to the hyoid bone, without i’njuring the epiglottis. The bleeding was arrested, the cautery being applied to some of the bleeding points. The wound was ducted over with lOdoform, the indiarubber tube was passed into the cesopbagus, and the upper end was brought out at the angle of the mouth. The wound was adjusted with silk sutures, and a dressing of iodoform wool was applied. Cblorotdm The plug was administered through the tracheotomy tube. in the pharynx prevented any blood passing into the air passages. Four ounces of brandy were given before the operation and two ounces and a half directly after it, and afterwards two drachms were given hourly. The patient On the eighth was fed by means of the cesophageal tube. day after the operation he was taking about five pints of beef-tea, four eggs, and six ounces of brandy in the twentyfour hours. With the exception of an attack of pneumonia, be made a good recovery. On the seventh day bronchitic rules were heard at the left base; on the ninth dulness with tubular breath sounds were detected on the left bide as high as the angle of the scapula; on the twelfth the tubular breath sound had disappeared and moist rates were heard. From this date the patient improved steadily, and on the fifteenth day he was !ed for the firt time without employing the oesophageal tube. He lefthis bed three weeks after the operation, and went home a week latter. At that time the glands along the bc,rder of the left sterno-mastoid were enlarging. He was in good health, and able to go about and enjoy himself after he left the hospital, but about three months and a half afterwards he was found dead in bed, probably from suffocation dependent on a large growth which had formed in his neck. CASE 2. Epithelioma of tongue ; removal of entire tongue by scigsorsfrom the mouth; recovery.-J. 1-1 --, a man aged sixty-one, was admitted on March 27th, 1888. He first noticed a lump in his tongue fifteen months ago. On admission, the whole of the tongue was indurated as far back as could be felt with the finger; its surface was very irregular and glazad, and there was a sloughy ulcer on the left border. No enlarged glands could be felt. On March 28tb, an enema of brandy having been given, and the patient being placed under the influence of chloroform, which was then administered through a nasal tube, Mr. Heath removed the entire tongue by means of scissors in the way recommended by Mr. Whitehead. The lingual artery was seen and secured before division ; the other was divided, clamped, and tied. After the bleeding had been stopped aud a comparatively dry surface secured, the floor of the mouth was painted with Whitehead’s varnish. An cesophageal tube was introduced through the mouth, and the upper end of it secured by a bandage passing round the forehead. After the operation the patient was given a drachm of brandy, with two ounces of beef-tea and milk alternately, every half-hour. On the following day eggs and oxtail soup were added to his diet. 011 the second day after the operation the brandy was given in double doses every two hourf, and on the fifth day it was given every four hours. All food was given through the oesophageal tube, but on the ninth day after the operation the patient found the tube troublesome, so it was removed. It was necessary to replace the tube on the following day, as the patient was not able to swallow. The tube was finally removed on the fifteenth day, and from that date the patient succeeded in feeding himself. His general condition was good and the floor of his mouth was healing well. It was frequently washed with Condy’s fluid, and was dusted over with iodoform powder daily. The highest temperature was 1084° on the fifth dy; after that, date it was normal. The patient was discharged on the seventeenth day after the operation.
CAMBRIDGE
HOSPITAL,
ALDERSHOT.
A CASE OF PHTHISIS COMPLICATED BY RECOVERY; REMARKS.
