Golfram's, in which a lympho-sarcoma of the upper lobe of the lung was found, are interesting, and since Weigert's work a considerable proportion of autopsies have shown conditions similar or analogous to the conditions described by him.

Anther condition apparently closely related is that of exophthalmic goitre or Basedow's disease. Nine cases of myasthenia reported by Kalischer, Goldfram, Karplus, Charcot and Marinesco, Murri, Hey, and Finzio presented symptoms of Basedow's disease more or less pronounced (exophthalmia or goitre or both).

On the relation between Addison's disease and Basedow's disease Gowers states that an affection of the abdominal sympathetic, similar to the constant affection of the cervical sympathetic, would explain the pigmentation, and the occasional watery diarrhea seems also to show that the abdominal nerves are sometimes involved.

The heart action in all conditions is seemingly increased in rate and in exopthalmic goitre the volume is increased; in myasthenia little affected, sometimes increased, while in Addison's it is almost constantly lowered.

The foremost symptom, myasthenia, which in itself would presuppose an electrical myasthenic reaction as described by Jolly, may under the light of future investigation prove to be an expression of disease of the ductless glands, or their sympathetic communications, and with the association of the ocular, or more particularly the palpebral symptoms, the character of circulatory disturbance, the presence or degree of pigmentation, with the gastrointestinal symptoms, we may definitely localize the seat of such disturbance.

In closing there may be added to these observations two queries: Has the languor or fatigue so frequently observed in chronic Bright's disease an explanation in the sympathetic communication of the renal plexus? and, may not the asphyxia which so often closes the scene in these cases as in the diseases under discussion be as likely due to this association as to uremia.

REFERENCES

1. Philips, Journ. Experimental Medicine, Vol. iv., p. 581.

2. Hun, Albany Medical Annals, 1904, Jan., p. 51.

3. Oppenheim, Die Myesthenische Paralyse, Berlin, S. Karger, p. 114. 4. Kalischer, Zeitschrift fur Klinische Med., 1896, Bd. xxxi., p. 93. 5. Goldfrom, Deutsche Zeitschr. f. Nervenheilkunde, 1893, Bd. iv., p. 332.

6. Neurologisches Centralblatt, 1902, Bd. xxi., p. 97.

7. Karplus, Jahrbuch fur Psychiatrie u. Neurologie, 1897, Bd. xv., p. 330.

8. Charcot and Marinesco, Comptes Rondes Hebdomaire, 1895, p. 131. 9. Murri, Il Policlinico, 1895, Vol. fi., pp. 441, 458.

10.

Hey, Muenchener Med. Wochenschr., 1903, Bd. i, p. 1867.

11. Finizio, La Riforma Medica, 1898, No. 1, xiv., 589.

12. Gowers, Diseases of the Nervous System, 2nd Ed., Vol. ii., p. 890.

A SUPPLEMENTARY REPORT.

By R. C. COFFEY, M.D.

Portland, Oregon

In the January number of THE DENVER MEDICAL TIMES an article of mine was published under the title, "Surgical Treatment of Displacements of the Uterus," in which was described an operation which I have been using for nearly three years. I have had an opportunity to see its results in a case which is reported below. On Aug. 9th, 1904, I operated upon Mrs. X. for extreme retroflexion and partial prolapse of the uterus. A certain amount of salpingitis and oophoritis existed, accompanied by some adhesions. The round ligaments were completely stretched, much attenuated, and temporarily paralyzed as far as action was concerned, the broad ligament also relaxed. Condition had existed seven years. Operation: Removed cystic portion of left ovary and enucleated a cyst from the right; tubes while inflamed were not disturbed; the operation here described for shortening the round and broad ligaments was performed, also amputation of cervix and perineorrahaphy. Patient went home, but soon began to notice pain in her left side, and considerable soreness was experienced in the pelvis. March 31st, 1905, nearly seven months

after the first operation, she returned. Examination showed tumor on right side in ovarian region. On opening the abdomen, a cyst was found in the right ovary the size of an orange. The left tube was markedly inflamed, and was covered in by omentum and intestines which had formed a wall around the inflamed tube back of the uterus. The folds of the broad ligament which had been plicated had blended absolutely, making a broad ligament as smooth as a normal broad ligament, and had blended with the uterine peritoneum exactly as sutured at the time of the operation. There were no inflammatory adhesions at the site of suturing of the broad ligaments. The uterus was held in place more firmly than by a normal broad ligament, but was freely movable. The round ligament had apparently straightened itself out as soon as the catgut had absorbed, had assumed its normal position and had regained its normal size. The result in this case as far as the support was concerned was better than my most sanguine anticipations, in fact, was perfect. The case proved to my mind more thoroughly than I have ever been able to prove in any other way the propositions which I have been trying to demonstrate:

First "The peritoneum is the universal suspensory support of the abdominal and pelvic organs."

