a return of the symptoms and if the standing position is maintained for ten or twelve hours the condition is more aggravated and the distress is consequently greater.

Pelvic disorders and neurasthenia are so often closely associated that frequently it is almost impossible to determine which is cause and which is effect. Any diseased condition should of course be given the proper surgical and medical attention before pronouncing it neurasthenia. It is in this class of patients particularly that the note of warning should be sounded against operating for pelvic disorders with the expectation of relieving the patient of her neurasthenic symptoms. The treatment of pelvic neurasthenia presents a varied problem to the attending physician. It would be advisable in many cases to treat the patient for several days before operating, if such a procedure is indicated. In this way the symptoms can be studied closely and the rest would be of decided benefit in many ways. This treatment could best be conducted with the patient in bed, and better in a hospital where she will be away from home influence. a few cases, a systematic Weir Mitchell rest treatment should be tried. If the patient responds to treatment there should be an increase of from two to four pounds a week. The benefit is often extraordinary not only as to the neurasthenia but also as to the pelvic condition.

In

The advantage of the rest treatment can best be demonstrated by the improvement shown by some patients during the three or four weeks in bed after operation. The rapid improvement is due not so much to the operation as to the enforced rest, for example, cases of extreme prolapsus uteri with its long train. of symptoms, such as emaciation, gastric and intestinal distress, nervous derangement, and the like; and it would be no exaggeration to say that such a patient derives as much good from the prolonged rest in bed as from the operation itself.

The only objection to this long continued inaction is that certain objectionable effects would manifest themselves, such as poor elimination, inactivity of muscles, accumulation of fat, etc. The most important measure to overcome these defects is the employment while in bed of regular systematic massage or manipulation of the muscles, by which means a healthy condition can be maintained until such time when regular muscular exercise can be resumed.

In regard to bodily exercise the index should be the strength and general condition of the patient. A mistake too often made. is to make weak and debilitated patients take long walks. For such a patient rest is more desirable and fresh air may be had at the same time.

It may seem from the foregoing that I am opposed to operative treatment in gynecological conditions, but such is not the case. Let us operate for true surgical conditions when a real indication exists.

The suggestions offered are not new, but the principle of rest is too often neglected or is relegated to a minor place in our treatment of gynecological patients, and the object of this paper is to emphasize a simple but most important adjunct to our nonoperative treatment of pelvic disorders.

DISCUSSION.

Dr. L. Litchfield, Pittsburg: It is very refreshing to hear the nonsurgical treatment of gynecological cases so exhaustively and suggestively discussed by a gynecologist. Dr. Weiss's most interesting paper shows us that at least one gynecologist appreciates fully the great value and importance of nonsurgical treatment in many of these cases. I am neither a gynecologist nor obstetrician, but I wish to bear witness to what Dr. Weiss has said regarding rest in these cases, and I wish particularly to call attention to the value of the knee-chest position combined with rest in many cases of chronic displacement, and, particularly, a postpartum case which showed a tendency to prolapse and retrodisplacements; also, as to the value of the pessary worn for a few months in some of these post-partum cases.

Dr. K. I. Sanes, Pittsburg: The importance of rest in acute pelvic inflammatory diseases has lately been recognised by the gynecological profession. Rest improves the general health of the patient and puts her in better condition for the operation. Having allayed the acute inflammation, it enables us during the operation to distinguish the diseased from the healthy tissues. It also enables us to study better our patient and her disease, and thus to correct our incomplete or faulty diagnosis. Even complete cure can at times be attributed to rest. But to get the benefit of the preliminary rest treatment and at the same time not to run any unnecessary risk of complications and accidents, it should be undertaken at the hospital under supervision of the surgeon and under care of a nurse so that sudden changes demanding immediate intervention may not be overlooked.

In this connection it is interesting to note the change that has been taking place lately in the postoperative treatment so far as rest is concerned. Instead of keeping our patients in bed three weeks after serious operations, we let them sit up on second or third day, let them walk on the fifth or sixth day and send them home at the end of the second week. Of course, we must use our judgment in this matter. Patients of low vitality, neurasthenics, hernias, and the like, must have their usual postoperative rest, but the severity of the operation itself bears hardly any relation to the length of time necessary for postoperative rest.

THE

A Compact Ether-Freezing Microtome.

BY EDWARD C. MANN., M. D.

Medical Department, University of Buffalo.

HE accompanying cut shows an ether-freezing apparatus which can be used with any microtome and by which the general practitioner is enabled to make a quick diagnosis.

Numerous methods of freezing material for microscopical sectioning have been used, chief among which are the carbon dioxid method, salt and ice, and ether freezing by means of a spray. The carbon dioxid, although perhaps the best method for a large laboratory, freezing larger pieces of material, is impracti

cable for small laboratories and the general practitioner. The tanks of carbon dioxid are expensive and apt to leak. The apparatus is quite expensive and cannot be obtained easily in all places. The tanks of gas are often found empty just when one wants to use them, and not rarely they contain a good deal of water and iron rust.

