RUPTURE OF UTERUS.-Albers Schönberg (Cent. f. Gynäk.) reports a case of rupture of the uterus on account of congenital displacement of the kidney. The patient had had two previous labors, difficult and tedious, but terminated without instrumental assistance. In her third confinement, when she had been thirteen to fourteen hours in labor, spontaneous rupture of the uterus seems to have taken place, the rent being across the anterior wall of the uterus just above the vagina. The woman was found somewhat collapsed, but the amount of hemorrhage was not great. The head was presenting and in the second position, but the greater part of it was projecting through the rent between the uterus and the vagina. The child was delivered by version, and proved to be a dead female, weighing 3,500 grams. The placenta was manually extracted. The absence of signs of severe internal hemorrhage, with other considerations, encouraged the hope at first that the rent might not involve the peritoneum, and no immediate operative interference was undertaken. On the fifth day stercoraceous vomit and signs of peritonitis led to the performance of abdominal section, but the uterine rent could not be found, because (as was subsequently ascertained) the rent was occluded by coagulated blood and fragments of uterine tissue; peritonitis and adhesions were present. The abdominal incision was then closed, a loop of intestine being fixed in the wound and opened. The patient sank soon after the operation. On post-mortem examination a complete transverse rupture, eight centimeters long, was found in the cervix uteri anteriorly. The left kidney lay in the hollow of the sacrum, with its upper end upon the promontory, and the hilum to the right. The renal artery came off just above the bifurcation of the aorta, and the renal vein entered the vena cava at a corresponding level. The pelvis was flat, with a true conjugate of 9.5 centimeters. The author says that the kidney would prove a more serious obstruction to birth in the second vertex position than in the first, and that the two previous safe deliveries may perhaps have their explanation in this fact.-British Medical Journal.

"LES MORTICOLES."-The soi disant medical or psychological (as the authors generally prefer to call it) novel has a decided vogue just now; the recent and remote effects of syphilis are discussed in present-day fiction with charming frankness, and the medical man takes the place of the priest as a breaker-up of homes happy till his fell shadow darkens their door. Despite this the profession of medicine is still held in honor, and its members are still trusted. It has been reserved for one of that nation which has given to science a Charcot and a Trousseau to hold up an honorable calling to infamy. The author of "Les Morticoles" is, we should say, a would-be member of the craft he disparages, for he exhibits a knowledge of its more salient features quite equal to that of a fourth year's student. He knows all about antiseptics and microbes, chloroform, post-mortem examinations, and ovariotomies-or, to be more correct, oophorectomies-while blood, pus, and ascitic fluid meander through his pages. The book is cast

in the form of a narrative told by a sailor, who, on arriving at Morticolia, enters the service of one medical man after another. With two exceptions they are uniformly vile, brutal, and immoral; one of them, whom his colleagues euphemistically term the "Fléau des Gosses," is a noted gynecologist; he gives a yearly dinner, the "diner des sans ovaries," the invitation cards for which are tied up with rose-colored ribbon and bear the device of an egg, under which is printed "Il est vide." This one extract will give an idea of the delicacy and good taste which characterize the book. To compare small things with great, it reminds the reader of the fourth part of Gulliver's Travels, in respect of which Thackeray says: "It is Yahoo language, tearing down all shreds of modesty, filthy in word, filthy in thought, furious, raging, obscene." That any one who inherits a name so deservedly honored in literature as that of the author of "Les Morticoles" should have written such a work is a matter for regret; that he should have seen fit to villify the members of an honorable profession is rather a subject for indignation.-London Lancet.

