Varying Tonicity of the Uterine Muscles with Reference to the Danger of Perforation During Curettement.-(Catharine von Tussenbroek, Zentralblatt für Gynaekologie, No. 34.) It has been eleven years since Vauder Mey called attention to the fact that very frequently during a curettement a sudden relaxation of the uterine wall takes place; he was able to show his students that the sound would oftentimes enter the uterine canal 2 cm, deeper after the curettement than before. Von Tussenroek is surprised that this variation, in the tonicity of the uterus has attracted so little attention. Since her at tention has first been called to it, she claims to have been able to observe it almost regularly. In some cases were the relaxation is only slight it might escape notice. She performs the curettement in the usual manner, after having scraped the uterus two or three times, the uterine cavity becomes more roomy and the walls become relaxed. If the curettement is now carefully continued, one can observe how the tonicity again return and the uterine cavity again becomes smaller, and at last one can hear the characteristic scraping sound, called by the French the "cri utérin. According to the usual teaching this sound does not occur until the mucous membrane has been scraped off. senbroek, however, does not believe this explanation to be correct. She claims that the curette takes off the mucous membrane with the first stroke, and not gradually; so after the first stroke of the curette the instrument is already on muscular tissue, and consequently we should get this characteristic sound immediately, which usually is not the case. She believes therefor that the "cri uterin" is a sign that the uterus which was at first relaxed has again regained its tonicity, and that instrument is now gliding along a more solid and tense base. The flabbiness .of course increases the danger of perforation. A number of illustrations are given that show that this transient relaxation is probably due to the mechanical irritation.

Tus

Permeability of the Tubes for Fluids Injected into the Uterus.(F. Buttenberg, Muenchener Med. Wochens., No. 35.)-The experiments on a number of cadavers showed that the tubes are permeable in the majority of cases, but that only a small amount of fluid can pass through them. In making injec

tions a return catheter should be used and the pressure should be no higher than that corresponding to a height of about one meter. Such poisonous materials as corrosive sublimate should not be used for uterine injections. The presence of inflammatory conditions contraindicate the use of caustics.

Extrauterine Pregnancy--Cases of Unusual Type.-J. H. Carstens (J. A. M. A., Nov., 1905) remarks that usually extrauterine preg nancy is easily diagnosed, but occasionally cases occur which do not manifest the usual symptoms and make mistakes possible. He reports two such atypical cases. These cases are to teach some lessons. One of these is that extrauterine pregnancy is more often met with than ordinarily expected. Another lesson is that a careful history of the onset of the disease will throw light on the subject. The patient often unintentionally throws the physician off his guard. He comes to the following conclusions: First, that extrauterine pregnancy must always be in the phyvician's mind in cases of sudden onset of pelsic trouble. Second, that the least irregularity of menstruation is suspicious of extrauterine gestation. Third, that inflammation and sepsis following a supposed miscarriage often are due to ruptured ectopic pregnancy. Fourth, that prompt operation is always indicated; the choice of the vaginal or abdominal route depending on circumstances.

PEDIATRICS.

A. LEVY, M. D.

Pyloric Stenosis and Hour-Glass Stomach after Peritonitis with Congenital Heart Lesion. -G. Mya, Monatschrift für Kindertheilkunde, October, 1905). Of interest on account of the uncertainty existing as to the frequency and pathogenesis of congenital pyloric stenosis, the author reports a case in which a morbid process taking place during fetal life seems to have been the etiological factor. His case was that of a girl baby who came under his observation on the fifty-second day of its life in a condition of great atrophy. Vomiting occurred with great regularity three or four hours after nursing, and obstinate constipation existed since birth. Objectively besides the symptoms of extreme cachexia there were found in the abdomen two globular tumors with peristaltic movements. One of these was in the epigastric and hypochondriac regions with peristalsis from left to right, the other in the iliocecal region and peristalsis from below upward. Stomach contents showed residual milk five hours after nursing in spite of vomiting. Enemas brought small amount of normal fecal matter. Vomiting and constipation with progressive emaciation continued till death occurred on the seventieth day. Clinical diagnosis, congenital pyloric stenosis partial dilatation of colon involving cecum and ascending colon congenital heart lesion and supposedly persistent opening between the auricles. The

