patients were now submitted to operation the average duration of life was another 104 days; so that the average life from onset of symptoms was about one year. Patients went, therefore, first to the surgeon when three-fourths of their space of life had already run out. After gastro-enterostomy the average existence was 193 days, a prolongation of about three months. After gastrectomy they lived 420 days, a lengthening of life of about fourteen months. Of the gastroenterostomy cases nine were still living, and of the gastrec tomy thirteen. Of these one was healthy in the eighth year after operation, one in the fourth year, two in the third, three in the second, and six in the first. As recurrence took place late in carcinoma of the stomach, freedom from disease for three years could not be accepted as a permanent recovery. The figures showed at least that surgery offered some improvement on the hopeless outlook of internal treatment only. It not only prolonged life, but rendered it more bearable. This was especially the case in gastrectomy, which rendered even a radical cure possible. The speaker concluded with the wish that the operation, like that of extirpation of the vermiform appendix, might become more popular, not only with the surgeon, but also with the public. With early operations. even better results might be obtained.

The Indication for the Surgical Treatment of Cholelithiasis. A. A. Berg (Med. Record, vol. 61, no. 18), from observations. personally made, states his conclusions as follows:

a. Indications for medical treatment: Cholecystitic pain or attacks of biliary colic, in either case unattended with fever.

b. Indications for surgical treatment: (1) Operations of choice-undertaken in the quiescent period; with the object of avoiding serious complications; a simple procedure and followed by 2 to 3 per cent. mortality. (a) Severe cholecystitic pain, or oft-repeated uncomplicated attacks of biliary colic; persisting in spite of medical treatment. In virtue of which symptoms the patient becomes invalided, and incapacitated for work. (b) After the first attack of acute cholecystitis, associated with fever. (2) Compulsory operations-undertaken at any time of the day or night; often amidst unfavor

able surroundings, and in patients who are septic, emaciated, and of low vitality. Difficult and laborious procedures, and attended with high mortality-50 to 75 per cent. (a) Foudroyant and intensely acute attacks of cholecystitis. (This may be the first indication of calculous disease, but usually follows previous milder attacks.) (b) Hydrops, empyema, gangrene, or perforation of the gall bladder, cholemia, abscess of the liver, and diffuse peritonitis.

Albuminous Expectoration Following Thoracocentesis.

D. Riesman (Amer. Jour. Med. Sc. vol. 123, no. 4) says: 1. Albuminous expectoration is a very rare complication of thoracocentesis. It is usually serious and sometimes fatal.

2. It consists in the expectoration of a viscid albuminous fluid closely resembling the fluid of serous effusion.

3. The condition is best explained on the basis of an intense congestion and edema of the lungs (congestion by recoil).

4. The principal cause seems to be either too rapid or too great a withdrawal of fluid.

5. Serious cardiac disease and morbid conditions of the opposite lung, hindering expansion, are predisposing causes.

6. Under all circumstances, but particularly when these complications exist, aspiration should be performed slowly. If the effusion is large the amount withdrawn at any one time should be moderate.

7. In some cases it may be wise to perform several tappings, drawing off a small quantity each time.

8. The treatment consists in counter-irritation, venesection, and artificial respiration, together with the use of morphine if the cough is severe.

Carcinoma of Penis.

At the Vienna "Gesellschaft fer Aerzte," Englisch (Cor. Med. Press & Cir., vol. 73, no. 3288) read a lengthy communication on cancer of the penis. In the protocols of Vienna for the years 1892 to 1898 inclusive, there were 540,539 patients treated; 12,607 suffered from carcinoma, 81 of whom were suffering from carcinoma of the penis (1.78 per cent.). In the literature of the subject he found 528 cases, 12 of which were

minutely described. The disease appears between fifty-one and sixty years of age. The origin usually assigned was slight inflammation of the foreskin, frenulum, or glans. Congenital phymosis was noted in only 29 per cent. of the cases, which fact was opposed to the view of this being one of the factors in the etiology of the disease.

The induration is usually preceded by edema, hypertrophy, extraordinary swelling, or, what is more frequently the case, tubercles in the form of warts or papillomata. The usual period of development is twelve to fifteen months.

The early symptoms are local, such as frequent micturition, burning in the urethra, particularly near the orifice, with sometimes a little discharge, then the glans become swollen when the external phenomena commence. These premonitory symptoms last about eighteen months. The glands of the inguinal canal, in front of the symphysis, pubis and bladder are usually enlarged. Metastases in the internal organs are very rare.

