the opening in the median line. These finally closed and the patient left the hospital weighing more than when he entered, and now feels as strong as ever. The Murphy button was found in the rectum on the twentyfourth day and removed. In closing the author gives a list of thirty-five cases in which the length of the resected portion of intestine varies from forty inches in the first case to twelve feet two inches in the last.-The Journal of the American Medical Sciences.

A NEW METHOD OF EXTRACTING FOREIGN BODIES FROM THE EAR.— There is no more delicate and even difficult task, so states the Medical Press, than the extraction of a foreign body from the external auditory canal. Irrigation often fails to bring it away, and in certain cases adds to the difficulty by causing the object, a pea for instance, to swell and become more firmly impacted. The employment of instruments is very painful, and requires considerable dexterity, besides supposing an armamentarium specially designed for the purpose, which few general practitioners possess. The recommendation is made of a piece of soft rubber tube, the length of a cigarette, and of the proper size, to be introduced into the ear. The end of the tube is dipped in paraffin and pushed into the canal until it comes in contact with the foreign body, whereon the operator, applying his mouth to the free end, aspirates forcibly, at the same time throwing back his head. Except in cases of angular bodies of irregular contour this method is usually attended by success, the body coming away with the tube.-Journal American Medical Association.

ANESTHETICS.-The fatal cases of anesthesia are classified by Miller under the following heads: I. Those where the anesthesia was blamed because no other cause of death was recognized. These are only of interest because of their frequency. 2. Cases in which the effect of the anesthetic on organs already diseased hastened the inevitable fatal termination. This mortality can be diminished by careful preliminary examination and preparation of the patients, and by attention to the selection of the particular anesthetic to be employed. Instead of sticking to ether in every case, we have at our disposal cocaine, which has an indefinitely wide field of usefulness, nitrous oxide with practically no mortality for brief operations, and sometimes longer ones, and chloroform, which may be safer in certain conditions, as in the young and very old, kidney and lung disease, diabetes, in the obese, in dyspnea from any cause, narrowing of the larynx, and in operations about the brain and mouth. The combination of oxygen with ether or chloroform may save patients who can not otherwise undergo the anesthetic. In the third class, where deaths are due to improper administration or overdose of anesthetics, the difficulty is twofold, and consist of inappreciation of the potency of the agents employed, and in a lack of understanding between surgeon and anesthetist. Medical schools slight the subject, hospitals pay little attention to it, in private prac

tice anesthetics are daily administered by those who have no experience and have not studied or interested themselves in the subject. Bungling administration, overloading the lungs with the anesthetic at any one time. are responsible for some of these cases. The anesthetist should have a thorough knowledge of the physiologic action of drugs, and there should be no misunderstanding as to the immediate responsibility. He is in a better position to observe the general condition of the patient than the operator, and should have chief consideration in this respect.-Ibid.

A CASE OF GESTATION AND LABOR AT FULL TERM IN UTERUS DIDELPHYS. (By Dr. J. H. E. Brock, Lancet, November 15th.) The author reports the case of a woman, aged thirty-five years, who had been attended by him ten years previously at the birth of her first child. When first seen at that time, labor had so far progressed that the head of the child was nearing the outlet of the pelvis, and vaginal examination revealed nothing abnormal. Labor progressed normally and uneventfully, as did the puerperium, the child being a well-formed girl. Six months later, having occasion to make a vaginal examination because of a complaint of difficult coitus, it was found that the patient had a complete double uterus (uterus didelphys), the vulva and vagina being divided by a median septum. In each vagina there was a complete cervix, and on passing a sound the body of the uterus was found to be also double. The septum was removed by operation. Nine years later the patient again became pregnant, and was again delivered at term of a normal infant. The pregnancy took place in the left horn of the uterus, the non-pregnant horn being rotated anteriorly and rising up out of the pelvis.-New York Medical Journal.

