over peritoneal sutures should be changed every four hours or oftener if they become saturated.

SMALLPOX IN TEXAS. Because of the prevalence of this disease in the State the city health officer of Rockdale made a houseto-house visitation and vaccinated about 200 negroes. At Hartzo mail delivery has been

Preventive Medicine; a Study in Education.

included under this title, and suggests that conditions are to be improved, (1) by sending educated and conscientious men to our town councils and general assemblies, and (2) by educating the public in the laws so that they will recognize the cause of unhealthy conditions, and know the proper methods of overcoming them. The education of the public involves firstly, the instruction of the people at large through the agency of the medical profession, popular lectures and the public press, and secondly, the education of the children both at home and in the schools. In the introduction of the study of hygiene into the school system lies the keynote of success in securing and maintaining a sanitary condition of the centers of population. For the correction of the social evil, the author advocates circumcision and instruction of the youth in the nature of venereal disease.

THE USE OF IODINE IN THE TREATMENT OF SUPPURATION.-W. S. Pugh recommends iodine very highly in the treatment of various suppurating wounds and applies by means of a cotton swab on the end of a toothpick the tincture of iodine. The cleansing power of this preparation and the small amount required, he asserts is very surprising. He has employed it with favorable results in scalp wounds, ulcers of the leg and other septic inflammations.-Therapeutic Review.

GONORRHEA AS A CAUSE OF DEATH.-Joseph Taber Johnson, Washington, D.C. (J. A.M. A., March 11), reviews the opinions of authorities as to the effects of gonorrhea in producing female sterility and disease, and states his belief that if the mortality from this cause could be ascertained it would be found to equal that from either typhoid fever, pneumonia or tuberculosis, and that possibly it might be found to exceed the mortality from all three diseases. He thinks that gonorrhea is the cause of at least 30 per cent of the deaths among prostitutes, and that through its later effects on the generative organs it may be the cause of death in a very large number of virtuous married women.

of variola.

CORK INDUSTRY OF SPAIN.-Under date of September 22, 1904, United States ConsulGeneral Julius G. Lay, Barcelona, Spain, reports that Spanish exporters of cut corks are complaining bitterly of the protection given to the cork-cutting industry in other countries, and are calling for legislative measures to curtail the exports of the raw material and to aid those of cut corks. In order to compete in foreign markets prices of cut cork are at present so low that only the barest profit is left, while the price of cork in sheets is kept up by the heavy demand from abroad. Spain and Portugal together produce about 30,000 tons annually. The shipment of cork in sheets form Spain is stated to have yielded during 1902 an average price of only about 8.22 pesetas ($1.17) per ton, whereas at the same time cut corks represented an average value of 15,000 pesetas ($2,142) per ton. This shows the loss to the country through the product being exported in the rough state. Rumors are current of attempts to form a cork trust embracing the entire production in both Spain and Portugal.-Meyer Bros. Druggist.

MYXEDEMA AND DIABETES MELLITUS.-A. A. Strasser, Arlington, N. J., J.A.M.A., March 11), reports the case of a child, 8 years old, in whom the characteristic symptoms of myxedema appeared after weaning. The thy

roid treatment was instituted with marked improvement in the symptoms, but diabetes intervened and it was discontinued, not because it was considered responsible for the intervening condition, but to eliminate it as a possible factor. The case was very carefully studied as to its metabolism; the child improved greatly in its mental symptoms as the diabetes progressed, but finally died in coma and convulsions. The author discusses the case with special reference to the effect of the diabetes on the myxedema, and considers the case as absolutely unique. Diabetes mellitus itself is not so rare in children as was formerly thought, but its occurrence in myxedema with the apparent marked effect on the latter condition here observed has not been reported heretofore. In a supplementary note he refers to two somewhat similar cases reported by Dr. Alfred Gordon in American Medicine, February 6, 1904, but he does not agree with the optimistic Gordon's views as to the prognosis in such cases.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

OBSTETRICS AND GYNECOLOGY

W. H. VOGT, M. D.

The Operative Treatment of Mammary Carcinoma and the Permanent Results.-F. Meibl

(Weiner klin. Wochenschrift, No. 51.)-Of the 247 cases operated on at von Eiselberg's clinic in Vienna, about 18% were permanently cured. The proportion of permanent cures. with the Volkmann technic was much higher than with the Haidenhaim, and approaches closely that obtained by Halsted.

