tened to the inner side of its proper In the ordinary history of both the Before closing, I wish once more to state briefly my belief about dermoids, viz.: That those which are found in cavities and depressions along the median raphe are undoubtedly due to the isolation of little particles of the mesoblast, which have become isolated and thus produced heterodymous, but have the same origin as the rest of the individual. But the dermoid of the ovary and testicle are undoubtedly due to the perverted functions of these Society Reports. ACADEMY OF MEDICINE. T. V. FITZPATRICK, M.D., Secretary. DR. A. W. JOHNSTONE read a paper on Dermoid Cysts (see p. 752). DISCUSSION. DR. GUSTAV ZINKE: I have seen some three cases of dermoid cysts in my own practice, as well as two in the practice of Dr. Palmer. The last one was as large as a uterus at six months of gestation. The cyst was filled largely with colloid fluid; at the bottom of it was found a large amount of bone tissue, containing five teeth, one of which was beginning to decay. There is no doubt that in many cases these dermoid cysts are the result of fetal remains, except when found in connection with the ovaries and testicles. DR. C. D. PALMER: I have not unfrequently encountered these dermoid tumors of ovarian location in my practice, and all, to the best of my knowledge, have gotten well after ovariotomies. My last case was different from any of the others. It was about the size of a medium-sized watermelon, contained no teeth, bone nor hair, but the sac was filled with a yellow dense fluid, looking like the thickest cream when warm, but which, after exposure to the air, solidified like butter in winter time. Dermoid tumors are of a congenital origin, and exist more frequently than is suspected, for they are found on postmortem examination in patients who have died of some other disease; their presence during life not being suspected, because small, too small to drain the body, or to produce pressure symptoms. Until they grow, from some cause, and create symptoms, they remain unnoticed, but when they do they should be immediately removed. I have often thought that this kind of ovarian tumor was misnamed. Dermoid is a misnomer. The term histoid is more appropriate. They always contain some skin, but there may be a great preponderance of bones (some one or more being characteristically developed), teeth, or other material. The case to which I referred consisted largely of a fatty fluid. The doctrine of an abnormal inclusion of the epiblast, showing their developmental origin, is the most satisfactory of any advanced. DR. GILES S. MITCHELL: One of the most obscure points in pathology is the origin of dermoid cysts. The theory which ascribes them to extra-uterine pregnancy does not deserve mention, since they are often found in children. The theory of diplogenesis by fetal inclusion is also inadmissable, on account of the number of teeth often present. Lebert employed the term heterotopia, which is only a name, not an explanation. The theory of parthogenesis, which accounts for their formation as due to a proliferation of germinating epithelial cells, is not convincing, since it fails to explain the presence of similar growths in other parts of the body where epithelium is not found. Probably the least objection able theory is that of impaction. This theory presupposes that during intrauterine existence certain portions of the blastoderm become impacted by pressure within the tissues, and afterwards develop into an irregular formation of normal tissues. Verneuil first announced this theory in connection with cysts of the branchial clefts of the neck and head. The complexity of the elements found in dermoid cysts of the ovary are better understood when we remember that the genital organs are developed from the axis cord. The organs formed by all of the layers of the blastoderm are the only ones which take part in the formation of the axis cord. Lannelongue accepts the theory of impaction without reserve. These heterologous growths add confusion by modifying the normal tissues in which they develop. Formerly it was taught that dermoid cysts were benign tumors, but experience has proven that they are prone to inflammation, and, so stimulated, grow rapidly, and tend to destroy life. As soon as diagnosed they should be removed. I am inclined to concur with the reporter, that dermoid cysts are of much more frequent occurrence than is generally believed. DR. ROBERT STEWART: It has occurred to me, in thinking the matter over, that a possible explanation for the occurrence of dermoid cysts might be found in the incomplete development of the ovum as the result of the retention of the polar bodies. It is well known that before fecundation of the ovum can take place two bodies are thrown off from the surface of the ovum, and these bodies are known as the polar bodies. And, while a positive explanation of their occurrence has never been given, that one which is maintained chiefly by Balfour-that these polar bodies are the male elements of the ovum, the throwing off of which is necessary in the preparation of the ovum for the reception of the fructify. ing element of