sure symptoms supervened, myomectomy was the ideal operation for subserous growths; failing that hysterectomy. After the child was viable, reposition might be tried, having radical measures until later. A cervical fibroid might be enucleated from the vagina. In all cases of obstructing fibroid, the child must first be delivered by Caesarian section, followed by myomectomy, supra-vaginal hysterectomy or pan-hysterectomy. If during child bed, fibroids became infected a prompt hysterectomy might save the patient. Prof. Murdoch Cameron read a paper upon the "Diagnosis and Treatment of Fibroids." He had not found these tumors more common in single than in married women. Fibroids were seldom single; some soft ones might be mistaken for ovarian cysts. They underwent a certain amount of atrophy at the menopause, with ergot, electrolysis and ligation of the ovarian arteries, but did not completely disappear. Sub-serous tumors, except from torsion of the pedicle, gave rise to few symptoms. When no urgent symptoms were present interference should be delayed. When operation became advisable hysterectomy as the most satisfactory procedure enucleation had been almost abandoned as well as oophorectomy. It was sometimes better to remove the tumor first and in that case an elastic ligature should be passed round the cervix. Dr. Maclean, of Cardiff, related two successful cases of Caesarian section in the case of dwarfs. Dr. James Oliver read a paper on "Study of Internal Hemorrhage in Association with Ectopic Pregnancy." Vaginal hemorrhage was sometimes the first symptom and was apt to recur. Rupture generally happened between the sixth and twelfth weeks. The consequent hemorrhage might stop, but was apt to return and prove fatal. Mr. Taigett (London) introduced a discussion upon "Tuberculosis of the Uterus and Adnexa." In tuberculous subjects the genital organs were affected in 7.7 per cent. The external genitals were rarely affected, and the internal genital organs were not infected primarily, but secondarily from the blood stream, or peritoneal cavity or bowel. The tubes were the seat of infection in 90 per cent of the cases. In the uterus, the tubercle might be miliary or caseous, or might cause a true pyometria. In acute cases the diagnosis was difficult, but in chronic ones, tubercle elsewhere might aid. Amenorrhea was not uncommon, otherwise dysmenorrhea was the rule, and pelvic pain generally present Laparotomy was beneficial with drainage through Douglas' pouch; the removal of tuberculous organs might be very difficult and was sometimes followed by general toxemia. SECTION OF STATE MEDICINE. Dr. Mackenzie read a paper on the "Relation between Vaccination and Acute Concurrent Infantile Diseases." Dr. McVail, the President, opened a discussion upon "Vaccination and the Prevention of Smallpox. He dealt with the present attitude of the profession and the present state of the law and the tenure of the public vaccinator. Dr. Nash, Dr. Newsholme and Major Firth discussed the spread of typhoid through sewage polluted shell fish. SECTION OF DISEASES OF CHILDREN. An important discussion upon "The Treatment of Chorea" was instituted by Dr. Lees. The great majority of cases he regards as cerebral rheumatism. With regard to treatment he advocated sodium salicylate 10-40 grains combined with double the amount of sodium bicarbonate every two or three hours for a child 6-10 years. SECTION OF PATHOLOGY. Prof. Hamilton (Aberdeen) the President, described some experiments performed by himself upon the inoculability of human tuberculosis upon calves. In 15 out of 19 experiments the results obtained left no doubt of the inoculability. PROFESSORSHIP OF SURGERY AT CAMBRIDGE. Mr. Howard Marsh, F.R.C.S., has been elected to the professorship of surgery in Cambridge University. Mr. Marsh has been for many years associated with St. Bartholomew's Hospital, London. He will not have to reside at Cambridge. SIR PATRICK MANSON. Among the recent birthday honors, none is better merited than the K. C. M. G. conferred upon Dr. Patrick Manson. He is a recognized authority upon tropical diseases, to which he has contributed many important facts. RICHARD T. HEWLETT. TO THE MEMBERS OF THE MEDICAL PROFESSION.-The President of the American Congress on Tuberculosis, to be held in Washington, D. C., April 4th, 5th and 6th, 1905, announces Dr. Alfred Meyer, of New York City, consulting physician to the Bedford Sanitarium for consumptives, chairman of a committee in charge of the Section on Sanitarium treatment of tuberculosis. It is probable that the climatic and other methods of treatment will be comprised under the work of this committee. THE TEST FOR MILK.