The rational treatment is amputation either with the knife or galvano-cautery, at the same time removing all enlarged gland within easy reach. Out of 465 cases operated on, 438 recovered completely (94.19 per cent.), while 5.8 per cent. went from bad to worse.

OPHTHALMOLOGY.

UNDER CHARGE OF A. G. SINCLAIR, M.D.

Professor of Ophthalmology, Otology and Laryngology, Memphis Hospital Medical College; Ophthalmic, Aural and Laryngeal Surgeon to St. Joseph's Hospital; Ophthalmic and Aural Surgeon to the City Hospital.

On Compression and Ligation of the Common Carotid Artery in the Treatment of Pulsating Ophthalmos.

Rascalon (Recueil d'Ophthalmologie) reviews the observations. of Lefort regarding the treatment of pulsating exophthalmos. Of seven cases not treated, two became better, two grew worse and three died, one of the deaths occurring from hemorrhage after operation for a supposedly malignant tumor. Of thirtyseven cases treated by compression, there was a complete cure in three cases, an incomplete cure in six, and sudden death in one case, while there was not any result in the remainder.

The author reports the following cases:

1. A 60-year-old married woman sustained a severe fall, leading to a fracture of the base of the skull, as demonstrated by hemorrhage from the left ear and nostril. There were violent cephalalgia and a roaring sound in the head. No abnormality was noted in the eyes for five days. On the sixth day edema of the right eyelids appeared, followed by an exophthalmos of a phlegmonous nature, associated with a considerable induration of the tissues and violent orbital pain. There was not any pulsation or bruit. On the twenty-third day pulsation, with thrill, but without any bruit, appeared, and could be noticed at the inner angle of the upper eyelid. Ocular compression was employed for a period of nine months, causing the disappearance of the exophthalmos, but not affecting the pulsation. There was a partial paralysis of the ocular muscles, with probable ocular atrophy, judging from the complete blindness.

The author believes the orbital swelling was due to an infection from the nasal fossa. The optic atrophy, he thinks, was the result of strangulation of the optic nerve by compression, and that the ophthalmoplegia depended upon either a contemporaneous effect of the accident or vascular distension. He hopes for a spontaneous cure, or perhaps as the result of the therapy that has been applied.

2. A 44-year-old female showed evidences of pulsating exophthalmos associated with Basedow's disease. Her family history was negative. Twenty-two years previously she developed the typical symptoms of Basedow's disease. In August, 1899, she fell, striking her head, left shoulder and side. She immediately developed a right exophthalmos, with loss of vision of the right eye. In eight days' time vision equaled one-sixth of normal, and there was a slight ptosis. There was a moderate amaurosis, the cornea was clear, the pupil was slightly dilated, and the iris was immobile. The ophthalmoscope showed that the media were transparent, the retinal arteries were slightly swollen, and the temporal side of the dise was somewhat pallid. The left eye was normal.

Ten days later the exophthalmos increased. There was ptosis. The cornea was hazy. There was a slight iritis. The

media were hazy, and a view of the fundus was impossible. The patient complained of a sensation like a continued hammering in the right side of the head. Exploratory puncture and palpation gave negative results.

Two days after this there was a distant pulsation of the eyeball, with marked exophthalmos and bruit.

Ten days later it was noticed that the globe could be made to assume a normal position, and the pulsation and bruit stopped by compression on the common carotid artery.

In three months' time it was found that all of the symptoms were diminished. At this time it was noted that a compress bandage had been applied from the first.

Under constant compression until July of the following year, all pulsation had disappeared, a very slight souffle could be heard with the stethoscope, and the exophthalmos had nearly gone. Vision equaled the ability to see to count fingers at two and a half meters distance.

NOSE, THROAT AND EAR.

UNDER CHARGE OF RICHMOND MCKINNEY, M.D., MEMPHIS. Laryngologist to East End Dispensary; Laryngologist to Presbyterian Hospital.

Chorea Pharyngis, with Perceptible Objective Ear Noises.

V. Pick (Monat. f. Ohrenheilkunde, vol. 36, no. 4) reports a case of a cabinetmaker 40 years of age, a Russian Pole, ill nourished, with an appearance of highly developed neurasthenia, who presented himself complaining of long enduring and unbearable noises noticed particularly in the evening, heard in the ears. Besides he complained of dryness of the

throat.

Examination and test of his organs of hearing revealed nothing other than a diffused cloudiness of both drum membranes. Only on auscultation with a stethoscope was there heard a tolerably loud, persistent sound resembling the beating of a loud sounding watch that repeated itself in irregular intervals up to one hundred times to the minute. This was caused by an apparent choreic and clonic twitching of the entire muscalature of the pharynx, by which the soft palate