fluence but a very few minutes at a time and did not seem to suffer pain.

The recovery was uneventful and at the end of the third day was returned to its mother. It very seldom cried and grew rapidly.

The three points I wish to bring out in this paper are: First: The appearance of the abdomen coupled with the finding of fluid in the abdominal cavity, which would seem to substantiate our theory of prenatal intra-abdominal pressure, perhaps in the early foetal stage.

Second: The departure from usual lines in repairing these deformities.

Third: The possibility of performing quite a radical operation on the newborn, with very little or no anesthesia.

The child is now two months old and as the accompanying picture shows, a rather well developed head and limbs. The abdomen is still flabby and pendulous. There is quite a deformity to the left side of the chest, it being quite prominent at the costo-cartilage juncture of third to sixth ribs. The left kidney is found floating freely in the abdominal cavity.

While we know that the reporting of one case is not enough to prove very much, yet these cases are so few that one man has very seldom more than one or two to report in his practice.

The non surgical treatment is entirely hopeless, while the previous surgical methods offered so little that I felt justified in presenting this case to you for discussion.

A Whole Nation Vaccinated.

Smallpox has been stamped out in Guatemala after a long epidemic, but only by the rigorous and unprecedented vaccination of every individual in the country. The whites have ever submitted voluntarily to vaccination; but the Indians, by reason of superstition, have heretofore always refused to be inoculated. Dr. J. A. Padilla, surgeon-general of the marine hospital and quarantine service of Guatemala, finding the epidemic beyond his control, made strong representations to President Cabrera of the necessity of immunizing the Indians, who were spreading the disease. The president then issued the order for general vaccination. Every physician in the republic was called on to assist, some thousands of dollars were invested in vaccine, and the soldiery concentrated the Indians. For three months the physicians worked daily. For the first time in its history (it is said) all Guatemalan ports are at present free of contagious diseases and passenger traffic is without restriction.

A young lady came into a drug store and asked the clerk if it were possible to disguise castor oil.

It's horrid stuff to take, you know. Ugh!" said the lady with a shudder.

"Why, certainly," said the clerk, and just then, as another young lady was taking some soda water, he asked her if she wouldn't have some too.

After drinking it the young lady lingered a moment, and finally observed: "Now, tell me, sir, how you would disguise castor oil."

"Why, Madam, I just gave you some-""

"My gracious me!" exclaimed the young lady. "Why, I wanted it for my sister!"

Acute Internal Hydrocephalus and Blindness Caused by Lumbar and Ventricular Puncture.

Unfortunately, most of the brilliant results obtained by decompression operations in blindness with choked disk are vitiated by the further progress of the brain tumor, which generally lies at the bottom of the trouble. With acute hydrocephalus, the case is different, as illustrated by the striking case reported by Pap (Abst. in Recueil d'Ophtalmologie, May, 1911, 159). His patient was a child of 7 years, who was suddenly taken with fever and vomiting, becoming completely blind in the course of two days. A week later, June 16, extreme oedema of the optic disk was noted, with no perception of light. Lumbar puncture removed 40 cc. of clear liquid with numerous leucocytes. Two days later patient could see light. Next day, violent headache, vomiting, blindness complete again; 4 cc. removed by lumbar puncture. Next day skull trephined and lateral ventricle punctured with needle 9 cm. long; 5 cc. of perfectly clear fluid removed. Immediately afterward, patient could count fingers. Next day, in spite of headache and vomiting, V=6-15. Three weeks later, vision normal,both sides and optic disks normal. GIFFORD (Omaha)

The Motor Function of the Pyloric Sphincter and Antropyloric in Dogs After Transverse Section of the Stomach. (Mitteilungen aus den Grenzgebieten der Medizin und Chirurgie. Band 23. Heft 3.)

Kirschner and Mangold have investigated both the secretory and motor functions of the pars pylorica after transverse section of the stomach. They found that the vagus innervation is of comparatively little importance to the function of this part. They freed the pyloric portion of the stomach from vagus innervation and from functional association with the cardiac portion. The tonus of the pyloric sphincter and the rhythm of its opening and closing in the emptying of the stomach remained completely normal. The increase of pressure brought about by the contraction of the antrum pylori and the manner of its contraction remain unchanged. The functional co-ordination of the sphincter and antrum were not affected. The chemo-reflexes set up from the duodenal mucous membrane persisted in the pars pylorica after section.