TECHNIC PROSTATECTOMY.-The method described by Bryson is the perineal one, in which, after the introduction of the staff, he makes a free median incision in such a way as to open the urethra just in front of the apex of the prostate. The forefinger is introduced and the staff withdrawn. Guided by the finger a blunt instrument is passed into the urethra and made to puncture, from the urethral side, the lowermost part of the mass. The puncture is always made in the lower posterior quadrant, and the instrument pushed well into the swelling. The finger follows, tearing its way in the opening through the capsule and loosening the lobe as far as its attachmeht to the urethra from which it is detached, care being taken not to take away too much of the sides nor any of the roof of the urethra. The hypertrophied lateral lobe is then removed. The process is repeated on the opposite side, after which a median posterior segment sometimes remains to be dealt with, which can easily be excochleated. Usually the finger can be then passed into the bladder, which is explored. The cavity is irrigated with a hot salt solution and a loose flap of mucous membrane found that can be made to occlude the vesical vault. Care should be taken not to push this back into the bladder when a large drainage tube is intro

duced and the cavity packed with gauze. This technic is modified to some extent according to the size of the prostate, as the incision must be made to correspond. In some later cases he has done a preliminary epicystotomy for drainage and for the treatment of the bladder and kidneys, and he thinks it is best, when this is to be done, to make it a preliminary operation.— Journal American Medical Association.

THE HEART IN PNEUMONIA.-The importance of an examination of the condition of the heart in pneumonia is insisted on by Wainwright, who describes the mechanism of dilatation and failure of the right heart in this disease. Its hypertrophy may be an important factor in producing pneumonia and other pulmonary diseases. He calls attention to one especially valuable physical sign, the pulmonic element of the second sound of the heart, which is underestimated by the profession. In young children this element is accentuated, and at the middle period of life the pulmonic and aortic are about equal in intensity, while in old age the aortic element becomes accentuated under normal conditions. In pneumonia, this wellpronounced accentuated second pulmonic sound becomes a safe guide for the administration of cardiac stimulants and aids in making an intelligent prognosis. A diminution of intensity of this sound is a confession of failure of the right heart, and should be a signal for the use of digitalis, alcohol, and other cardiac stimulants. The rapid and weak pulse is not so reliable. He speaks in regard to the use of digitalis, that when not indicated it is a pernicious drug, but when it is really indicated nothing is better. In the discussion following, Professor Andrew H. Smith takes a somewhat different view as regards the use of digitalis, holding that it has often done more harm than good. Its use is pernicious except when there is arrhythmia, indicating heart failure; then it may be of use to steady it. -Ibid.

ONE THOUSAND One HundrED CATARACT EXTRACTIONS.-—(Dr. A. G. Archangelsky, Roussky Vratch, October 12th.) The patients operated on by the author included 552 males and 401 females, the first operation having been performed in 1887. The ages varied, but in 92 per cent of cases the cataracts were operated on in old people, and in 8 per cent in young children. The patient was prepared for the operation in each case by an enema and a general bath on the previous day. The eyelids, brows, etc., were scrubbed carefully with soap, then irrigated with sterile salt solution; the rest of the head was wrapped in sterile gauze, or towels, and the eye was cocainized. In 80 per cent of cases the operation consisted in the peripheral linear extraction of Von Graefe, the incision varying in size. The iridectomies were always made broad, as experience showed this to be of great advantage in facilitating the steps of the operation. The incision in the lens capsule was also wide. The lens was delivered by means of Critchett's loop, or by means of massage of the cornea from below upward by Daniel's spoon. The wound was then irrigated with salt solution and

the eye was dressed with sterile gauze, cotton, and bandages. In 114 cases the author made extractions without iridectomy, but experience showed that unless the cases were carefully selected for this operation there followed prolapse of the iris with all its consequences. Therefore she now operates in this manner only when the active reaction of the eye to light shows that the iris is sufficiently elastic to retract after the extraction, and when the cataract is thin, fluid, with a small nucleus. In 12 per cent of the extractions she noted prolapse of the vitreous body. In some cases this is productive of no harm, i. e., when the eye is otherwise normal, but if there is also glaucoma, masked by the cataract, then the vitreous begins to ooze out before the eyes of the operator, and this is followed by hemorrhage of the central artery, which destroys vision then and there. This occurrence is not the fault of the operator's technics, but we must be careful to diagnosticate the presence of glaucoma before the operation, if possible, which is not always the case in senile cataracts complicated with glaucoma. In three cases the lens disappeared into the vitreous body. This is a rare and disagreeable complication, the origin of which probably lies in technical errors. As a rule, the patients were allowed to rise on the second day and to walk about the room, the dressing being changed daily. The rooms were not kept darkened, and the dressing was done in full daylight. The patient was discharged on the tenth day, the bandage having been finally removed on the ninth. Complications were observed in 29.5 per cent, and included the greatest variety of accidents, including deaths from external causes. In 2 per cent there was glaucoma as a complication, in 10 per cent there was iritis, and in 2.8 per cent infection of the wound.-New York Medical Journal.

