Nov. 28, 1891.] THE BRITISH MEDICAL JOURNAL. 1143 retson is recommended by Hildenbrant.27 Beau,28 of Toulon, used a semilunar flap in the cheek from a little behind the anterior border of the masseter to the chin, turned it up, and trephined over the entrance of the inferior dental nerve and divided it. He then exposed the mental nerve at its foramen of exit, thoroughly freed it and pulled the above piece througlh, the mental branches having been dissected out and divided. In Warren's method an

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... incision was made from the sigmoid notch to the lower border of the jaw. The fibres of the masseter were cut, and a trephine of 20 to 25 millimetres applied below the notch, exposing the nerve and vessels. The nerve was drawn down and 11 millimetres excised. Velpeau's modification of this consisted in raising a V-shaped flap with the convexity downwards, avoiding injury to the parotid. Galignani2'recommended an incision along the lower border of the jaw, and behiind the ramus, as high as the lobule of the ear. The periosteum was raised until the tendinous insertion of the internal pterygoid was reached. This was divided and the periosteuini elevated until the dental foramen was reached. The nerve was drawn down with a hook and 52 millimetres exsected. Weir Mitchell30 trephined at the aijgle of the jaw and excised part of the nerve. He also suggested blockinig up the end of the canal to prevent reunion. Thlese are some of the nuinerous operations proposed and actually carried out for the relief of neuralgia of the inferior dental nerve. Further, the body of the jaw or the ascending ramus has been perforated by the dentist's drill (Tomes) so as to comlpletely destroy the nerve, that is, cut it across. All these operations have the disadvantage that the nerve is not sufficiently removed between the foramen ovale and the upper end of the inferior dental canal. It was to provide a means of doing this without injury to important parts that I suggested and have frequently carried out the operation wlich I shall now describe. In devising this operation the objects which I had in view, besides that alluded to, were: (1) To secure separation of the lingual and inferior dental nerves from their continuation with the main trunk just outside the foramen ovale. (2) To effect this without notable sear and without injury to such important structures as the facial nerve, parotid gland and the articulation of the lower jaw. (3) To see clearly every step in the operation and to have the nerve in view, not only where it is first exposed, but whlere it is divided. (4) To obtain immediate union of the wvound. (To be continued.) 27 Loc. cit. Obstctiic Plhysician to the Bristol General Hospital, and Lecturer on Gymecology at the Bristol Medical School; AND W. 1I. C. NEWNHAM, M.A., M.B.CANTAB., Assistant Obstetric Physician to the Bristol General Hospital. IIhANIG worked at this subject for now four years, we are iniduced to put before the readers of thle BRITISH MEDICAL JO0URNAL our experience of it after giving it a fair trial. We shall not enter into the details of apparatus, etc.; this can be learnt from Apostoli's published works. We will simply state what we consider to be the value of the continuous current and of the interrupted current in the treatment of certain diseases peculiar to women. We may state that the amount of knowledge of electricity that is required to carry out this treatment can be very easily acquired by anyone who is willing to devote a little time to obtain it from books and from conversation with electricians, but we consider that something more than a mere smattering of knowledge of diseases of women is necessary to avoid mistakes, which even with the most experienced will sometimes creep in. We have used the galvanic current over 500 times in 100 separate cases without any ill result, and in most of them with benefit. Myoma Uteri. The first set of cases we will take will be that of myoma uteri. We have used it for growing fibroids without bleeding, and for the same class of tumours with bleeding, for stationary tumours accompanied by bleeding, and for the same kind of tumours without bleeding but accompanied by pain. The results have been as follows: There has not been a very great reduction in the size of the tumours, but rapidly growing tumours have been checked in their growth in all instances except one. The bleeding has been lessened in a very marked degree by the intrauterine use of the positive pole. The pain also has been lessened and in some cases removed entirely. The general health has been much improved, the feeling of weight has been removed to a great extent, and this out of all proportion to the diminution of the size of the tumour. In a short paper like this we cannot quote details of cases. We simply give our opinion after working at the subject. We do not regard electricity as a means of cure or even of relief in all cases of myoma uteri; we regard it as a very valuable addition to our means of treating a very troublesome set of cases. Fibroids of the uterus have been often classified according to their position in the walls of the uterus; this to a certain extent is useful, but we are sure what is often of as much importance is the fact of their being accompanied or not by any other diseased pelvic condition, especially dlisease of the uterine appendages. An ordinary uterus will bleed most profusely in some cases when there is disease of the appendages; how much more so then will a fibroid uterus bleed when complicated with a similar disease? These cases we regard as least amenable to the electric treatment, and in all probability they require removal of the diseased appendages with the double result of removing diseased organs and bringing about the menopause. The removal of the appendages does not always check the uterine haemorrhage. We have had placed under our care for electric treatment a patient from whom a very able surgeon removed both appendages; this young woman has had profuse uterine haemorrhage ever since the operation. We dilated the uterus and found a myoma situated in the anterior wall and bulging well into the uterine cavity. She has had two applications of electricity and the uterus is already much smaller, and the heemorrhage has lessened although it has not yet ceased entirely. We have followed the rules laid down by Apostoli, and can to a great extent verify his statements. Subinvolution. In ordinary cases of subinvolution of the uterus the intrauterine application of the positive pole with a current of 50 milliamp6res given once a week for three or four times has a very good effect, the uterus very rapidly undergoing involution. The cases do best where the enlargement of the uterus is the principal lesion; those cases complicated with endometritis are best treated by ordinary intrauterine medication and curetting. Dysmenorr hcv. In cases of dysmenorrheea, due to a narrow condition of the cervix uteri, the intrauterine use of the negative pole causes at once a dilatation of the canal, which remains permanent, and removes the pain which was due to the stenosis. We know of no treatment so effectual for the relief of pain in these cases if the cause is simply a narrow canal. Often these cases are complicated with tubal or ovarian disease; if so, after dilating the canal with the galvanic current, the faradic current should be used for the relief of the other pain. Caustic Action. Destruction of diseased.tissue is most easily effected by the negative pole either by puncturing or simply by touching. It is most useful in urethral cases, and in chronic inflammatory deposits in the pelvis, in order to assist absorption or to drain away pus, etc. The Faradic Current. Although relief of pain is very marked by the use of the galvanic negative pole within the uterus, yet the best agent for this purpose is the faradic current. To relieve pain by the faradic current it is necessary to attend to a few brief directions. In a very large class of cases, all that need be done is to