ovaries and the Fallopian tubes were both normal. The appendix being found diseased, was removed, and the uterus curetted. The patient made an uneventful recovery and left the hospital in two weeks. The vaginal discharge, however, soon recurred, and an opening was found communicating with what seemed to be the right rudimentary cervix uteri. The opening was enlarged to the right of the left cervical opening, considerable pus was found, and the cavity packed. The discharge ceased and the patient was up and around in one week.- Medical Record.

ORIGIN OF OBLIQUE AND TRANSVERSE POSITIONS.

(Fritz Kermauner, Centralblatt fuer Gynaekologie, No. 34.) An oblique position was observed by the author in a nineteenyear-old primipara. The pelvis was somewhat generally contracted, and the head lay on the left ileum. The patient was placed on her left side during labor in the hopes of correcting the position, but without any effect. An internal examination was then made, and it was found that the entire pelvis was filled with a fairly tense cystic tumor about the size of a child's head. The membranes were unruptured and the os was dilated to a degree sufficient to allow two fingers to pass. This tumor was immediately suspected as being the filled bladder. Upon catheterization 900 cc. of urine was drawn, whereupon the tumor immediately disappeared and the head entered the pelvic inlet. He mentions the fact that transverse positions in primipara with a full term child are rare and usually the causes of the same are obstructions preventing the presenting part from entering the pelvis, as tumors, contracted pelves, and in very rare cases placenta prævia. The fact that the bladder remained in the pelvis after being so tensely filled with urine makes this case interesting, for we know, although the bladder is a pelvic organ, it rises out of the pelvis when greatly filled. Strange, too, is the fact that on the second day of the puerperium the bladder at one time contained 500 cc. of urine, and still it was not to be felt above the pelvic inlet. Medical Fortnightly.

MALIGNANCY IN UTERINE MYOMATA.

Some authors describe a form of malignant degeneration in myomata, whose starting-point is the muscle cells. It is called leiomyoma malignum and described as being distinguishable from sarcoma of the uterus. H. F. Lewis (Am. Jour. Obstet., Oct. 1905) considers it unprofitable to try to distinguish malignant diseases of the mesoblastic type in the uterus as malignant myoma and as sarcoma. The dividing line is vague, the same tumor, in parts not widely distant, may show varying proportions of young muscle cells, spindle cells, large round cells, small cells, and polynuclear cells. All of these tumors are malignant, in that they tend to recur, to grow rapidly, to become necrotic, and to form metastases. They are consequently all sarcomata. A fibromyoma of the uterus is composed of smooth muscle fiber, differing but slightly from that of the uterine wall, and of connective tissue bundles, a true myoma existing only at the earliest stages of the growth. The tumors, composed mostly of muscle tissue, are more prone to malignancy than those chiefly made up of connective tissue. Williams recognizes a myoma sarcomatodes, springing from the muscle cells of a fibromyomatous tumor, and a myosarcoma, a mixture of myomatous and sarcomatous cells, due to sarcomatous changes in the connective tissue elements. Weir would add a third class, resulting from changes in the connective tissue of the uterine wall, without previous existence of any myomatous tumor. The writer would add a fourth class, a sarcoma arising in the connective tissue of the endometrium of body and cervix, the majority of uterine sarcomata being of this variety. The signs of sarcomatous change in a fibromyoma of the uterus are sudden rapid growth and softening, casting off of necrotic tissue (if the growth is submucous) and early cachexia. Carcinoma is a more frequent accompaniment of fibromyoma than sarcoma, although an etiological sequence can be more frequently traced in fibromyoma and sarcoma than in fibromyoma and carcinoma. It has been found that malignant disease is a rarer form of complication of fibroids in the cervix than in the body of the uterus. Inasmuch as the signs and symptoms of the presence of malignant disease are not quickly

distinctive, the writer believes that every fibroid of the uterus should be operated upon as soon as the diagnosis is made, except small ones in cases in which the patient can be examined at frequent intervals.- Medical News.

THE ETIOLOGY OF ECLAMPSIA.