autopsy verified the diagnosis. The findings were persisting dilated ductus Botalli, dilatation of stomach with apparent hour-glass shape; coils of small intestine hypertrophic cecum and ascending colon of abormally great caliber with thickened walls. The stomach was almost covered by a thick veil of fibrous connective tissue which attained a considerable thickness in some places and formed a membrane drawing together the cardia and pylorus in such a manner that at about the junction of the left two-thirds with the right one-third of the stomach was formed a deep cleft or buckeling giving rise to the hourglass appearance. The formation of this membrane caused adhesions of the stomach to the intestines in several places. At one place the membrane involved the transverse colon to such an extent as to bring about a stenosis of the latter; the greatest change was in the duodenum which was so involved in the membrane and fastened to the stomach that its whole course was changed and it was found to be strictured by bands and by sharp angles. Thus the lumen of the digestive tract was found constricted in three places first the hour-glass stomach; second pyloric opening; third transverse colon. The author explains the anatomical findings by supposing that during intrauterine life a localized peritonitis took place involving especially the upper part of the abdomen causing a fibrinous exudate which became organized into connective tissue; this resulted in a number of constricting bands which changed the form of the stomach dividing it into two cavities and narrowed the caliber of the pylorus and transverse colon Constriction of the transverse colon was the cause of the dialtation and hpyertrophy of the cecum and ascending colon. The cause of the fetal peritonitis could not be established. The mother showed no symptoms; the author feels sure that these conditions (stenosis) existed at birth since the child showed all the symptoms vomiting, constipation, etc., from birth. He remarks further on the varied present day opinion in regard to congenital pyloric stenosis. He believes that American authors are too ready to diagnose it and agrees with Pfaundler, that congenital pyloric stenosis is a relatively rare disease, and that the hypertrophic form is nearly always an erroneous interpretation of anatomical findings, though he does not doubt that it exists in certain rare case, quoting three of his own.

PHOSPHORUS is of value in those diseases of the nervous system which are due to depressed nutrition.

OPHTHALMOLOGY.

WALDEMAR FISCHER, M. D.

Sclerosis of the Cornea. Dr. J. Meller, Vienna (Klin Monatsbl.f. Angenheilk., Sept.) reports two cases of this interesting condition. The first is a man aet. 40, whose left eye was injured in childhood. The eye was enucleated on account of recurring pains on injection. The uniform whitish discoloration of the cornea developed gradually, in some cases there are no inflammatory attacks whatever. Macroscopically the corneal surface is smooth and retains its lustre. whitish discoloration of the cornea in this case was due to a coarse layer of connective tissue which had developed between the corneal epithelium and Bowman's membrane. A process designated as Pannus Degenerativas by Baas. In the second case the bluish white opacity of the cornea was due to a solution of the corneal ground substance caused by the deleterious action of the aqueous humor on

The

the cornea on account of a solution of continuity and absence in places of the endothelium on Descemet's membrane. Leber was the first to emphasize the injurious effect of the aqueous humor on the corneal substance, if there be a solution in continuity of the endothelium of Descemet's membrane. The fibrillae in the deeper portions of the cornea had undergone solution, and the cornea was swollen to nearly three times its normal thickness. The diseased portions of the cornea were easily detected macroscopically, as they were exceedingly pale and scarcely accepted the eosin stain. This is classed under the category of corneal opacities, following a solution in continuity of Descemet's membrane, in this instance the endothelium of Descemet's membrane may have suffered by the altered consistency of the aqueous humor caused by the degenerated condition of the eyeball.

A New Lid Speculum.- Docent Dr. L. Mueller, Vienna (Klin. Monatsbl. f. Angenheilk., Sept., 1905.)-Many ophthalmic surgeons operate on cataracts and other operations in which a loss of vitreous may occur without the application of a lid-speculum on account of the extreme difficulty to rapidly remove the instruments at present

in use.

The essayist has so modified the Mellinger speculum that when the arms which have the spoons attached to them are closed the spoons will make a turn of 90 deg., so that the instrument will practically expell itself. All other instruments require a slight separation of the lids before the instrument can be removed, during which maneuver great quantities of vitreous humor often escape, causing irreparable damage to the eye.

SOCIETY PROCEEDINGS

MEDICAL SOCIETY OF THE NEW YORK

POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

Stated meeting held November 6, 1905. The President, Dr. J. J. MacPhee, in the

chair.

SYRINGOMYELIA.

This patient presented by Dr. J. C. Lynch, was an Austrian, 44 years of age; married; no children. Was perfectly well up to ten years ago last August, when she began to suffer from pain and weakness of the upper extremities on attempting to do any work. Her symptoms became gradually worse, and about five years ago her hands became deformed. This deformity is most characteristic, and at once suggests the condition from which she is suffering, syringomyelia. The condition is rare, and is due to cavitation of the spinal grey matter or a congenital dilatation of the central canal of the spinal cord, when it is known as hydromyelia, the analogue of hydrocephalus. Syringomyelia is usually the result of a neoplastic process or hemorrhage of the gray matter of the cord and the resulting secondary degeneration of the central portion gives rise to the cavity.

