present, are influenced by special treatment of the structure even when disease there has been successfully combated. CYSTS OF THE VAULT OF THE PHARYNX, DR. V. RAULIN, of Marseilles, reports (Revue de Laryngologie, No. 17, 1891) two cases, giving synopses of the literature on such cysts, and presents a systematic study of the entire subject. DERMATOLOGY. UNDER THE CHARGE OF LOUIS A. DUHRING, M.D., PROFESSOR OF DERMATOLOGY IN THE UNIVERSITY OF PENNSYLVANIA. ANATOMY OF CHEIRO-POMPHOLYX. A. WINKELRIED WILLIAMS (British Journal of Dermatology, October, 1891) succinctly describes the clinical features of this much-discussed disease, as exemplified in the case under consideration. 1. Depression of the nervous system. 2. Vesicular eruption confined to the sides of the fingers and thumbs, which comes out suddenly accompanied by slight itching, consisting of minute vesicles imbedded in the epidermis, which resemble sago grains, increasing in size and becoming agglomerated. 3. They last about a week or ten days, drying up without rupture or exudation, followed by slight desquamation, leaving a surface sensitive and reddened. 4. Hands generally hyperidrotic. Section of excised lesions show that a mild inflammatory action in the papillary layer results in an exudation of serum, which finds its way between the rete cells and leads to their compression, degeneration, and destruction, forming vesicles. The contents dry up and desquamate. The theory of the vesicles being dilatations of sweat ducts, as advanced by some observers, is disproved by these studies, as well as by those of Robinson, of New York, and of Santi, of Berne. ICHTHYOL VARNISHES. UNNA, after various trials, has succeeded (Monatshefte für praktische Der matologie, 1891) in presenting a formula for a rapidly drying ichthyol varnish, one that dries thoroughly. It is made up of 40 parts of ichthyol, 40 parts of starch, concentrated albumin solution 1 to 14 parts, and water 20 parts. The starch and water are first mixed, the ichthyol then incorporated, and finally the albumin added. A compound varnish of carbolic acid and ichthyol may be prescribed as follows: ichthyol 25 parts, carbolic acid 24 parts, starch 50 parts, water 22 parts. The ichthyol is incorporated with water by gently warming, the starch gradually added. Other varnishes containing pyrogallic acid, chrysarobin, resorcin, sulphur, etc., may be likewise made; to these the addition of a small quantity of linseed oil is of advantage. The film or coating which is formed may readily be washed off with water. LEPROSY AND VACCINATION. TEBB, in a small pamphlet published by R. W. Allen, London, 1891, seeks to show that leprosy is becoming more prevalent, and that its spread in later years may be traced in a great measure to vaccination, as all evidence tends to prove that the disease is contagious by inoculation. As to the treatment, in view of the past and present experience as to its incurability, the writer makes this remarkable statement, a statement which, if accepted and applied to medicine in general, would stay all medical progress: "In view of these experiences, which can be multiplied, and on the ground of humanity, is it not time to put a stop to the torture to which the incurably sick lepers are subjected by drug medication and inoculation, and let these miserable creatures be made as comfortable as tender nursing, varied occupations and amusements and hygienic conditions will allow, and let them die in peace?" The status of the writer on the vaccination question is made evident by the following: "I think it is obvious that the most effective method of arresting the serious encroachment of leprosy, all the world over, is to discourage the practice of vaccination." If the facts set forth in this small pamphlet are, as they appear to be, well founded, this sweeping statement may not be entirely without justification. PSOROSPERMOSIS AND MOLLUSCUM CONTAGIOSUM. In a discussion on this interesting subject (La Semaine Medicale, No. 47, 1891) before the second Congress of the German Dermatological Society, recently held at Leipzig, the following views were expressed: Neisser, of Breslau, has seen three cases of psorospermosis. He believes in the contagiousness of molluscum contagiosum (acne varioliformis of French writers), and regards the affection as a psorospermosis; also that warts are infectious. Pick, of Prague, thinks the clinical facts prove the contagiousness, in all probability, of molluscum contagiosum, but that up to the present date there has been no positive experimental proof. Touton, of Wiesbaden, has absolute faith in the contagiousness of molluscum contagiosum, and is of the opinion that the microorganismic causes are the gregarinæ. Von Sehlen, of Hanover, has recently noted a case of molluscum contagiosum where