The consideration which the author finds the deterring factor in preventing the trial of this method by surgeons to whom it is a novelty, is the fact that the surgeon is not able to see the orifice produced by the ligature. He closes the abdomen on still intact intestines, and is obliged to put his trust in the slow, unseen action of a constantly contracting rubber cord. He desires the evidence of his senses but is obliged to put faith in things unseen. It is only after repeated trials of its efficiency that he learns to have confidence in a procedure which McGraw considers the simplest and least dangerous of all methods for making an intestinal anastomosis.

Carcinoma of the Vagina.-G. W. Maly, Centralblatt für Gynækologie, reports the case of a woman of 67 years who had worn a ring pessary for 39 years, only occasionally removing it for cleansing purposes. During all this time the patient felt perfectly well until ten months before consulting the writer. Upon examination there was found a large carcinoma of the vagina involving all its walls, and containing a furrow into which the pessary fitted. The case was inoperable, and palliative treatment was given. The author found six similar cases reported in literature (Veit's Handbuch der Gynækologie) the occurrence of cancer being due to the constant mechanical irritation of the pessary worn for a long period of time.

A Case of Hairpin in the Uterus Discovered by the X-Ray. The following case was reported by Dr. A. H. N. Lewers (London) at the meeting of the British Medical Association. The patient went to the London Hospital and said that she was pushing in the hairpin in order "to open an abscess" when it disappeared. On examination there was some blood-stained discharge but nothing could be felt of the pin. The uterus and the bladder were examined by the sound with negative results. A radiograph taken by Mr. Hannan showed the hairpin distinctly lying with its points downwards. Under anesthesia the cervix was dilated with Hegar's dilators, and each point of the hairpin was seized with a Spencer Wells forceps and the pin was extracted. There was also found a mass of placental tissue of the size of a walnut, but no foetus. The patient became very ill after the operation, having a rigor and a temperature of 106 F. Subsequently pelvic cellu

litis and suppuration in the left thigh developed, the latter necessitating incision. An incision was also made into the vaginal roof and pus was evacuated. Ultimately, however, she completely recovered. Reference was made to the literature of the subject of foreign bodies in the uterus. Negebauer had recorded 74 cases, and of these 16 were due to hairpins. This was the first case recorded in which the diagnosis had been made by the X-rays.

Cause of Inversio Uteri.-F. Schauta (Wiener Klinische Wochenschrift, July 9, 1903), refers to a case of inversio uteri, in a woman 72 years old, and says that inversion in an old woman with highly atrophied uterus brought him to the conviction that the inversion of the puerperal and the nonpuerperal uterus was due to the same cause; that it was never due to muscular activity, but to muscular weakness or deterioration through atrophy, or through thinning of the walls combined with pressure from above or tension from below. Pozzi says that to produce inversion of the uterus it is necessary that one part of the organ, having become inert and thin, be seized by contraction of the part of the uterine muscle situated below it. MacNaughton Jones states that the essential-as it always is the predisposing-element in inversion is an atonic state of the uterine parenchyma, favoring relaxation of the muscular fibers. This leads to a partial prolapse of the uterine wall; the prolapsed portion is treated by the uterus as a foreign body; it excites contractions which end in expulsion of a part or the whole of the fundus. Schauta, however, claims that the inversion of the uterus never occurs during a contraction, as during contraction the uterus is hard and stiff, and this condition is unfavorable to inversion. After reviewing the opposing views of Treub and Thorn, he asserts that contraction plays no part in inversion; but that inversion is caused by weakness of the organ through paralysis, atrophy, thinning of the walls, or distention of the uterine cavity by a myoma, etc.-American Medicine. A Liberal Offer and a Good AnatomicoPhysiological Chart.

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VOL. XLVI-42.

PEDIATRICS.

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

Acute Pyelitis in Infancy.-James Ritchie (Scottish Med. and Surg. Jour., July, 1902) reports a case in a baby 7 months old. He says that the condition may be suspected in any case which presents considerable and perhaps irregular variation of temperature with apparent integrity of other systems. The condition of the urine-acid with pus and bacteria-will complete the diagnosis. Cystitis may be excluded by the absence of painful and frequent micturition. The amount of pus varies as does the degree of tenderness. Treatment consists chiefly in rendering the urine neutral, and so removing the condition necessary for the growth of the bacillus; maintaining a copious flow of urine so as to render it as little irritating as possible to the inflamed tracts, and general hygiene care. In the case described, marked improvement followed the use of sodium salicylate, the symptoms becoming worse when it was stopped. The existence of constipation and anal fissure may require special treatment.

