vaginal hysterectomies. Many operators, no doubt, will dispute this assertion and say that such treatment is likely to cause salpingitis instead of curing it. Clinical facts, however, bear him out in his statement that minor operations and simple measures obtain the best results in many cases and preserve both the patients and their normal functions. The author submits the following table of cases in his own practice, whose diseases predestined them to sterility or castration, and who were cured by conservative methods and later gave birth to children:

Hydronephrosis.-Hildebrand" and Haga made a series of experiments to search for the cause of hydronephrosis and its relation to floating kidney. The experiments showed that a kinking of the ureter will produce a hydronephrosis and a degeneration of the entire kidney. A detachment of the kidney from its capsule never causes hydronephrosis, even if complicated by a twisting of the ureter.

Vaporization of the Uterus.-Pincus" reports a few more cases and highly praises the value of this method in cases of

climacteric bleeding and as a means of sterilizing the uterine cavity prior to the performance of hysterectomy. About two minutes' vaporization with his modified apparatus suffices to produce entire obliteration of the uterine cavity.

Nervous Disorders following Castration.-Schmitz reports 3 cases of grave disturbances following the oöphorectomy. In all of these the ovaries were removed in connection with uterine fibroids. Schmitz questions whether it would not be better to not remove otherwise healthy ovaries. The symptoms following castration are probably analogous to those after the removal of the thyroid gland, and it is probable that the ovary forms secretions, the presence of which is important to the organism, while their absence produces disturbances. Schmitz formulates the rule that in all benign uterine tumors the ovaries should be preserved.

Injuries to the Bladder from Abdominal Operations.Bloch" discusses the influence exerted by large abdominal tumors upon the form and position of the bladder and the injuries to this organ which may occur from removal of the tumors. This accident happened to Bloch five times amongst 110 abdominal sections, and he also collected 33 cases occurring in the hands of other operators. In 27 cases the bladder was injured during the removal of the ovarian tumors; the others were cases of fibroid tumors. The changed position and appearance are mainly responsible for this accident. The diagnosis of an altered position is very important, but always difficult, and often almost impossible, not only before but also during the operation. Examination with the catheter is not reliable. times injury to the bladder is not discovered during operation, because the organ may be empty, and even if some clear urine does escape it may be mistaken for serum. In some of the cases described by Bloch the injury occurred in locations where no one would expect to find the bladder. The best treatment of such an injury is to suture at once. The prognosis is not very favorable, as Bloch reports 14 deaths amongst 36 cases, but in some of these death apparently was not due to the injured bladder.

At

Cystitis due to Typhoid Bacillus.-Thomas Houston" records the first known case of cystitis produced by a localized unmixed infection with the typhoid bacillus. The cystitis had existed for three years, and repeated careful bacteriological examinations of the urinary sediment showed a pure culture of the bacillus of Eberth.

The case seems of interest for the following reasons: 1. The history gave no evidence that the patient ever had typhoid fever, and the fact that she spent so much of her time in hospital and was under medical treatment at home may be held to exclude any possibility of mistake in this respect. In cases of typhoid fever the bacillus of Eberth is often found in the urine, even some weeks after the temperature is normal. This case is one of typhoid infection without the usual symptoms of typhoid fever, and since there is no point in the history subse

quent to the commencement of the cystitis three years ago which suggests the occurrence of a new infection, the probability is that the typhoid bacillus has been present from the beginning. When we consider the fact that typhoid bacilli are so easily destroyed by more vigorous forms, such as Escherich's bacillus, it seems highly improbable that at any time during the course of the cystitis the typhoid bacillus has displaced the colon bacillus in the bladder. The acidity of the urine excludes the probability of other forms commonly found in cystitis ever having been present.

2. The blood serum gave a decided "reaction of infection." This shows that the case is not a simple bacteriuria, but that the bacillus has a nidus somewhere, as, for example, in the mucous membrane of the bladder, and thereby has such an effect on the blood and tissues as to cause the serum to acquire the agglutinating power.

3. It seems to follow that in this case the bacillus of Eberth was capable of producing a local lesion without the patient suffering from typhoid fever.

