by the rectum may be employed, either alone or in combination with the abdominal and vaginal touch. It is seldom necessary, however, to resort to rectal examination.

Resuscitation in Chloroform Asphyxia. By Howard A. Kelly. In spite of the most careful attention during the administration of chloroform, an alarming asphyxia occasionally occurs. In such cases not a moment must be lost, but immediate efforts must be made to revive the patient. Fifteen cases were treated with uniform success by the following method: The adminis tration of the anesthetic is instantly suspended and the wound protected. An assistant steps upon the table and takes one of the patient's knees under each arm, thus raising the body from the table until it rests on the shoulders. In the meantime the head has been brought to the edge of the table, where it hangs extended. The patient's clothing is pulled down under her armpits, completely baring the abdomen and chest. The operator, standing at the head, institutes respiratory movements as follows: inspiration, by placing the open hands on each side of the chest posteriorly over the lower true ribs, and drawing the chest forward and outward, holding it there for about two seconds; expiration, reversing the movement by placing the hands on the front of the chest and pushing backward and inward, at the same time compressing the chest. From ten to thirty of these acts of induced respiration will usually suffice to excite voluntary respiratory movements.

One Hundred Cases of Ovariotomy performed on Women over Seventy Years of Age. By H. A. Kelly and Mary Sherwood. Two cases of successful ovariotomy performed recently at the Johns Hopkins Hospital on patients aged respectively 73 and 75 years suggested the desirability of collecting statistics

of similar cases.

The main facts emphasized by a study of a hundred cases may be thus briefly summarized:

1. That ovariotomy in the aged presents no essential differences from this operation in cases of younger years.

2. That the rate of mortality from this operation on patients over 70, as shown by results in one hundred cases, is twelve per cent. 3. That the indications and contra-indications for ovariotomy in the aged are essentially the same as for this operation in general.

Besides these papers the volume contains a description of the new gynecological operating room, a report of about five hundred abdominal operations performed from March 5th, 1890, to December 17th, 1892, and notes of the autopsies upon all patients dying in the gynecological wards. It is evident that much valuable information can be elicited from a critical study of these reports. Most of the essays are illustrated by a large number of excellent photographs, which greatly enhance the value of the work.

J. R.

TRANSACTIONS OF THE SOUTHERN SURGICAL AND GYNECOLOGICAL ASSOCIATION. Volume vi., pp. 388. Published by the Association, W. E. B. DAVIS, Secretary, Birmingham, Ala., 1894. This volume contains the thirty-one papers presented at the meeting held last November in New Orleans. It is equal in interest to its predecessors, though a larger proportion is devoted to topics of general surgery. The gynecological papers include an "Address in Memory of Ephraim McDowell," by McMurtry; "The Diagnosis of Pelvic Inflammatory Disease," by Kelly; "The Conservative Treatment of Pyosalpinx," by Kollock; "The Incision in Abdominal Section," by Price; "The Vaginal Route in Pelvic Operations," by Engelmann; "The Diagnosis of Tumors supposed to be Ovarian," by Goggans; and Does Gonorrhea in the Female invariably prevent Conception?" by Wilson.

TRANSACTIONS OF THE AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS. Volume vi., for the year 1893. Edited by WM. WARREN POTTER, M.D., Secretary. Pp. 308. Philadelphia: Wm. J. Dornan, 1894.

Many of the articles contained in this instructive volume have already appeared in this JOURNAL for August and September, 1893, where a full abstract of the proceedings of its last meeting may be found. The high average value of the papers maintains the growing reputation of the society, while the discussions are noticeably fearless in their criticism.

ABSTRACTS.

1. MUNDÉ, PAUL F.: TREATMENT OF MAMMARY ABSCESS BY COMPRESSION (The Medical Annual, 1894).-I first began to employ compression by a large wet sponge for the cure of mammary abscess about the year 1875. I do not recollect precisely how my attention was first called to the method, but, so far as I know, the idea was original with me, and I never before saw it applied or heard of it being used for abscesses of the breast by any one else. I rather think that my experience as an army surgeon in the treatment of large superficial abscesses and suppurating sinuses by compression with properly fitted unopened roller bandages and wads of cotton, or sponges, led me to apply the same principle to abscesses of the breast. The ease with which the mamma can be compressed against the flat, unyielding surface of the thorax by roller bandages or broad cloths renders abscesses of this organ most adapted to this method of treatment. The object is, by steady, uniform, gentle compression, to keep the cavity of the abscess free from

pus and serous accumulation, and, by holding the walls of the abscess in apposition, to induce the fresh granulations to unite and thus close the cavity.

This treatment is, of course, applicable only to fresh abscesses with healthy granulating walls capable of agglutination and union. Where the abscess has persisted for some weeks or months, and the interlobular cellular tissue of the gland has been destroyed by suppuration, and only broken-down, unhealthy granulations exist, the removal of this diseased tissue by the curette, and packing with iodo form gauze until the wound has assumed a healthy granulating appearance, must precede the closing of the cavity by sponge compression. This, however, is not the class of cases to which I first applied my method, and still I have succeeded in curing two cases of old, chronic mammary abscess, one of three months', the other of a year's duration, in this manner, without the use of knife or curette. In both instances, it should be stated, however, that the abscesses, or rather sinuses, were superficial, and therefore more amenable to this treatment. Both were entirely well in less than two weeks.

My method is very simple, and this simplicity has required but very little modification since its inception. It consists in the proper selection of the case (viz., a fresh abscess, not an old, neglected, necrotic cavity), a large, flat, coarse bathing sponge, two large three-cornered cloths (unbleached muslin or very large square handkerchiefs folded from corner to corner) or a broad, long roller bandage, a piece of oiled silk large enough to cover the sponge, and some large nursery pins.

