allow them to gain entrance to the uterine cavity. For this reason I am satisfied it is not easy to throw into the uterus any fluid that might be used in a syringe, or to wash into it any poisonous secretions that might be found about the vaginal walls. With these exceptions I am fully in accord with every thing the essayist has said as to the character of the trouble, and I only regret that it does not appear from this description, or from that given by Dr. Cartledge, that we may hope for a great deal in the cure of these conditions. causes. Dr. F. C. Wilson: One of the causes of sterility not mentioned particularly by the essayist is the frequent efforts on the part of newly married couples to prevent conception; the use of douches of various kinds in order to prevent too early conception, as they term it. This too often results in sterility; in fact, I believe it is one of the prime Of course this leads to inflammatory conditions, and the various changes take place as mentioned by the essayist, and the practice ought to be condemned. When people of this class want children they find they are unable to get them. Where a narrowed condition of the cervix can be detected by examination, sterility may be overcome by dilatation if that be the cause. That may not be the cause, but where a young woman suffers greatly from dysmenorrhea, and at the same time is sterile, a careful examination may detect a narrow cervical canal or a flexed uterus; I believe dilatation to a moderate extentwhich would hardly amount to a surgical procedure, but, of course, ought to be done aseptically-will frequently overcome the difficulty and relieve the sterility. I have had cases of this kind where after the measures suggested were carried out conception promptly occurred, which was proof positive that the sterility had been relieved, and at the same time the dysmenorrhea completely disappeared. If there is a constricted cervical canal and conception occurs, nature does the rest in a much more perfect way than the surgeon can. Dr. Louis Frank: I fully agree in every thing the essayist has said. The main point in the paper, a point that the essayist has thoroughly established, is recognized by all authorities to-day, viz: that sterility does not exist as a disease per se, or as a functional disorder, but is really due to some diseased condition-some pathological condition of the genital organs of the woman. I recognize, however, as I know he does, the fact that these lesions may be so slight in character, may be so obscure, so situated along the genital tract-about the ovaries, for instance, as would follow an old gonorrhea-a pyosalpinx which may have subsided, leaving a condition which results in sterility, though we can not make out the cause by examination of the patient during her life. It is in many of these cases, for instance, where, without any demonstrable cause, sterility has extended over a long period of years in women who have been married fifteen or twenty years without any efforts at the prevention of conception, without any history of any mechanical lesion or pathological condition about the genital organs. Some of these cases have become at the end of that time pregnant and borne children. In these cases, if we could carefully examine pathologically the ovaries and tubes, we would find evidence of pre-existing disease. I am perfectly in accord with what Drs. McMurtry, Cartledge, and Bailey have said in regard to the vaginal douche, and I certainly do not agree with Dr. Grant in this respect, nor in respect to displacements of the uterus per se producing sterility. These displacements may produce sterility secondarily by bringing about and maintaining a diseased condition of the uterus itself. There may be a secondary infection the result of catarrhal conditions, which we improperly term endometritis, not inflammatory in character, but which will prevent conception. These conditions do not necessarily prevent ovulation, but they do prevent the transplantation of the ovum on the endometrium and the development of the pregnancy. That there may be stenosis of the cervical canal to such a degree as to permit of the outflow of the menstrual fluid and prevent the entrance of the spermatozoa I can not conceive. We must remember that pregnancy sometimes takes place notwithstanding the presence of large tumors pressing upon the cervix and almost obliterating its canal; that ectopic gestation occurs in a tube where constriction is sufficient to prevent escape of the ovum into the uterus, still this does not prevent entrance of the spermatozoon into the tube. In the cases mentioned by Dr. Wilson dilatation of the cervix was probably beneficial by producing alteration in circulation and thus improving the condition of the endometrium and permitting successful implantation of the impregnated ovum. In many women, and these would come under the same class mentioned by Dr. Wilson, the newly married, we have another element to consider, which is also true in the case of prostitutes, those who indulge in frequent sexual intercourse, namely, a congestion of the genital organs frequently repeated which brings about a condition just as brought about by the cold douche; the uterus is chronically enlarged and congested, with alteration in circulation sufficient to prevent successful implantation of the impregnated ovum. I believe that frequently lacerated perineum will bring about the same condition, although this was not touched upon by the essayist. We also have to consider the open, flaccid vagina which permits the easy emptying of the seminal fluid and spermatozoa, thus acting as a factor in the production of sterility. I hardly agree with Dr. Cartledge that the mucous plug in the cervix would be an active factor in the production of sterility. It seems to me the spermatozoa possess sufficient vitality and motion to penetrate or pass alongside of this mucous plug and find their way into the cervix; and where mucous plugs have apparently been the cause of sterility I believe the condition was actually due to hyperacidity or alkalinity of the secretions, which prevented the life of the spermatozoa being maintained sufficiently long to permit them to come in contact with the ovum to be fructified. B. A. ALLAN, M. D., Secretary. TREATMENT OF CARCINOMA UTERI.