Liepmann publishes the results of a very extensive series of animal experiments undertaken with eclamptic placentas. The material was minced, dried, finely powdered, and injected peritoneally into rabbits. As a result of these observations the author comes to the conclusion that the placenta in eclampsia contains a poison not present in the normal structure. This poison is apparently the toxin of the disease, for the more of it the organism has absorbed, as shown by a large number of convulsions, the less of it is to be found in the placenta. On the other hand, the placenta is richer in poison the less of it has entered the maternal circulation. Apparently the chorionic epithelium plays an important part in the formation of this poison, and the placenta therefore appears to be both the site of formation and of distribution of the toxin. The toxin shows a pronounced affinity for the cerebral cells, which are paralyzed by its action and neutralize it. In addition, the poison injures the renal parenchyma, but the liver substance may also be attacked, with the formation of necrotic foci. The injury to the kidney is always a secondary consequence of the poisoning, and if albuminuria already exists it may be markedly increased by the toxin. Both theoretical and practical considerations lead to the conclusion that the best treatment for eclampsia consists in emptying the uterus as promptly as possible, for the expectant plans have given much less satisfactory results. Venesection and intravenous infusion of salt solution are valuable adjuvants, but sudorific treatment by hot packs is directly injurious. In coma or with superficial respiration artificial respiration is of great value; chloroform and narcotics should be used as sparingly as possible. The best results were obtained by chloral hydrate given in 3-grain doses per rectum.- Medical Record.

ECTOPIC PREGNANCY, COMPLICATED BY DOUBLE INTRALIGAMENTARY

CYST.

Dr. A. M. Judd reported an interesting case he had this summer of an ectopic pregnancy of two months' history. When he opened the abdomen he found as a complication a double intraligamentous cyst. The physical examination previous to operation revealed what was thought to be a big mass of clotted blood behind the peritoneum, lifting up the intestines. He found something that was considerably more difficult to remove when he got inside. There was nothing especially interesting about the history of the ectopic.

There was a considerable loss of blood. Each cyst held at least 16 ounces. The cyst on the right side was, after puncture and allowing escape of contents, stripped out after incising the anterior layer of the broad ligament. The left could not be so removed, but was removed by a triangular incision with the base at the upper side of the broad ligament and stripping out portions of cyst wall remaining, tying vessels as they were cut.- Brooklyn Medical Journal.

THE RETROVERTED UTERUS.

This subject is discussed briefly by Stoner (American Medicine, Nov. 10, 1905), who considers the Alexander operation ideal in those cases which are free from complications. When adhesions of the uterus or disease of the adnexa exist the abdomen should be opened. By suspension of the uterus to the abdominal wall the organ is left in an unnatural position, but the clinical results are exceptionally good. The Mann operation for shortening the round ligaments deserves the highest credit. By this means the ligaments are made of treble strength and are less liable to subsequent elongation, but it does not wholly correct the pathologic condition. The author has applied the procedure of Mann to the uterosacral ligaments, doubling them upon themselves and whipping them together with silk or chromatized gut. The operation is very difficult or even impossible to perform when adhesions have destroyed the outlines of the ligaments.

When adhesions are not present these ligaments are plainly brought into view by pulling the fundus of the uterus strongly forward. Therapeutic Gazette.

INFLUENCe of menSTRUATION ON THE GENERAL ORGANISM.

Tobler of Florence has been investigating the local and general disturbances and the influence of menstruation on the physical and mental capacity, extending his research to 1,020 women. His summary states that the menstrual period in the women of our day is generally a time of more or less physical depression and languor. This is not as Nature intended nor is it necessary. It is the result of modern modes of life, and of a less vigorous constitution. The products of metabolism are increased in amount at this time by the periodical excitation from the genital system, but instead of being systematically utilized to the profit of the body, they accumulate and have a toxic action. Many women do not experience this menstrual physical depression at first, but it gradually comes on them later, showing its acquired character. Other women never experience any physical depression or languor at this time. Still others find it a period of exalted vital energy and exhiliration. This latter is the theoretical ideal, and, he thinks, is probably what Nature intended for the period in which a new living being can be formed and developed. -Jour. A. M. A.