A MUCH REGULATED COMMONWEALTH. Whether the people of the State of New York are well regulated or not, may be a question; but that they are much regulated there can be no doubt. Under the laws of the State not only the practice of medicine is regulated, but also the practice of dentistry, pharmacy, veterinary surgery, chiropody, plumbing, and horseshoeing, and a bill is now before the legislature to regulate the practice of optometry, and we are informed that the barbers are to introduce a bill to regulate the practice of the tonsorial "profession." The bill to regulate optometry was defeated in the last legislature, lacking, however, only seven votes in the assembly. A new bill has just been introduced which provides that the Regents shall appoint a State Board of Examiners in Optometry, which shall examine all persons engaged in optometry in the State, and shall confine its examinations to such knowledge as is essential to the practice of optometry. The proposed act is to be construed so as not to apply to persons who sell spectacles or eye-glasses, without making pretentions to scientific knowledge or skill in adapting them to the eye. Registered physicians are exempt from the provisions of the act. The practice of optometry is defined by the bill as "The employment of subjective and objective mechanical means, to determine the accommodative and refractive states of the eye and the scope of its functions in general, or the act of adapting glasses to the eye by using such skilled means as will determine their choice." The Optical Society of the State of New York, under whose auspices we understand the bill has been prepared, state that the principal object of this bill is to protect the public against incompetent and designing persons who may in the future attempt to traffic upon postulate skill in adapting glasses to the sight. In a circular entitled "The Optician and the Oculist," published by the Society, the argument of the oculist that the testing of eyes for glasses should be done by him and not by the optician, is met by the following argument, which is, to say the least, ingenious, that "as the optician refracts, or bends, rays of light with his lenses before they enter the eye, and not afterward, he is treating light, not treating disease." George W. Brush, M. D., Senator from the Fourth District, desires an expression of opinion from the medical profession as to this bill, and will send copies to those who desire to examine its provisions more in detail. PROGRESS IN MEDICINE. SURGERY. BY GEORGE R. FOWLER, M.D., HIGH CASTRATION AFTER VON BUNGUER. C. Lauenstein (Deutsche Zeitschrift für Chirurgie, Vol. xliii., p. 588) reports thirteen cases of removal by avulsion of the vas deferens. In his opinion, as much of the vas cannot be extracted in the living subject as in the cadaver. In one case operated upon, a case of testicular suppuration, following fracture of the pelvis and rupture of the urethra, the vasa gave way immediately at the seat of traction, on account of their adhesions to the surrounding tissues, due to inflammatory infiltration. In two other cases of suppurative epididymitis, the length of the pieces extracted amounted to but nine and ten centimeters. In the remainder of the cases the vas measured twenty to thirty-five centimeters. Lauenstein repeatedly observed considerable hemorrhage following the operation, which might prove harmful to the patient. By the traumatism inflicted upon the vas deferens, its vessels (a branch of the hypogastric artery) and its branches must be torn off. This may give rise to a considerable hematoma, which in one case of L.'s, a poor subject of forty, was quite palpable, both from in front and rectally, as a large tumor occupying the site of an inguinal hernia, and presenting dulness. still another case a sausage-shaped hematoma appeared in the region of the inguinal canal. These hematomata, L. concludes, are inaccessible to direct surgical treatment because of their deephidden location, and are dangerous on account of the ease with which suppuration is induced. In For these reasons L. advises care in the avulsion of the vas, avoidance of traumatism, and the excision of that portion of the vas only which is accessible to the eye. DIFFICULTIES MET WITH IN CATHETERIZATION OF THE MALE URETHRA. A. Kollmann (Chirurgische Beiträge Festschrift für Schmidt, Leipsig, Ed. Besold, 1896) after an exhaustive research in the literature of urethral exploration, agrees with Dittel in nam ing the following as obstacles to the passage of instruments through the urethra: the symphysis, lamina media fasciæ perinei, sinus bulbi, prostatic sinus with the prostatic ring, and the trigonum vesicæ (Lientaudi). Of these, the sinus bulbi is the most important. In addition to these, extreme sensibility of the urethral mucous membrane (spastic stricture) may be met with ; also great width of the bulbous portion, with its multiplicity of folds, and finally those cases in which the distance between the base of the sinus bulbi and the entrance of isthmus is very great. The author attributes less importance to the other folds and pouches formerly described, with the exception of the pouch at the upper wall of the fossa navicularis, together with the lacuna of Morgagni and the mucosa border of Morgagni's crypts of the cavernous portion. The former is often of considerable depth, but the latter can interfere with the passage of nothing but thin elastic instruments. The same holds good in case of the excretory ducts of the acinous mucous glands which, in health, are small microscopic fossa, but under the influence of a gonorrhea may enlarge, but never to sufficient size to arrest a large instrument. K. claims for urethroscopy that it allows of an exact study of the urethral mucous membrane with all its glands, pouches, and fossæ, and that Oberländer, Neelsen, and