GLYCOSURIA AND ALBUMINURIA, SIGNIFICANCE OF SLIGHT.

The writer thinks it may be said that the presence of albumin in any appreciable amount in the urine is not normal or physiological, but that it does not necessarily imply that the existing disturbance of function is permanent or progressive. At the same time, it cannot be denied that a certain number of cases which at first are rightly placed in the above category, do later on show signs of definite organic kidney disease.

The presence of sugar in the urine in any appreciable quantity is abnormal, and in the young it is of serious import, and if persistent, it is likely to lead on to diabetes. In people past middle life, and especially in those of gouty type, it is of less consequence and usually yields to treatment more or less speedily, to recur, however, in some cases, under conditions similar to those under which it first appeared.

The presence of both albumin and of sugar in the urine indicates serious disturbance in the metabolic processes, calling for relief to the nervous strain which the patient may have been undergoing, and an adjustment as far as can be of his environment, but under favorable conditions these patients may continue in at least fair average health for many years. R. W. Burnet (Britism Medical Journal, January 20, 1906).—Monthly Encyclopedia.

Dr. T. L. McDermott, of Louisville, Ky., writing, says the best results from Sanmetto in his hands were obtained in sub-acute gonorrhea and gleet, in which the results in many cases were very marked, and for this exasperating ailment sufficiently rapid to encourage the patient to continue the treatment. He says that this in itself is of no small measure of praise, for all physicians are aware of the fugitive nature of these patients, their lengthened chronicity, and the painstaking attention necessary to efffect a cure. He says that he has seen excellent results from Sanmetto in many cases of nocturnal enuresis, cystic catarrh, and other functional diseases of the bladder; however, its general use by the profession speaks loudest of its efficiency in these cases.

OBSTETRICAL

A NEW OPERATION FOR COMPLETE PROLAPSE AFTER THE

MENOPAUSE.

T. Landau proposes the following procedure to relieve prolapse in patients who have passed the menopause, other operations having proved unsatisfactory in his experience. There are nine stages: First, the usual disinfection and drawing forward of the prolapsed uterus as far as possible. Second, a long incision in the anterior wall of the vagina beginning close under the urethra and extending to within two or three cm. of the os uteri. Third, detach the vaginal walls after incising the anterior lip of the cervix, and separate the bladder from the uterus. Fourth, open the vesico-uterine pouch of the peritoneum and antevert the uterus. Fifth, pick up a fold of the peritoneum of the posterior cul-desac and by means of a silkworm gut suture which is passed through the posterior surface of the uterus as well as the peritoneum of the cul-de-sac and the wound in the anterior vagina, the cul-de-sac is obliterated and the uterus is turned forward into the vagina. Tying the suture closes the peritoneal cavity and fixes the posterior wall of the uterus and the cervix. Sixth and seventh, remove the adnexa and the greater part of the body of the uterus, using a longitudinal incision and leaving behind a portion of the posterior wall of the cervix; also resect the superfluous tissue in the anterior walls of the vagina. Eighth, close the anterior vaginal wound and the remains of the uterus with sutures. Ninth, perform a high colpoperineorrhaphy. The operation lengthens the vagina, fixes the posterior portion, aided by the remains of the uterus, and, with the support afforded by the strengthened pelvic floor prevents prolapse of the abdominal contents. There are no difficulties in the technique, according to Landau, and he considers the operation less serious than total excision of the uterus.-Boston Medical and Surgical Journal.

GYNECOLOGICAL EXAMINATIONS BY A NEW METHOD.