Second-"Two peritoneal surfaces brought together firmly and held together in an aseptic state will blend and become as one.” Third-"The connective tissue or outer side of the peritoneum cannot by any known means be made to permanently adhere to a muscle, connective tissue redeveloping and loosening it from its moorings as soon as the agent holding it is removed."

Fourth-"The muscular ligaments of the uterus act exactly as muscles in other parts of the anatomy, namely,—to contract and produce motion, and will under no circumstances bear any considerable weight constantly."

According to my friend, Dr. S. C. Baldwin, the well-known orthopedist of Salt Lake City, a muscle which has been overstretched for a long time becomes temporarily paralyzed and useless. If the tension is removed, it shortens to its normal length and regains its normal power. In discussing this paper, Dr. Baldwin believed this to be the case with this operation. I scarcely thought it possible until I saw that it did actually occur in this

case. Apparently as soon as the catgut holding it was absorbed, the weight of the uterus being held by the folded and blended peritoneum, the round ligament began its contraction and soon straightened itself out in the connective tissue under the peritoneum, and at the same time regained its normal size and appearance.

THE TREATMENT OF GASTRO-INTESTINAL
DISEASES IN CHILDREN.

By D. T. QUIGLEY, M.D.

North Platte, Neb.

The gastro-intestinal diseases of children under six months of age are almost invariably associated with the presence of pathogenic bacteria, and the disease process usually depends on the production of toxins due to putrefactive and fermentative changes in the contents of the canal; toxins are absorbed and cause the fever, depression, etc. There is another condition which is always present in greater or less degree, and may be overlooked; that is an inflammation existing in the mucous lining of the stomach and bowels, as a result of direct contact with the acrid products of decomposition. These conditions are more frequent in the child under six months, because the stomach of the baby of that age secretes very little hydrochloric acid, which in an older child protects the organ to a certain degree on account of its antiseptic action.

The necessary steps in treatment are, therefore, (1) speedy evacuation of the bowels; (2) the use of antiseptics; (3) something to counteract the acidity of the bowel-contents and have a soothing effect on the inflamed mucous membrane. The first indication I meet by the injection into the rectum of a solution of bicarbonate of soda, followed by a 1:1000 solution of Acetozone. The second

is met by giving the solution of Acetozone (1:1000) in teaspoonful doses every half hour, if the stomach will tolerate it that often. Given this way it not only kills bacteria but destroys the toxins by oxidation. The third indication will require, in many cases small doses of bismuth subnitrate, which may or may not be combined with calomel (gr. 1/20). In many cases the bismuth will not be needed on account of the healing effect of the Acetozone.

NORMAL OBSTETRICS.

(CHAPTER THIRTEEN.)

THE DIAGNOSIS AND MANAGEMENT OF LABOR.

By T. MITCHELL BURNS, M.D.

Denver, Colo.

Professor of Obstetrics, the Denver and Gross College of Medicine.

The Obstetrician's Clothing and Person.-The obstetrician's clothing and person should be clean and neat. His hands and gloves should be kept especially clean. While an obstetrician should not attend an infectious case, especially scarlet fever, diphtheria, infected wounds or puerperal infection, he may do so by using due precaution in the matter of disinfecting when called to an obstetric case. After attending a septic case, he should render his hands aseptic by the permanganate method, take a general bath, shampoo his head, change all his clothing, and have those worn at the septic case disinfected by sunlight or formaldehyd.

Calls. All calls to confinement cases should be answered immediately. Before going, the physician should write and leave the address or telephone number of the patient, so that if another important call comes in while he is gone, a message may reach him. He should also carefully examine his obstetric satchel to see that it contains everything he may need. The things which are liable to be missing, through their being all used or left at a previous case, are bichlorid tablets, chloroform and inhaler, ergot, vaseline, boric acid, nail brush, manicuring scissors, sutures, umbilical cord ligatures and the uterine irrigator.

The Obstetric Satchel.-The best obstetric satchel is the cabin style. It is the best because it holds the most for its size, and because the contents may be easily seen. It is a little too large to carry on a wheel. The lining of the satchel should be made of tanned leather, so that it may be disinfected easily with formaldehyd or turpentine or cleaned with gasoline. Some use a detachable linen lining which can be boiled, but probably the tanned leather lining is just as good. (The author has used both.) The interior of the satchel should be touched as little as possible when the hands