4. The fact that the bacillus can grow in the tissues without any symptoms of enteric fever resulting, and produce there a local lesion, is in favor of the view that this fever is a true general infection, and not merely of local origin, in the Peyer's patches of the intestine.

5. It also proves that the bacillus may occur in the tissues, and the blood serum give Widal's reaction, without the infec tion which we recognize as typhoid fever resulting.

6. To explain the anomalous fact that we have here a lesion, restricted apparently to the urinary organs, produced by the typhoid bacillus, which has persisted for a very considerable time without any symptoms of typhoid fever, three theories seem admissible: (a) This patient for some reason or other was not very susceptible to infection with Eberth's bacillus, so that when the opportunity for infection occurred a local lesion alone resulted and no general infection. This agrees with the result obtained when a non-susceptible animal is inoculated with a given bacillus. (b) We have here a form of typhoid bacillus which differs in its infectious power from the recognized form of Eberth's bacillus. (c) Typhoid fever is not solely due to the bacillus of Eberth, but other etiological factors must be brought to bear on the patient before the clinical features of typhoid septicemia result. The researches of Sanarelli, which show how the virulence of the typhoid bacillus is increased by the injections of the toxin of the bacillus coli communis, and also those of Sidney Martin, which confirm his results, make it certain that the bacillus coli communis may be directly concerned in producing a virulent typhoid infection in animals.

The persistence of the typhoid bacillus in the bladder possibly for three years appears less remarkable when we recall the cases in which abscesses containing typhoid bacilli have been observed six or seven years after the occurrence of typhoid fever in the patient.

Extirpation of the Vagina.-A. Martin' discusses the indications for this operation, and describes a new method and a successful case of extirpation of the vagina and uterus for cancer. He first makes an incision encircling the introitus, and then proceeds, without using any instruments, to detach the vagina from the rectum and bladder. After reaching the cervix the uterus is extirpated in the usual manner. The resulting wound is covered with peritoneum, which is stitched to the outside edges, and he then proceeds to obliterate the vagina transversely. The case reported (a woman 61 years old) made an uninterrupted recovery, and six months later there had been no recurrence. Martin states that this operation is exceedingly simple and free from technical difficulties, and should be adopted not only for malignant diseases, but also in cases of extreme prolapse. The author states that during the last two years he has operated on 6 cases successfully which had been unsuccessfully treated by ventrofixation and different perineoplastic operations.

42

Pathology and Therapy of Prolapsus Urethræ.-Singer ** describes 8 cases of prolapsus of the urethra from Chrobak's clinic and states that this affection is not so rare as generally believed. It occurs most frequently in children, and women past the menopause. Its cause can generally be traced to angiomata, a relaxed urethra, and to the introduction of foreign bodies. The patient may have no disagreeable symptoms, but usually there exist vesical tenesmus and bleeding from the protruding mucous membrane.

Abdominal Hysterectomy.-Funke" publishes a report from the University Clinic of Strassburg on the excellent results obtained by Freund from abdominal hysterectomy for cancer of the uterus. The main objection against this operation was the high mortality, which, according to Kaltenbach, amounted to 67 per cent. Freund's statistics until 1894 showed

a mortality of 33 per cent, but since then he has operated in 20 cases with a mortality of only 20 per cent. Funke states that in all cases of advanced cancer of the uterus abdominal section should be made and that the uterus, with the adjacent interstitial tissue and glandular structures, should be entirely extirpated.

Torsion of Pedicle in Salpingo-ovaritis.-In discussing this subject after reporting 3 cases, H. Hartmann and E. Reymond" state that pain at the seat of the lesion, sometimes relieved by pressure, is usually the first subjective symptom. The tumor increases rapidly in size. Metrorrhagia does not seem to be caused by the torsion. Neither the direction of torsion nor the number of turns is constant. The affected organs are usually previously diseased, but in one case reported torsion of healthy appendages occurred during pregnancy. few cases have been reported that it is not possible to explain the mechanism. It seems to depend, however, upon the form of the tube, which possesses a long and yielding pedicle, with an extremity which is large and heavy on account of increase

in size of the tube near its outer end or of its adhesion to a hypertrophied ovary. It may depend also upon modifications in the size and situation of neighboring organs, as in the case of a fibroid or pregnant uterus. Adhesions seem to act chiefly in fixing the tube in its abnormal position.