Finger cleared up by its means those conditions which were matters of conjecture even to recent anatomists. Folds, pouches, and fossæ, others than those mentioned above, are, in the author's experience, exceptional. A case of Grünfeld's is mentioned in which there was found an opening three centimeters deep and eight centimeters from the external orifice, on the posterior urethral wall, leading down to a cavity lined with mucous membrane. Into this cavity instruments as large as fifteen Charrière could be passed. Author has seen a similar case; in the lower urethral wall, just anterior to the bulb, was a blind sac, one and one-half centimeters deep, lined with urethral mucosa, and lying parallel to the long axis of the urethral canal. This allowed of the easy introduction of a No. 23. Such diverticula are to be regarded as congenital, and not as acquired. K. has had the opportunity of observing rudimentary pouch formations which interfered with catheterization, and which were not found described in endoscopic publications. He regards them of congenital origin, and on account of their situation considers them to be places of exit of Cowper's ducts. Henle ob served in cadavers that the ducts of these glands were to be recognized by the accompanying small folds of mucous membrane, and pits or fossæ. In the conclusion of his most interesting paper the author suggests that an urethroscopic examination should be made from the gland to the bulb, and not in the reverse order, as is usually the case. This is important in order to make a complete examination of the urethral mucous membrane, as otherwise the folds mentioned above may be so smoothed over the orifices of the ducts as to conceal them. ELECTRICAL LIGHTING OF THE STOMACH. P. Cornet (Progres Med., '96, xxxvi.) gives a brief résumé of the methods previously used in lighting the stomach for diagnostic His own apparatus is, with slight modification, that purposes. of Einhorn. A hollow esophageal bougie, having a small electric light at its tip, is introduced through the cardiac orifice. The stomach is distended by means of 600-1200 cc. of water at 35° C., and the current turned on. The results are, of course, more satisfactory in persons with thin, rather than those with thick, abdominal walls. The author has used the lamp in seventy cases, in twenty-five of which the results were negative, in fifteen doubtful, and in thirty, of decided importance. In all these cases percussion and auscultation were negative. In addition to diagnosing gastrectasiæ, C. claims to have been able to recognize unpalpable tumors. He concludes his observations as follows: 1. Electric lighting of the stomach in suitable cases allows of prompt recognition of dilatation, and frequently of gastroptosis. 2. It shows the existence of tumors, especially those of the anterior wall, and, in fact, any thickening of that wall. 3. The method admits of considerable improvement. OBSTETRICS. BY CHARLES JEWETT, M.D., SC.D. SIMULTANEOUS OVARIAN AND UTERINE PREGNANCY. H. Ludwig of Chrobak's clinic (Wien. klin. Woch., July 2, 1896) The patient had previously been delivered at term of five healthy children, three of whom were still living. She became pregnant for the sixth time. On February 20, 1896, labor-pains men. came on. In six hours she was delivered of a healthy girl, which presented by the vertex. It was evident that another child remained. Five days later she was admitted into Chrobak's clinic. On examination, a living child could be mapped out in the abdoThe puerperal uterus was about the size of a man's fist, and the appendages on the right side were normal. On the left side a short, thick cord could be felt extending into a tumor which filled the left iliac fossa. Per vaginam this tumor was felt pressing down into Douglas' pouch, and the child's head could be made out in the pelvic excavation. The lochia were normal. Laparotomy was performed. The ovum was found attached to the left side of the uterus, from which the placenta appeared to grow. The vascular relations were so intimate that removal of the sac without the uterus was impracticable. The sac was opened and a healthy, well-developed male child extracted, who cried lustily. An elastic ligature was placed on the uterus at the level of the internal os, and uterus and appendages were removed. The cervical canal was cauterized, and the stump treated extraperitoneally. Recovery was delayed by a right-sided pneumonia, but the mother and child left the hospital well at the end of a month. The right tube and ovary were perfectly normal. The left tube could be distinctly traced into a tuboövarian ligament about half an inch wide The ovarian ligament proper lost itself in the upper part of the sac; from the free end of the tube an ovarian fimbria led into the sac, of which the outer layers appeared to be formed by the remains of the ovary. The sac consisted of two parts, one of which, closely attached to the left side of the uterus, was solid, while the other, situated externally, was membranous, and had contained the ovum. The former consisted mainly of a normal placenta, which received from the uterus two large vessels artery and vein; the latter corresponded in its relations to a greatly enlarged ovary, and showed on its surface a number of cystic protrusions, ovarian follicles. Microscopic examination showed the presence of ovarian tissue covering the whole of the membranous portion of the sac; it contained true ovarian tissue, a large number of follicles, and two corpora fibrosa. The placental tissue was normal in structure. The essential points in the diagnosis of ovarian pregnancy have been stated by Veit as complete presence of both tubes and one ovary, the other either being absent or forming part of the sac wall, while at the same time one ovarian ligament must run into the sac. All these re |