CASE OF OVARIAN TERATOMA.--Glockner (Centralbl. f. Gynäk., Leipzig, 1901, No. 37) publishes a report on a case where he removed an ovarian teratoma in which there was a large amount of nervous tissue. Hair, teeth, bones were all found, and in addition skin which, under the microscope, showed sebaceous and sweat glands, and also nerve tissues. In this, gray matter predominated; pyramidal ganglion cells were present, and a central canal lined by cylindrical epithelium. The ganglion cells resembled those found in the spinal gangliæ, while others were arranged in a similar manner to the sympathetic ganglia connected with the posterior roots of the spinal cord. Embryonic eye tissues were also found, such as choroidal pigment and cells resembling the granular layer of the retina.-Ibid.

THE SURGICAL TREATMENT OF RETROVERSION OF THE UTERUS.Huiet (Gynecologie, Paris, August, 1901), considers this condition chiefly from the intra-abdominal method of shortening the round ligaments. He considers that such a procedure is preferable to ventro-fixation, and further that the intra-abdominal method is better than that designated as the Alexander-Adams operation, as, by the former method, adhesions and pathological changes in the appendages can be seen and dealt with; and further, as the strongest portion of the round ligament, which is found nearest to the uterus, can be employed for fixation purposes. This holds specially true in the Doléri operation, where the round ligament is passed through a slit in the peritoneum muscle and fascia of the anterior abdominal wall and fixed to those and to the other round ligament, which has been treated similarly. Huiet considers that the operation should not be performed under the following conditions: (1) Where the retroversion causes no symptoms; (2) where the retroversion can be corrected by use of a pessary; (3) where the condition can be rectified by proper massage; (4) retroversion complicated by prolapse of the pelvic visceræ. Labor and pregnancy, in the author's opinion, are less frequently interfered with by shortening the round ligaments than by ventro- or vaginal fixation.-Ibid.

SUTURE IN FRACTURE OF THE PATELLA-Barker (Archiv. für klin. Chirurgie, Band lxiii., Heft 4), after describing in detail the technique of his well-known method of subcutaneous suture, states that he has performed this operation twenty-one times. With the exception of one case, which died of delirium tremens on the seventh day after the operation, the results were perfect, the patients regaining the full use of their legs.-The American Journal Medical Sciences.

DISCUSSION UPON SPINAL ANESTHESIA.-Hendrix (Jour. de Chir. et Annales de la Soc. Belge de Chir., No. 7, 1901) states that Bier, the discoverer of this method of anesthesia, has stated that he considers it more dangerous than chloroform, disapproves of the enthusiasm with which it has been received, and that it should never be employed without full knowledge of those modifications which have been found to be indispensable.-Ibid.

A CLINICAL LECTURE ON IDIOPATHIC DILATATION OF THE ESOPHAGUS.-Swain (British Medical Journal, November 16, 1901) states that dilatation of the esophagus which exists without any obvious mechanical obstruction is a rare condition. The author reports the case of a woman aged twenty-six years, who complained of difficulty in swallowing and a sensation of choking, followed by vomiting, especially at night. There was difficulty in swallowing and considerable pain in the chest, which, however, was relieved by vomiting. Examination showed that a tube could be easily passed into the stomach. After washing out the stomach through the tube and then withdrawing it about eight inches, undigested food could be washed out of the esophagus. The reaction of the fluid removed from the stomach was acid, while that from the esophagus was neutral. Treatment has not proved very satisfactory-electricity, tonics, and feeding with the stomach-tube have given no relief. A comparative degree of comfort only has been obtained by the ingestion of soft foods and the systematic lavage of the dilated esophagus. The question of gastrostomy has been considered, but has not been thought advisable as long as the patient is keeping up her nutrition.-Edinburg Medical Journal.

