HAEMATOMA OF THE OVARY.

Hæmatoma of the ovary occurs in the first half of menstrual life, in the married and the single. The disease tends to be bilateral, and appears not to be associated with gonorrhoea or tubercle, but may be caused by certain forms of septic infection; but more evidence is needed. The onset may be acute, but the pain becomes chronic and is located in the lower abdomen. Menstruation is not affected, though there may be a slight menorrhagia. Dysmenorrhoea may occur. There is marked disorganization of the ovary, converting it into a firm, non-collapsible shell of ovarian tissue of very varying thickness, due mostly to oedema and interstitial extravasation of blood. The contents consist of dark chocolate blood, generally of a viscid character. Broad adhesions to surrounding parts are always present, being an indication of inflammation of a more or less severe nature. The adhesions are more marked where the tumor is thinnest.

The Fallopian tubes more often than not show no gross changes, although primarily it is possible that they may have been inflamed to some slight degree. The relative freedom of the tube is in marked contrast to what obtains in the ovary. Smallwood Savage (British Gynaecological Journal, February, 1906).

THERAPEUTIC NOTE.

THE PROPER STRENGTH OF ADRENALIN SOLUTIONS IN THE TREATMENT OF HAYFEVER.

In the treatment of hay fever with adrenalin chloride, it has been suggested that weak solutions, frequently applied, are apt to yield better results than the occasional application of a strong solution. One of the pathological features of this peculiar malady is a turgescence of the turbinal tissues due to excessive dilation of the capillaries. That this is the result of a neurosis involving more or less pronounced vasomotor paralysis is pretty gener

ally conceded. Overstimulation, by reaction, is very sure to result in a complete paralysis of the vasomotor supply in the region affected. On the other hand, gentle stimulation with weak solutions is not so likely to be followed by reaction.

These views are in harmony with the published observations of Crile, of Cleveland, who found that in a decapitated animal the heart's action was better sustained by the continuous administration of a weak solution of adrenalin chloride. Furthermore, this is probably nature's method of supplying this vital principle to the healthy human body through the agency of the suprarenal gland, its constant presence in the blood in minute amounts being sufficient to maintain vasomotor equilibrium.-Buffalo Medical Journal.

TONGUE-FORCEPS CONDEMNED.

No anesthetist should use tongue-forceps-they are utterly inexcusable. If the tongue drops back into the throat and chokes the patient, elevation of the jaw by placing two fingers under the angle on each side and throwing the head upward and backward therewith, will produce instant relief, unless there be accumulation of mucus in the throat, in which case the head must be turned to one side and a swab introduced to clean out the obstruction. When extensive operation is to be done in either mouth or throat a strong silk thread should be passed through the tongue far back and tied in a huge loop; this will enable the assistant to hold the tongue up out of the way without the serious mutilation which results from the use of forceps on the tongue.-American Journal of Clinical Medicine.

THE ADMINISTRATION OF Drugs for thE CONCURRENT RETARDATION AND STIMULATION OF SYSTEMATIC OXIDATION.

Bernard Oettinger believes that a methemoglobinemia of nontoxic proportions may exist, and hence that this blood condition must not invariably be regarded as deleterious to conservative

metabolism. He shows that good comes to a patient from slight methemoglobinemia, effecting an increased oxidation of a selective character. This is an oxidation through methemoglobin of intermediate products of metabolism, which in diseased conditions accumulate in abnormal amounts in the blood, but which, at the same time, is an oxidation without effect on the normal tissues. Therapy makes use of this blood change to aid in conservation of nutrition. As examples of the drugs used for this perpose the writer cites, among others, amyl nitrite for angina pectoris, and pyridin inhalations in asthmatic attacks. In connection with the foregoing hypothesis the writer advances a second to explain rationally the concomitant use of another class of drugs whose relation to systematic oxidation is opposed to those already mentioned. Quinine, arsenic, phosphorus, iron, and strychnine are used in both acute and chronic diseases. The first three are given individually, under widely different indications. Their concomitant use, the writer believes, is due to the fact that they have in common the property of retarding tissue oxidation. In disease, regressive metabolism is always increased. Against such increased catabolic tissue oxidation the use of a drug which retards oxidation must be valuable. Thus is explained the simultaneous use of drugs to effect concurrent retardation and stimulation of oxidation.-Medical Record.

OBSTETRICAL

TUBERCULOSIS OF THE PLACenta.

Dr. Alfred Scott Warthin, of Ann Arbor, said that only twenty cases of placental tuberculosis had been described so far in the literature, one observer alone reporting half of these, and Dr. Warthin three. Placental tuberculosis he thought to be more common than generally supposed, and it was a fact that tuberculosis could be transmitted through the placenta. The first case he reported was one of ectopic gestation with tuberculosis of the tubes, fetus, and chorionic villi. The second case was met with by him during a study of a series of fifty autopsies of the kidney in the mother with acute miliary tuberculosis at about the fourth or fifth month of pregnancy. Abortion took place and the fetus was discharged. Unmistakable evidences of transmission were offered. The placental tissue he believed to be less resistant to tubercle bacilli than formerly supposed.-Medical Record.

GRAPHIC METHOD OF RECORDING MENSTRUATION, ETC.

The importance of loss of blood from the uterus in the diagnosis of cancer of that organ and the difficulty of getting exact menstrual histories have led De Seigneux (Centralblatt für Gynäkologie, No. 9, 1906) to prepare a chart for the graphic record of all menstrual and inter-menstrual hemorrhages.

The chart, which covers a period of one year, is divided transversely into 365 spaces (one for each day) and longitudinally into four, marked respectively 1-2, 1, 2 and 3. For convenience in reading each five days is separated by a heavier line, and each month by a still heavier. Whenever there is any loss of blood the corresponding day is blacked in to line I if it is a normal menstruel loss, to line 1-2 if it is slight, and to line 2 if abnormally great. A birth or abortion is drawn up to line 3. If there is pain, a cross is put under the corresponding day, and if it is

severe the cross is underlined one or more times according to the severity. A whitish discharge is shown by a horizontal line above the chart.

Such a chart gives complete information as to: (1) The regularity of menstruation; (2) the duration of each period; (3) the length of the interval; (4) the amount of blood lost; (5) the amount, number, and chronology of all atypical hemorrhages; (6) whether the period is accompanied by pain, and on which day these occur; (7) whether there is pain between the periods: (8) the severity of such pains.

Such a chart should be given to each gynecolgic patient at the first visit with instructions to bring it at least once in three months for inspection. As the first symptom of carcinoma uteri is always irregular bleeding, such a chart would give an exact knowledge of such irregularity and arouse the physician's attention in time for the operation to be performed with success.

The author believes that similar charts will some day be in as general use as temperature charts are today, and that women will go every few months to a gynecologist to "see that everything is in order" just as many persons go regularly to the dentist today.-Therapeutic Gazette.