esthetic. Bromide of ethyl is then given until the patient is unconscious. The ethyl is poured upon an ordinary chloroform inhaler, about half a drachm ordinarily sufficing. As soon as the patient is unconscious ether is substituted and continued by the "drop method" until the operation is complete. With some subjects it is occasionally necessary to add a few drops of chloroform to secure complete relaxation, but this is a rare necessity. By this method there have been no deaths, nor have serious symptoms developed in any case. Vomiting seems to have been reduced to a minimum, and the collection of mucus in the throat, which ordinarily is so annoying, is entirely obviated. The patient usually sleeps quietly for several hours after being returned to bed. The anesthetic is always begun in the patient's room, though full surgical anesthesia is not secured until the patient has been finally prepared on the operating-table. The patient is unconscious, however, before leaving her room.

PRIVACY.

All patients are regarded as entirely pri

vate, and are very carefully protected from newspaper publicity. For this reason, and as the only mention made of patients is that made in connection with their deaths, many persons have been led to assume that the mortality must be very high, being entirely ignorant of the enormous amount of surgery done here, and of the fact that Grant Hospital is the largest hospital of its kind in the world. Well informed physicians are, however, familiar with the facts and this explains the success of the hospital. It is the only hospital in Columbus to which medical students are not admitted to witness operations. Although all publicity is thus carefully avoided, friends of the patient, especially the relatives, are freely admitted to the operating-room, if they wish to be present, so they can see exactly what operations are performed. This privilege is taken advantage of quite uniformly, much to the satisfaction of the patient and the immediate friends. Straightforward, honest surgery should have no secrets, and the permission to friends to be present is looked upon as an evidence and guarantee of good faith.

In reading THE LANCET-CLINIC of September 14 I notice the report of a case of labor in which there was obstruction from Bandl's ring, and having had two cases of that sort recently I thought that it might possibly be of interest to report them.

I was called to see Mrs. H. August 21, 1907, whose labor had just begun. I had her go to Bethesda Hospital, where I saw her some two hours later, when labor seemed to be progressing nicely. The position was occiput posterior and to the right, with the os about the size of a silver dollar, soft and dilatable. From this time on she seemed to make no progress; although the pains were good, the head would not engage. After waiting another two hours with no progress, the patient becoming worn out by the ineffectual pains, and as the fetal heart sounds showed signs of weakening, I decided to deliver with instruments.

Under complete anesthesia I inserted my hand into the vagina, and, finding head not firmly engaged, I rotated to anterior position of vertex without much difficulty. I then applied forceps to bi-parietal region of head with some difficulty, the head being so high. I then discovered the contraction ring. In

making pretty strong traction I found the lips of the cervix would come down in front of head without any appreciable effect on the size of the cervix. When the head became molded sufficiently to engage (it was rather a large head) in pelvis the lips of the cervix would still advance, and finally came almost to vulva, so I knew I must use the utmost caution to avoid rupture of uterus, or at least a bad tear of cervix. But by persistently making strong traction and relaxing to avoid too much depletion from continued pressure on soft parts, I felt the ring gradually give. Then I went even more carefully, fearing something might have torn, which it did not, however, as it was merely the relaxing, as I take it, of the contraction ring. After possibly three-quarters of an hour of pretty hard work the head was delivered with cord once around neck, but not so very tight. The remainder of delivery was easy, and I thought my troubles over, but I had great difficulty in resuscitating the child. But after possibly three-quarters of an hour and after resorting to every method of resuscitating I knew of, was successful in getting baby to breathe.

The other case was a Mrs. G., delivered on August 25, 1907, which ran along about

as did the other case, except that I had to use much more force-more, in fact, than I had ever used before in any case. The contraction ring gradually gave way, as did the above case. I considered myself very fortunate in not scarring either child after such hard traction.

I would also like to report a case of placenta previa which I think will be of interest to the readers as another illustration of the gravity of these cases, and also as a warning to investigating any bleeding about or after the seventh month.

Mrs. H., a multipara, called on me about August 14 to engage me for her confinement, expected about November 1. Examination revealed a cross position, the head being in right iliac fossa, buttocks in left. By external manipulation I was able with comparative ease to change it to a vertex. But she told me the next day that I had scarcely had time to get home before she felt it slip back into its original position. I did not suspect placenta previa at this time.