The Pathology and Therapy of Fibroma of the Pregnant Uterus.-E. B. v. Fernwald (Weiner klinische Wochenschrift, No. 52) discusses the views of other writers on the subject and analyzes six cases. In one case a conservative myotomy during the third month of pregnancy did not interfere with the normal course of pregnancy. In one case a large myoma, the size of a child's head, was present. The child was extracted with forceps, living, and the mother recovered. In two cases the mother recovered after conservative Cesarean section with myotomy at full term. In two other cases a supravaginal amputation of the myomatous uterus was done at the end of the fourth month, with good results.

Total Inversion of the Uterus.-R. Wanner (Zentralblatt fuer Gynekologie, No. 52.)-Two cases of inverted uterus were cured by extirpation. In the one case there was a complete tear of the perineum and the inversion occurred while straining at stool fifteen days post partum. The other case was one due to a large myoma, the prolapse taking place while the patient was lifting a heavy object.

The Histology and Pathogenesis of ChorioEpithelioma Malignum. Th. Burdzinsky (Zentralblatt fuer Gynaek.. No. 52) after examining six cases of chorio-epithelioma the author comes to the following conclusions: (I) That the neoplasms arise from the epithelial elements of the coverings of the choronic villi, and (II) that the growths always contain representatives of the two typical elements thereof. Since he found many mitoses in transition forms, in syncytial masses and in polynuclear protoplasmic masses, he concludes therefrom that the syncytium in chorio-epithelioma is capable of dividing itself directly and indirectly. He also believes that the cells of Langhans arise from the syncytium, representing a later stage of development.

The

Eclampsia with Report of Cases. --L. M. Allen (American Jour. Obstetrics, New York, February) concludes that eclampsia is due to a toxin, which very probably has its origin. in the liver, and comes from the mother rather than from the fetus. Premonitory symptoms are always present, especially frontal headache being a very constant one. The diagnosis of toxemia of pregnancy should be made early, and if the patient is under observation this can generally be done. premonitory symptoms should be treated until in spite of the treatment they get worse; then empty the uterus, and in some cases this is the only method of stopping the progress of the disease. Deliver as quickly as possible, consistent with cleanliness and preservation of the soft parts; bleed, remove from 300 to 700 cc., as may be indicated in the individual cases, and infuse from 500 to 1000 cc. of salt solution, the amount of salt infusion depending on the amount of blood withdrawn and the character of the pulse, this may be repeated again later. To relax the muscular system inject hypodermically

gr. morphine, and as a purgative give croton oil, 1 to 2 drops in 1 to 2 drams of olive oil, followed by magnesium sulphate. oz.in saturated solution until effectual. Give liquid diet.

New Operation for Cystocele.- James C. Wood, Cleveland (American Jour. of Obstetrics, New York, February) describes his operation as follows: The ordinary circular denudation is made, which should correspond in size to the size and degree of prolapse of the cystocele. While in conformation it should be oval, ordinarily it should be wider above than below, because in nearly all instances there is a greater degree of relaxation in the upper part of the vagina than in the lower. After denudation is made, the mucous membrane is dissected from the bladder to the extent of three-eighths of an inch entirely around the denuded area. The dissected can be made either with a scalpel or a pair of scissors. Mattress sutures are now passed in such a way that when tied they will make a bridge of tissue three-eighths of an inch in depth, and which is composed of the dissected mucous membrane lifted from the bladder. The edges of this column of tissue are brought together with a running catgut suture. If there is a urethrocele, or if there is incontinence of urine because of weakness at the internal meatus, the dissection is extended along the urethra for a sufficient distance to support the neck, as well as the base of the bladder. When the uterus is entirely without the vagina, it is absolutely imperative to narrow the vaginal wall; this to be

