Haemophilia 32 in children, in 1 of which the diet had been condensed milk. Suckling reports a case of scurvy, with purpuric spots on the legs and swollen ankles and knees. The red corpuscles numbered but 1,290,000 per cubic millimetre. Retinal hemorrhages were present. Speyr 2 records a fatal case of scurvy, and remarks that this seems to be an unusual termination. 19 .Mar.28 214 May 15 147 Nov. Mar.15 The nervous element in the causation of purpura is as interesting as its results have been mysterious and startling. To this class of cases belongs, undoubtedly, a case reported by Anderson. The patient was a young woman whom the doctor had treated for several years, during which she had suffered epistaxis, menorrhagia, metrorrhagia, hæmorrhagic diarrhoea, etc., always accompanied by great mental strain, fits of crying, fright, anger, and the like; at times, death seemed imminent. Another case of the same nature is that of Yahoubian. 22. In this instance, a girl of 16 years, in good general health and with no marked history of hysteria, began to bleed from the pulp of her fingers. This occurred without provocation and without rupture of the skin, and was not attended by any further symptoms, excepting despondency, almost amounting to melancholia. A third case, in which the nervous element seemed marked, was one detailed by Isabel Lowry. A young woman, whose child also had purpura, suffered with enterorrhagia, purpuric eruptions, and uterine hæmorrhages. She had, in addition, lain in a "trance" for some time, had had paraplegia after labor, and again on slight provocations later; had paræsthesia and irritable feelings during hæmorrhagic attacks, all of which pointed strongly to a nervous element in the purpura. Besides this case in which mother and child had purpuric manifestations, Vanderveer 5 reports some cases of hæmorrhagic disease illustrating heredity. A man who suffered with hæmaturia several times had two daughters and a son, of whom the son only showed any tendency to bleed, and that very slight. The first daughter had seven children, of which a son and two daughters were entirely free; one son died of hæmorrhage from the tongue; another of hæmorrhage from the gums after lancing of a tooth; a third was a bleeder, but died of meningitis; while the last daughter suffered with occasional swelling of the joints, but was otherwise unaffected. The second daughter had four children, the first of which died in infancy, but not of hæmorrhage. The other three died of hæmor Haemophilia rhage. The son, himself slightly affected, lost no children by hæmorrhage. 3 July 22 Hayem reports a case of hæmorrhagic diathesis in a young woman with menorrhagia. The spots came out after the onset of menstruation. Such cases as this-and he has seen 2 others 2 Hayem regards as post-hæmorrhagic hæmophilia. The blood does not clot firmly, and the white corpuscles are decreased in number. Jardine reports the death of a child, on the twentieth day, from hæmorrhage from the umbilicus. The mother was not a bleeder, but the father and a sister bled freely at the nose. Mar.21 DISEASES OF THE UTERUS, PERITONEUM, AND PELVIC CONNECTIVE TISSUE; DISORDERS OF MENSTRUATION. BY PAUL F. MUNDÉ, M.D., AND LEONARD S. RAU, M.D., NEW YORK. PELVIC DISEASE. 19 Feb.7 61 July 18 General Considerations.-At the present time writers are all urging the necessity of the use of great care in the employment of the minor gynæcological instruments, both for diagnostic and therapeutic purposes. Noble, Baldy, J. Watkins, 647 and Ferguson, all speak of the possible dangers resulting from the use of the uterine sound, and claim it to be a useless instrument in most cases. Playfair calls attention to the neurotic element which so often arises in connection with pelvic disease. He strongly recommends the Weir Mitchell plan of treatment in these cases. 1 May 16 6 Apr.25 Murray emphasizes the association of rectal and pelvic disease. The vascular supply of the uterus, ovaries, and tubes is indirectly connected with the lower third of the rectum, the veins on the left side emptying into the left renal vein. The varicose condition of these veins is often the cause of ovarian hyperæmia and acute oöphoritis. Constipation particularly favors these conditions. When retrodisplacements exist pressure is brought to bear upon the rectum, this causing an inflammation and resulting constipation. As a result of this chronic constipation, we often have a pouching of the lower third of the rectum. This gives rise to pains in the back, discomfort on standing, a sense of dragging and fullness. This may cause a fissure at the entrance to the vagina, which can only be cured by relieving the constipation. Hæmorrhoids and anal fissures are frequently associated with uterine disease. In order to cure these hæmorrhoids, the uterus. must be replaced, patients kept in bed, and vaginal douches employed. MENSTRUATION. 