uterine irritation. Leucorrhea is, as a rule, present on account of existing endometritis. The menstrual function will be disturbed in time, duration, quantity or quality, according to the stage of the disease, the degree of hyperemia and the portion of the organ which is especially involved.

At the beginning of the disease, whether from subinvolution or otherwise, as a rule, menstruation is profuse, prolonged or too frequent. The menstrual flow becomes less free until it is scant, or may after years become very irregular and cease altogether, thus causing an "early change of life.” The uterus becoming harder and denser as the diseased condition produces growth of the connective tissue. A dull aching pain through the uterus and a congestive dysmenorrhea-is often experienced, commencing a few days prior to the menstrual flow and increasing until it is well established. It is usually relieved by the depletion caused by the flow. All of these symptoms are aggravated by the occurrence of any serious amount of displacement. They are likewise more pronounced when the body of the instead of its neck is the seat of the disease. The productive functions are affected in various ways. Subinvolution and beginning hyperplasia, appear rather to favor pregnancy, though abortions are more apt to follow.

Advanced stages of hyperplasia and sclerosis are attended with sterility. Pregnancy completed, parturition normal, a prolonged careful attention during the lying in state will doubtless do much to impove the previously existing morbid condition of the uterus.

The treatment of the various conditions of enlargement is so dependent on their causation, that each individual case demands a separate investigation. The ideal way of approaching this subject lies in the direction of prevention, which in a great many cases the attending physician is able to do. But as gynecologists we meet disease already developed, and we have to devise methods which, if not curative, are to say the least, palliative.

Our first attention to the patient is to see that the bowels are kept freely opened, and the digestive organs are in as good a condition as possible. Give, if necessary, a tonic to stimulate the appetite, and in every way doing what we can to improve the conditions of her general health.

I believe it advisable in all cases that the patient be placed in a recumbent position at least for a while, and ascertain, if possible, the exciting cause of the disease. We must have the patient abstain entirely from sexual excitement.

It is my experience that all cases of this kind do better in a hospital or sanitarium where absolute quietude can be had. It is essential in nearly all cases to make a curettement, for in this disease we generally have endometritis of a granular nature. By curettement we not only remove the diseased endometrium, but also assist in depleting the entire organ which is very essential in this disease. To make the blood-letting more complete, I have found it necessary to make several incisions or punctures over the cervix. It may be necessary to make two or three curettements before the patient is relieved.

In order to make a curettement in the correct way we must first dilate the cervix, so that we have proper drainage. Should a laceration exist

large or small, it is our duty to repair it as soon as possible, for we all know that a very slight laceration will in itself cause enough irritation to produce this disease, or to continue it when it already exists.

Should there be no laceration but a granular endometritis, and we cannot make a curettement, I have found nothing better than the applica. tion of a 95 per cent carbolic acid to the entire diseased mucous membrane, always being very cautious not to let any of the acid come in contact with the mucous membrane of the vagina. Should this occur, however, we should at once apply alcohol which will neutralize the phenol.

In making this application I use a strip of gauze one inch wide and two feet long, saturate it with carbolic acid, squeeze the surplus out and then pack the uterine cavity leaving it in place for 48 hours. This is also necessary after curettement if we are treating an infected uterus. Repeat this four or five times, and at the same time tamponing the vagina with wool or cotton saturated with a solution of boroglyceride. This will give the very best results in the majority of cases. I do not believe the steam and hot water treatment will ever be used with any success in general practice, or that it will be very popular in hospital work. Iodine and the caustics in my hands have not been of much service, in fact, in my opinion the caustics do more harm than good.

In neurotic patients nothing is better than a change of climate and scenery. In some cases a simple change in the surroundings do much good. To sum up the treatment, we should rest the patient, remove the cause, deplete the diseased organ and, if possible, improve her general health.

609 Francis street.

THE POSSIBILITIES OF THE NORMAL SALT SOLUTION.

L. Clyde Davis, M. D., St. Joseph, Mo.

EFORE going into a discussion of the above subject, one that I consider of paramount importance, and also one that is deserving of inexhaustive investigation and experimentation by the medical profession, it may be well to define my position in the matter.

When the idea embraced in the subsequent pages first came into my mind, I decided to experiment and demonstrate my theories upon the lower animals. But the more I thought of the matter, the more apparent it became to me that those ideas were no longer theories, but were rather stern common sense facts; and up to the present time no argument has been brought to bear upon me that has caused me to change my mind in the least. Therefore, after giving the subject, in all its different phases, my utmost consideration, I have resolved to make known to the profession, what I have maintained to be common-sense facts, and suffer the consequences, whether it be praise or ridicule. In fact the latter is the most effective. It will be impossible to embrace in this paper alone, all the different uses, and all the different pathological processes in which in my opinion the normal salt solution will attain brilliant results. But it is rather my intention to present only a general outline of my opinions. As far as I have been able to ascertain, about the only conditions in which the saline solution is used at the present time is in the treatment of shock, induced by the loss of blood, by intravenous injection, and probably the occasional washing out of an infected belly cavity. It has been found where used to supply the loss of blood to do an almost unlimited amount of good. It being a most powerful cardiac and nutritive stimulant, as well as possessing a peculiar property of including the production of new and healthy red blood corpuscles. As a result of its employment in this particular class of cases, a great many patients that were in a state of almost fatal collapse, owe their present existence. These facts and these facts alone are the foundation of the reasoning that prompted me to write this paper.

