of an obstruction to the air passages is well known, and the writer thinks that the quality of the voice is of some importance. In laryngeal obstruction some alteration of the voice is always found, while an obstruction lower down causes little or no change. On reviewing the literature on the subject it is found that not a great number are recorded. They are almost all found in young children, and the commonest situation of the perforation is into the right bronchus. G. E. GASK. JEHLE (ALEXANDER). Empyema with Secondary Esophageal Fistula. Wiener med. Wochnschr., 1904, p. 998. A CHILD, aged 2 years, acquired a right-sided pneumonia, which was followed by an empyema. This was treated by an incision in the fifth costal interspace in the posterior axillary line, and a large quantity of thick pus evacuated, which on bacteriological examination yielded a pure culture of pneumococci. Some three weeks later it was found that particles of food were being passed with the pus, and later the communication between the pleural cavity and oesophagus was confirmed. The discharge slowly discharged, and about five months later entirely ceased, the child recovering without any evil results remaining. G. E. GASK. BÖCKER (W.). A Case of Loose Bodies in Both Knee-Joints, with Double Displacement of the Patella Outwards. Deutsche med. Wochnschr., 1904, p. 844. THE case recorded is that of a man, aged 33, who at the age of 13, suddenly without any obvious cause, experienced pains in the left kneejoint, which prevented him from moving his leg. These pains recurred at intervals, and a few years later he himself discovered a moveable body at the outer side of the patella. Three years after the beginning of the trouble the right knee-joint became similarly affected. The joints were often swollen, and at times became locked, and gradually the patellæ became displaced outwards. Examination of the joints revealed several easily palpable movable bodies. The patella were exceedingly movable and on extension became dislocated outwards. The movements of the joints were good and painless. There was considerable atrophy of the muscles of the thigh. An operation was performed with the object of removing the loose bodies and curing the displacement of the patellæ. The joints were opened and several loose cartilaginous bodies, containing a bony nucleus, removed. On the right side the semimembranosus bursa was found to contain a similar body. The interesting feature of the case lies in the fact that in each knee there was a defect of the inner portion of the internal condyle of the femurs, and one of the bodies corresponded in shape with the missing portion of the femur. The joint surfaces otherwise appeared normal; there was no evidence of any arthritis deformans (osteoarthritis). The capsular ligaments were, however, lax and stretched, and to obviate the displacement of the patella the semi-membranosus muscle was detached at its insertion and stitched to the inner surface of the patella. As regards the pathology of the case, the author is inclined to class it with the series of cases described by König under the name of osteochondritis dissecans, and he does this on the following grounds:1. The total absence of any history of injury. 2. The extent and situation of the morbid process. 3. The fact that corresponding portions of both knee-joints were affected. The operation proved successful; the movements in the knee-joints being good and the patella remaining in position. G. E. GASK. SAMTER (0.). A Case of Myoma of the Pylorus. Wochnschr., 1904, p. 914. Deutsche med. An account of a tumour of the pylorus in a woman, aged 49, in whom symptoms of obstruction had lasted twelve months. The tumour was removed by pylorectomy. On microscopic examination it proved to be a Leio-myoma, which apparently was growing from the circular muscular layer of the pylorus. TABORA. The Bloodless Treatment of Cicatricial Contractions of the Stomach. Wiener med. Wochnschr., 1904, p. 1075. A FAVOURABLE account of the use of subcutaneous injections of thiosinamin in a case of fibrous stenosis of the stomach with formation of an hour-glass contraction. HABS. Bier's Venous Engorgement Treatment. Wiener med. Wochnschr., 1904, p. 1129. A REFERENCE to Dr. Habs' results on the treatment of diseases of joints by Bier's method of producing venous engorgement. He approves of the method in cases where the tuberculous lesion is localised to the joint and in which no sinuses have occurred; where, however, there are sequestra or the bone is involved the method is not so successful. In arthritis deformans no good results followed. G. E. GASK. MARTIN (E.) and THOMAS (T. T.). Fractures of the Patella. Therap. Gazette, 1904. Vol. xxviii. p. 76. THE authors come to the following conclusions as regards treatment:1. The conservative treatment of fracture of the patella is applicable to blow or tear fractures in which the separation of the fragments is not greater than half an inch when the knee is flexed to a right angle and when there is no great joint tension. 2. All fractures of the patella independent of the amount of fragment separation attended by marked and immediate joint tension. should be treated by the open method. 3. All fractures of the patella in which the fragments are separated more than one half-inch when the knee is bent to a right angle should be treated by the open method, the torn tendinous expansions of the quadriceps being closed by mattress sutures and the patellar fragments by silver wire. DUJARIER and LECÈNE. Traumatic Cysts of the Hand. La Presse Médicale, April 16th, 1904, p. 241. THE authors describe two cases of these cysts; in both cases the cysts were situated on the palmar surface of the metacarpo-phalangeal articulation of a finger following an old injury; both were subcutaneous, hard and relatively painless. In one case the structure was that of a traumatic epidermoid; in the other case the cyst was formed of dense connective tissue organised round a foreign body. The first is an example of an "implantation cyst," epidermic cyst, epidermoid or epithelial cyst. The nature of these cysts can in many cases only be determined by a histological examination. PRIESTLEY LEECH. PATEL (MAURICE) and VIANNAY (CHARLES). Operations on the Pelvic Sympathetic Nerves. Gazette des Hôpitaux, March 26th, 1904, p. 347. as THESE authors describe the