In cases of unruptured ectopic gesta tion the vaginal operation, if congenial to the surgeon, may be elected. In non active cases of encysted haematocele vaginal section and drainage constitute the operation of choice. Situation of mass low down, and the broad, roomy vagina of parous women are favorable to lower route. Before evacuating ec topic collections through vagina prepara tion for abdominal section should be made. In cases of free or uncontrollable haemorrhage, after removing products of ectopic gestation vaginally, the abdomen should be opened at once. Vaginal oper ation in appropriate cases is attended with less mortality. W. D. Haggard, Jr. (Amer. Gyn. and Obst. Jour., July, '98).
Conclusions regarding extra-uterine pregnancy are:— 1. Extra-uterine pregnancy is more frequent than is generally believed.
2. When left to Nature's resources, the mortality is very high, the patient dying from primary haemorrhage, or, sec ondarily, from sepsis and peritonitis.
3. The diagnosis is usually easy after the rupture takes place.
4. The surgical mortality, in skilled hands, when done in time, is very 5. No case of ruptured tubal preg nancy is out of danger until after a good ligature has secured the bleeding points.
G. The abdominal route is the best and safest manner of approach in these cases.
7. Most cases should be irrigated prop erly and drained after removing the dis eased tube and liberating all adhesions. Cordier (Annals of Gyn. and Peed.; Amer. Medico-Surg. Bull., July 10, '98).
Treatment of ectopic pregnancy is by immediate operation as soon as diagnosis is made.
In cases left without operation all the children and 76 per cent. (Martin) of the mothers die. By early operation the mortality should not be over from 6 to 8 per cent. (Kelly). If the child is viable, an operation should be performed at once; if nearly so, operation should be delayed until the child is viable. If the child has just died it is better to wait a few weeks, unless the symptoms are urgent, as the circulation in the pla centa will then stop and it will become loosened, thus lessening the danger of and making the removal much easier. E. M. Pond (Med. Rec., Dec. 24, '98).
Treatment of tubal pregnancy by vag inal route is not only possible, but ad visable under the following conditions: In case of absolutely certain diagnosis, provided the pregnancy has not gone on for more than two months; the pelvic measurements should be normal and the vagina and pelvic floor elastic; the uter ine ligaments should be of normal elas ticity; the operator should be familiar with the technique of vaginal operations.
Ph. Becker (Centralb. f. Gyn., Jan. 14, '99.
In early ectopic gestation, if the sac of the ovum has not been ruptured, the entire ovum should be extirpated as soon as possible. If the sac ruptures into the abdominal cavity, and luemato cele does not form, abdominal section should be done at once.
When, nevertheless, himnatocele has formed and is distinctly limited, opera tion should be undertaken for positive and complicating indications only.
In cases of tubal abortion, either with or without limatocele, and where a dead ovum is retained in the tube, there is no stringent call for interference, but patient should be kept under obser vation. Veit (Zeit. f. Geburts. u. Gyn., B. 60, H. 1, '99).
Pruritus Vulva.
This is one of the most annoying troubles of the pregnant state, and oc curs alike in primipara and multipara. It consists in an intense and intolerable itching of the skin of the labia and cir cumanal region and sometimes the mu cous membrane of the vagina, and is especially annoying at night after the patient has retired to her bed. The rub bing and scratching which are provoked induce excoriation and sometimes severe inflammation of the skin, often lead to the formation of the masturbation habit, and may make the patient's life truly miserable. There may be very little ex ternal evidence of disturbance, or the skin may show cracks and abrasions. It is sometimes dry, red, and parchment like; in other cases it is moist, with transuded serum, and the entire vulva may be swollen, hot, and painful to the touch.
There are three principal causes, ac cording to my observation: 1. Dis charges from the vagina or cervical canal 2. Parasites of the skin. 3. Irritation of cutaneous nerve-endings of central origin.
Discharges from the vagina or cervical canal. The turgid, congested condition of the vagina and uterus during preg nancy conduces to the hypersecretion of glandular fluid and the transudation of serum from the vessels. This discharge may be bland and unirritating or it may be acrid and corrosive. Want of cleanli ness and possibly the action of the bac teria of the skin favor the development of the troublesome condition. The dis charge may be white and watery, or col orless and slimy, and it may be scanty or abundant.