-In the discussion of the best means of securing pure milk for Chicago, and the best way for families to test the supply, one wise fellow says: "Let the milk stand in a warm room. If it does not turn sour it contains preservatives and should not be used." That's all right. If it doesn't turn sour it is unfit for use, and, of course, its unfit for use if it does turn sour.-Chicago Clinic. FOR SUMMER COMPLAINT OF CHILDREN.- Liq. antiseptic (Tilden's).... ... f 3ijss f 3ss M. Sig.: Shake well. Teaspoonful every two or three hours, as re quired. PAPERS for the Original Department should be in hand one month in advance, and contributed to THE MEDICAL FORTNIGHTLY exclusively. A liberal number of extra copies will be furnished authors, and reprints may be obtained at reasonable rates, if request accompanies the manuscript. Engravings from photographs furnished free. Contributions and books for review should be sent to the Editors, 318-320 Century Bldg., St. Louis. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. ARTHUR R. EDWARDS, M. D., Chicago, Ill. RICHARD T. HEWLETT, M. D., London, Eng. HOBART A. HARE, M. D., Philadelphia. J E. JENNINGS, M. D., St. Louis, Mo. H. M. WHELPLEY, M. D., St. Louis. Human Asymmetry. BY MASKEL LEE, M. D. ATLANTA, ILL. Read before the Brainard District Medical Society at Springfield, III., July 23, 1903. ORG RGANIC nature furnishes nothing that is symmetrical. No leaf has its exact duplicate, no organ has its exact counterpart, and no individual is constructed with absolute symmetry. The foot-rule, square, and compasses seem never to have been employed by the Divine Architect in the construction of the animal and vegetable kingdoms. We are so accustomed in the vegetable world to a lack of symmetry as at times to find that any suggestion of it is artificial, wanting in beauty, disappointing. This is especially true in the case of trees, and the occasional effort of the French landscape gardener to give symmetry to trees and shrubs only made them grotesque, and illustrated the absurdity of the undertaking. Some plants and flowers do, indeed exhibit apparent symmetry, but on close study it is found not to be absolute. The higher animals are mainly built up of groups of organs more or less alike which combine in harmonious action, and are generally supposed to have their corresponding parts symmetrical, but in many it is in appearance only, and on close examination by the artist or the physician the lack of symmetry is marked. The subject is so broad we are compelled to limit our paper to human asymmetry. Its facts are well known, but we believe they have never been made the theme of an article for this society. As a rule the nearest approach to individual symmetry is in infancy, but with growth and environment and toil, all of which operate in different degrees upon the two sides of the body, there comes asymmetries which by the time that growth is completed are fixed and permanent characters of the individual. Normal asymmetries are often supplemented by those that are pathological. Both have for the physician and the surgeon great significance, at times aiding in the appreciation of disease and injuries, and their treatment. Anatomically asymmetry is apparent on slight study. The two sides of the head are seldom alike. This is the common knowledge of every hatter, and in injuries of the skull it is occasionally difficult to determine whether localized prominences or depressions are natural or the result of accident. The ears rarely correspond exactly in place, size and shape. The eyes are often unsymmetrical, and the pupils at times contrast widely. From slight convergence or divergence of the eyes to pronounced squint, from approximate emmetropia to extreme amatropia there are many shades of lack of symmetry that should not be deemed pathological. The nostrils are not equally patent, and the turbinated bones may differ. Deviations of the nasal septum are common, do not invariably obstruct respiration, and are not always pathological. When we look into the mouth, asymmetry is marked by irregularity of the teeth unless they be artificial, inequality of tonsils, dissimilarity of the right and left halves of the uvula and tongue, and the differences which the mirror of the laryngologist makes apparent. Remove the clothing from the chest and the lack of symmetry can be seen in unequal muscular fulness, fatty development, bony formations, circumferential measurement, and in tilting of the ensiform cartilage. The dressmaker is constantly