John Thompson (ibid.) concludes from his study of this disease that: 1. In infant girls, when debilitated by any cause, acute pyelitis may be set up by the immigration of the bacillus coli from the bowel. 2. The presence of the disease is sufficient to occasion very high fever, extreme distress and a copious deposit of pus and bacteria in acid urine. 3. Unlike any other disease, except malaria, it frequently causes rigors even in young children. 4. The presence of anal excoriations has possibly an important etiological significance in these cases. 5. The prognosis (when the case is treated) is altogether favorable, although complete recovery is sometimes delayed for many weeks. 6. The only essential treatment consists in the thorough and long continued neutralization of the acid in the urine by the alministration of alkaline remedies.-Amer. Jour. of Obstetrics.

Acute pyelitis in infants is not, according to Thompson, very rare. Undiagnosed it is an alarming disease, but under proper treatment it is a curable one. The alkaline used by Thompson is citrate of potash. In severe cases he advises giving 36 to 48 grains per diem.

Whooping Cough-a New Method of Treatment.-Theron Wendell Kilmer (N. Y. Med. Jour. and Phila. Med. Jour., June 20, 1903) says that the medical treatment which has proved the most efficacious in his hands is that devised by Dr. Kerley, namely, the alternate use of antipyrin with bromide and quinine. The application of an elastic belt to the abdomen or thorax (or both), as occasion requires, combined with the above medicinal treatment, has proved itself to be the best and most effective method in the treatment of whooping cough. A stockinette band is placed upon the child in the same manner as is done by orthopedists before applying the plaster-of-Paris jacket. This band extends from the axillæ to the pubes, and fits snugly. Two shoulder straps are used to prevent the band from slipping down. Upon this stockinette band a single width of elastic bandage is sewn, extending entirely around the body and covering the abdomen. This bandage is sewn on when very slightly on the stretch. The elastic abdominal belt is used to control the obstinate vomiting seen especially in nurselings, when the infant in some cases would die without its use, on account of the inanition caused by the incessant vomiting. The most aggravated cases of vomiting in nurselings have been seen to stop immediately upon the application of the elastic abdominal belt. Should the vomiting continue after the belt has been applied, tighten the belt slightly, and in most cases the vomiting will cease.

There are, of course, occasional cases that will not yield. The belt is also of use in aborting the paroxysmal stage; when wearing it the paroxysms will be noticeably milder. In some cases it causes a slight eczema of the underlying skin, but this clears at once when the belt is removed.Amer. Jour. of Obstet., Sept., 1903.

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PHYSIOLOGY.

Under charge of FRANCIS WILLIAMS, M. D.

"Some Notes on the Interrelation of the Circulatory and Nervous Systems,' in part from the Harvean Oration, 1902.

That Vasoconstrictor Nerves are Absent from the Lungs has been proven by the failure of adrenalin chloride, which acts upon the ends of the vasoconstrictors, to constrict; while barium chloride, which acts upon the unstriped muscle of the arterioles, does constrict. This was proven by artificially circulating solutions of the above substances through the lungs and noting the resulting pressure and resistance-no increase occurred when adrenalin was used, while the increase did occur with the barium chloride solution. The matter, however, remains an open question, and its settlement has some bearing upon the use of vasoconstricting remedies during pulmonary hemorrhage.

The Blood Pressure in the Aorta and Heart Influences the Vasomotor Center through certain afferent nerve fibers running from the lining of the heart and aorta in the vagus to the vasomotor center. These fibers are known, because of their action on the vasomotor center, as the depressor fibers, and in the rabbit run in the vagus sheath as a separate nerve easily isolated and stimulated, with a resulting fall in the blood pressure through vasodilatation. The depressor fibers are normally stimulated by any more than normal increase in the cardiac and aortic blood pressure; while their action is general they especially affect the splanchnic area. This interrelation aids to protect the heart, relate arterial to venous pressure, and supply functionally active organs.

Cerebral Congestion Slows the Heart, and a decrease in cerebral blood pressure quickens the heart so as to maintain pressure and supply the brain, e. g., upon. rising, etc.

Dilatation in the Splanchnic Area causes vasoconstriction elsewhere as well as an increase in the heart's rhythm. This may add another reason for the benefit of catharsis in cerebral congestion.

Stimulation of sensory nerves usually causes a rise in