The result of his investigation of these three cases is a conviction of the intimate relation of this condition to syphilis and epithelioma as is the case in buccal or lingual leukoplakia. In the three cases presented by M. Verdalle, the leukoplakia, under the form of pearly, shining, smooth mucous patches had preceded by eight years or more the development of carcinoma; in two cases in the cervix, in the third in the body of the uterus.

In all three cases the mucous patches of leukoplakia occupied the anterior aspect of the portio vaginalis. Inasmuch as the appearance of leukoplakia seems to herald several years in advance the advent of malignant disease, M. Verdalle considers the matter of great importance. Less rare, perhaps, than the silence of authors would indicate, he advises its careful investigation and advises the forewarning and most careful watching of all such cases.Annals of Gyn. and Pediatrics.

Simultaneous Intra and Extra-Uterine Pregnancy.-The above-named condition is rarely met with, and the writer, Dr. Karl Reifferscheid of Bonn, Germany, (Centralblatt für Gynekologie) could find only sixty-eight similar cases in the literature, the earliest of which was recorded in 1761.

The following case came under his observation in the Women's Clinic at Bonn: The patient, Mrs. J., 26 years of age, was admitted to the hospital November 4, 1902, for severe abdominal pain. She had had one normal delivery, December 29, 1900. Convalescence was normal. She believed herself to be about three months along. About three weeks before admission, began to have pain in left iliac region, which grew steadily worse, finally causing her to seek admission to the hospital. Within the past two days has had several very severe attacks of pain, associated with fainting spells.

Bimanual examination revealed a mass about the size of an orange on the left side which was not easily outlined, not freely movable and very sensitive. The uterus was about the size of a three-months pregnancy.

The above symptoms and bimanual findings associated with anemia made a probable diagnosis of extra-uterine pregnancy seem certain. The possibility of a concomitant intra-uterine pregnancy was not overlooked.

Cœliotomy was shortly performed and a left-sided tubal abortion was found. The uterus continued to enlarge after the operation and the pregnancy was otherwise uncomplicated, she being delivered at full term.

Only three analogous cases could be found in the literature, viz., those of Ott, Hermes and Mond. In all the remaining cases the patients aborted.

As it is impossible to be certain of an associated intrauterine pregnancy (the uterus enlarging as it does, in extra-uterine pregnancy up to the end of the fourth month [Olshausen and Veit]), the writer strongly advises against the diagnostic use of the sound, claiming that many of the miscarriages are undoubtedly due more to its use, than to the operative procedure, provided the latter is performed with gentleness and care.-Annals of Gynecology and Pediatrics.

Surgical Treatment of Tuberculous Peritonitis. -From a quite large experience in the treatment of this disease Ochsner, of Chicago, draws these conclusions: 1. Patients suffering from tuberculous peritonitis should first be subjected to careful medical treatment. 2. This treatment should consist in the use of intestinal antiseptics. and antituberculous remedies and rest in bed. Sterilized

food and improved hygienic conditions generally should be employed. 3. So long as the patient's condition improves reasonably this treatment should be continued. 4. In case the patient's condition does not improve, abdominal section is indicated. 5. If the disease is confined to a part which can be safely removed without injuring any portion of the tuberculous peritoneum, this should be done, provided the surface can be covered with healthy peritoneum. 6. If the removal of any infected portion necessitates the severing of the tuberculous peritoneum or leaving a portion of the peritoneal surface denuded, the diseased tissue must not be disturbed. 7. In case there is fluid in the peritoneal cavity it is doubtful whether it is best to remove any tuberculous tissue, even though it be circumscribed. 8. Enormous quantities of tuberculous material can be absorbed from the peritoneal cavity after simple laparotomy. 9. It is best to avoid all manipulation of intra-abdominal organs during the operation in case there is a diffuse tuberculous infection, and to confine the opera

tion to simply opening the peritoneal cavity, permitting the ascitic fluid to drain out, admitting air to the peritoneal cavity and closing the abdominal wound. 10. Peritoneal adhesions should never be disturbed in patients suffering from tuberculous peritonitis with ascites, for fear of causing intestinal fistulæ. 11. During the time of recovery from the surgical operation and for a considerable period of time after this the patient should be treated medically. 12. The hygienic conditions of the patient must be permanently improved and he must not be permitted to expose himself to the conditions which primarily caused the tuberculous infection. 13. Permanency of cure is much more likely in patients who are not predisposed to pulmonary tuberculosis. 14. Chronic cases with fluid, notably if encapsulated, not benefited by medical and hygienic treatment, are especially amenable to surgical treatment. 15. Repeated operations are indicated in case of reaccumulation of fluid.-Amer. Surg. and Gyn.

PEDIATRICS.

Under charge of LOLITA B. DAY, M. D.