INTERNATIONAL MEDICAL CONGRESS AT MADRID.-It is believed that a considerable number of American physicians will attend the Fourteenth International Medical Congress to be held in Madrid, April 23-30, 1903. As all those who wish to attend the congress have a common objective point, it is thought that they can be associated to advantage in one or more excursion parties. In this way the social features of the trip will be enhanced, and each individual will be surrounded by those who are personally congenial. By such association better accommodations can be secured and at a considerable reduction in price. Additional security will also be attained, as parts of the trip which include comparatively unfrequented routes of travel, will be under the charge of a traveling conductor who is thoroughly conversant with the language and customs of the countries visited. As there will doubtless be some divergence as to choice of routes, depending on individual inclination and previous opportunities of foreign travel, several returning routes have been selected, the itineraries of which, although separate from a portion of the journey, have been arranged that the principal points are visited together. The party will sail from New York City on April 11th, on the twin ocean steamer "Princess Irene," North German Lloyd, direct to Gibraltar. Tickets for the round trip,

including hotel and sight-seeing, $265, $375, and $550, according to the tour selected. It is important that all who contemplate taking this trip should register at once, so that reservations for hotel in Madrid may be satisfactorily arranged. Final arrangements will be in the hands of the well-known conductors, Thos. Cook & Sons, which insures perfect and complete service in all details. Full information and copies of itinerary may be obtained by addressing either of the last-named undersigned. W. W. Keen, Walter Wyman, Nicholas Senn, C. A. L. Reed, Howard A. Kelly, A. Vanderveer, Jno. B. Murphy, Joseph Mathews, Robt. T. Morris, Lucien Howe, Chas. H. Hughes, W. F. Southard, Ramon Guiteras, 75 W. 55th St., New York City; Chas. Wood Fassett, Krug Park Place, St. Joseph, Mo.

MEDICAL SOCIETY OF THE MISSOURI VALLEY.-The spring meeting of this Association will be held in Council Bluffs, Iowa, on Thursday and Friday, March 19 and 20. The membership of this Society includes the representative men of Iowa, Nebraska, Missouri, Kansas, North and South Dakota, and the meetings are always interesting and profitable to those who attend. A feature of the first day's session will be a symposium on Syphilis, and on the second day a symposium on Typhoid Fever will be presented. The following papers have been promised:

Hereditary Syphilis, R. C. Moore, Omaha, Neb.; Syphilitic Immunity, or Second Infection, A. C. Stokes, Omaha, Neb.; Syphilis as Affecting the Nervous System, F. E. Coulter, Omaha, Neb.; Congenital Syphilis in the Newborn and Young Infants, Mary Strong, Omaha, Neb.; Affections of the Eye due to Syphilis, W. B. Lemere, Omaha, Neb.; Treatment for Relief of Nasal Reflexes, with Report of Cases, F. W. Dean, Council Bluffs, Iowa; A Study of a Case of Dual Personality, S. Grover Burnett, Kansas City, Mo.; Embryology, Histology, and Pathology of the Eye (illustrated), Flavel B. Tiffany, Kansas City, Mo.; Report of Uses of X-Ray in Chronic Eczema, Acne, Cancer, etc., W. L. Kenney, St. Joseph, Mo.; The Psychologic Factor in Medicine and Its Application to Nervous Diseases, John Punton, Kansas City, Mo.; A Few Cases of Loss of Cornea from Neglected Dacryocystitis, D. C. Bryant, Omaha, Neb.; Orthopedic Surgery, Bloodless, Non-bloodless, and Mechanical, Jas. W. Cokenower, Des Moines, Iowa; Some Cases of Cured Appendicitis, Harry H. Everett, Lincoln, Neb.; Diagnosis of Diastolic Heart Sound, LeRoy Crummer, Omaha, Neb.; Insanity and Tuberculosis Following Typhoid, and Report of Two Unusual Cases, F. E. Walker, Worthington, Minn.; Diseases Simulated by Typhoid Fever, D. T. Martin, Pomeroy, Iowa; Diphtheria, O. C. Kessler, Ravenwood, Mo. Regular program will be issued March 1st. Titles should be sent to the secretary not later than February 15th, as the program is limited to twenty-five papers. A cordial invitation is extended to the profession.

J. M. BARSTOW, Council Bluffs, Iowa, President. CHAS. WOOD FASSETT, St. Joseph, Mo., Secretary.