GYN..ECOLOGICAL DISORDERS. — In vaginitis and catarrhal endometritis a tablespoonful of a 10-per-cent. solution of formalin to a quart of water has been found useful.
Formic aldehyde used in one hundred and fifty-five cases of diseases of women. It is an efficient remedy in vaginitis and catarrhal or blennorrhagic endometritis. It was used in the form of vaginal in jections, 1 tablespoonful of a 10-per-cent. solution of formol to a quart of water, together with cauterization of the cer vix and intra-uterine mucosa with the same 10-per-cent. solution. Von Winckel (Les Nouveaux RemRies, Apr. 24, '94).
Under the influence of the injections of formaldehyde in gonorrhoea, a rapid disappearance of the gonococci from the discharges observed, while the character of the latter was changed from purulent to serous. The injections should not contain more than 5 per cent. of formal dehyde. Orloff (Wratsch, July 4, '95).
Six cases of gonorrhcea treated with formalin. In every case the gonococcus was found. A 'L.-per-cent. solution used for injections. For the first two or three days irrigations of 1 quart of hot formalin solution were given twice daily; afterward once daily till the dis charge ceased to contain the gonococci. No internal treatment was given except cathartic pills. All highly-seasoned food, alcohol, tea, and coffee were pro hibited. The patients were advised to drink 2 or 4 quarts of pure water in the 24 hours. J. T. Howland (Jour. of Cut. and Genito-Urin. Dis., 227, June, '96).
Good results claimed from the use of formaldehyde in gonorrhoea in women. Sixty cases, some very obstinate, were cured. The vulva was washed with a 1 in 1000 solution, and the vagina douched through a speculum with a strong solution, varying from 2 in 1000 to 5 in MO. If the uterine cavity and cervical canal were involved, some of the same solution was injected. When there is laceration of the cervix, tam pons soaked in 1 in 1000 of formalde hyde are left for two to three hours in the vagina. When fungous endometritis is present, the curette must be first ap plied. The applications give rise to no pain, and may be used daily, or every second clay. De Smet (La Semaine Med., June 3, '90).
The recent announcement of the suc cessful use of a weak formalin solution injected subcutaneously in a case of se vere puerperal sepsis. followed by re ports of other cases not so successful, has attracted much attention, both in the profession and out of it. We have known for some time that formaldehyde is an antiseptic of great power, and it has been used more or less successfully in a variety of conditions. but the con sensus of opinion seems to have been that, while it is extremely active, it is too irritating to be used in any degree of strength in contact with delicate tissues. The report from careful ob servers in New York that they had used considerable quantities of a 1 to 5000 so lution subcutaneously or intravenously with what seemed to them good results, and certainly without causing any im mediate apparent damage to the blood, gave rise to much interest in the pro fession and to some excitement in the daily press. However, the observers
themselves will undoubtedly readily ad mit that one or two cases prove practi cally nothing, and those of us who have read the reports will be very loath to admit that any startling advance has been made.
The first case reported was evidently in a very bad way from uterine strep tococcic infection, with a temperature of 10S° F. (42° C.), and after the for malin injection there was a rapid fall in both temperature and pulse, followed by several performances of the same kind, a second injection of formalin meanwhile having been given. The argument of the observer was post hoc propter hoc as re gards the injection, but it seems to us entirely too early to draw any justi fiable conclusions in favor of the efficacy of the treatment, in spite of the fact that the bacteriological condition of the patient's blood improved rapidly. The violent extremes of temperature which this patient exhibited are not uncom mon in severe eases of sepsis, and occur without treatment or after the subcu taneous use of salt solution and other forms of treatment; and we must re member that the uterus in this patient had only recently been cleared thor oughly of its septic contents when the formalin was used, so that any good ef fect from this intravenous treatment might also have been expected to mani fest itself about the time when the amelioration of symptoms began.
The other cases reported are still too incomplete to discuss fairly, but we may note that in one an injection of only 100 cubic centimetres of a solution of formalin made by mistake 1 to 2500 in stead of 1 to 5000 caused very serious collapse, with cyanosis,—symptoms which we are constrained to consider due to a poisonous action upon the red blood-cells. if we are justified in this belief the margin of safety is evidently very narrow, and the need of extreme caution is very clear. The announce ment in the lay press of a new procedure in medicine or surgery is always fol lowed by much discussion, and often by a good deal of perhaps injudicious ex perimentation, into which medical men are sometimes practically driven in their relations with the enthusiastic lay men. It is, therefore, wise to emphasize the importance of an accumulation of evidence, and to await the results of more eases. We know so far that con siderable quantities of formalin can be injected into the human circulation with reasonable safety, and in one or two in stances the injection seems to have been followed by benefit; but we are not in the possession of a real cure for septi cemia, and shall not be until we get a true antitoxin, and not a mere germi cide. Editorial (Med. Record. Jan. 31, 1903).