there existed 135 lesions and which had been regarded as syphilitic, the patient at the same time having had an indurated chancre. Kaposi, of Vienna, has seen cases where the growths had appeared suddenly, but he was not able to say whether the disease was infectious or not. Caspary, of Königsberg, was convinced of the contagiousness of the affection. Neumann, of Vienna, states that he has seen cases resembling in appearance a pustular syphiloderm; and Arning, of Hamburg, has observed typical seborrheic warts appear after massage, and fourteen days later an eruption of molluscum contagiosum upon the scalp and the body. DERMATITIS HERPETIFORMIS, WITH REPORT OF A CASE. LESLIE PHILLIPS (Birmingham Medical Review, October, 1891) calls attention to this disease, and expresses himself in favor of the distinct entity of the same, the four great diagnostic characters being: 1, the polymorphism of the lesions; 2, the grouped arrangement of the lesions; 3, its pruritus; and, 4, its chronicity. The patient was a girl, of florid complexion, aged fifteen years and six months, who had grown very quickly, and whom her mother described as "shockingly nervous." The disease portrayed the papulo-vesicular type; had existed two years, and had resisted treatment. It made its appearance a month prior to the first menstrual epoch. From the history Dr. Phillips thinks that "the case seems to indicate that there may exist a special sympathetic relationship between the cutaneous nerves of the gluteal region and the outer side of the thighs with the plexuses of the pelvic reproductive viscera." OBSTETRICS. UNDER THE CHARGE OF EDWARD P. DAVIS, A.M., M.D., PROFESSOR OF OBSTETRICS AND DISEASES OF CHILDREN IN THE PHILADELPHIA POLYCLINIC; VISITING OBSTETRICIAN TO THE PHILADELPHIA HOSPITAL, ETC. POISONING FROM TWO PER CENT. SOLUTION OF CARBOLIC ACID. In the Zeitschrift für Geburtshülfe und Gyäkologie, Band xxi., Heft 1, KRUKENBERG describes minutely the case of a multipara who had aborted, and in whose case it was thought advisable to curette and wash out the uterus with a quart and a half of warm water to which was added sufficient carbolic acid to make a 2.7 per cent. solution. The curette brought away about a teaspoonful and a half of necrotic decidua, following which the fluid was injected. After three-quarters of a quart had been used, the receptacle holding the fluid was raised upon the shoulder of a woman of average size. During the injection the patient's pulse suddenly failed, and it was necessary to interrupt further procedures. An improvement in the pulse was followed by failure in the respiration; artificial breathing was performed, and the patient gradually rallied to consciousness, presenting symptoms of oedema of the lungs. A specimen of urine passed two hours after the injection showed evidences of carbolic-acid poisoning and contained oxyhæmoglobin. Four hours after the uterus had been washed out, the patient complained of prostration, and expectorated an abundant mucus from the lungs. Her most striking symptoms were oliguria, complete anorexia, and the persistence of a scanty, brownish, vaginal discharge The spleen was enlarged. Death followed about ten days after the intra-uterine injection. Post-mortem examination revealed acute parenchymatous nephritis with endocarditis, A microscopic examination of the kidneys showed multiple hemorrhages in the connective tissue between the tubules. Krukenberg has reviewed the literature of the subject and concludes that severe intoxication may follow the use of a two or three per cent. carbolic-acid solution resulting from absorption of the poison through the respiratory or digestive tract. In puerperal cases poisoning results from entrance of the solution into the veins of the uterus. The symp toms produced by such absorption are due to the effect of carbolic acid upon the blood, and not to reflex action. Hæmoglobinuria is occasionally observed accompanying carbolic-acid poisoning. The observance of the necessary precautions in employing carbolic acid makes it the safest antiseptic for intrauterine use DEATH AFTER LABOR, FROM RUPTURE OF PERITONEAL ADHESIONS. An instance of this remarkable cause of death during labor is given by HOLOWKO (Zeitschrift für Geburtshülfe und Gynäkologie, Band xxi., Heft 2). The patient had lifted a heavy weight, and had strained her muscles by reaching above her head to hang clothing to dry. The patient was a multipara, but complained of great pain which had not been present at previous labors. The uterus was tetanically contracted, and the foetal heart-sounds could not be heard. The patient's temperature rose to 104°; the pulse was between 100 and 120. On the next day the pains increased, and finally a macerated child was born. The patient's condition became rapidly worse, the abdomen