She was

On August 31, while making rounds at Christ Hospital, I was sent for hurriedly. When I arrived I found her in a chair with a pool of blood in the middle of the floor, her clothing saturated with blood and another pool of blood beneath her chair. almost exsanguinated. Her face appeared bloodless; was unable to find any pulse at the wrist. Knowing that such a condition could come from nothing but placenta previa, I ordered her moved to Christ Hospital on a stretcher. She, fortunately, lived near.

As the hemorrhage had ceased we had her cleaned up and rendered as aseptic as possible, then made my examination, confirming my diagnosis, but finding a very rigid cervix only admitting one finger. Under anesthesia I began the dilatation by inserting one finger, then two, which was done with the greatest difficulty; then by much stretching I was finally able to insert my whole hand. I found a central implantation, rather I found the placenta over the os, but completely detached and wedged down into the os. I could also feel the uterus filled with blood clots, so I knew what to expect later. The feet were grasped and child turned and rapidly delivered, applying forceps to after-coming head. The cord was immediately tied as the placenta was presenting at vulva and I knew what was back of it.

On removing the placenta another fearful gush of blood came, but this was the last, as the uterus was kept firmly contracted by following down the child and keeping hand in uterus all the time. The child was dead,

probably died at the first hemorrhage, as I was unable to detect any fetal heart sounds before delivery.

I neglected to mention above that the patient was given twelve ounces of salt solution under the breast, as we could detect no pulse at the wrist and not deeming it safe to give an intra-venous injection, as it would make the danger of a recurrence of the hemorrhage greater, and under the breast would be absorbed so slowly that it would not have the same effect.

The patient made an uninterrupted recovery, the temperature being subnormal for two or three days, then gradually rose up to the normal but never above normal.

The points of interest in this case, as I see them, are, first, the frightful loss of blood as the first evidence of anything wrong (there were no pains at all); second, the hardness of the os uteri; and third, the complete detachment of the placenta.

Endothelioma of the Ear.

W. S. Bryant, New York (Annals of Otology, Rhinology and Laryngology, Vol. xvi, No. 2), reports a case of endothelioma of the middle ear. The patient was a man of forty-one years. The chronological sequence of symptoms was as follows: Running ear. Right eyebrow drooped. Mental change. Decrease of hearing in left ear and tinnitus. Pain in vertex, herpes of the ear. Pain in and about the ear, headache, twitching of face. Severe pain in teeth and numbness of jaw. First noticed trouble in the nose. Double vision. Total deafness left ear. Marked facial paralysis. Exophthalmos. Thoracic pain, dyspnea. Death. When Bryant first saw the case it was too far advanced for a radical removal. The course of the disease was about two and a half years. The largest single dose of morphia was twenty-six grains. The details of the symptomatology are given with great particularity week by week.

Traumatic Mastoiditis-Typhoid Mastoiditis.

Geo. A. Mathewson, Montreal (Montreal Med. Journal, Vol. xxxvi, No. 5), reports a number of cases of acute mastoiditis, among which is one complicating a fracture at the base of the skull and one case of double mastoiditis in a man of twenty-nine years in the course of typhoid fever. In the latter case both mastoids were operated upon at an interval of a week, and patient made an excellent recovery both from typhoid and the operations.

C. R. H.

gastric curvature. The greater gastric circle is formed by the anastomosis of the gastroepiploica dextra and sinistra, and completed by the gastric and splenic branches. The gastro-epiploica dextra arises from the hepatic, while the gastro-epiploica sinistra arises from the splenic. The greater gastric is a constant structure. It is of considerable magnitude.

The relation of the blood supply to the stomach practically does not differ from that of the enteron and colon, e.g., the blood supply to the enteron is typical, consisting, first, of a large trunk (arteria mesenterica proximal); second, of branches (rami intestinale); third, of mesenteric arches, one to six (arci mesenterii); fourth, of a straight terminal vessel of the intestine (vas intestini terminale rectum), extending from the mesenteric arches to the intestine. In other words, there is trunk, branch, arch and straight vessel typically manifest in the blood supply of the enteron and colon.