1 Jan.24 Automatic Menstrual Ganglia.-Robinson has investigated the relation of the tubes, uterus, and ovaries in menstruation. He examined about 250 ovaries, tubes, and uteri of sows. The most frequent disease of their ovaries was found to be a cystic condition of the Graafian follicles. The normal ova he observed would mature and rupture by a periodic rhythm. The tubes show a state of rhythm even more plainly, and they are almost always congested. They have an intermenstrual periodic peristaltic motion. The activity of this motion is greatest during menstruation. Menstruation, he says, might be called the motion of the tubes. The muscular part of the fimbria which is attached to the ovary induces some tubal motion by its periodic contraction and relaxation. His theory is, that menstruation is governed by the ganglia situated in the uterine walls and along the tubes, and closely connected with the ovaries. The tubal motion constituting the cycle of the menstrual period is due to ganglia. The uterine ganglia are found in the muscularis mucosa, and cause the uterus and tubes to perform rhythmical action. He found that the uterus is composed of adenoid tissue, and is therefore a gland. This endometric gland is only functionally active at a definite period of life. The greatest amount of movement and congestion takes place in the fimbriated extremity of the tube. The tubes execute vast cycles of congestion, motion, and decongestion. The irritation of the ganglia governing this tubal cycle induces the fimbria to approach the ovary and to secure, if possible, the egg. The ganglia in the uterus and tubes induce a cycle generally once a month. Therefore, menstruation is governed in its rhythmic cycle by the automatic uterine and tubal ganglia. June Ovulation and Menstruation.-West 1002 gives a careful résumé of the literature of the subject, and from these and his own observations he comes to the following conclusions: (1) that the increased familiarity with the pelvic organs, the result of modern surgery, has not materially added to our knowledge of their functions; (2) that though the ovular theory of menstruation has not been overthrown, yet the weight of accumulating evidence seems against it; (3) that the most recent observations point to a com mon nervous origin for both ovulation and menstruation, and yet an individual independence. 194 Dec. 11, '90 Early Menstruation.-Lutaud reports the case of a wellformed, healthy girl, who began to menstruate at 7 years and 2 months. The menstrual flow was accompanied each time with lumbar pains and a general feeling of fatigue. 99, Apr.16 Amenorrhoea.-Davenport divided amenorrhoea into congenital and acquired. The congenital variety is due to faulty development, such as atresia, or to anæmia. The best remedies for this 99 Apr.16 81 Apr. variety are iron in some form, permanganate of potash, binoxide of manganese, and, above all, electricity, faradism seeming to give better results than galvanism. The acquired variety may be due to shock following childbirth, superinvolution of the uterus, change of climate, obesity, fevers, chronic diseases, etc. The treatment is much the same as in the congenital form. For the treatment of amenorrhoea, Strong recommends galvanism, and reports 4 cases successfully treated by this means. Hill advises the use of apioline, giving capsules containing 3 grains (0.19 gramme) each, three times a day for a week preceding the expected time of menstruation. Gattorno, recommends massage (Thure-Brandt). He employed it in 14 cases of amenorrhoea, and in all but 2 he obtained most excellent results. He finds it especially indicated in small atrophied uteri, and, according to his observations, the massage appears to increase the size of the uterus. Ward 18 speaks highly of the use of sanguinaria Canadensis as an emmenagogue. He begins its use about two weeks before the expected menses, and gives 1 drachm (3.75 grammes) of the tincture three times a day and ounce (15 grammes) before retiring. He combines its use with strict hygienic treatment. He found the effects of the drug to be slight nausea and pains in the loins. Jones, commends the employment of indigo, using a mixture of indigo, 2 ounces (62 grammes); bismuth, ounce (15 grammes). Of this mixture he gives drachm (1.94 grammes) in one-third of a glass of water, three times a day. He reports 13 cases thus treated. All were cured except one. 24 Dec. 28,*90 Menorrhagia and Metrorrhagia.-Terrillon De states that the loss of a large quantity of blood from the uterus is generally indicative of lesions of the genitals and may often threaten life. He distinguishes four principal types: One where the menstrual |