They argue that we are justified in assuming similar condition existing in man because the physiology of the dog's sphincter pylori and the human shows marked similarities. In case the clinical observations already made do not conflict with the results gained in the dog, the experiments on the dog stomach should hold for the human. A transverse section was made in some instances and immediately sewed together again with a complete restoration ad integrum in a physiological sense inasmuch as the regulative and motor functions of the distal portion of the stomach remained unaffected.

DUNN (Omaha)

Tuberculosis in Pregnancy.

Schauta (Monatss. f. Geb. u Gyn., 1911, Band XXXIII, Hef. 3, S. 265), has published a very interesting discussion on tuberculosis in relation to pregnancy. There has been much controversy in the literature on this subject and much difference of opinion has been expressed. Because of the great importance of the subject the following epitomy of the article of Schauta is

presented:

Seventy-three per cent become worse and 45% of tuberculous pregnant women die. Old cases relapse in 68%. The influence of tuberculosis upon pregnancy is usually not manifest until some weeks or months following confinement; this is true in many of the patients, who apparently improve in their general condition throughout the course of pregnancy. Schauta observed that many of the German sanitoria refuse to take tuberculous cases because of their unfavorable prognosis. In Norway the mortality has been observed to be 50% of the cases treated in sanitoria. A little more than one-fourth of the cases treated during pregnancy persue an unfavorable course in spite of the best of care.

It is found that there is a great mortality of the children born of tuberculous mothers; few of them live beyond 20 years of age; 89% of the mothers are benefited by induction of labor in the first stage of tuberculosis; 83% are benefited by the induction of labor in the second stage of tuberculosis and only 25% in the third stage; 91% are improved where pregnancy is interrupted in the first month of gestation. The conclusion, therefore, is that it is the duty of the physician to interrupt pregnancy at the earliest possible moment. Schauta believes that it is best to sterilize these patients because tuberculous women

conceive easily. To accomplish this he advises the removal of the fallopian tubes.

PALMER FINDLEY (Omaha)

Recent Views on the Origin of Tuberculosis of the Lungs.

Rumpf (abst. in Monatsschrift f. Ohrenheilkunde, p. 416, 1911), in reviewing the weight of opinion, as shown at the recent Tuberculosis Congress, says that the infection, through the ailmentary canal, is given a wider scope than formerly, and that more and more investigators are coming to a belief in the great frequency of a haematogenous origin of lung tuberculosis. The bacilli reach the lung tissue, not by direct inhalation, but indirectly through the lymph glands of the neck and bronchi, and thence through the blood. The tubercles in the lungs originate in metastases in the smallest blood vessels. Many authorities lay great weight on the pharynx and tonsils, especially the pharyngeal tonsil, as a port of entry for the bacilli. The experiments of Bacmeister confirm the view of Freund, as to the importance of a too narrow space beneath the first rib, as a predisposing factor in apex tuberculosis. He wound wire closely around the first rib of young rabbits and then inoculated the animals, in an inguinal gland, with tubercular bacilli. A localized tuberculosis developed as soon as the lungs grew into the narrow ring of the first rib, and this effect could not be produced by causing the animals to inhale the bacilli. Rumpf pointed out the analogy between tuberculosis of the lungs and of the female genital organs. Here also are communicating canals communicating widely with the outside world, and thence open to infection, nevertheless Jung at the last Gynæcological Congress said that the great majority of cases of tuberculosis of the female genitals occur by way of the blood.

GIFFORD (Omaha)

The Cause of Pellagra.

(Editorial from American Medicine. Volume IV, No. 10, October, 1911.)

The cause of pellagra is still unknown, but the facts seem to indicate a living parasite and not a poison produced by some saprophyte on spoiled corn or any other food. Sambon (Jour. Trop. Med., September 15, et seq., 1910), has the best of the argument so far and certainly all the facts are explained on