degeneration.

Boyd, in 1900, published forty-one cases of oophorectomy for mammary carcinoma, 37 per cent. clearly showing considerable benefit.

One of the successful cases reported by Abbe was that of a woman 70 years old, showing that while the menopause may have produced atrophic changes in the ovary, its functions had not entirely ceased. C. L. W.

POLITICS IN MEDICINE.

The address of the retiring president of the Denver and Arapahoe County Medical Society, held January 14, and published on page I is such as to commend itself to the perusal of every member of our profession. The topics discussed are not of only local interest although of special importance in Den

ver.

The evils resulting from the influence of politics upon medical men and medical ideas are too apparent for us to cavil at a discussion of them at any and all times. The politician we have with us always. He has a direct interest in making all things bend to his purpose. The control of medical appointments is of course but another element in the growth of his power.

The entry of politics into the management of our public hospitals has always been decried by the leading members of our profession. It is an evil unquestionably, and should be uprooted. Its existence is due to the patience and endurance, even the tacit consent, of the profession at large. Unfortunately

there seems to be no practical method of putting a stop to it.

Until a few years ago politics did not dictate the appointments of physicians to the staff of the Arapahoe County Hospital. When the first changes were made on that account they aroused mingled indignation and approbation. Indignation among the members of the profession generally in that politics was the all influential factor. Indignation among the friends of those not reappointed, because it was a rebuke to the faithfulness of their long service rather than a reward. Approbation from the friends of the new appointees, because the advantages of the hospital were extended over new fields.

As

This subject has been discussed before now in the JOURNAL, and plans suggested which we believe would be for the better interest of all concerned. The evils of political methods in medical appointments are readily understood and are dependent upon the indifference and inertness of those of the medical profession not immediately concerned and the selfishness of those whose interests are more directly at stake. already mentioned, when the changes were first made on political grounds indignation was aroused, but no fitting rebuke was given. The same condition has existed at each successive appointment of the staff. Those who held positions have been very active to bring political influences to bear to secure their reappointment. Those who were on the outside were just as energetic in pulling wires to secure the plums for themselves. We have not heard of any

resignations from the staff caused by the political character of the changes made, nor have we heard that any of those reappointed, at any time, were considering any such step as an expression of their righteous indignation. Great is virtue, but still greater is personal preferment.

Oophorectomy for Carcinoma.

Abbe, in the Medical Record for December 14, 1901, reports several cases in which he performed oophorectomy for recurrent carcinoma of the breast.

Case 1. Single woman, 42 years old, menstruating. Was operated on eighteen months ago by Dr. H. C. Cole for malignant mammary carcinoma. Two months later she presented herself with a recurrent and another malignant growth in the opposite breast about the size of a hen's egg. The recurrence around the scar consisted of about a hundred small nodules covering an area four by seven inches; the central part formed a mass in a solid cake, which was attached to the ribs and involved the pleura, with evident recurrence within the pleura.

There was a pleural effusion rising to the level of the fourth rib. The infraclavicular glands on the operated

side were involved, and on the opposite side a large chain of glands extending from the breast to the axilla.

No operation was done upon the recurrent disease, but on March 4th of the first year both ovaries were removed, there was a quick convalescence, and in one week slight changes were noted in the nodules near the old mammary scar.

In two weeks most of the nodules were becoming pale and flattened, the flattening resembling umbilication, in some a ring of hard tissue remained. In four weeks almost all the nodules had disappeared and the tumor in the opposite breast was becoming smaller. At eight weeks, when the patient was shown to the Practitioners' Society, every vestige of cancer that could be felt had gone and the invaded tissue showed atrophy. The fluid and dullness, however, remained.

The disappearance of the cancer re

currence was in every instance in the order in which the nodules had consecutively appeared. The last to disappear was the axillary glands on the side not operated upon.

The patient was next seen in midsummer four and one-half months after oophorectomy. She seemed perfectly well and no trace or recurrence of the carcinoma could be observed. The fluid level in the chest seemed an inch lower, but an examination was not convincing.

The patient was not seen again until three months later, October, 1901, when it was found that she had aphonia and a little hacking cough from pleural extension. She did not look as well and had lost weight.

Palpation of the atrophied spots representing the original nodules of recurrence showed a little thickening of some, but at least two-thirds of the recurrent nodules had permanently disappeared. The opposite breast, from which the tumor entirely disappeared, showed enlargement and a diffuse fibroid thickening, without pain or nodules. The patient had taken thyroid after operation, but had taken none during the two preceding months. She was advised to renew this. Since

then there has been no material change

in her condition.

It is presumed that in the cases reported by Dr. Abbe the diagnosis of malignant disease was made after careful pathological examination.

In view of the increasing mortality from carcinoma and our inability to successfully treat it either medicinally or surgically, Dr. Abbe's paper is im

portant and worthy the consideration of every surgeon. Dr. Dennis believes that after six months duration carcinoma is not to be cured by surgical intervention.

Ointments and other medicinal agents can be relegated to the quacks and nostrum mongers so far as their curative value is concerned.

The operation of oophorectomy for malignant disease, while still in an experimental stage, may possibly offer a measure of relief by inhibiting the growth of the malignant tumor if not absolutely arresting it.