Under the care
EMPYEMA ;
of
Surg.-Major W. H. HORROCKS.) of following phthisis treated in this boqpital presents many points of interest, and illustrates the arrest of phthisical processes by means of fluid pressure. Private MoH——,age thirty-one (twelve years’ service), THE
case
1247
I possible
I
syringe being passed into the pleural cavity a syringeful of pus was withdrawn. On considering all the details of the case, and how the patient was rapidly being exhausted by the constantly recurring haemorrhage from the cavity in the right apex, it was determined to allow the fluid toaccumulate in the right pleural cavity, in the hope that by its pressure the diseased lung might be so compressed as to practically close the cavity in the upper lobe of the right lung, at the same time carefully watching for any signs of congestion in the sound lung or interference with the heart’s action. Accordingly day by day, with the increase of fluid in the right pleura, it was noticed that the sanguineous expectoration gradually diminished in quantity, and in a little more than fourteen days amounted to only three ounces of muco-pus, without a trace of blood. On Sept. 26th, the left (the sound) lung beginning to show signs of congestion, and the dulness on the right side having mount,ed to the third rib, aspiration was performed in the right axilla, and twentysix ounces of pus removed. On Oct. 13th aspiration was again performed, and on the 19th a drainage tube was inserted between the seventh and eighth ribs in the midaxillary line. After this operation there was no return of haemoptysis, and the secretion of pus from the pleurat cavity gradually diminished. On Dec. 12th no ra!es could be heard over the right apex, the physical signs being harsh breath sounds and resisting dulness on percussion. On Feb. 9th, 1888, the secretion of pus having ceased, the drainage tube was removed, the wound rapidly healed, and no reaccumulation of pus took place. A month later the patient was discharged, having regained his former weight of twelve stone; the physical signs present in the right lung indicated a bealed cavity surrounded by induration of lung tissue in the upper lobe and pleural adhesions over the middle and lower lobes. Remarks.-The influence of serous effusions in temporarily arresting tubercular lucg disease is often seen in practice, and had the fluid in this cafe been simply serous there could have been no doubt as to the propriety of adopting the line of treatment detailed above. But a purulent effusion has infective as well as pressure effects; consequently, it was only after considering how rapidly the patient was being exhausted by the beemoptysiq, the imminence of a fatal result, and the futility of all drugs, that it was considered right, as a last resource, to risk the remote possibility of infection in order to obtain the immediate benefit of fluid pressure. After producing decided intra-pleural pressure, it seemed advisable to aspirate two or threr times and slowly diminish the pressure before introducing the drainage tube, so as to obviate the disastrous results of rupture of lung tissue and cardiac syncope, which have been reported as occurring when a large quantity of fluid has been suddenly removed from the pleural cavity. Lastly, with regard to the origin of the empyema in this case, it appeared most probably due to the giving way into the pleural cavity of a small patch of caseous softening 13 u2
OBSTETRICAL SOCIETY OF LONDON.
1248
situated just under the visceral pleura, the patch of softening being isolated, and having no communication either with a bronchus or the cavities previously formed, for there was no evidence of the formation of a pyo-pneumothorax.
LINCOLN COUNTY HOSPITAL. A CASE OF TARSO-CHEILOPLASTIC OPERATION FOR
TRICHIASIS.
(Under THE
the
of Mr. W. J. CANT.) reported by Mr. W. H. B. Brook,
care
following case was
house surgeon. -
-
-
-
I
abrasions of the cervix uteri; extra-uterine fcetation; fibroid tumours of the uterus; and cancer. The author then invited discussion on the relative merits of other caustics and modes of treatment employed in the affections mentioned as compared with their treatment by electrolysis. Dr. Lovrr L DRAGS read a paper on cases of Chronic Cervical Catarrh treated by Electrolysis. These cases formed In all, the healing an addendum to Dr. Steavenson’s paper. of abraded area was promoted. In one instance, where the chronic condition of the cervix was complicated by a Hunterian chancre on that part of the uterus, the beneficial effect of the treatment was well marked. No untoward effects were produced by the electrolysis, menstruation was not interfered with, nor was pain caused either at the time when the current was passing or subsequently. All the cases were of long standing, and other treatment had failed to give relief. Dr. Drage therefore contended that a claim could fairly be made for the recognition of electrolysis as a useful treatment in such cases. Dr. R. A. GIBBONS communicated a paper on Electrolysis in some Chronic Uterine Affections, and gave some illustrative cases. The cases had been under his care at the hospital, and were those of chronic metritis, endocervicitis, lupus minimus, caruncle of the urethra, and cancer of the uterus. The latter were accompanied by profuse bremorrhage, and were mentioned in order to call attention to the efficacy of the positive pole in arresting bleeding. After explaining the action of each pole on the tissues, the author dwelt upon the advantages derived from the use of the negative pole as a caustic in chronic inflammatory conditions of the body and neck of the uterus. The glairy discharge, so common in this class of affections, became electrolysed, and thus the lining membrane could be acted upon directly and thoroughly. The accuracy with which the application of electrolysis could be made was greater than that of any caustic. During manipulation the operator had no difficulty in keeping the electrolytic power under his perfect control. After giving technical details, Dr. Gibbons dwelt on the necessity of a reliable galvanometer. This method of employing electrolysis had never been described in any English
