restricted and outdoor exercise should be recommended. The doctor must be sure that the patient spends consider able time in the outdoor air. Systematic disturbances of any kind, as any of the forms of dyspepsia, constipation, or genito-urinary conditions, or pelvic troubles in women, must be corrected, of course, or the local treatment will bring about improvement in vain and relapses will inevi tably occur.-N. Y. Med. News, ERNEST PRING, M. D. 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; and City and County Hospital, San Francisco. A New Modification of Operative Procedure for Retroflexion of the Uterus.-At the meeting of the Obstetrical Society of Philadelphia, reported in Annals of Gyn. and Pediatrics, DR. E. E. MONTGOMERY describes his modification of the operation devised by Ferguson, of Chicago. The abdomen is opened by median incision. The round ligament is picked up one and one half inches from the cornu of the uterus and a ligature is passed beneath it. Both ends of this ligature are carried by a Deschamps needle through an opening in the peritoneum anterior to the round ligament, to the parietal surface and beneath the parietal peritoneum to a point about the outer margin of the rectus muscle, where it is carried through the peritoneum, muscle and aponeurosis. The ligament on the opposite side is treated in a similar manner. The projecting loops of the ligaments are fastened by sutures to the aponeurosis, the final ones being passed in such a way as to decrease the size of the opening through which the loop was brought. The advantages he claims for this operation are as follows: The uterus is maintained in an anterior position; it affords mobility to the organ; it introduces no adhesions nor extraneous material within the abdominal cavity and yet affords structures which will undergo hypertrophy and involution should the woman become pregnant. Moreover, it is of advantage in cases in which there is a tendency to prolapse of the ovary and tube as the relation of the retracted broad ligament to these organs form a shelf upon which they are more likely to rest. He claims that it is also of service in cases of femoral hernia in that it decreases the directness of the pressure of the intestines on the femoral opening. The Treatment of Gall-Stones Found as a Coincidence in Abdominal or Pelvic Operations.-DR. JOHN G. CLARK, of Philadelphia, in a paper read before the American Gynecological Society, and reported in the Amer. Jour. of Obstets., states that he believes that many symptoms now attributed to gastralgia, indigestion and functional disturbances of the gastrointestinal tract, etc., would, as our knowledge increased, be ascribed to the presence of gall-stones with associated infection, which was so frequently found in cholelithiasis. In referring to the etiology of gall-stones, he said that three facts had been prominently established: (1) That the bile, as formerly believed, was not bactericidal; (2) that the micro-organisms in the gall-bladder were predisposing, if not absolutely causative factors in the formation of gall stones; (3) when gall-stones were present in the gallbladder, infection in that viscus was much more likely to take place. He quoted Musser, who believes that we are just entering a new era of gall-stone surgery, and that many secondary conditions which now result from delay in operating for gall-stones will not occur if the proper surgical treatment is applied earlier. In almost all cases of cholelithiasis which came to operation bacteria were discovered. Even if the gall-stones were dormant, the patient was constantly in more or less danger, for there were three general avenues through which infection might enter the gall-bladder: (1) From bacteria circulating in the general blood stream and reaching the liver through the hepatic veins; (2) by the direct passage of bacteria into the common bile duct from the duodenum; (3) by the transportation of bacteria from the intestine through the portal. circulation. The point which he especially dwelt upon was that the gall-bladder, which contained calculi, was a point of decided resistance, and was frequently the source of an infection. He recurred to the frequently quoted statement that 95 per cent of gall stones did not produce. symptoms, and showed from his own series of cases that in at least 5 per cent there were varying symptoms from undoubted attacks of colic and jaundice to less pronounced gastro-intestinal symptoms. He quoted-Dock's statement that more had been learned from the surgeon than from the pathologist in these cases, and claimed that if the abdominal surgeon would go very fully into the history of his cases, and then check these histories by careful examination of the other organs of the abdominal cavity, a valuable link in the chain of cholelithiasis might be established. In order to justify the operative intervention in cases which were not producing well-defined symptoms, the mortality as well as the morbidity should be a very low In his own experience no death had occurred, nor had there been any serious complication referable to the secondary operation. Further, he quoted the statistics of Kehr, Mayo, and Mayo Robson in simple cholecystotomy, where the operation had been done because marked symptoms were present. In a large series of cases in all three of these surgeons' hands the mortality had been less than 2 per cent. one. Methylene Blue in Gynecology and Obstetrics.