Sections.

MEDICINE.

Under charge of H. D'ARCY POWER, L. S. A. Eng., L. R. C. P. Ire. Professor of Principles and Practice of Medicine, College of Physicians and Surgeons, San Francisco.

The Refrigerant Treatment of Fever.-In a most useful paper on "Simple Expedients in Physical Therapeutics," Dr. W. E. Wynter describes a method of treating typhoid and other pyrexic conditions which in simplicity and convenience offers many advantages. It consists merely in arranging a sort of tent over the bed in which the patient lies naked or very lightly covered. The two ends may be left partly open to encourage a current of air or the effect may be intensified by suspending a trough inside containing broken ice. In hospital the tent is usually made of metal hoops covered by a sheet or blanket, but in an ordinary bedstead a rod or cord extending horizontally about two feet above the patient and attached to the head- and foot-pieces is all that is necessary. In this way the surface of the body can be exposed indefinitely to an atmospheric temperature of about 60° F., which can be easily regulated, the natural cooling effect of radiation and evaporation being thus enhanced. The great advantages of this method are its simplicity; its remarkable efficiency, the continuity of effect being not only of value in continued febrile states but in reducing high temperatures; its comfort to the patient; the avoidance of the repeated shock and disturbance of applying water; and the freedom and security it gives to the medical attendant who is not called upon to cope with periodical alarming temperatures, but can leave the nurse to meet the variations of the thermometer within a reduced range by regulating the draught or by applying ice or a blanket within the tent as indications require. Furthermore, he suggests that in place of the ice cup, with its constant tendency to get out of position, we should use an ice bag placed under the nape of the neck and occiput, which is more efficient and does not shift.

The Danger of Inflating the Stomach. -DR. MOSES BEHREND has recently reported (Medical News, Dec. 19th) three deaths due to the inflation of the stomach for

diagnostic purposes with CO,. In one case death resulted from hemorrhage from an ulcer torn by the distension. In the other two, which were cases of malignant stenosis of the œsophagus, the fatal result was seemingly the result of shock consequent on the sudden distension of the œsophagus within the thorax. Such fatalities make it evident that this is by no means a safe diagnostic procedure. It should be more generally known that Hemmeter's bag is much safer and gives more reliable information.

The Control of Vomiting.-The same writer asserts that by continuous inhalation of oxygen the most severe cases of vomiting (such as post-operative emesis) may be controlled with safety and certainty.

The Significance of Pain and Tenderness in Appendicitis.-The Medical Review of Reviews reports a lecture by Dr. C. W. Mansell Moulin on the above subject, in which it is pointed out that the viscera (and their visceral peritoneum), including the appendix, are not provided with sensory nerves and are shown by clinical evidence to be insensitive, whilst on the other hand the parietal peritoneum at the post-peritoneal cellular tissue are acutely sensitive.

From these facts the following conclusions are drawn: 1. Absence of pain is no indication that the most serious mischief is not going on. 2. The initial pain of acute inflammation of the appendix, which is so commonly referred to the umbilicus, is due to the peristaltic action of the cæcum or appendix dragging upon the attachment of the peritoneum to the abdominal wall. 3. The cessation of this abdominal pain without improvement in other symptoms, is due to cessation of the peristalsis caused by the inflammation having spread to the muscular coats of the bowels. When this occurs the walls of the bowel are no longer able to contract, and this source of pain disappears. 4. The development of local pain which precedes, as a rule, by some short time the cessation of the umbilical pain, means that the inflammation has spread from the appendix to the parietal peritoneum or to the post-peritoneal cellular tissue. 5. Absence of local pain does not indicate anything, but severe pain is of serious import, as it implies either wide extent or great severity of inflam

mation. 6. Deep tenderness indicates extension of inflam mation to parietal peritoneum or underlying cellular tissue. 7. Superficial hyperesthesia is a reflex from the corresponding spinal center. If sudden, cessation without improvement of general symptoms suggests gangrene of the appendix and the need of immediate operation.

Reaction with Perchloride of Iron in the Urine of Grave Cases of Hepatic Cirrhosis.—In an article by F. PARKES WEBER, M. D., of the German Hospital, London, he remarks that in the progress of urine testing he has repeatedly obtained a strong perchloride of iron reaction in the urine of patients with hepatic cirrhosis. A certain amount of urine was taken, and a weak solution of perchloride of iron added. The color obtained was not always the same; sometimes it was like that obtained from the presence of diatetic acid in cases of diabetes mellitus, but at other times the color was like that of urine from patients taking sodium salicylate. In but one case was there a history of there ever having been any glycosuria. The appearance of the reaction sometimes coincided with very threatening general symptoms, such as drowsiness, in one case. An exact analysis was delayed, so it is impossible to say that the reaction is due to pressure of diatetic acid in the urine. Four cases, in hospital, of hepatic cirrhosis, gave the perchloride reaction, during the time patients were in hospital, although their general symptoms improved.