the male-would show these to be the remains, so to speak, of that elemental life in which the animal has the power of self-fructification, and these polar bodies are thrown off to prevent the self-fructification of the ovum. If this theory of the polar bodies be true, why isn't it possible that the retention of these polar bodies in the ovum leads to an imperfect fructification of the female element, and, as a consequence, the production of an imperfect being, such as we find in the dermoid cyst? DOCTOR-"" -"You must give up drinking and—” Mr. Sickly-"I never touch a drop." Doctor-" And stop smoking." Mr. Sickly-"I don't smoke." Doctor" Humph! that's bad. If you haven't anything to give up I'm afraid I can't do much for you." YEARLY Subscription to the LANCET CLINIC $3.00 if paid in advance, Translations. PARISIAN MEDICAL CHIT- Translated from La France Médecale, BY T. C. M. Louis XIV and the Republic.-Other Times Other Morals.-Some Medi cal Decisions of Ecumenical Coun- Not long since we published an old proclamation of Louis XIV. By the terms of this Royal edict, a physician on his second visit to a patient must oblige the sick one to call in a priest for confession, and not make a third visit until a certificate of the patient's confession was exhibited. This applied to Catholic France only. At the first glance this would look like an attack on the liberty of conscience, and one might be inclined to grow indignant. But on serious reflection one's judgment of the edict is softened, and we are led to believe that things are no better at the present day than they were in former times, and that we have only changed masters. To-day the State interferes, the world over, with private affairs in the name of public rights or in the general interest. Under the old regime the State professed the Christian religion, and believed that its subjects who held this faith should be protected by all sorts of legal meas ures. To-day the State is laical, and it assures by all the methods that laws can enforce to give predominance to the laical spirit in its teachings and methods of public assistance. Aside from all religious considerations is vaccination not a motive of general interest? Is it not the imperious duty of a Government to assure proper measures for the conservation of the health of all its subjects? warn them when in peril of death of the approaching danger. Aside from its religious aspect all will agree that this is a sad duty for any physician to perform. No doctor ever dreams of shirking this duty when called on, and there are no severe penalties for avoiding the obligation. One cannot always prognosticate death on a second visit. Under Louis XIV there was only one way of not more than two or three visits to a avoiding the difficulty: it was to make patient who might have neglected his This church confessor in the interval. In 1429 the Council of Paris recommended the same salutary practice, which was afterward renewed by the Ecumenical Council of Latran. Later, Pope Pius V renewed the same interdiction in the same formal terms. Louis XV was a staunch defender of ecclesiastical bulls, but modified the edict of his predecessor in a more liberal way: "Spiritual succor" says he, "being necessary at some times, notably to our subjects who are newly united to the church, it is desired that when their life or safety is endangered, they be warned," etc. Let us turn now from things spiritual to things more terrestial, and admit that there is more medical humbuggery and quackery in this so-called scientific age than there ever was, even in good, old golden mediæval times. The gynecologists, laryngologists, aurists, oculists, etc., in Paris, must lower their colors to the United States for introducing a new species of medical men, who have been bravely baptized orifice specialists. Needless to say it is a Chicago product. This is the acme of specialization. The following case applies not only to French, but to foreign medical specialists: A woman, mother of three children; well formed, in perfect health Should not the same, or more rigor- in appearance, as well in mind as in ous methods be enforced to save souls? body; had, from time to time, violent Without doubt, morals are transformed, attacks of headache, and called a Governments succeed each other number of physicians in consultation. and doctrines change. Every physician | With a common consent all these doctors, should respect the religious sentiments strange to say, agreed that the pain was of his clients, and make it his duty to of reflex origin, but no two of them as were in accord upon the starting-point | were those who insisted that the unof this irritation; each being a specialist, fortunate lady was disfigured for life by located the trouble in that portion of a double strabismus. the body most familiar to his specialty. The consultation ended in bitterness, and it was decided that the patient should be treated successively by each specialist until such a time as the disease should be cured. The first specialist was the distinguished French gynecologist, Dr. S., a man without a rival in the treatment of diseases of women. The patient was taken to