OPERATION FOR EPITYPHLITIS IN THE FREE INTERVAL; ENTEROANASTOMOSIS.-Martin (Centralblatt für Chirurgie, September 28, 1901) states that Jaffe recommended entero-anastomosis as the best operation in the free interval for those rare cases of epityphlitis in which it is impossible either to find the appendix or to remove it. Jaffe reports two such cases, in each of which he resected the cecum, but both developed a fecal fistula, while in another case he performed entero-anastomosis after a long and fruitless search for the appendix, but the case died of peritonitis. As a result of this experience Jaffe has since stated that he believes enteroanastomosis to be an operation of no value in this type of cases. The author reports the case of a man who had had repeated attacks of epityphlitis during three years, the attacks recurring at shorter intervals, with finally the formation of a tumor in the ileocecal region, severe pain, and other symptoms of intestinal obstruction. As a result the patient was incapacitated from his work, and operative interference was decided upon. On operation it was found that the ileum was bound down to the cecum with old tight adhesions, and as a result it was impossible to find the appendix so, the ileum was then anastomosed with the colon and the wound closed. The patient made an uninterrupted recovery except for attacks of slight pain in the ileocecal region. Although it is impossible to draw results from one case, still this case shows that in those cases of relapsing epityphlitis, operated on in the free interval, where the appendix can not be found except by a prolonged search, or even then not at all, it is much better to perform entero-anastomosis at once than to endanger the patient's life by a perhaps fruitless search for the appendix.—The American Journal Medical Sciences.

EMULSION-ALBUMINURIA.-Cramer (München. Med Wchnschr., January 21, 1902) had already met with two cases of milky urine, passed shortly before death from puerperal eclampsia, in which the milky appearance arose not from any admixture of fat associated with chyluria and lipuria, but due to some proteid substance in an unusual physical state. Last year a third case fell under his observation, similar in most points except for the fact that it was not of puerperal origin. Here again, shortly before death, the urine voided was milky. Neither warming, nor addition of acid, nor filtration, removed the milky appearance of the urine. Innumerable globules of the most minute size could be detected under high powers of the microscope. When water was added to excess, a few drops of acetic acid or of liquor potassæ reduced the milky condition to one of opalescence only. Heating the mixture hastened this change; water added to great excess produced the same result. On boiling, a copious precipitate was obtained, with disappearance of the opacity. Ether extracted no fat; osmic acid failed to give any indication of fat. Artificial peptic digestion cleared the urine; HCl alone did not. Independently of the milkiness, uric acid crystals separated out in considerable number. After heating with one per cent HCI for one hour, a crystalline deposit was obtained, which was identified as allantoin on analytical investigation. According to the author, no other instance of milky urine due to native proteids, similar in nature to the three observed by him, is to be found in medical literature.

[Byrom Bramwell and Noël Paton gave details of a case in which a copious precipitate of some variety of globulin in crystalline form was present in the urine; the urine, however, was not milky.-Rep. Lab. Roy. Coll. Phys., Edin., Vol. V.—A. L. G.]—Edinburg Medical Journal.

THE SURGICAL TREATMENT OF AFFECTIONS OF THE PANCREAS.— Recent events have excited so much renewal of interest in diseases of the pancreas that the symposium of the New York State Medical Association on this subject has more than a local interest.

Whatever may be the eventual outcome, there is but little question at present that surgery alone can be expected to afford relief to the more severe affections. The contribution of Dr. Roswell Park, therefore, is especially timely and deserves a wide distribution. The methods of operating are stated by him with sufficient clearness and thoroughness, although the conditions to be operated upon evidently are debatable. The value of the dictum "when in doubt, operate" depends altogether upon the doubter, and it can easily be admitted that so experienced a surgeon as Dr. Park would be justified in undertaking an operation which should be regarded as unwarranted if performed by a tyro.

The importance of a thorough exploration of the region of the pancreas in severe injuries of the upper abdomen, especially from penetrating wounds, is sufficiently obvious, and is not likely to be neglected. The negative results of exploration are not to be too confidently depended

upon, since the situation of the organ and its relation to surrounding parts are such that slight injuries may be overlooked or disregarded.

Experience, however, shows that apparently slight injuries to the pancreas may be followed by the most disastrous consequences. Temporary drainage does not add materially to the risks, and may be the means of securing the best possible effect from surgical treatment.

When acute pancreatitis or omental bursitis results from injury or from other causes, there can be no question of the propriety of surgical treatment. Although recovery from acute pancreatitis may take place without operation, the course in such cases is relatively mild, and there are usually no urgent symptoms seeming to demand surgical interference. The grave manifestations call for treatment by the surgeon, whatever may be known or unknown as to their causation. No more striking illustration of the truth of the latter statement can be offered than the noteworthy communication of Dr. J. W. Mayo, which shows that success may follow the surgical treatment of necrotic pancreatitis and disseminated fat-necrosis-critical as was the condition at the time of the operation.