The modus operandi is as follows: The patient presents herself with a large fluctuating abscess of the breast; this is opened by one moderately large radiating incision at the most dependent point, the pus is gently expressed, and the abscess cavity irrigated with a 1:10,000 bichloride solution or, what is probably just as good, plain boiled (sterilized) water, all of which is gently squeezed out, and the abscess cavity closed by gentle manual compression by the patient herself, while the other dressing is being made ready. The sponge, which has been previously thoroughly cleansed by boiling and has been freed from sand and other impurities, is now fitted to the shape of the collapsed breast by hollowing it out in the centre with scissors so as to admit about one-half of the organ. It is then soaked in as hot water as can be borne by the hand, rapidly squeezed out in a towel, placed over the breast so as to entirely envelop it, covered with the piece of oiled silk, and then uniformly and evenly compressed against the thorax with the roller bandage or with the two three-cornered cloths, the first cloth being applied over the lower part of the breast and tied or pinned behind the neck, the other straight around the thorax. Compression should be as tight as the patient can comfortably bear. The other breast, I

must not omit to mention, must be protected by a covering of cotton wadding.'

This dressing is left undisturbed until the next day, except, if necessary, tightening the bandages, as they may become loose. On the following day the whole dressing is removed, the sponge washed in hot water and reapplied as at first; and this procedure is repeated every day until the abscess is completely healed, which, in my experience, has seldom been longer than a week. Indeed, the cavity is usually closed after the third daily dressing; but, to avoid possible pocketing of pus through uneven application of the compression, it is well to examine the breast carefully each time, and, if such pocketing is found, either express the pus through the original incision or make a new opening. I have never known this occur when I myself applied the dressings, for I have always been particularly careful to adhere to the indispensable axiom of success-that is, uniform, even compression of the breast from the periphery toward the centre, and from the surface toward the thoracic wall.

Occasionally, especially if the abscess has been opened and this method employed while there was still an unsubdued cellulitic induration of a part of the gland, the original abscess may be healed by compression and an additional fresh abscess form by its side, which should then be treated in the same manner. However, I have known a mammary abscess to refuse to close under the routine treatment of drainage tube, gauze packing, and irrigation, which produced a secondary infiltration about the wound, and heal completely within a week, with entire disappearance of the infiltration, under hot wet sponge compression. It is seldom necessary to change the sponge dressing oftener than once in the twenty-four hours. In properly selected cases the method is so simple that I can remember, when I first began to use it, in several charity cases, showing the husband how to apply the sponge and bandages, the recovery being as rapid as if I had done the dressing myself. I have used this treatment in every fresh case of mammary abscess which has come under my observation in the last eighteen years (and I may say that the number has been fairly large, in some the abscess involving the whole gland, which floated in a sea of pus), and in not a single instance have I failed to achieve a prompt cure. Several times the abscess was of longer duration than a few weeks, and had been treated by repeated incision, irrigation,

1It may be as well to mention that nursing from the sound breast should be suspended until the sick breast is well. Convalescence would only be retarded by the sympathetic congestion of the inflamed breast produced by the physiological activity of the healthy side. If the treatment is successful and the abscess heals within a week or ten days, it may not be impossible to restore lactation on the sound side, and possibly even in the one that had undergone suppuration. The compression of the healthy breast by the bandages which cover the diseased one controls the lacteal secretion, and eventually, if kept up long enough, suppresses it.

drainage, and gauze packing by other surgeons, and still, by sponge compression, aided by judicious pressure with wads of gauze or wet cotton, the old sinuses were speedily closed with out knife or curette. However, as I have already stated, old necrotic abscesses are not fit cases for this treatment until a healthy granulating wound has been secured. One old abscess was of a non-puerperal, traumatic origin; it had lasted over a year, and had been unsuccessfully treated with plasters and ointments. I cured it permanently in a week by sponge compression. In several instances the abscess was submammary, and I found these cases particularly amenable to the treatment. I have never brought this method prominently before the profession, except casually on two recent occasions (see my letter in the March, 1893, number of THE AMERICAN JOURNAL OF OBSTETRICS), partly because I considered it so self-evident that undoubtedly it must have been employed by others as well as by myself, perhaps before me, and partly because gynecological topics have gradually occupied my attention more than those of a purely obstetrical nature.

2. LEOPOLD AND MIRONOFF: OVULATION AND MENSTRUATION (Archiv für Gynäkologie, Band xlv., Heft 3). This paper forins a continuation of the well-known investigations by Leopold published in 1883 in the Archiv für Gynäkologie. Its deductions are:

1. Ovulation usually, but not always, accompanies menstruation.

2. Menstruation is dependent upon the presence of the ovaries and a development of the uterine mucous membrane; without these typical menstruation is impossible. Menstruation does not occur if the ovaries are absent or the uterine mucous membrane is in an atrophic condition. The perfect development of either alone is not sufficient. Maturing and rupturing of a Graaffian follicle is irrelevant.

3. Ovulation usually coincides with the menstrual epoch. If the influx of blood to the genitals lasts for a few days a typical corpus luteum results.

4. Under physiological conditions ovulation rarely occurs between the menstrual crises.

5. An atypical corpus luteum is formed by the flow of blood to an immature, not rupturing Graaffian follicle.

6. Graaffian follicles are present during the progress of senile atrophy; these may rupture and change into typical corpora lutea.

Menstruation accompanied by ovulation is the more frequent, without ovulation the rarer, phenomenon. It is certain that ovulation may take place at the time when menstruation should normally appear but is suppressed by one cause or the other.

J. R.