There is a certain class of gynecological cases in which for various reasons a bimanual examination may be rendered difficult or impossible, and very often it is necessary to anesthetize the patient before a satisfactory diagnosis can be made. This method of procedure is of course open to many objections, and aside from the natural tendency to avoid narcosis unless an absolute necessity for the same exists, anesthesia suppresses a symptom of great diagnostic importance, namely, localized pain. Thus a pa tient may refer her pains to the ovarian region, and when on examination under ether an enlarged ovary is found, the trouble is naturally attributed to this source, although in fact it may be due to a lesion in the pelvic cellular tissue or the peritoneum. The exact site could have been elicited only when the patient was entirely conscious and able to respond to the touch of the examining finger; during anesthesia no such distinction could be drawn. A mutilating operation of greater or less extent may even be done without producing any relief from the original disturbances. To obviate these shortcomings in gynecological methods of examination, Profanter (Wiener klinische Wochenschrift, No. 6, 1905). suggests a novel procedure which he has found eminently satisfactory. This requires the patient to assume a half-reclining position in a bathtub filled with warm water. It is found that the tense abdominal muscles are immediately relaxed, and as soon as the water is permitted to enter the vagina the latter is distended and readily permits the introduction of the examining finger. Another beneficial effect of the bath method consists in the disappearance of all local sensitiveness, so that the necessary manipulations can be done without causing pain or producing resist ance. Under ordinary circumstances the method may be objected to by the patient as entailing an undue amount of exposure, and by the physician as being productive of considerable discomfort in its execution, but the writer promises a suitable apparatus at an early date in which these sources of objection will be entirely overcome.-Medical Record.

UNUSUAL CASES OF TUBAL PREGNANCY.

Dixon cites two cases. The first patient, a multipara, menstruated regularly from May, 1902, till September, 1904, which period she missed. On September 14, she noticed a slight flow of blood which commenced with a severe pain lasting a few hours, starting in the region of the rectum and extending toward the stomach, accompanied by nausea. Eight days later she had a similar attack, only more severe. Two days later the pain was general over the abdominal cavity. There was muscular rigidity over the right inguinal region, flatness on percussion and some soreness. Vaginal examination showed a large swelling, soft and painful on the right side, extending posteriorly. September 26 the patient had another attack of pain, more severe than the preceding ones, but of some character and location. She had been removed to the hospital the day before operation, and a few hours later the cavity was full of blood, the bleeding being from the right tube. Recovery was uninterrupted.

She menstruated regularly until May 22, 1905, when she had an attack of pain, paroxysmal in character, in the left side. She had none of the usual symptoms of pregnancy. A flow had existed since April 13. Examination showed a large swelling in the left pelvic region, pointing downward, painful and soft, with the uterus slightly enlarged. Operation showed rupture of the left tube, which was removed. Recovery was uninterrupted. In the case of the second patient the right tube was the one involved. In 15 cases seen by Dixon the pregnancy was always on the right side, except in the one in which there was a secondary pregnancy on the left side. In most of these cases there was rigidity of the muscles over the site of the trouble, which Dixon thinks is a point worth noting, because the absence of the rigidity usually is given as a differential sign between tubal pregnancy and appendicitis.-The Journal.

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COMMENCEMENT EXERCISES OF THE MEDICAL DEPARTMENT OF VANDERBILT UNIVERSITY.

The annual commencement occasion of the Medical Department of Vanderbilt University took place in the well-appointed auditorium of the college building on the evening of May 1. A large audience of the friends and well wishers of the graduates taxed the seating capacity of the hall to its utmost, and the interesting exercises were greatly enjoyed, as manifested by the enthusiasm and applause of those present. The stage was occupied by the members of the faculty, and excellent music was discoursed in the intervals of the program. Floral decorations in profusion beautified the audience hall, and bouquets in the greatest number for the graduates attested the admiration and congratulations of their friends. The exercises were opened by an appropriate prayer by Rev. F. F. Reese of Christ Church, who, in an eloquent manner, invoke the blessings of the Supreme Being upon those about to be initiated into the mysteries and the hardships of the practitioner's life.

Prof. W. H. Witt was then introduced as the member of the faculty chosen to represent that body, and he delivered an address replete with excellent advice and good counsel to the class. This address appears in another part of this issue, and we commend it to our readers as a most admirable and appropriate effort. The special address of the evening was that delivered by Dr. Richard Douglas, formerly a prominent member of the fac