his private hospital, where, under the best hygienic conditions, a most careful bimanual exploration showed that the uterus and ovaries were in their normal position, and presented no appreciable lesions by this method of examination. "Nevertheless," said the specialist, "this woman's troubles arise from a reflex irritation of the womb or ovaries, and I have already cured a number of cases by operative procedures." An exploratory incision was then made, in order to find, if possible, direct indications of the cause of irritation; besides the operator desired to complete his series of three hundred consecutive cases of abdominal section. When the interior of the abdomen was exposed to view there were no lesions, the uterus and ovaries were perfectly healthy. But, thinking that the woman had better avoid ever having a chance for any cyst of the ovaries or pyosalpinx, the two little ovaries were removed. The patient's attacks of headache continued at times, just the same. The patient next passed into the hands of B., the great Russian oculist, who had insisted that the headache was due to a reflex irrition of the fifth pair, and that the only remedy was section of the muscles of the eye. After a careful examination as to refraction, which showed that the patient's vision after all was normal, the doctor made the section of the muscles. Both eyes were treated the same. The result was a deviation of the optic axis, but the patient's headaches still occurred as before. The eminent oculist, in order to excuse himself, insisted that this deviation of the eyes gave the patient a piquant and coquettish air, but there Dr. L., the noted throat and nose doctor, was next called in the case. He had, to a certain extent, agreed with the oculist that the trouble originated in the fifth pair, but, as he was a nose specialist, he placed its origin in the fibres distributed in his branch of a medical specialty. He proceeded to ablate, with the galvano-cautery, several small polypi in the left nares. Then he picked out some of the turbinated bones, and cut off the uvula; but, strange to say, this did not cure the patient, who still suffered attacks of headache. Now came a strange medical hallucination. Dr. P., the world-known orthopedist, was called in, and at once decided that one of the lady's legs was shorter by a millimetre than the other. He claimed that the reflex irritation arose from the hip-joint, and used the cautery. He then desired to perform tenotomy, which the patient violently opposed, and Dr. P. retired. Dr. R., the distinguished rectal specialist was next employed. This end-of-the-intestine-specialist physician declared the lady's headaches due to a lesion of the mucous folds of the rectum. He chloroformed the patient and dilated the sphincter to such an extent that the muscle was paralyzed, and the lady condemned to a temporary incontinence of fecal matter. The patient, now thoroughly disgusted, poor in health, and worse than ever, left Paris, and went to a quiet, country town, where she called in the village physician, who always cured each attack of what he called rheumatic neuralgia by a single dose of antipyrine. What would Moliere say of modern doctors could he revisit this earth? What a world of satire the present specialists and germ theorists would afford him! THE Progrès Médical announces the death at Bordeaux, of Dr. Stanislas Zalewski, a medical man of Polish origin, at the patriarchal age of nearly III. Dr. Zalewski was born at Warsaw, on December 25, 1780. In the morning the salve is removed, the skin cleaned with some fluid fatty substance, as paraffine, the remains of the salve, the crusts and secretions thus being removed. The skin is disinfected with the corrosive sublimate solution and the salve or vaseline appled during the day. Vaseline may be employed if the patient's business prevents his using the salve during the day. In this manner the writer has treated successfully thirty cases of sycosis. TREATMENT OF CHRONIC CRURAL ULCERS AND ECZEMA BY UNNA'S ZINC AND GELATINE DRESSING. Prof. L. Heidenhain (Berliner klin. Wochenschrift, No. 14, 1892) recommends the use of this procedure in the treatment of obstinate crural ulcers and chronic eczemas. The patients first take a warm foot bath for fifteen to twenty minutes, in which they carefully cleanse the extremity with soft soap and a wad of cotton. After wiping the entire extremity is disinfected with a 1 per cent. solution of sublimate, the ulcer being only moistened with a wad of cotton dipped into this solution. Then the surrounding skin, as well as any eczematous spots, are rubbed with Lassar's zinc paste (oxide of zinc and starch, aa, gm. I, and vaseline gms. 2), of which a thick layer is applied. The ulcer itself is dusted over with iodoform, and later, when it has cleared up, red precipitate salve is rubbed on. If the secretion is profuse dermatol will control that in a striking manner. Only when the ulcer secretes profusely is it covered with a layer of sterilized gauze. Unna's zinc and gelatine dressing is, at the ordinary temperature, thick and hard. If placed into a wash-dish it becomes, in a few minutes, fluid. formula is: |