Sclerosis of Broad Ligaments, etc.-Keiffer" reports a case of atrophy of the vagina, uterus, bladder, and broad ligaments in a virgin 39 years old. While such a sclerotic condition is not uncommon in cases of uterine fibroid, the instance reported showed the presence of only a small tumor of this character in the anterior wall of the uterus.

REFERENCES.

1 Ann. de Gyn., Oct. * Cent. für Gyn., No. 41. 3 Hospitalstidende, No. 1. Jour. d'Accouchements, July. Münch. Med. Woch, No. 42. Münch. Med. Woch., No. 43. 'Münch. Med. Woch., No. 44. 8 Berlin Klin. Woch., No. 47. La Clin., Aug. 10 Münch. Med. Woch., No. 39. 11 Wort. Med. Korresp., 1898. 12 Med. Rev, Oct. 13 Gazeta Lekarska. 14 Zeit. für Geb. u. Gyn., Bd. xxxix. H 3 15 Bull. de la Soc Belge de Gyn, vol. ix., No. 4. 16 Arch. Ital. de Gyn. 17 Ann. di Ost. e Gin.. vi., 30. 18 L'Obst., Sept 19 Med. and Surg. Bull., Dec. 20 Münch. Med. Woch., No. 41. "Cent. für Gyn., No. 39. 22 Lancet, Nov. 12. 23 Cent. für Gyn., No. 45. 14 Presse Med., Sept. 24. 25 Thèse de Paris, 1898. 26 Bull. Johns Hopkins Hosp., Nov. 27 Am. Jour. Med. Sci., Jan. 28 Penn. Med. Jour., Dec. "Chic. Med. Rec., Dec. 30 Ann. of Gyn. and Ped., Dec. 31 Bost. M. and S. Jour., Dec. 15. 32 Buff. Med. Jour., Dec. 33 Ann. of Surg., Dec. Med. Jour, Dec 35 Practitioner. Dec. 36 Med. Rec., Dec. 10. 87 Med. Rec.. Dec. 17. 38 La Clin, 1898. 39 Archivo di Ost. e Gin., Anno v. Far. 6. Deutsch. Zeitschr. für Chir., Bd. xlix., H. 1. 41 Nord. Med. Arch., No. 6. Monatschr. für Geb. u. Gyn., Bd. viii., H. 4. 43 Zeit. für Geb. u. Gyn., Bd. xxxix., H. 3. 44 Ann. de Gyn., Sept. 45 Bull de la Soc. Belge de Gyn. et d'Obst., No. 6. 46 Jour. de Méd. de Paris, Sept. 4. 47 Am. Gyn. Jour., Jan. 48 Obstetrics, Jan. 49 Johns Hopkins Hospital Reports, vol. vii, No. 4. 50 Bost M. and S. Jour., Feb. 2. 51 Brit. Med. Jour., Jan. 14. Jour. des Sci. Méd. de Lille, Oct. 28. 53 Ann. of Surg, Feb.

1

DISEASES OF CHILDREN.

84 Ed.

Acute Diphtheroid Angina due to Leptothrix.-Henri Meunier and M. Bertherand' report a case of a child of 3 years, previously well and never having suffered from any angina with exudate, who at the onset of scarlatina had a pseudo-membranous angina which presented all the characteristics of diphtheria and was treated as such. Repeated bacteriological examinations failed to reveal the Löffler bacillus, but demonstrated the presence of a special parasite, a leptothrix (possibly the leptothrix buccalis). The authors were unable to produce the same lesion in an animal as in the patient by means of this micro-organism, and yet, in spite of their nonsuccess, they have no doubt that the filament played a pathogenic rôle, as it is otherwise impossible for them to understand certain special characteristics revealed by their bacteriological experiments. The appearance of the preparations, where, to almost entire exclusion of all other bacteria, swarm numberless colonies of the leptothrix; the presence of a thick layer of