anatomy and distribution of the pelvic sympathetic nerves. They think various diseases may be due to disease of these nerves, e.g., pelvic neuralgia in women, vaginismus, uterine pains, certain disorders of menstruation in women, and in men pain at the vesical neck, frequent micturitions where physical examination reveals no cause for these pains. Prof. Jaboulay describes such cases vaginismus in man. Sciatic neuralgias may also be due to disease of the sympathetic. Prof. Jaboulay has resected the ganglions and the trunks of the sympathetic by separating the rectum from the sacrum. Injections of air and later of serum into the retro-rectal tissues with the object of stretching the sympathetic nerves has also been tried. These methods are scarcely likely to recommend themselves to surgeons. GAYET and PATEL. Total Gastrectomy for Plastic Linitis. Arch. Génér. de Méd., 81st year, Vol. i., p. 770. In this case the patient, a woman, 44 years old, was operated on for cancer of the stomach infiltrating the entire walls of the stomach. Prof. Jaboulay did a total gastrectomy. An analysis of the gastric contents previous to operation had given total acidity 1,93, HCl 1,13; no free HC1; no lactic acid. At the operation no glands were found; the duodenum was closed and a loop of the jejunum was brought up to a small piece of the cardia of the stomach which had been left. On microscopical examination after many sections had been made it was found that the lesion was a very atypical epithelioma originating in a chronic inflammation. The inflammation showed nothing specific and there was nothing to suggest tuberculosis, no giant cells, no distintegration, no glands. PRIESTLEY LEECH. NATTAN-LARRIER (L.) Purulent Arthritis Due to the Gonococcus. Arch. Génér. de Méd., 81st year. Vol. i., p. 785. THE patient, a woman, aged 38, was admitted complaining of pains in the right knee. The presence of the gonococcus was proved by making cultures. Three times the joint was punctured and the joint recovered without further treatment. STERN (W. G.). Morton's Painful Disease of the Toes. American THIS disease is generally held to be rare, and by some writers (the French) its existence is denied. From inquiries among shoemakers and shoe salesmen, Stern finds that opinions as to its frequency vary according to the class of business. This and his own experience lead him to believe that this particular disease is the property of the well-todo and is quite frequent among them, while the poor who do not usually indulge in narrow, thin-soled uncomfortable shoes, are rarely afflicted. He believes the cause to be a breaking up or flattening of the anterior transverse arch of the foot. Almost all the patients belong to the better and wealthier classes; few have sedentary occupations, many have grown stout within a short period of time, and in nearly all cases there is a history of a severe trauma shortly before the pain, e.g., runaway accidents, jumping into the saddle, football, mountain climbing, etc., are repeatedly given as the causative agent of the trauma. Well-marked evidences of wearing tight shoes are usually to be found. He recommends Whitman's insole as most useful. In future cases he intends to fasten pads of soft rubber to a flat German silver insole to give a much-needed elasticity not found in Whitman's plate. PRIESTLEY LEECH. RHOADS (THES. L.). Abscess of Liver Caused by Distomum Sinense of Intra-hepatic Bile Ducts. American Medicine, Febuary 6th, 1904, p. 225. OUT of 21 operations for liver abscess this is the only case due to distomum sinense. The patient was a sergeant in the U.S.A. Navy, and was supposed to have caught the infection in China or Japan. HUNT (J. RAMSAY). Acute Infectious Osteomyelitis of the Spine and Acute Suppurative Peri-meningitis. Vol. lxv., p. 641. THE author has seen two cases of this disease, and he thinks that the true frequency of the disease has been underestimated, although it is a rare disease. The writer's conclusions are as follows:-The vertebral column is rarely the seat of acute osteomyelitis. He has collected and analysed 62 cases. Great diagnostic difficulties are sometimes encountered owing to the immediate relation of the spine to the vital organs of the thoracic and abdominal cavities and the spinal cord and its membranes. Hence retro-pharyngeal, mediastinal, retro-peritoneal and para-nephritic abscesses, pelvic abscesses, peri-dural suppurations and general pyæmia may be mentioned among the more important complications. Peri-dural abscess or suppuration occurred in 24 of 62 cases. Of these 15 cases presented grave symptoms of compression of the spinal cord. The essentials of the clinical picture are: symptoms of a severe general infection associated with the local signs of an inflammatory process of the spine, e.g., excruciating pain and tenderness, oedema and fluctuation. The mortality is 50 per cent. Immediate and thorough surgical interference is the only treatment. He thinks all cases of idiopathic or primary suppurative peri-meningitis are identical with acute osteomyelitis of the spine. PRIESTLEY LEECH. LESSER (FRITZ). The Etiology of Fibrous Orchitis. Münch. med. Wochnschr., March 22nd, 1904. THE author says that several surgeons have doubted whether this condition is always due to syphilis. To elucidate the question he uses the statistics of the Moabit Hospital in Berlin. From 1896 to 1902 2,979 male adults came into the post-mortem room, and of these there were 133 cases of orchitis fibrosa. It is also found in 45 per cent. of all grown up men. In 94 out of the 133 cases there were definite signs of constitutional syphilis, i.e., 70'6 per cent. ; in other 20 cases there were doubtful signs of constitutional syphilis. In ordinary cases in the post-mortem room in adults only 9.6 per cent. have anatomical signs of syphilis, against 70 per cent. in cases where there is fibrous orchitis. In only exceptional cases is it caused by gonorrhoea, and unless there are other circumstances of etiological moment fibrous orchitis must be looked upon as due to syphilis. PRIESTLEY LEECH. GUYOT (JOSEPH). the Femur. Acute Osteomyelitis of the Superior Extremity of THIS condition is comparatively rare, the writer analysing 54 collected cases, including one of his own. It appears to be commoner in the male sex, and is essentially a disease of the growing period of life. The |