obliged to pad the unsymmetrical busts of her patrons, as well as their other deforming disproportions, and she in turn, by the mandates of fashion, creates asymmetries of internal organs. In the arms asymmetry is exaggerated by right-handedness which enlarges the bones, thickens the muscles, changes the contour of the chest, and developes one upper extremity at the expense of the other. Looking behind we find tendencies to spinal asymmetry before we reach well-defined lateral curvature, lordosis, or beginning Pott's disease. There is asymmetry of the testicles and the veins of the scrotum-the left testicle being as a rule the larger, and venous asymmetry favor-left varicocele. With pelvic asymmetry which introduces a serious element in the progress of labor, the obstetrician is much concerned. The inequali ties of the lower extremities are demonstrable by both longitudinal and circular measurements as I have fully verified in some 2000 pension examinations, and the feet which were never alike have their asymmetries intensified by the bootmaker. When we come to internal and concealed organs our subject receives further illustrations. If we admit that we have a double brain it is probable that its corresponding parts are unequally developed. Most of us have our best eye, and our best ear, and are conscious that our motor activities, and sensory impressions are a little more evolved on one side than the other, and by many people it is admitted that when one leg leads the other lags. Popularly the lungs are thought to be symmetrical. Anatomically we know that they are very unlike, and that the heart largely contributes to the differences which are to be noted in their size, shape, lobar divisions, weight, and location. The heart itself is a very unsymmetrical organ. The kidneys may be said to be never symmetrical. Such azygous organs as the liver, spleen, uterus, and prostate gland have some lines of symmetry which disease often distorts. Arterial asymmetry is often seen and sometimes felt in the radials, making the pulses extremely unequal. In disease we find similar organs not both affected, or, if affected, not in the same degree. Headache and earache are often one-sided. Earwax may form in one or both ears. Disease of but one tonsil may be present. Neuralgia of one side of the face, sciatica of one limb are common While the selective action of many diseases can be easily explained, there are still numerous affections in which it remains a mystery. We are frequently confused by what may be termed asymmetry of symptoms. Pain that is present in one condition may be absent under conditions that seem similar. In fevers and inflammation the subjective and objective symptoms are often said to be out of proportion to what we have read, or have seen, being in this sense unsymmetrical, and introduing an element of doubt and confusion in the minds of many consultants, thus making diagnosis obscure and prognosis difficult. Much has been written upon this phase of our subject, and more remains to be learned. The two lungs are seldom equally involved in any affection. In respiration the two sides of the chest may expand unequally, or one side may not expand at all. Lagging respiration is sometimes noted as the only symptom in the beginning of pneumonia and pleurisy. Arterial sclerosis advances in different degrees in corresponding vessels, and asymmetry of pulse may come from injuries to the arm, aneurismal or other tumors of the chest cavity, emboli and clots, or from compression of the subclavian artery. Asymmetrical movements of the eyes and of the pupils in disease may be of serious import and multiply diagnostic doubts. It is not yet determined to what extent, in comparing the two sides of the chest, slight relative differences obtained by inspection, palpation, measurement, auscultation and percussion may be considered within the range of normal symmetry. As no two individuals are alike there is no exact standard of percussion note and auscultation sound in health. Not only do healthy sounds differ in different individuals, but delicate shades of differences, due to relative asymmetries, exist in health in the same individual. The subjective element in the physician introduces another condition of variation, and the time must come when some more exact method of eliciting percussion sounds than that now practiced will be adopted. Symptoms asymmetry mark neurological conditions. As we do not know the nature of nervous force, we have to study its effects, which in disease of the nervous system are frequently emphasized by characteristic |