supplemented by the necessary cervical work and reparation of the pelvic floor. Wood's modification of the ordinary flap slitting operation is as follows: A semicircular incision is made with elbowed scissors, the incision extending through the several layers of fascia. The flaps are caught in forceps, one above and one below, and the dissection is completed with the fingers well into the crest of the rectocele. If now a suture is passed, beginning at the crest of the rectocele, first through the vaginal flap and buried in the tissues from left to right, being brought out and reintroduced as often as may be necessary to complete the circumference of the wound, and finally brought out at the point of entrance, when tied it will necessarily bring the divided levator ani fibers together in the median line. From one to three vaginal sutures thus introduced will convert the vagina into a mere slit in the pelvic floor. The last The last suture is introduced within three-fourths of an inch from the vaginal orifice. The vaginal flap should be kept tense while these sutures are being passed, so that the posterior vaginal wall will be perfectly smooth when the operation is completed. The superfluous tissue is removed from the upper and lower angles of the wound. By doing this, all scar tissue is done away with, and the perineum is left smooth, with its entrance slightly depressed. The wound may be closed from the perineal aspect, as the operator elects. Wood uses interrupted catgut sutures which, he belieres, approximate the fascia and muscles better than does the buried suture. is taken not to tie the external sutures too

If care

The Calculation of the Date of Delivery in Pregnancy.-W. J. Caie (British Med. Jour., Feb. 4, 1905) finds that a nearer approximation of the date may be obtained if, instead of adding seven days, only five days be added in Naegeli's method of calculating. Loewenhardt's method, he believes to be more accurate than Naegeli's. It consists in counting the number of days between the last preceding menstrual period and the one preceding that and multiply by ten.

The Supposed Dangers and the Real Advantages of the Method of Swinging for the Resuscitation of the Asphyxiated Child.-B. I. Schultze (Muench. Med. Wochenschrift, No. 6, 1905) believes that most cases of fractured ribs and clavicles, tearing of the spleen, etc., reported, are due to careless manipulation. He also shows and proves that certain conditions, such as small hemorrhages in the pleura and pericardium, as have been reported following his swinging method: are really the cause of the asphyxia in the child and not brought about by the practice of his method of resuscitation at all. The indica

tions for the swinging he gives as follows: When the child is pale and all muscles are relaxed, and upon introduction of the finger in the mouth no action of the muscles of the pharynx are observed, if after tying the cord and the child, after being placed in a warm bath, remains in the same condition, probably now and then making an inspiratory movement, with drawing in of the abdominal muscles, and a weak heart action present as the only remaining sign of life,

The Effect of Tubal Abscess upon the Position of the Ureter.-Ernest Boyer Young's (Boston Med. and Surg. Jour., Feb. 6) conclusions, from the study on the living as well as on the dead, are as follows: (1) That small collections of pus in the fallopian tubes do not displace the ureters. (2) That larger collections displace the ureters (a) outward generally, whether the ureter is above or below the mass; (b) downward rarely, on to the posterior cul-de-sac. (3) (a) That such displacements are probably due to the traction upon the infiltrated broad ligaments by the distended tubes; the ureter moving with the broad ligament; (b) direct pressure from the growing abscess, forcing the ureter in the direction of least resistance; (c) a combination of both. Previous to the investigation of this subject the operation of vaginal section has seemed a somewhat haphazard procedure, but in the light of what has been found our lack of accidents seem quite fully explained.

SOCIETY PROCEEDINGS

CLINICAL SOCIETY OF THE NEW YORK
POLYCLINIC MEDICAL SCHOOL
AND HOSPITAL.