If the saline solution will impart to the system lost or severely impaired vitality in this class of cases, I ask, why in the name of common reason will it not do the same in other pathological conditions, where the state of affairs are practically the same, but that are not caused by the same thing, the deciduated loss of blood, but that are caused by toxines, both drug and germicidal, or more plainly speaking, conditions or diseases which depend upon the blood and tissues of the body for their cultivation and overwhelming multiplication, which at the present time, always terminates fatally, if the resistive powers of the patient and a few drugs will not destroy the infection or counteract the effect of the drug? Unfortunately there are numberless conditions where the vitality of the patient and the drugs count for naught, and as a result of the pent up poison in the circulatory system the sufferer dies.

Man has yet to devise a culture medium for the cultivation of bacteria that equals the human organism in this respect. It seems as though

our poor bodies have been particularly adapted for that purpose. A culture medium devised by man must be made to favor the growth of that special germ that is to be cultivated. But nature has been intensely kind to the medical profession and to micro-organisms, in adapting the human body as a fertile soil for the growth of every character of bacteria. It matters not what it is.

The most important constituent of the human body being the blood, it is also the prime factor in promoting the growth of the infection, and allowing it to penetrate every limb, organ, tissue and recess of the anatomy, and thereby overwhelming the patient with its virulence, and destroying what the sufferer most dearly loves-his life.

It is needless to go into detail as to how this is accomplished; because all are familiar with what is known at the present time concerning it. There are a great many things that we do not know; but we do know that any poison, whether it be drugs or bacteria, is rapidly absorbed by the blood. If the quantity of the toxine is large enough, this absorption soon causes severe constitutional disturbances that keep increasing, until, as it is too often the case, the patient succumbs to the inevitable onslaught of the powerful toxine and surrenders his life.

Of late years, blood-letting or venesection has fallen into disrepute and is rarely, if ever, used at the present time. But I say, all hail to our venerable ancestors of the medical profession who did resort to it. They had advanced one step in the right direction when they attempted to relieve their suffering patients of the virulent poison that was pent up in their circulatory system, by opening the veins. Of course, with only at their command this single expedient, that of bleeding, they lowered the vitality or killed their patients by so doing. But, in my opinion, we now have at our fingers' ends the means to counteract the untoward effects of venesection, and that is the intro-venous injection of the normal salt solution. Some have been incredulous to maintain that it will do no good. Yet, as I have said before, I have yet to hear the argument that will convince me to the contrary, and I still assert that it will prove supremely beneficial in all cases of drug toxemia or septic intoxication, or in any condition where the blood is overloaded with drugs or bacteria, causing general constitutional pathological conditions.

The human body may be compared to an acute circumscribed abscess. Before it is possible for the regenerative powers of the tissues to restore the normal condition of the part, it is necessary to open the abscess and drain it of the poison causing the pathological process, so it is with the entire body, it must be drained of a certain amount of the toxic blood and replaced by an agent that will assist regeneration; and in the normal salt solution we have that agent, to be used in co-operation with other effective means we now have at our command.

The conditions where in my opinion its use is indicated: I will assume that the patient is in a state of profound collapse, with a slow and fast weakening heart, accompanied by a sluggish circulation; of course it is the height of folly with the patient in this condition to withdraw blood from the vessels and allow the central ones to become engaged, the one at

the periphery to collapse, this procedure always means death, but to overcome this barrier I have devised instruments with which it is possible to withdraw a certain amount of the poisoned blood and replace it with a like amount of the saline solution simultaneously; thereby keeping the volume of fluid in the vessels exactly the same, and at the same time relieving the patient of a certain amount of the virulent poison, and replacing it with the powerful stimulating properties of the normal salt solution. Nature is able to dispose of so much of the toxic element, and no more so if by the above process we can assist nature by mechanically withdrawing a certain amount of the toxine and replacing it with a powerful cardiac, nutritive stimulant and antiseptic agent, without increasing the danger to the patient in the least, I ask, why not do it?

I myself see no logical reason why such treatment is not possible as well as eminently practicable. I do not mean to say this, and this treatment alone will attain the brilliant results I claim for it. But with other means at our command, such as external heat, alcoholic stimulants, cardiac excitants and nutritious diet used judiciously in combination with the above plan will accomplish all that is claimed that it will.

In this paper it is my intention to give an outline of what I would consider good and beneficial treatment in two different classes of toxemia. But even they, all things being equal, produce practically the same condition, profound depression and collapse. I first will consider septic intoxication or septicemia.

Senn says: That septic intoxication or septicemia is caused by the absorption of a preformed ferment or toxine, which produces the maximum result as soon as it reaches the circulation, and the symptoms subside with the arrest of further supply and the elimination of the septic material from the blood. At the present time we have absolutely no means of preventing septicemia other than prophylactic means; it rarely ever occurs in cases of wounds made by the scientific surgeon, but it is usually the result of slight accidental wounds, and are brought to the surgeon's attention too late for him to be of much service other than to give his attention to the wound of septic entrance. Antiseptic means should always be most rigidly carried out here, the bowels, kidneys and skin should be kept active, external heat, cardiac stimulants and nutritious diet are to be judiciously employed. The temperature is better let alone than be lowered at the expense of the heart by antipyretics, or cardiac depressants. As I have before stated, this is about the extent of the treatment at the present time. But I beg leave to add to the above the judicious use of the normal salt solution; with the heart supported by cardiac stimulants and the general system by good, rich, easily digested food, a pint of the fatally poisoned blood can be withdrawn from an ordinary individual and be replaced by the life saving properties of the saline solution. If the patient shows an evidence of a reaction the process can be repeated from time to time at the discretion of the surgeon. All that is necessary is merely to assist nature in eliminating these deadly ptomaines from the circulation at such times as it is indicated, thereby relieving the patient each time of a certain amount of the septic material