De

TUBERCULOUS MENINGITIS.-Dennig (Münch. med. Woch.) discusses the diagnosis of tuberculous meningitis. Besides the cerebral symptoms, heredity, the gradual onset of an apparently harmless indisposition which slowly but steadily increases, and the general symptoms, including rapid loss of flesh and irregular temperature, must be taken into account. partures from the type are very common. A negative ophthalmoscopic examination does not exclude tuberculous meningitis. None of the distinctions from so-called simple meningitis are absolute. The author records an atypical case in a child aged two years and three months, with the necropsy. On admission there was a slight angina. The respiration pulse ratio was disturbed, and signs of pneumonia were present on the right side. Later cerebral symptoms supervened. A pneumococcus meningitis suggested itself. Quincke's lumbar puncture could not be had recourse to during life. After death, however, the fluid drawn off in this way showed, both morphologically and by experiment, numerous tubercle bacilli. Most of the organs were affected with tubercle. In both lungs there was tubercle, but in the left there was also a vicarious emphysema; hence the difference in physical signs noted during life. The absence of basic cerebral symptoms was explained by the slight involvement of the meninges at the base. The author strongly recommends the lumbar puncture and the bacteriological examination of the fluid in such cases.-British Medical Journal.

LAMINECTOMY.-Dundore (Medical News) reports three cases of laminectomy for injury, performed by Biddle and himself. The author holds that though the results of this operation for fracture and dislocation of the vertebræ are very uncertain, it is an imperative duty to practice it unless the patient is actually in a dying condition. The patient is afforded a chance for improvement, with little if any danger of shortening his lease of life,

provided the operation be performed aseptically. The first case was one of persistent paraplegia after partial dislocation of the ninth dorsal vertebra. After an interval of five months laminectomy was performed. The cord was found to be compressed and much congested, but there was no evidence. of laceration. The lamina and spinous processes of the eighth and ninth dorsal vertebræ were cut away, and all the pressure on the cord thus relieved. For the first month after the operation there was very little improvement in the condition of the lower limbs, but subsequently the paralysis gradually disappeared, and nine months later the patient, who was twentyone years of age, walked very well.

In the second case the operation was performed four months after a fracture of the tenth dorsal vertebra, which had resulted in complete loss of sensation and motion below the seat of injury. The cord was found to be completely severed, the divided ends being almost an inch apart. Death followed at the end of a month.

The third patient was operated upon for a fracture of the ninth dorsal vertebra within twenty-four hours of the receipt of the injury. The cord was found to be severely lacerated. The lamina and spinous processes of the eighth, ninth, and tenth vertebræ were cut away. The wound had united by the twelfth day, but the patient never improved, and died three weeks after the operation.-Ibid.

LARVAL FORMS OF DIPHTHERIA.-Heubner (Deut. med. Woch.) speaks of anomalous cases of diphtheria occasionally seen in weakly and ailing children. The child does not present the ordinary manifestations of diphtheria, but symptoms referable to the respiratory or digestive organs, and a less characteristic fever. Then more or less suddenly severe laryngeal stenosis may reveal the nature of the case, but at times the disease is recognized only at the necropsy. The author records an illustrative case in an infant, one year and a half old, admitted with severe rickets and a fracture of the femur of sixteen days' standing. Some four weeks after admission the temperature rose. This was attributed to a nasal catarrh and broncho-pneumonia. The throat appeared healthy. Four days before death hoarseness supervened, and three days later symptoms of laryngeal obstruction, for which intubation was done. Diphtheria serum was then injected. A few hours later tracheotomy was performed, but the child died the next day. The author thinks that probably the diphtheria began in this case with the rise of temperature seventeen days before death. He records another atypical case. The disease was here suspected, and then bacteriologically proved. The child was treated with antitoxin, and recovered. A third case is also reported, in which the disease ran clinically an absolutely latent During life the symptoms pointed to a severe gastric affection. There are two facts to be remembered: (1) The condition of the child before the infection, and (2) the presence of atypical symptoms which are likely to be put down to the original disease. In a foot-note Heubner takes the

course.

opportunity of refusing to accept any responsibility in the views put forward by Hansemann before the Berlin Medical Society concerning a case from his own clinic.-Ibid.