— Amer. Jour. of Obstets. quotes from Bull. Méd. de la Clin. St. Vincent de Paul, that Chaleix-Vivie and Kohler have found by animal experiments, bacteriological and clinical study that chemically pure pulverized methylene blue is an odorless, non-caustic and non-toxic agent in uretritis which rapidly arrests menorrhagia and metrorrhagia, diminishes or stops leucorrhea, has sometimes a rapid and durable analgesic action, especially in dysmenorrhea, due to changes in the mucoso or to uterine anteflexion with stenosis of the cervix. It is efficacious in old ectropion, bleeding and infected. It had no unfavorable influence when there was parametritis or salpingitis. In gonorrheal vaginitis during pregnancy, applied to the vaginal walls, and in gonorrheal endocervicitis at that time, applied to the outer surface of the cervix, the writers claim excellent results. Operative Treatment of Chronic Bright's Disease.-R. GUITERAS (N. Y. Med. Jour.) reports cases extensively, and arrives at the following conclusions: 1. Chronic nephritis should not be operated on until medical treatment has proven of no avail. 2. The time for operation is when it is noticed that the process is advanc ing rapidly and we fear that the heart will soon become overtaxed. 3. The operation for chronic Bright's disease which has proved least dangerous and which has shown the best results, is nephropexy, performed on a single moving kidney. 4. The most unfavorable cases for operation are those of diffuse nephritis. 5. Cases of general anasarca with bad heart action should not be operated on; if the heart action is good an operation performed as a dernier ressort may give the patients a few extra months of life, provided they survive it. 6. Where there has been a marked destructive process in the kidneys, as a result of nephritis, the operation may relieve them for a number of weeks or months, but they generally fail again and die when the new capsule begins to contract. The Jabonlay-Lumiere Button in Gastroenteroanastomosis.-GAYET (Revue de Chirurgie, Paris) has selected 100 cases out of a larger experience in which this button was used, and extols its advantages. No suture of any kind is required, as it automatically performs its office. The rapidity with which it can be introduced and the anastomosis completed render it particularly valuable in palliative cancer cases, "in which even moments count." This button has been in use since 1900, and the mortality in the 100 cases of cancer has been 18 per cent; during 1902 it was 7.6 per cent, and for six months in 1903 it was only 6.6 per cent. The average survival was seven months, but this includes a number who have shown no sign of recurrence to date. The 100 cases are tabulated. The button does not require any thread thrown around it, as it locks firmly. The slit in the side enables the button to be worked into the viscus through a very narrow opening, on the principle of the cuff buttons inserted by screwing them in.-Jour. A. M. A. "THEY tell me you have cured yourself of chronic insomnia." "Yes; I'm completely cured." "It must be a great relief." "Relief! I should say it was. Why, I lie awake half the night thinking how I used to suffer from it."-Cleveland Plain Dealer. VOL. XLVII-42 PACIFIC MEDICAL JOURNAL WINSLOW ANDERSON, A. M., M. D., M. R. C. P. LOND., etc. W. F. SOUTHARD, A. M., M. D., Managing Editor. COLLABORATORS. U. F. BUCKLEY, B.A., M.D., L.R.C.P.Edin., etc. GEO. C. MACDONALD, M.D., F.R.C.S.Ed. W L. ADAMS, M.D. CARL C. HANSEN, M.D. GEORGE H. POWERS, A.M., M.D. J. H. DAVISSON M.D. C. A. RUGGLES, M.D. FRANK HOWARD PAYNE, M,D. A. W. MORTON, A.B., M.D. OHAS. E. JONES, A.B., M.D. WM. J. JACKSON, Ph.G., M.D. WM. A. BRYANT, M.D., D.D.S, WALTER F. LEWIS, D.D.S. FRED W. Lux, M.D. H. N. ROWELL, M.D. CLARK L. ABBOTT, M.D. SOPHIE B. KOBICKE, M.D. LOLITA B DAY, M.D. ROBERT E. O'CONNELL, D.D.S. CHAS W. MILLS, A.B, M.D., D.D.S. THURLOW S. MILLER, M.D. B. F. WILLIAMS M.D. WILLIAM BURFIEND, D.D.S. JOHN M. STOWELL, M.D. BERTHA WAGNER-STARK, M.D. J. H. SEYMOUR, M.D. CALVIN W. KNOWLES, D.D.S., M.D. CORYDON B. ROOT, M.D., D. D.8. J. LORAN PEASE, D.D.S. M.D. J. C. HENNESSEY, D.D.S. J. W. KEY, D. D.S., M.D, The Editors are not responsible for the views of contributors. All matters relating to the editorial and business departments should be addressed to the PACIFIC MEDICAL JOURNAL, 1025 Sutter St., San Francisco. SAN FRANCISCO, NOVEMBER, 1904. Editorial. THE STUDY OF CRIMINOLOGY. The American Bar Association at it session at St. Louis did some very valuable work in criminology. The special committee on penal laws and discipline reported favorably on the establishment in the Department of Justice at Washington, D. C., of a laboratory for the study of the criminal, pauper and defective classes. TO STUDY CRIMINOLOGY. The following resolution was reported by the committee on penal laws and prison discipline, with the recommendation that it be adopted: Resolved, That we are in favor of establishing in the Department of Justice at Washington a laboratory for the study of the criminal pauper and defective classes, it being understood that such investigation is a development of work already begun under the federal government; that such study shall include a collection of jurisprudential, sociological and pathological data in institutions for the delinquent, dependent and defective, and in hospitals, schools and other institutions; that especially the causes of social evils shall be sought out with a view to ameliorating or preventing them. |