at their point of opening into the intervillous spaces, and with necrosis of the material decidua and hemorrhage into its tissue. The changes in the terminal openings of the maternal arteries are laceration of the vessel walls and thromboses. Rupture from its surroundings, inflammatory changes, and pressure from ingrowing villi are amongst the causes of necrosis of the decidua. Infarcts are most frequent where the blood stream is slowest, or where the conditions are most favorable for separation of the placenta, necrosis of the decidua and venous thrombosis. Hence the frequency of marginal infarcts. The infarcts are closely related to, and generally lie with their broader base upon, the arterial terminations. The growth of large cells is a secondary phenomenon, is most pronounced about the margin of an infarct, and is more active when the infarct is of long standing. Fetal endarteritis is also regarded as a secondary result of infarction.

INTERSTITIAL (TUBO-UTERINE) GESTATION. Steffeck (Centralbl. f. Gynäk.) reports a case where, after the period had been missed for six weeks, severe abdominal pains with symptoms of internal hemorrhage set in. There was no tumor in Douglas's pouch, but a crackling sensation was noted when pressure was made in its direction. The uterus was of the size of the second month, and a soft prominence could be felt on its right side. Abdominal section was performed, and the peritoneal cavity was found to contain much free blood; the intestine adhered firmly to the back of the uterus. On separating the adhesions, free bleeding occurred from the ruptured fundus. The uterus was amputated at the cervix, and the patient made a good recovery. A two-months fetus lay in a cavity in the uterine wall on the right side supericrly; the tube was intact.

TUBERCULOUS MENINGITIS AFTER SOUNDING OF UTERUS.

The sound, like every other appliance necessary for clinical research, must be used with caution. It may perforate the uterus or pass up the canal of one tube, a subject which has occasionally come under notice in our columns. That it may transfer septic and specific germs from one patient to another there can be no doubt. It is not only the gonococcus, streptococcus, and staphylococcus which may be introduced into a healthy uterine cavity and cause local disease. In a case recently reported by Henkel (report of a meeting of the Gesellschaft für Geburtshilfe und Gynäkolgie zu Berlin, Zentralbl.

f. Gynäk.) a girl, aged twenty who had never menstruated was admitted into the Berlin University Clinique. She suffered from regular monthly pains in the sacral region without any show of blood. The sound had been repeatedly used, never with success. Stenosis of the os internum, retroflexion, and hematometra were suspected. A thorough examination was conducted under an anesthetic, an attack of very acute tuberculous cerebro-spinal meningitis followed and proved fatal. The uterus was found retroverted; its fundus contained a mass of calcified tubercle; the sound appears to have reached it, making a false passage. Besides other local lesions there was tuberculous disease of the left fallopian tube. The general diffusion of tubercle was quite recent and appeared undoubtedly due to local injury from the sound.

LABOR OBSTRUCTED BY A CYSTIC TUMOR.

M. Haagen (Dept, med. Woch.) reports the history of a woman, aged thirty, who had her first baby on December, 1896. On examining her, he found that the posterior vaginal wall was pushed forward by a large tumor. With some difficulty, an anæsthetic having been administered, he succeeded in passing the finger past the tumor, and found that the vertex of the fetus was presented. The tumor appeared to be of about the size of a fetal head, was densely hard, and did not reveal any fluctuation. Before having any recourse to abdominal section an attempt was made to decrease the size of the growth, and, on puncturing it a quantity of fluid escaped .An incision of about 234 inches was made into the tumor, which proved to be multilocular and through this incision the finger was passed and the septa broken down. Some 34 litre of dark brown, turbid, odorless fluid was evacuated. As the pains did not come after waiting for three hours, Haagen applied the forceps and delivered a full-time child, which however, was deeply asphyxiated, and could not be resuscitated. The perineum was ruptured to the second degree. This was sutured. The lying-in was complicated with fever, post-partum hemorrhage, suppuration of the cavity of the cyst, retention of urine, and general weakness, and the patient was not well for three months. In the beginning of 1899 she again consulted Haagen, and he found that there was a truncated hypertrophy of the cervix, with deep tears on each side of it. Retroversion and flexion of the uterus, and non-union of the perineal rupture. The cervix was therefore amputated, and colporrhaphy, anterior and posterior, and Alexander-Adams's operation were performed by Professor Winter.

She became pregnant in the following year, and on October 6, 1900, the pains set in. On arriving Haagan found that the waters had already escaped, the fundus reached a hand's breadth above the umbilicus, and the fetal head could be felt above the pubes. She was probably in the seventh month of pregnancy. On examination per vaginam a tumor of the same size and in the same position as at the first labor was felt. This time it was not so hard. With difficulty he succeeded, without anæsthetizing the patient, in palpating the external opening in the uterus. This opening was round, of about the size of a sixpenny bit, and felt densely hard and fibrous. The head could be felt through the opening.

As the patient was in good condition he delayed interference for a time, but on the morning of the 8th, as the patient's temperature was rising, and the os was not dilating, and as no fetal movements could be felt and no fetal heart sounds heard, he punctured the cyst and let out about 1⁄2 litre of fluid. Two vaginal specula were then introduced and as the os had not enlarged from the size mentioned, he made three small incisions into the fibrous tissue without causing any hemorrhage. The labor did not progress, and he therefore perforated the fetal head and delivered by means of the cranioclast. The mother did well.

Haagen points out the importance of making an exploratory puncture into a vaginal tumor which is obstructing labor, even if it feels densely hard, before proceeding to operate.

REPEATED TUBAL PREGNANCIES.

Cohn (Zentralbl. f. Gynak.) gives a short but clear report of two clearly authentic cases of that condition In the first a fetus 31⁄2 inches long was found in the peritoneum; its placenta lay in the ampulla of the left tube, which bore a laceration big enough to admit a finger; the funis hung out of it. It was reported that the right appendages were normal. Four years later a second operation was performed for ruptured tube; the fetus, 234 inches long, had been expelled with its placenta through a rent in the ampulla of the right tube. In the second case a fetal sac in the left tube was removed; it was noticed at the time that the right appendages were bound down by adhesions from which they were set free. One year and a-half later the patient underwent abdominal section for internal hemorrhage with rise of temperature. An incomplete tubal abortion was discovered. The patient made a good recovery.

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