Adjunct to Chair of Pediatrics, College of Physicians and Surgeons
San Francisco; on the surgical staff of St. Winifred s Hospital
and the California General Hospital, San Francisco.

Treatment of Ophthalmia in the Newly Born.— (Archives Ped., Nov.)-Portillo recommends the use of a one in five thousand solution of protargol in the treatment of ophthalmia neonatorum. This solution should be applied twice daily, or, if the inflammatory signs be very intense, the strength may be increased to 2 or even 7 per cent, and the remedy used as an instillation. He devised a new form of irrigating apparatus, which elevates the eyelid and allows the complete flushing of the conjunctival sac with these solutions. Solutions of boric acid in warm water may be used in large quantities in this irrigating apparatus several times during the twenty-four hours, in addition to the application of protargol. A small quantity of a one in two thousand solution of formalin may be added to the irrigating fluid. Several times between the irrigations, or, if need be, every half hour, the eyelids should be half opened, so as to give an opportunity for the escape of pus

which bathes the cornea. It is well, also, to apply a small amount of vaseline with iodoform 2 per cent to the edges of the lids by means of a small camel's hair brush. This prevents the adhesion of the lids and disinfects the eye. The eye should be protected from glaring light but should never be bandaged permanently, as darkness and heat favor suppuration. Application of silver nitrate or of bichloride as caustics during the first stage of the suppuration are to be absolutely proscribed, and the same is true of bichloride solution, and of iodoform in powder, which is still often used in this condition.

Purpura Hemorrhagica Fulminans.-MACADAM, (Med. Rec.,Aug.,) reports an interesting case. A girl aged five years had had scarlet fever, but otherwise gave a negative history. The child had always appeared strong and healthy. The onset was sudden. The mother noticed that the child was drowsy and stupid one morning. After three or four hours there appeared three ecchymotic spots on the forehead. When first seen the body was covered with petechia. One-half hour later, the child was almost moribund from hemorrhages from the stomach, lungs, bowels, kidneys and nose. After entering the hospital she was given ten minims of adrenalin every three hours, the menstruum being orange juice. The recovery was gradual.

Treatment of Apparent Death of the Newly-Born. (Amer. Med. Jour., Oct. 24.)-Zangemeister remarks that the attempts to apply the inhalation of oxygen as a therapeutic measure have not been very satisfactory as a general thing, but there is one condition in which it is proving extremely valuable. This is in severe asphyxia neonatorum. The almost invariable success and the rapidity of its action, with no inconveniences, render it a most valuable aid in this emergency. He uses a thin-walled rubber bulb filled from a small portable tank of compressed oxygen. The oxygen is forced through a tracheal catheter into the infant's lungs by gentle regular pressure on the bulb. When the lungs have become distended he applies gentle external pressure to the thorax. The air escapes along the outside of the catheter, which must be of small diameter to allow this. The lungs are then inflated again by gentle pressure on the bulb and emptied as before, and these procedures are repeated continuously as long as required.

The prompt reddening of the skin shows a favorable action. of the oxygen. It can be applied while the infant is in a warm bath. The narcosis from carbon dioxid is dispelled in this way more rapidly than by any other means and the stimuli applied become more promptly effectual.

Thymus Gland and Marasmus.-(Amer. Med. Jour., Sept. 19.)-Ruhrah reports the results of studies of 18 cases of marasmus. Excepting the terminal infection, atrophy of the thymus was the only lesion found in any of the necropsies. The changes consisted in marked atrophy with thickening of the capsule and trabeculae.. He reaches the following conclusions: 1. Atrophy of the thymus gland is always found in cases of infantile atrophy. 2. The condition of the thymus is an index of the general nutrition of the infant. 3. The state of the nutrition in infants may be estimated by a microscopic examination of the thymus at necropsy.

PHYSIOLOGY.

Under charge of FRANCIS WILLIAMS, M. D., Lecturer on Physiology, College of Physicians and Surgeons of San Francisco.

Effect of Light on the Nerve Endings of Skin.. -In primitive animals devoid of organs of special sense the skin is responsive to many different stimuli, light included, e. g., the earth-worm, though devoid of eyes, is quickly responsive to light. It is interesting to note while light is playing so prominent a part in skin therapy, that the skin of newts and frogs is responsive to light rays to a degree sufficient in many cases to determine and direct muscular movements. In the American Journal of Physiology for September, G. H. Parker describes experiments upon frogs with light acting upon skin and eyes. His conclusions, in part, were: 1. Individuals with the skin. covered and the eyes exposed were positively phototropic, i. e., turned and leaped towards the light from which the heat rays had been removed. 2. Individuals with the eyes removed and skin exposed are also, as a rule, positively phototropic through action of light on skin.

Action of Rennin.-Though it has long been known that this enzyme has the power of splitting the casein of milk into paracasein (coagulated) and whey proteid (in