The salt and ice method gives much more trouble, is slower and not so cleanly as the method here shown. A physician always has ether in his office. Ether freezing is then the ideal method if an apparatus which is not cumbersome, will not wear, and which will freeze the material can be had. In particular most ether freezing atomisers require rubber tubing for the connections. The rubber dissolves and soon plugs the fine tubes. The cut shows a convenient and compact ether atomiser con

structed entirely of metal, devised by the writer. The ether is sprayed in finely divided globules by means of an ordinary atomiser nozzle. That which does not evaporate is run off from the spraying part into the cup which holds about 10 cc. of ether, enough to freeze a piece of material 1 m. m. thick and 1 cm. square, thus allowing sufficient number of sections to be cut with a minimum of ether and time. The material should be fixed in a 10 per cent. formalin solution, that is, (10 per cent. of the 40 per cent. solution of formaldehyde) as is usual in all methods. Certain forms of tissue, as fat, are very hard to freeze, but for general work and quick diagnosis, the apparatus here shown, made by the Spencer Lens Company, will be found very satisfactory. Only the best quality of ether should be used.

37 ALLEN STREET.

ABSTRACTS.

The Influence of Urotropin on the Urine. INTERESTING findings are reported by Richard Stern (Zeitschrift f. Hygiene u. Infektionschrank., Vol. 39, 1908), in which he says: with urotropin a liberation of formaldehyde or antiseptically-acting formaldehyde compounds best takes place in acid urine. A urotropin urine with alkaline reaction is less antiseptic. By alkaline urines Stern means urines to which sodium bicarbonate has been added. There is therefore no contradiction between his experimental results and the clinical observation that urotropin acts well when the urinary reaction is alkaline. For a clinically alkaline urine means one which has undergone ammoniacal decomposition-one which is acid in the kidneys and is only in the bladder infected with uric acid-decomposing bacteria. For the practical employment of urotropin it is important not to weaken its action by simultaneous free administration of alkalies.

Though free flushing of the urinary organs is rightly regarded as an important therapeutic measure, it involves diluting the antiseptic in the urine. Therefore, when the dose of urotropin can not be proportionately increased, the patient should be ordered to drink large amounts of liquids throughout the day, while larger doses of urotropin are given morning and evening.

Deep seated inflammatory processes of the bladder, renal pelvis, and the like, are less amenable to urinary antiseptics. In tuberculosis and other deeply penetrating infectious processes, a cure can not be attained with urotropin. The remedy is, however, of service by restraining bacterial development in the urine

and alleviating the irritating action of the urine on the diseased

mucosa.

Stern thinks urotropin is by no means used enough before and after instrumental procedures on the urinary organs. Urotropin in large doses uniformly distributed (60 grains a day in 3 to 6 doses) should be given in all cases in which obstructed urination favors infection, before and after the introduction of instruments (catheters, cystoscopes), and before and after gynecological or surgical procedures in which injury or contusion of the bladder may occur. Stern recommends a large dose late at night, to render the nocturnal urine antiseptic. Otherwise much of the success attained during the day is negatived during the night.

In phosphaturia, says Stern, urotropin acts when the excretion of urine turbid with earthy phosphates is due to ammoniacal fermentation. His cases of this class were mostly of preceding gonorrhea in which secondary staphylococcus infection occurred. In neurasthenics, who often suffer from hyperacidity and constipation and therefore freely take alkaline waters and vegetable acid salts, the food alone may suffice to produce an alimentary phosphaturia. Here urotropin is unavailing. But when the urine of such patients is weakly acid or neutral, a moderate formation of ammonia or uric acid-decomposing organisms suffices to induce precipitation of earthy phosphates. A stronger urinary infection can, of course, also lead to phosphaturia, even if the food is not responsible. In such cases the phosphaturia is rapidly obviated by urotropin in medium-sized doses. Usually the urotropin must be given continuously because generally only an inhibition of uric acid-decomposing organisms is effected.

Stern considers it erroneous to speak of the dose. It varies in accordance with the resistance of the disease producers and other factors in each individual case. Often when 71⁄2 grains urotropin thrice daily proved unavailing, the number of bacteria. rapidly decreased when the dose was doubled or trebled.

Urotropin in the Lumbago of Febrile Affections. FRANZ WEITLANER (Weiner klin.-Therap. Wochenschr., No. 25, 1908,) adverts to the fact that some of the commercial hexamethylentetramins develop upon standing-especially when the air is moist an odor of ammonia or formaldehyde which is offensive to the patients. This, however, he never saw with Schering's urotropin.

In 1904 (Monatsh. f. prakt. Dermat., Vol. 39), he recommended urotropin in spinal neurasthenia with phosphaturia and lumbar fatigue and in all forms of lumbago. He now lauds it