We can but express our satisfaction with Dr. Park's article as a whole, and have no doubt it will warmly be welcomed by the surgeon and lead to more active interference in possible or probable disease of the pancreas than has hitherto been undertaken. Not the least benefit to be derived from the repetition of such operations will be the acquisition of greater accuracy in diagnosis and prognosis, which, when attained, will permit the elimination of the unnecessary from the necessary efforts by removing the doubt from the mind of the operator.-Boston Medical and Surgical Journal.

THE LYMPHATIC GLANDS IN CANCER.-Covdray (Revue prat. a’Obstetrique et de Gynecologie, No. 9, 1901) concludes an extended paper on this subject by expressing doubt as to the advisability of extirpating glands which are apparently healthy, the cancerous growth being in an incipient stage. Glands which are enlarged and non-adherent should always be removed; if adherent, their ablation is usually fraught with danger to the patient. Theoretically, exposure of the open lymphatics favors fresh infection; but practically there is as yet no method of operation which avoids this danger.

The writer suggests what he calls the "sclerogenous" method, which aims at closure of the lymphatics in the neighborhood of the tumor by making numerous injections of chloride of zinc around the growth. He reports a case of scirrhus of the breast in a woman, aged fifty-eight years, five years after treatment by this method. Nothing remained of the original growth but a small, hard nodule. Five years later the cancer had recurred, with enlargement of the axillary gland. He infers that in a certain class of cases the growth of circumscribed cancer can be arrested for a long period by the artificial production of fibrous tissue around the growth, which causes obliteration of the lymphatics. This treatment is especially applicable to patients who refuse a radical operation.-The American Journal Medical Sciences.

FOURTH TRIAL OF A SUIT FOR DAMAGES. The fourth trial of the suit brought by Miss Helen Ward against St. Vincent's Hospital, to recover 30,000 damages for injuries alleged to have been received by improper treatment at the hospital, resulted on March 21st in a verdict in her favor for $19,420, which includes an allowance for counsel's fees. It will perhaps be remembered that Miss Ward, who is a sister-in-law of ex-Judge Henry E. Howland, had an operation performed on one of her legs while she was a private patient at the hospital, and that after the operation a nurse carelessly allowed a hot-water bag to remain in contact with the limb, in consequence of which, it was claimed, permanent injury had resulted. the first trial of the suit the case was dismissed; the second resulted in a disagreement of the jury; and on the third trial she secured a verdict for $10,000. The case was then appealed, and the Appellate Division reversed the judgment on the ground that the hospital was not bound to provide a patient, even though a private one, with its best nurse, and ordered a new trial. Boston Medical and Surgical Journal.

VAGINAL PUNCTURE AND INCISION.-K. Franz has studied eighty-one cases in which vaginal puncture was done in Fehling's clinic, in thirty-five of which an incision was also made. The clinical diagnosis was confirmed by puncture fifty-six times; in five a doubtful diagnosis was decided, and in ten the diagnosis was changed. Puncture is of special value for differential diagnosis of tubal tumors in Douglas' pouch, whether inflammatory, following tubal pregnancy, or from pelvic peritonitis. Incision gives its best results in uncomplicated abscesses in Douglas' cul-de-sac. It is contraindicated for hematocele. In this the healing is no more rapid than without operation, and there is always a great chance of infection.American Journal of Obstetrics.

MAYDL'S OPERATION FOR EXTROVERSION OF THE BLADDER.-Pendl demonstrated a successful case of the above to the Medical Society of Vienna. The patient was a boy, aged seven. The bladder was freed after securing the ureters by the introduction of a fine catheter into each, and was excised, saving only a portion 1.5 cm. long and 5 mm. broad, which included the openings of the ureters. The peritoneal cavity was then opened at the upper angle of the wound, and the sigmoid flexure exposed and incised longitudinally. The portion of bladder, including the ureters, was stitched into the opening, the sutured area being largely extra-peritoneal. At first the urine escaped continuously per rectum; after two months there was continence for three or four hours. Frank reported that the patient demonstrated to the Society two years before, on whom a similar operation had been performed, was in the best of health, and was continent for five or six hours. The available statistics show that Maydl's operation has been successful in 87.5 per cent of the total cases, a result which should dispel the fear of an ascending infection of the ureters and kidneys.- Wien klin. Wchnschr.