-Cullen, of Baltimore, gave before the International Congress of Medicine a summary of one hundred and seventy-six cases occurring in the Johns Hopkins Hospital during the last six years. Of these, seventy-three came too late for operation. Of the comparative cases, sixty-one were squamous cell carcinoma of cervix, twelve adenosarcoma of cervix, and thirty adenocarcinoma of body. Twentyone per cent of the first group were well the first day of the present year; sixteen per cent of the second, and sixty-five per cent of the third. To avoid implanting carcinomatous into healthy tissue, he recommends the abdominal operation of Werder, which consists of the following steps: Removal of broken down carcinomatous cervical tissue, preferably a few days before; insertion of ureteral bougies if desired; ligation of ovarian vessels and round ligaments; freeing bladder from uterus and broad ligaments; opening of broad ligaments, location and freeing of ureters to points at which they enter bladder; ligation of uterine vessels near points of origin; dissection of bladder and of rectum free from vaginal vault; removal of pelvic lymph glands; freeing vaginal fornices; closure of pelvic cavity by uniting vesical peritoneum with that of rectum, an assistant meanwhile making strong traction on cervix from below; closure of abdomen; ringing of vaginal vault with thermocautery or knife, to free uterus and surrounding vaginal mucosa; application of light gauze pack to space left in vaginal vault.-Denver Medical Times. "NEC TENUI PENNÂ." VOL. 31. JUNE 1, 1901. No. 11. H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors. Books for reviews, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER AND NEWS, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. THE KENTUCKY STATE MEDICAL SOCIETY. The forty-sixth annual meeting of the Kentucky State Medical Society was held in Louisville, May 22, 23, and 24, 1901. This meeting was one of the most successful in the history of the Society. The attendance was greater than at any previous meeting of the Society, except that which occurred at Danville when the McDowell monument was unveiled. Many things aided in bringing about this increased attendance. First of all, Louisville being the center, induced many members of the profession to attend who otherwise would not have done so. Secondly, the President is a very popular member of the profession and a classmate of many of the doctors in the State, and his personal popularity doubtless had much to do with the increased attendance. Thirdly, the efforts of the Secretary of the Society and of our Secretary of the State Board of Health no doubt had much to do with the increased attendance. Dr. McCormack has been very persistent in his efforts to impress upon the profession of the State the great necessity for organization, and he has accomplished much good in this line of work. His address before the Society was upon this subject, The Organization of the Medical Profession of the State and Country in General, and it is a paper that is well worthy of the consideration of every doctor who is interested in his profession. Dr. McCormack has presented these facts and truths in such a manner as to enable a most obtuse individual to grasp them. On several occasions we have reminded our readers through the editorial columns of this journal of the great necessity for organization and of taking active interest in their profession, and we again call their attention to the great necessity of organized effort, and this effort can only be made through the medium of the various medical societies that are now in existence or may come into existence. As an evidence of the fact of the good work of the journals throughout the country and of Dr. McCormack's special effort in this State the membership of the Kentucky State Society increased over one hundred at the recent meeting, now giving the Society a membership of more than six hundred doctors. While this speaks well for the profession of the State, there is no good reason why every reputable doctor should not be a member of this great Society. It is simply a matter of credentials and $3.00. The prestige of the Society is worthy any man's consideration, and every right-minded doctor should bring it to his aid. Current Surgical and Medical Selections. CLINICAL EXPERIENCE WITH ADRENALIN.-By Emil Mayer, M. D., Surgeon New York Eye and Ear Infirmary, Throat Department; Fellow American Laryngological Association and of the New York Academy of Medicine, New York. Abstract from original paper in the Philadelphia Medical Journal, April 27, 1901: The aqueous extract of suprarenal gland is perhaps the best culture medium known. Its instability, the involved method of preparation, its unsightliness, and the inexactitude of its various strengths tend to make us welcome a preparation that is exact, stable, and, above all, clean. Dr. Jokichi Takamine undertook the task of isolating the active principle of the suprarenal gland. He obtained a substance in stable and pure crystalline form, which raises the blood-pressure, and which he named "adrenalin." The author has used solutions of adrenalin chloride, I to 1,000, I to 5,000, and 1 to 10,000; his cases were all rhinological. Blanching of tissues followed the application of the strongest of these solutions in a few seconds, and was very thorough. In no instance was there any constitutional dis |