R. E-, a delicate girl, aged eighteen, was admitted into the hospital suffering from trichiasis of the left lower eyelid, the lower segment of the cornea being nebulous from the constant irritation caused by the lashes rubbing on its surface. There was free muco-purulent discharge with blepharospasm, the vision being reduced to perception of light. For a few days an antiseptic and slightly astringent lotion was ordered to be used, which diminished the discharge. On Jan. 23rd the patient was put under the influence of the A.C.E. mixture, and an incision 15 mm. in length and 4 mm. in depth made along the margin of the lower lid, just posterior and parallel to the lashes. On turning the lid down with the fingers, a gap was left between the edges of the incision about 3 mm. wide. Four silk sutures were then passed, one end of each through a fold of skin as near the lashes as possible, the other through a similar fold about 8 mm. down the cheek; on these being tied, the lower lid was drawn and the incision opened. All bleeding from the lid having ceased, a piece of mucous membrane was removed from the lower lip of the same shape as, but slightly larger than, the wound, into which it was accurately fitted with gentle pressure. No sutures were used to fix the graft, but the whole was dusted with fine iodoform powder, a pad of wool moistened with hot perchloride of mercury solution (1 in 2000) and a bandage being used to maintain the graft in position. The dressings were removed two days after the operation, when adhesion of the graft was found to havetaken place; work. on the fourth day the silk sutures were removed. At the Dr. J. SgAw read a paper on the Constant Current in the present time (Feb. 20th) the lashes are found to be in a Therapeutics of Gynaecology. The author described the normal position, without any tendency to in curve ; the appearances presented by a myonbroma when subjected, opacity of the cornea has greatly diminished, and the vision about twelve hours after its removal, to the prolonged is improving. The operation seems to afford a permanent action cf a constant current, and treated of the chemical cure for these most troublesome cases. and microscopical results observed in a subsequent experiment, also of certain attendant electrical phenomena. The different action on granulations of the positive and negative poles respectively was described, and the effects of the constant current in intra-uterine applications and punctures, on the circulation, temperature, sensibility to pain, and urinary excretion, were in turn detailed. From these obserOBSTETRICAL SOCIETY OF LONDON. vations, the author concluded that the constant current acts on a fibroid in a threefold manner-(I) to but a small degree by electrolytic action, the positive pole most affecting Electrolysis in Gynaecological Practice. the cellular and the negative the formed elements; (2) by A MEETING of this Society was held on June 6th, Dr. John the haemostatic action of the positive pole and the derivative Williams, President, in the chair. influence of the negative; (3) by increased arterial tension, Dr. W. E. STBAVENSON read a paper on the use of Electro- and so diminished nutrition, accompanied by some alteralysis in Gynaecological Practice. The author drew attention tion of the mutual relation of the fluid and solid elements. In the discussion which followed the reading of the above to the numerous cauterising agents used in gynaecological practice with the object of raising a discussion OR their papers, Dr. HoRROCKS noted the important admission of relative merits and values. Reference was also made to Dr. Steavenson that electricity possessed no specific virtues, the use of the actual cautery, Paquelin’s cautery, and the but acted as a stimulant, caustic, or cautery. A powerful galvano-cautery, but the paper was chiefly devoted to battery was expensive, ponderous, and hard to work and advocating a more extensive use of electrolysis. It was keep in order; hence, in general practice, it would hardly pointed out that this property of electricity is especially be preferred to acids, alkalies, the knife, or the thermouseful in the treatment of affections in parts difficult of cautery. In hospital practice he had found the battery to access, and perhaps finds its widest field for usefulness in the be of certain value, but he agreed to Dr. Steavenson’s admistreatment of those diseases of women in which local appli- sion. Even in the treatment of paralysis careful friction cations are necessary. It is a more efficient and elegant of the affected muscles proved as beneficial as electricity. way of applying caustic than any other that we possess; it Statements about the number of cells which were used in can be most accurately localised at the part it is wished to a given case were unreliable, for newly charged cells were affect ; the amount used and the extent of tissue to be de- stronger than the same cells charged for some time or not in stroyed can be regulated to a nicety, and its action can be perfect working order. A means of measurement was absocommenced and arrested at any moment at the will of the lutely necessary ; for this purpose a galvanometer answered operator. A brief account was given of the action and best, but that appliance introduced another complication and theory of electrolysis and of the batteries and instruments expense.-Dr. AusT LAWRENCE said that allowance must be to be employed. Its action and the method of employing made for rest in bed, purgation, and the other altered conit in the following affections were then given-viz,, stricture ditions to which a patient under treatment by electrolysis of the female urethra; stenosis of the os uteri or cervical was subjected. A highly trained electrician was not indiscanal; dysmenorrhoea and sterility, in the place of the pensable, as with a little help and study anybody could tents, dilators, or incisions that are often employed; master the details sufficiently to be able to employ electro-
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