MIDWIVES AND DEATH CERTIFICATES.-On Monday last Mr. Braxton Hicks held an inquest at Battersea upon the body of a male infant, and, upon the facts then before him, made some noteworthy remarks. The child, it appeared, was born on the previous Monday, and had died fortyeight hours later. No medical man attended the mother, but a midwife wrote a certificate that the death of the child was consequent upon exhaustion at birth. This certificate was given to the undertaker, who very properly handed it to the coroner's officer; and as a result of a necropsy it was then discovered that the child had died from pleuro-pneumonia. On the same day the death certificate of another Battersea midwife was in question in a court-this time in a police court-and Mr. Braxton Hicks was himself prosecutor. The facts went to show that the defendant had certified an infant to have been still-born, when as a matter of fact it had lived for eighteen hours, the proceedings being taken under the Registration of Births and Deaths Act. The woman was fined, Mr. Braxton Hicks saying that he would in this particular case be satisfied with the infliction of a moderate penalty. But his words from his coroner's chair in summing up the case we have first referred to sufficiently proved that he did not regard the misdemeanor as a light one. He pointed out in the clearest and simplest manner that to permit such irregularities in death certification to go unnoticed must be an enormous incentive to crime, an opinion we cordially indorse.-London Lancet.

LAENNEC, the discoverer of Laennec auscultation, was, it appears, not only a devout Catholic, but a fervent Royalist, and his practice lay largely among the blue-blooded denizens of the Faubourg Saint-Germain. On the title-page of his Traité de l'Auscultation he places after his name, before any of his academic distinctions or official appointments, the title of "Médecin de S. A. R. Madame la Duchesse de Berry." What Her Royal Highness thought of her physician we do not know; that she was not the most appreciative of patients we know from the somewhat malicious descriptions of Dubois and the other obstetricians in whose hands she had been, which we quoted a little time ago. It is certain that among Laennec's aristocratic patients there was at least one who allowed herself to speak of him with scant respect. In a letter which appears in a book recently published (Les Correspondants de J. Joubert, par P. de Reynal), Madame de Chateaubriand writes as follows, referring to the retirement of the famous physician from Paris: "Our little dry stick of a Laennec has gone to his own part of the country, Quimper; he said good-bye to nobody, but sent his account to every one. I don't think he will come back. I have, however, adopted the plan of keeping wonderfully well, and I have made up my mind to have no

other physician than common sense and no other physic than asses' milk." There speaks the ordinary patient when he does not happen to be ill-especially when the doctor takes the liberty of reminding him about his fees. It should be stated that two years before Laennec had cured Madame de Chateaubriand of a broncho-pneumonia which brought her to the very brink of the grave.-British Medical Journal.

SERUM ANTITOXIN-A PATENT.-The Law Journal, December 15th, contains an article which states that provisional protection under the patent laws has been applied for and granted with relation to the production of the antitoxic serum. . . . It is almost impossible to realize what may be the effect on the use of the serum if it is patented. These great discoveries of men of science have been freely offered to the world to relieve humanity. If they become the subject of a patent right, then the general public is excluded from their advantages. The remedy becomes the privilege of the rich. The poor are denied its benefits. The price may be so high that it would become impossible to use it in hospitals. It is a matter that affects all classes of the community. We believe that the application for a patent has been made by a Frenchman, and that he is finding considerable difficulties on his road. Whether he is successful or not, he has at all events drawn attention to a peculiarity in our law that requires to be remedied. If the discovery had been a new explosive for purposes of warfare the government would have stepped in and purchased. Because a means has been discovered for combating one of the most distressing diseases, the State stands idly by and allows it to take its chance as to whether or not it becomes a patent remedy.-Ibid.

THE MEDICAL STUDENT POPULATION.-An American contemporary announces that “England has but 552 medical students; there are 8,000 in the Germany (sic) universities, but the United States has 13,000. We could loan England a few thousand and have plenty to spare." Figures are generally a strong point with our American cousins, but it is difficult to imagine whence the above inspiration has been drawn. A study of the records of the General Medical Council would have shown that the number of students registered as having commenced their curriculum this year in England alone amounts to 980. In 1893 the number of freshmen in the medical schools of England, Scotland, and Ireland was 1,747, and by adding up the entries of the last four years it is clear that at present there must be over 7,000 students in the medical schools of the United Kingdom. So that we have ourselves a great many students to "loan," and, as with us they have to undergo a five years' curriculum, they might be tempted by the briefer period of study in the great Republic of the West.-Ibid.

ALIMENTARY GLYCOSURIA IN LEAD COLIC.-Brunelle (Arch. Gen. de Méd.) points out that the presence of modified pigments in the urine, the subicteric tint in the conjunctiva, the diminished amount of urea excreted,