GYNECOLOGY AND ABDOMINAL SURGERY.

Under charge of S. B. KOBICKE, M.D.,

Adjunct to Chair of Gynecology and Abdominal Surgery. College of Physi cians and Surgeons of San Francisco; on the Staff of St. Winifred's Hospital and the California General Hospital of San Francisco.

Gauze-bearing Tape and the Gravity Pad in Pelvic and Abdominal Surgery.-Dr. John M. Fisher at the October meeting of the Obstetrical Society of Philadelphia, (reported in Annals of Gyn. and Ped.,) read a paper on this subject. The tape, it is claimed, obviates the annoyance of a miscount in the number of gauze pads used for isolating and exposing the field of operation, and positively eliminates the danger of the loss of any pads within the abdominal cavity, at the same time

minimizing the possibility of losing unsecured pads for rapid sponging, while the other supplements and enhances the advantages of the Trendelenberg posture. The gauzebearing tape consists of a piece of white tape about a halfinch in width and of variable length (3 or 4 feet), armed at one end with a long blunt-pointed needle or bodkin. The gravity pad is nothing more than a large gauze pad, concealed within its folds and fastened to the center of which is a lead plate, 2 by 3 inches, and weighing a half-pound. Instead of a single piece of lead, smaller plates of the metal may be held in quilted squares of the pad or at indifferent points. The practical utility of the tape was first demonstrated by Dr. Fisher in July, 1903, in an operation for pelvic disease requiring a number of gauze pads to hold the intestines at a proper level and expose the field of operation. One end of a long piece of gauze was introduced into the abdomen while the nurse quickly, and without any loss of time to the operator, perforated the other extremity with the needle and tape, securing its edges to the distal end of the latter with a turn-over tie. After the entire pad had been packed into the cavity with the free portion of the tape trailing from the abdominal opening, other pads were strung on the tape in a like manner but without the necessity of securing them with a knot the first and successive pads acting as points of fixation for those that followed. No account was taken of the pads thus introduced, nor was this necessary, for the reason that, after a sufficient number were in use to answer the purpose indicated, the removal of same after completion of the operation, simply depended upon the withdrawal of the tape to which all were attached. He contends that by the use of this pad the certainty, not alone of confining the intestines to the upper abdominal cavity, but that the maintenance of a more or less immovable wall, against which gauze may be packed, to isolate the field of operation and protect the healthy peritoneum from contact with infecting materials, seems to be assured.

Dr. Howard

The Stump in Appendectomy. Lilienthal, in the Medical News of Nov. 28, 1903, advocates a simple method of treating the stump which he has successfully employed for ten years in many hundred cases.

After carefully and thoroughly ligating the stump, he cauterizes the distal portion of the canal with a drop of 95 per cent carbolic acid taken up on the point of a sterile artery clamp. There is no attempt made to bury or otherwise cover the stump, but after about 30 seconds it is dropped without any danger to the surrounding structures. He answers the two main objections raised against this method. First that the stump is insecure because mucous surfaces will not adhere to each other. Dr. Lilienthal has proved by many observations, both in recent and prepared specimens that the ligature so crushes and cuts the mucosa as to yield perfect healing with an entirely adequate stump. Another objection is the increased liability to adhesions after the employment of this method. Basing his conclusions on post-mortem observations, or in those cases where a reopening of the abdomen has been necessary, Dr. Lilienthal thinks this method is the best of all in preventing adhesions between the stump and the surrounding structures. The distal portion of the stump is cast off and absorbed at the end of from 3 to 6 days and with it disappear any adhesions that may have formed. In some cases, although there were occasionally adhesions found in the vicinity, the area at the former site of the appendix was perfectly smooth.

Two Unusual Uterine Growths. - Opitz, in Zeitschrift fur Geb. und Gynakologie, Stuttgart, as reported in the Journal of the Amer. Med. Assn., describes a mixed tumor, a combination of adeno-carcinoma and sarcoma, removed from a woman aged 57. The mucosa of the corpus was the starting point. All the cases on record similar to this were in women at the climacteric age. The growth was comparatively benign and the sarcoma was polypous, consisting partly of round and partly of spindle cells. He suggests the possibility that the same cause may incite the epithelium to carcinomatous proliferation and the connective tissue to sarcomatous. If this prove to be true, then carcinoma and sarcoma may be considered identical from the etiologic standpoint. In the second case described, a mucous polyp removed from the vagina proved to be carcinomatous. The pedicle of the polyp sprang from the tubal corner and an epithelioma had