The stomach possesses exactly a similar

condition, which is evident when demonstrated. The great trunk for the gastrium is the celiac trunk (trunkus coeliacus), the branch for the stomach is the gastric artery, and in the stomach the branch and arch are practically united. practically united. Finally, the straight terminal vessel of the stomach (vas gastrii terminale rectum). The straight vessel of the gastrium arises from the branches of the celiac axis (gastric, hepatic, splenic). Hence, the arrangement of the blood apparatus of the stomach resembles the arrangement of the blood apparatus of the enteron and colon. In short, the arrangement of the blood apparatus of the tractus intestinalis consists of a trunk, a branch, an arch, and a straight terminal vessel. The gastrium could be extirpated, leaving in situ the two concentric gastric circles, by simply incising the straight terminal vessel.

The "concentric gastric circles" are plainly visible with the gastrium reflected proximalward. (See illustrations).

100 State Street.

The grain is sown and entrusted to nature, that good old nurse, until it is ripe. Then it is cut and bound with its kind, having been multiplied many fold. It may now be threshed, and the good seed sown again.

Before the various inhabited islands and continents were discovered by civilized man, famines due to many causes were more or less frequent. Cyclones, floods, disease, drouth and constant warfare were the principal causes which sometimes depopulated certain islands and continental districts.

The rulers and their advisers early recognized the necessity of laws or customs that would limit the population of their respective dominions. One of the earliest and probably one of the greatest customs for limiting the number of human beings was cannibalism. Homer believed it "a universal custom with earlier man, especially as human flesh was highly prized and deemed an offering worthy of divinity."

The natives of Cumana and New Guinea castrated those children intended for eating, so that the muscular parts would be tender. The Hottentots removed one testicle from the children in order to make them fleet, or as a punishment to rebellious members of the tribe.

These people, no doubt, like the Spartans, destroyed the defective children. But, unlike the Spartans, they prepared them for food, especially if they were in danger of a famine.

No country or people has been free from this custom. Even the Gothic and Celtic races, the Irish man-eaters, have been stained with the custom. The appetite once formed, the custom grew until man-hunting and maneating became a pastime.

A Solomon Island merchant personally described a custom prevailing at the present time illustrating a unique method of limiting the population of the island. The pregnant woman at the sixth month is placed inside a stockade on a hill near the village with an attendant. Food, water and clothing are supplied when necessary. The attendant cares for her during confinement.

If the child is a female and the tribe wants a female, the mother stays in the stockade until the child is sixty days old, and then the mother returns to her home with the baby. If the child is a female and they do not want a female, they will exchange it for a male of another tribe. If they do not want the female

or have enough male children, the child is then slain on the day following its birth. The body is then roasted and eaten with great ceremony. If the child is a male and the tribe desires a male, the mother stays in the stockade for sixty days and is then brought back into the village to her friends again. If the child is a male and they do not want a male, the child is slain on the day of its birth and is devoured in the same manner and with the same ceremony as the female. They will never trade a male child to another tribe, for they do not want any of their strength to be transmitted to their enemies through the blood of their children. In this way the population of the island is limited and the density of population remains always the same.

There is still another custom which has prevailed within the last century in southern California, and which has been described by P. C. Remondino, of Los Angeles. The chief of the tribe would inform each male adult that he might become the father of a certain number of children, the number depending upon the ability of the father to care for them. When the number allotted has been attained the father was subjected to a posterior external urethrotomy, which was dilated with a bamboo probe from time to time until sexually incapacitated by senility or otherwise. Should his children be destroyed by any cause the fistula is allowed to close and the man is again able to become a happy father. The permanent perineal fistula caused the spermatozoa to become short-circuited.

French Fear of Physicians.

That the law-makers of France distrust physicians is evident, and lest these worthies should be tempted to book their patients too quickly into the hereafter, a law was passed to the effect that a medical man may not benefit under the will of a patient whom he attends in his last illness. This law may invalidate the will of Miss Susanna Margaret Coggers, a wealthy American lady who recently died at Montpellier, leaving her large fortune to a local physician. Her two brothers have instituted proceedings to set aside the will, but the physician claims as he was out of the city at the time of her death he does not come under the provisions of the law.

E. S. M.