We have long known that the removal of the ovaries will produce an atrophy of the mammary gland. Their influence on the general and nervous. system is also well known.

Dr. Abbe reported that in two cases where he removed the ovaries and not the breast tumor because of the extensive involvement of the latter, there had been a slow but progressive retro

grade change in both cancer tumors and the glands.

This subject is exceedingly important and the value of Beatson's operation can only be demonstrated after a more general application of its prin

ciples in mammary carcinoma.

Tubo-Ovarian Disease.

The above is the title of a paper recently contributed to American Medicine by Dr. Farnand Henrotin of Chicago.

The following is quoted:

I. Diseases Involving the Tubes.— Salpingotomy and tubal resection is a

most undesirable operation and only the most formally expressed desire for offspring on the part of the patient, after explanation of the uncertainty of results, will warrant their perform

ance.

Pyosalpinx always demands exsection and any tube materially damaged by any disease should be removed in its entirety.

II.

Ovarian Disease.-All diseases of the ovaries adjudged to be nonmalignant can be cured and should be treated by resection of the diseased portions only. Recent ovarian abscess can be cured more quickly, more certainly and with less danger by vaginal incision, when this is practicable.

When the abscess is of long standing the sack should be removed, but even then some healthy ovarian tissue can almost invariably be preserved.

III. Chronic Composite Disease.— In most diseases of a composite nature in young women, when the tubes and ovaries are materially and equally involved, salpingectomy, with ovarian resection, is the most satisfactory operation, the uterus being retained.

Dr. Henrotin's paper is a valuable contribution to recent gynecological literature.

In view of the author's prominence and success as a surgeon, his conservative views regarding the treatment of uterine and pelvic disease leaves little. for discussion, but should carry material for thought to the "ultra-radical."

Caesarian Section for Placenta Praevia.

Gustave Zinke is quoted in the

Medical Review of Reviews: He cites various opinions for and against the operation and gives a tabulated record of all Cæsarian sections and Porro operations made for placenta prævia from 1891 up to the present time.

In the analysis of eighty-one cases given in his table two cases are rejected from consideration where the fatal results to mother and child cannot be rightly charged to the operation itself, one having been performed under unfavorable circumstances, the other performed as a last resort when instrumental delivery and manual interference had failed.

Admitting these two cases, four of the six operated were Cæsarian section, and two Porro hysterectomy. Of the six mothers, five lived and all the children were born alive.

The author quotes a maternal mortality of 17 per cent. and a fetal of nil in the treatment of placenta praevia by the aid of the Cæsarian and Porro operations.

Zinke also quotes statistics of the mortality of placenta prævia under all treatments and of the mortality of the Cæsarian section and Porro operations for all indications. He summarizes an average mortality for the Cæsarian operation of 4.14 per cent. for the mother and 13 per cent. for the child, and for the Porro operation an average mortality of 37.89 per cent. for the mother and 22.2 per cent. for the child.

The author believes that Cæsarian section and Porro operations are perfectly legitimate and elective procedures in all cases of placenta praevia,

central and complete, and especially so when the patient is a primipara, when the os is closed and the cervix unabridged, when hemorrhage is profuse and cannot be controlled by tampons and separation of the placenta around the internal os is difficult or impossible.

Vesical Hæmorrhage During Labor. Dr. George A. Brown, in the Montreal Medical Journal, reports the following case of vesical hemorrhage during labor: Mrs. A. B., aged 46, multipara, has had eleven children; after each labor has had some complication, usually post-partum hemorrhage. Wednesday evening, December 5, patient had a fall. Thursday she complained of pain in left hip, which did not prevent her from sleeping. At 6 p. m. the following morning she awoke with pain in her bladder and a desire to urinate, but was unable to do so.

At times she had a bearing down sensation which gradually developed into labor pains.

On seeing her she was catheterized and half a pint of bloody urine drawn off, which on microscopical examination contained nothing but blood. At 2 p. m. he was again called as the membranes had ruptured and the pain in her bladder and desire to urinate had returned.

She was again catheterized and more bloody urine drawn off. On making An external examination the child was found in the fourth position (dorsopost.) with head in upper zone and the eech presenting.

During the afternoon the pains were irregular and the patient complained of the peculiar tearing character, as if her bladder was being draged out of her. After the pain became regular there was no progress as the pressure of the breech came on the anterior vaginal wall. He then decided to keep her in the knee chest position until the external os dilated.

After dilitation of the os the child was extracted in the usual way.

December 8 patient was catheterized and a half pint of dark, bloody urine drawn off.

December 9, patient not being able to pass urine, she was again catheterized and a pint of bloody urine drawn off. She was then given urotropin grm. ss. t. i. d. The bladder symptoms finally disappeared.

Floating Kidney.

Watson of Boston is quoted in the American Journal of Surgery and Gynecology. He maintains that abnormally loose kidney is not of minor importance, as contended by some recent writers, especially with women.

While he admits that wandering kidney is often present in neurasthenic women, he strongly believes that in such cases it is often the direct cause and not merely an accompaniment of the neurasthenia.

He says that movable kidney sometimes results in much more serious consequences than the production of neurasthenic symptoms. These are: I. Hydro- and Pyo-nephrosis. 2. Fixation in an abnormal position of a previously movable kidney. 3. In a few rare in