The diagnosis of syringomyelia rests upon the presence of three characteristic symptoms. In this case, as in the majority of instances, all three are present. The existence of any one of the symptoms should excite suspicion, but the presence of any two makes the diagnosis possible.

These symptoms are: First, the disturb ance of sensation known as Charcot's dissociated anesthesia, i.e., the loss of sensation of pain and temperature in any part of the body, with preservation of the tactile sensibility in the analgesic area; second, the tropic disturbances in the skin muscles, bones or joints; third, the progressive muscular atrophy with the accompanying weakness. We also meet with associated conditions i.e. spastic paralysis; disturbances of tactile senses with pain; transverse myelitis; spinal deformities; eye symptoms; speech defect,

etc.

The patient presented is a typical clinical picture of this condition, the lesion being situated in the cervical portion of the cord. The symptoms depend upon the location and extent of the lesion according to the anatomical paths in the cord, whose physiological functions are interfered with or impaired. On close inspection, marked wasting (atrophy) of the muscles of the thenar and hyperthenar eminences of both hands, also of the

interossei, is observed, while overaction of the unimpaired muscles gives rise to marked deformity of the hands. The wrist joint of the right hand shows the characteristic deformity known as a Charcot's joint. The muscles of the forearm of the right side are wasted, while neither the left forearm, arm nor shoulder are involved.

There is well marked cervical dorsal kyphosis, while the drooping of both shoulders, with retraction of the chest produces the deformity known as Mariss' thorax en bateau. The reflexes of the upper extremities are present, while in the lower extremities they are exaggerated with extension response. There is no ankle clonus nor disturbance of the organic reflexes or of sensibility.

Bulbous eruption of the skin, herpes, perforating ulcers, shading of the nails, hair, teeth, spontaneous fractures of the long bones and painful red swellings of the extremities are occasionally met with in this condition. When pricked with a pin over the hands, forearms, arms and shoulders, the patient presented shows no evidence of pain, but when pricked anwy here below the mid dorsal region in front or behind, she immediately jumps, and cries out.

As to differential diagnosis, in a case so typical there is no danger of confounding it with any other condition excepting intraspinal tumor. If the case is seen early and the dissociated anesthesia is absent, it might be confounded with several conditions, of which pachy meningitis cervicitis hypertrophica stands first. This condition, Charcot's Jaffray's syndrome, is a chronic inflammation of the inner layer of the dura mater of the spinal cord, which is characterized by thickening of the membrane, which compresses the nerve roots and spinal cord, resulting in atrophy and sclerosis.

It

Syringomyelia runs a chronic course. may progress slowly for years, or may remain quiescent, as in the case presented. No treatment is of any value.

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MEDICAL MISCELLANY

BUTTERMILK is being recommended as a valuable food for chronically sick infants.

SITE OF ORIGIN OF GALLSTONES L. L. McArthur, Chicago (Jour. A. M.A., Dec. 9), reports a case in which there was total absence of prior illness and no colic, but operation revealed innumerable stones in the ducts with offensive colon bacillus pus and no stones in the gall bladder. There were also innumerable stones in the finer hepatic ducts, with suppurative cholangitis. The stones consisted of cholesterin alone, bilirubin calcium alone, or varying proportions of both, cholestrin usually predominating. He concludes from his consideration of this case that: "1. All gallstones do not originate in the gall bladder. 2. The origin of cholesterin stones is probably in the gall bladder, with subsequent growth either in the gall bladder or ducts where it may lodge. 3. Bilirubin calcium is the constituent of the smaller intrahepatic ducts. 4. Calculi in immense numbers may have existed for months in the ducts without producing a symptom. 5. The surgeon need not reproach himself too much if there be recurrence of the symptoms after drainage.

THE ALKALOIDAL CLINIC HAS CHANGED ITS NAME TO THE AMERICAN JOURNAL OF CLINICAL MEDICINE.-With the January issue in preparation, we change the name of The Alkaloidal Clinic to one which more fully em

We

bodies the scope of our propaganda, namely,
The American Journal of Clinical Medicine.
We have added to our present strong editor-
ial force (all of which is retained, and with
no change in management, or any financial
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believe the physician should pluck the
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etc., all of these offer us in mighty weapons
for our battle with the enemies of the human
race, disease and death, and the new, enlarged
rejuvenated, and strengthened Clinic now
called (as better indicating its scope) "The
American Journal of Clinical Medicine, "will
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DRS. ABBOTT & WAUGH,
Chicago, U.S.A.