Stated Meeting, Held February 6, 1905.

The President, Dr. Daniel S. Dougherty, in the chair.

CHRONIC ABSCESS OF THE LACHRYMAL SAC.

Dr. Earl Conner exhibited two patients with chronic abscess of the lachrymal sac. The first patient had been treated by probing, which is the classical procedure usually followed in these cases. The speaker said that his experience had been that this mode of treatment afforded temporary relief, but the attacks of inflammation usually recurred, and the patients returned for treatment from time to time, and he did not think that a cure could be obtained by this means. The patient had absolutely refused operation, and his condition at the present time presented the highest type of relief that could be obtained without the use of the knife.

The second patient gave the history of suppuration for four years. Two years ago he was operated on at another hospital, and the eye was dressed for eight months, gauze being packed into the wound, cauteries applied, and several forms of treatment tried, all of which failed to produce a satisfactory result. He was admitted. to the Polyclinic Hospital and was operated on, the dome of the sac being dissected out, and a much longer incision was made than at the time of the first operation. The first operation was a failure because the incision was too short, but the second one was successful, and the patient was discharged the third day after this procedure, and his condition at the present time is very satisfactory.

Dr. D. S. Dougherty opened the dicussion of this case. He said that often a frontal sinus, with a sinus running down to the lachrymal sac might be mistaken for abscess of this sac. He thought the latter condition sometimes dependent upon a nasal deformity, and relief of this deformity would have a curative effect upon the disturbance in the lachrymal sac. He thought, too, that slitting up the sac and washing it with an antiseptic would produce very good results.

Dr. J. A. Bodine said that in his opinion it would be a very simple matter to cure the disease by dissecting out the sac from below, but he would like to know what the result of closing up the outlet for tears would be.

Dr. Conner said that hemorrhage would follow such a procedure, then blood-clot would

fill the cavity and organize; the clot might break down; granulation tissue would form, and gradually the obliteration of the sac would follow. The patient presented still had a watery eye; and by use of astringent collyria, the epiphora would be overcome; or, if it was not, removal of the lachrymal sac would relieve it. The object in showing the patient was to demonstrate that so long as the abscess existed, so long was the eye in danger A simple abrasion, for instance, might produce a sloughing of the cornea, and then the eye. may be lost. He thought operation justifiable to preserve the health of the eye.

LADDLE-BACK DEFORMITY OF THE NOSE.

Dr. G. B. McAuliffe showed this patient. In the operation, the nasal bones had been fractured at the sides and the septum separated from the line of the bone and the osseous deformity was broken up by forceps. There was left a projection which, by a slight ex. ternal operation, was cut down on and removed. On three subsequent occasions, paraffin was injected along the line of the bridge, and the result was very satisfactory. If the paraffin is in a worm-like condition, and the syringe is properly used, with a graduated screw, one can regulate the amount injected into the tissues. There is no reason why the use of this agent should not result satisfactorily, and there should be no danger of it spreading.

A

Dr. Bodine said that this work was interesting because it was one of the best results from paraffin injection that he had seen. few years ago paraffin was being used generally, and many failures resulted from the improper handling of this agent. He was one case on record where it was injected into the nose, and immediately the patient complained that she could not see out of her right eye, and she has never since had the use of her sight in that eye, probably because the paraffin entered the ophthalmic vein. He also spoke of a patient at St. John's Hospital who had a fistula, followed by sloughing of the rectum. There was an immense amount of scar tissue, and the patient had absolutely no control of his bowels. The tissue surrounding the anus had sloughed to such an extent that there was no structure to work on for a plastic operation, so that the speaker injected paraffin from the midline in front to the midline in back on one side of the rectum, and sufficient was injected to produce a distinct resistance when the operator pushed his finger into the bowel. The patient's bowels now move but once or twice a day, and he experi ences but little trouble, although, no doubt, in case of a diarrhea he would be unable to control them.