Surgical Observations. BUSHROD W. JAMES, M. D., PHILADELPHIA, EDITOR. ATLEE'S UTEROTOME. Obstetric surgeons frequently find cases where there is a permanent contraction of the os tincæ, and often an entire closure of the os and neck of the uterus, and an incision has to be made to relieve the difficulty. Dr. W. L. Atlee, who has large experience in uterine cases has found the bistoury difficult oftentimes to use, and the dilatation from the application of sponge tents and bougies being so unsatisfactory-giving in the majority of cases only temporary relief-that he invented the instrument shown in the cut (A), known as the uterotome. This uterotome is nothing more than a novel form of scissors in which the cutting edges are on the outer edge instead of on the inner or closing ones, When it is closed it looks like a probe-pointed flattened sword with handles, the edges being protected by the shutting of the blades. In cases of contraction of the mouth or neck of the uterus it is inserted closed and then opened to a sufficient extent, which amount of expansion of the blades is regulated by a small screw on the handle. As soon as it is opened it is to be withdrawn, and this simple withdrawal performs the cutting required, and the operation is over almost instantly. The instrument is not straight entirely but the cutting portion of the blades bend off somewhat at an angle, so that it will adapt itself to the parts better. Mr. Gemrig has so modified the handle of the instrument that there is one main handle to which a thumb-piece moves the other handle and blade of the 33 November. uterotome by an additional joint or two, making a more manageable instrument thereby, and one that can be held more firmly and used with a much greater degree of satisfaction than in the original form. ATLEE'S DILATOR. In the healing of the wound made by the uterotome a serious result frequently occurs unless proper precautions are observed -the wound will close and seal up entirely the os tincæ, and thus produce retention of the menses and other untoward results. Granular inflammation of the os not unfrequently closes up the mouth of the womb in the same way, and hence the inventor was led to have constructed this instrument. It is constructed (B) much like a pair of scissors with crossed handles, and has a lock-catch on the handles to hold it dilated when open. It is inserted closed and when opened withdrawn, and having no cutting edge it simply dilates. After the uterotome has been used it must be applied every four or five days, to keep open the os, and as soon as no blood comes away on the instrument it is known that the wound has healed over with mucous membrane, and no fear of closure need then be apprehended, and the use of the dilator may be discontinued. REPRODUCTION OF THE TIBIA.-(Richmond and Louisviile Medical Journal.) This is an interesting account of a case in which Dr. Cheever removed the entire diaphysis and lower epiphysis of the tibia, with subsequent reproduction of the bone, a useful limb resulting. Since Ollier, in his great work de la generation des os, has only collected five cases, Dr. C. thinks such renewals are rare, and appends to his article extracts from all five of them at length. In the practice of the late Dr. Thompson F. Craig, of Danville, Ky., we some years ago saw almost a precise counterpart of the case which Dr. Cheever has detailed. CRIMINAL ABORTION.-Ely Van De Warker, M.D., Syracuse, N. Y. (Journal Gynecological Society of Boston), says that the practitioner ought to bear in mind that instrumental abor tion, procured with malicious intent, presents almost always features of malignancy. It is isolated by these features from other accidents of the puerperal state. The innocent abortion. is preluded by nature with organic changes which fit the womb for the expulsion or its contents. In the forced abortion demands are made upon a healthy organ for it to instantly violate the laws of its physiological action. This he believes to be the key to the difference between the two cases.-Medical Record. COMPRESSION of the uterus in expulsion of the placenta (Medical Record) has been treated of at length by Professor Crede, of Leipzic, and more recently by Dr. Chantreuil, of Paris. The latter has tried it in five hundred and forty cases, with the result of expediting very much the delivery of the afterbirth, and favoring an early return of the uterus to its normal size. When the uterus has reached the maximum of its contraction after the expulsion of the infant, it is to be grasped between the palms of the hand placed in front and behind it, and steady pressure maintained. The result in the majority of cases is, that the delivery of the placenta is accomplished in a much shorter time than is usual, without being followed by hemorrhage or other unfavorable symptoms. OVARIOTOMY-At the meeting of the Royal Medical and Chir. Society, on the 13th of June, T. Spencer Wells presented a fourth series of one hundred cases of ovariotomy, which, folfowing the order of former papers, he had arranged as follows: Series 1. Cases in which ovariotomy was completed-100 cases; 78 recoveries, 22 deaths. Series 2. Cases in which ovariotomy was commenced but not completed-6 cases; 2 relieved or cured, 4 died. Series 3. Cases where an exploratory incision was made-7 cases; 5 recovered from incision, 2 died. He showed that the mortality after ovariotomy was steadily diminishing. Of his first 100 cases, 34 died; of his second 100 cases, 28 died; of his third 100 cases, 23 died; and of his fourth 100, 22 died. Of this fourth series, 44 had been in hospital, and 56 in private practice. In private practice the mortality was only 14 per cent., while in hospital it was 31 per cent. The author believed that the mortality in private practice might be taken as a guide to what might become the general average mortality after ovariotomy, and he was convinced that it might be reduced to about 10 per cent. without excluding those extreme cases when the operation was performed as a last hope.British Medical Fournal. EROTOMANIA.-Dr. R. L. Parsons, Resident Physician of the New York Lunatic Asylum (The Journal of Psychological Medicine), in an interesting article on "Erotomania," says that this affection has been observed in persons of both sexes, and of ages ranging from childhood to an advanced period of life. Women are much more subject to all forms of the disease than men. Whatever may be the cause or form of the disease, there is always an impairment, and sometimes a marked perversion, of one or more of the mental faculties. Cases of self-abuse, in which there is no such impairment, should not be included under the disease. Erotomania is usually classified as one of the forms of emotional insanity. Insane delusion may or may not exist. The voluntary power is always weakened. There is often melancholia, with extreme depression, both mental and physical, and in these cases there is usually a suicidal impulse, which is sometimes very strong, and may be accompanied by a desire of self-mutilation. The suicidal impulse probably arises from the conflicting and painful emotions caused by a sense of shame and moral degradation, and a feeling of utter inability to resist the debasing sensual impulses and desires. Among the causes of the sentimental form of this disease may be enumerated—a life of indolence; the reading of sentimental and voluptuous romances; a lack of the habit of self-control, especially of the emotions; too great seclusion from the society of the opposite sex; and the habit of self-abuse. These same causes are also efficient in the production of aidoiomania, the physical form of the disease. Cutaneous eruptions, pruritus, hemorrhoids, ascarides, amenorrhoea, ovarian disease, lack of cleanliness, and erethism, are also efficient local causes in the production of aidoiomania. Whenever there is an evident exciting cause, the obvious indication for treatment is a removal of the cause. Hence all local sources of irritation are to be removed; habits that act as causes are to be combated; the general health and tone of the system are to be improved; and proper physical and mental employment are to be provided. The brain is also at fault, and hence we can rarely secure the cooperation of the patient. For this reason constant watchfulness and other measures of restraint are required to prevent a continuance of evil habits. If self-abuse be either a result, or both a cause and result, it is absolutely essential that the habit be prevented. The point is unfortunately very difficult of attainment. Among the means of prevention, confinement of the hands, and local applications that produce a considerable degree of pain and soreness, are worthy of a trial. In several cases in which there was an excessive erethism of the external genitals, an ablation of the |