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Foreign Cleanings.FLEXIONS AND VERSIONS OF THE UTERUS, WITH MECHANICAL

TREATMENT OF UTERINE DEVIATIONS.

IN an exhaustive article published on the above, by Dr.B. S. Schultze, in the Archiv fur Gynaekologie, the authorputs down various conclusions which may be summed up asfollows :-1. The normal position of the empty uterus isanteflexion or anteversion. When a woman is in a standingposition the posterior surface of the uterus is turned up-wards. 2. Anteversion and anteflexion must be regardedas pathological conditions only when the uterus is fixed in

its vicious position, or limited in the movements which arecommunicated to the organ. 3. Thickening and shortnessof Douglas’s ligaments (the habitual consequences of para-metritis) constitute the usual causes of the persistence ofanteversion or abnormal exaggeration of anteflexion. 4. Onthe other hand, the lengthening of the same ligaments(through muscular weakness of the retractores uteri) neces-sarily leads to retroversion and retroflexion, of which it isthe most frequent cause. 5. The line of flexion of theuterus follows exactly the primarily anterior or posteriorsurface of the organ. If the body of the flexed uterus ismore or less deviated to the right or left, almost alwaysthere exists at the same time a rotation of the organ on itsaxis. 6. Pressure exerted on the abdominal viscera increasesthe following deviations-normal anteversion, or anteflexionof the empty uterus, abnormal flexion backwards (throughposterior fixation), retroversion and retroflexion throughlaxity of Douglas’s ligaments. 7. Uterine catheterism doesnot suffice for recognising the normal situation of the organ,and the direction of its deviations. Palpation with bothhands, properly effected, is a safer way of making out thediagnosis. 8. Persistent anteversion and anteflexion of theuterus can be combated with benefit only by the help ofrevolving agents that tend to cause the disappearance ofthe exudata which maintain the uterus in its vicious posi-tion. 9. Retroversions and retroflexions, whilst they are yetreducible, must be treated by means of the hand, and notof the uterine sound; but in the greater number of cases itbecomes necessary to have recourse to mechanical meansfor maintaining the uterus in its normal position-namely,slight anteversion. 10. The only rational means of overcom-ing displacements of the uterus backwards is retroposition ofthe vaginal portion. The innumerable intra-uterine pes-saries used for the purpose do not generally contributemuch to that effect ; but the use of Dr. Schultze’s modifiedvaginal pessary produces this result : when the vaginalportion is fixed behind intra-abdominal pressure maintainsthe uterus in a position of normal anteversion. 11. Pressureexerted by the abdominal viscera is not capable of modifyingflexion. When in such cases of flexion pain is abated byretroposition of the vaginal portion, it may be necessary toadd an intra-uterine sound to the vaginal pessary.

ASPIRATING PUNCTURE IN STRANGULATED HERNIA.

At the last meeting of the Societe de Chirurgie, Dr. Dieu-lafoy communicated a paper on the above, in which he in-vestigated successively these three points :-1. Is punctureof the intestine in strangulated hernia harmful, or of anature to cause accidents or to compromise the success ofother and ulterior curative means ? 2. In what cases andat what time should aspiration be practised? 3. Whatshould be the modus operandi? P In answer to the firstquestion, Dr. Dieulafoy stated that out of twenty-four casesnow known, and including herniae of all kinds, umbilical,crural, and inguinal, of more or less recent date, in not oneinstance had there occurred the slightest accident, andwhen kelotomy had been practised on the spot, the pricksmade with the needle could scarcely be found out. As tothe question of opportunity or seasonableness, the authorsaid that, aspiration being the most direct and efficaciousauxiliary of taxis, rational treatment of strangulated herniashould, with some rare exceptions, invariably begin withpuncture. In the twenty-four cases extant, and which hadresisted forcible taxis, or repeated taxis with the aid ofchloroform, aspiration had afforded sixteen cases of cure,

and had in no way interfered in the other cases with theperformance of kelotomy. As to the modus operandi, it wasof the simplest: the needle (No. 1 or 2) is introducedthrough the skin after vacuum has been established, andaspirates all the liquid and gaseous matter which it meets,those of the intestine as well as those of the sac. The tumourcollapses, and reduction is most readily accomplished. Whenthe hernia is not reduced it shows that there exist adhe-sions ; then it is needless to prolong taxis, and kelotomymust be practised.TRAUMATIC RUPTURE OF THE MEMBRANUM TYMPANI, FROM

A MEDICO-LEGAL POINT OF VIEW.

In one of the last numbers of the Wiener Med. Wochensch.there is an interesting article on the above by the celebratedVienna aurist, Dr. Politzer. He describes the origin of thelesion (generally a blow with the open hand on the ear);the character of the lesion-an oval opening, with bloodylips, seated rather below and behind, at equal distancefrom the hammer and cartilaginous ring; the disorders ofhearing-which are more intense when the blow has pro-duced contusion of the labyrinth, and especially when theshock has been transmitted to the terminal nerves. Whenair is blown into the ear, it produces a dull noise, whereasthe sound is acute and whistling in cases of pathologicalperforation. Cicatrisation generally takes place rapidly (ina few weeks), after which the lesion cannot be made out(even when there has been suppuration, which is rare) ; sothat for a medico-legal inquiry the surgeon must be calledin soon after the accident.

COLD A PRESERVER OF ARTICLES OF FOOD.

At the last sitting of the Academy of Sciences, M. Bous-singault exhibited two bottles, one containing beef-tea andthe other sugar-cane juice, which in 1865 had been steeped-during two hours in a refrigerating mixture at less twentydegrees (centigrade). The two liquids are as excellent to-day as they were when bottled. In connexion with M.

Boussingault’s communication Baron Larrey remarked thatduring the Prussian campaign his father had often noticed.the bodies of men and animals buried under the snow to bemuch better preserved than those lying on the surface.

PERIODIC DISORDER OF THE AQUEOUS HUMOUR OFTHE EYE.

This case is recorded by Dr. Macario in the PresseMidicale Belge. The patient was aged forty, an anaemicfemale. Every morning on waking up there supervened adisorder of sight in the right eye, which lasted till 10 or11 A.M., after which the sight became better and better tillthe following morning, when the same phenomenon oc-curred. The disease, however, increased in intensity andduration, to the degree of lasting all day. It diminishedin the afternoon. Pallor of the iris and a well-markedopaline hue of the aqueous humour were the only appreci-able lesions. Sulphate of quinine proved useless, and theemployment of a derivative plan of treatment was 4uc-cessful at the end of six months.

THE STRUCTURE OF MILK-GLOBULES.

C. Schwalbe (Schultze’s Archiv, viii., p. 269) maintains,in opposition to Kehrer, that milk-globules possess amembrana propria, for chemically he finds there is someother substance present besides oil, and that this is probablyof an albuminous nature; whilst microscopically theglobules, after their fatty constituent has been removed,present a double contour when treated with perosmic acid,and exhibit folds when treated with perosmic acid andsubsequently with acetic acid or ether. The presence of amembrane is also rendered probable by the slowness withwhich ether dissolves them, as compared with the rapiditywith which molecules of butter or oil disappear when thatmenstruum is added to milk.

HYDATID SAC IN THE BREAST OF A WOMAN.

This case was observed by Dr. Ledentu in one of theParis hospitals. The patient had been suffering for twoyears, and was admitted into his wards for a tumour ofthe breast, presenting all the rational signs of a scirrhus ofthe mammary gland. It was impossible to avoid an errorof diagnosis. Ablation of the breast was decided on, andthe first cut with the bistoury fell within the walls of asac, which was opened and gave issue to a hydatid fluid.