was greatly distended, the pulse 140. Shortly after the expression of the placenta by Crédé's method, the patient died. Upon post-mortem examination a large quantity of fluid blood was found in the abdomen. The uterus was uninjured. Upon the right side the colon had been bound down by adhesions which had been ruptured by the patient's exertions, and hemorrhage had followed. No single blood vessel could be found from which the hemorrhage had occurred, and the bleeding must have arisen from the rupture of the adhesions which bound down the large intestine. The symptoms of such hemorrhage are obscure: in the present case no signs of extreme anæmia were observed, while the pulse and appearance of the patient were not those usually seen in severe hemorrhage. TRIPLE CEPHALHEMATOMA. OUI reports in the Archives de Tocologie, No. 18, 1891, a case of precipitate birth, in which the infant fell to the ground between the mother's legs, the ⚫ cord rupturing three or four centimetres from the umbilicus. Upon examination a tumor was found upon each parietal bone, and one upon the occipital. The tumors were treated by incision and evacuation, under careful antiseptic precautions, and uncomplicated recovery followed. THE VALUE OF THE IODOFORM-GAUZE TAMPON IN POST-PARTUM HEMORRHAGE. Additional testimony as to the value of the tampon of iodoform gauze in treating post-partum hemorrhage is given by STAHELI (Correspondenzblatt für Schweizer Aerzte, No. 21, 1891). In the clinic at Berne, 9 fatal cases of postpartum hemorrhage occurred in 5424 births during a period of eight years. Of the 9, 6 were cases where anæmia was the immediate cause of death. In 49 cases in which the tampon was used, better results were obtained than by any other method of treatment. These cases were divided into two groups: one, in which hemorrhage occurred from a source which was determined, and the other, in which the tampon was used as a prophylactic against hemor rhage. In the first were cases of placenta prævia, transverse position, and other similar complications. In the second class were cases of contracted pelvis, and also of Cæsarean section. In using the tampon, strips of iodoform gauze are preferred; thorough antiseptic precautions should be taken to disinfect the patient and the material which is used. THE TREATMENT OF ECLAMPSIA. In the British Medical Journal, No. 1610, 1891, ROBERT BARNES states his belief as to the causation of eclampsia, and outlines the principles of treatment as follows: he would interrupt pregnancy whenever marked albuminuria, with or without convulsions, is present. He values venesection highly; he is also careful to avoid contact with the patient before albuminuria is present; salines, calomel, podophyllin, are eminently serviceable. In the eclamptic stage chloroform is best, and occasional inhalation of nitrite of amyl. RUPTURED RIGHT Tubal PREGNANCY, WITH PERFORATION OF THE VERMIFORM APPENDIX. A fatal case of hemorrhage from ruptured tubal pregnancy is described by ROBB in the Johns Hopkins Hospital Bulletin, No. 17, 1891. The patient had complained of abdominal pain for a week before coming to the hospital. There was impairment of appetite and a condition of mental hebetude. The abdomen was uniformly distended, with an indistinct sense of fluctuation. Upon laparotomy, the peritoneal cavity was found to be filled with dark fluid blood. The right tube was ruptured; the feeble condition of the patient made it impossible to proceed with the operation. The tube and ovary on the right side, where rupture had occurred, were removed, but the patient perished soon after. On post-mortem examination an extensive perforation and sloughing of the wall of the appendix were found. It is probable that adhesions formed between the appendix and the right Fallopian tube, and that the immediate cause of perforation was tubal pregnancy. Two CASES OF MISSED ABORTION." CHOLMOGOROFF (Zeitschrift für Geburtshülfe und Gynäkologie, Band xxii., Heft 2) reports two cases of missed abortion which were remarkable for the length of time during which the ovum was retained. In the first of these cases the life of the embryo persisted for four months, while the product of conception was retained for seven months after the death of the embryo. The entire pregnancy persisted for eleven months. In the second case the embryo perished at three months, but was retained for two months after death in the uterus. In neither case was operative interference indicated; the patients were kept under observation, and the expulsion of the ovum followed spontaneously. Both patients made uninterrupted recoveries. DIAGNOSIS IN DOUBTFUL PREGNANCY. In the British Medical Journal, No. 1610, 1891, NAPIER describes six cases in which the diagnosis of pregnancy was rendered difficult by coexisting dis |