Special stress was laid upon a closer union between the hospital organizations and the biochemical laboratory, and he expressed his belief that the most primising field of medical research at the present time was that now presented to the biological chemist. Among the interesting problems which biological chemists are now studying is the question of the matabolism in typhoid and the best diet for those suffering from this disease.

Before the patholog

Acidosis in Pregnancy. ical section of the Royal Society of Medicine, J. B. Leathes discussed the subject of acidosis in pregnancy as lately brought into prominence in papers by Zweifel, Williams, Ewing and Wolf. Zweifel found that there was a smaller proportion of the nitrogen in the urine excreted in the form of urea than is normal; the percentage of the total nitrogen excretion that was accounted for by urea varied in different cases from 27 to 70 per cent.; the ammonia nitrogen was, on the other hand, always high, and in one case amounted to 16.5 per cent, of the total nitrogen. To account for the high ammonia coefficient Zweifel found the urine frequently contained lactic acid. Williams describes cases of toxæmic vomiting in the early months of pregnancy in which the ammonia in the urine accounted for 32, 35 and 45 per cent. of the total nitrogen excreted, and in one clinically identical case the liver showed central necrosis of the lobules similar to that

found in acute yellow atrophy. These cases had no jaundice, no albuminuria, nor other signs of renal disease, and in two of them the liver dullness was normal, while in the third it was somewhat diminished. The high ammonia coefficient is characteristic. It is not found in cases of neurotic or reflex hyperemesis, nor in the pre-eclamptic toxæmia accom

panied by albuminuria, and, therefore, is an important diagnostic sign of a dangerous condition. A coefficient of 10 to 15 per cent., he says, would seem to justify the diagnosis of toxæmic vomiting and to afford an urgent indication for the prompt termination of the pregnancy. Ewing and Wolf give a most valuable series of analyses of urine in more than 30 cases of pregnancy. The first six cases showed no symptoms of abnormality, except that in the urine of one of them the ammonia coefficient was somewhat raised and the urea was low, and in all six the undetermined nitrogen gave high figures, 14 to 15 per cent., even when the NH was not above the normal, and 24 per cent in one case when the NH coefficient was 11 per cent. The normal undetermined N coefficient is, according to Folin's estimation, no more than about 6 per cent. The next six cases, characterized by very severe vomiting beginning early in pregnancy, are grouped together by the authors as toxæmic. In four of these the urine was found to contain large amounts of ammonia, forming 20 to 43 per cent. of the total nitrogen excreted in one case. In the other two the ammonia coefficient was normal, but in all six the undetermined nitrogen was at least doubled.

The point raised for discussion before the section was whether with the data as yet available it was justifiable to conclude that the abnormal composition of the urine was causally connected with the grave conditions referred to. It was

pointed out that ammonia coefficients, such as those described, were common in starvation, in severe vomiting and diarrhoea, with diets from which carbohydrates were excluded in diabetes, and amongst other conditions in certain diseases of the liver. In these last cases there was some evidence that the associations of high ammonia coefficients with hepatic disease was incidental rather

than causal, and the same sort of connection had not yet been proved not to hold in the disorders of pregnancy. More striking than the high ammonia coefficients was the large amount of nitrogen in unknown combinations to account for which there were fewer possible known causes. It was particularly noteworthy that in complete starvation, so far as the available data went, there was no evidence for a similar phenomenon. But, on the other hand, there was some difficulty in attributing greater significance to this sign, as all the six cases described by Ewing and Wolf as being free from symptoms of any grave disturbance excreted more than twice the normal amount of nitrogen in such unknown combinations.-British Medical Journal.

Etiology of Epithelioma.

A new chemical theory of the origin of epithelioma is put forward by A. E. Hertzler in the Journal of the American Medical Association. It is based on the hypothesis that "the epithelial cells are held in restraint by a chemical difference between them and the underlying connective tissue, probably the basement membrane of its equivalent, and that in malignancy there is a disagreement of the balance, usually by a lessening of the acidity of the connective tissue." He adduces a number of clinical facts in support of this hypothesis, all based on the assumed predominance of the alkalinity at the points where cancer occurs. His conclusions are summed up by him as follows: I. Cancer occurs at that point where irritation and exposure to an alkaline secretion coexist. 2. When a chemical, which has the power of combining with the acidophilic elements, is injected into a tissue made up of epithelium and connective tissue, the epithelium proliferates and invades the connective tissue, simulating

the process in beginning epithelioma. 3. The same chemical process which prevents blood from coagulating limits the invasion of one tissue by another. Epithelium everywhere rests on a tissue similar to the membrane elastic of the blood vessel. It is this layer that confines epithelium within the normal limit. The aberrant growth of the cells is but the expression of some disturbance in the chemical relationship of the different kinds of cells. The results of experiments, based on the knowledge of tinction chemistry, permits us to state in general terms the nature of such disturbance of chemical balance.

Cytodiagnosis.

The principal points of diagnostic value. in the enumeration of the cells in exudates and transudates are given by J. E. H. Sawyer in a paper in the Lancet. The author claims that it is necessary to examine the fluid as soon as possible after it has been removed, as after a few hours the cells begin to degenerate and become. in consequence, very much more difficult to recognize. Some of the fluid should be gently centrifugalized, and care should be taken not to use force, as otherwise many of the cells are destroyed. A differential count of 500 cells should be made whenever necessary, although in some cases, as in cerebro-spinal fluid, the cells are so few that it is impossible to count such a large number. In other cases one type of cell so predominates that accurate results can be gained by the enumeration of a smaller number. The principal point of diagnostic value is the type of cell which predominates, small lymphocytes, polynuclear cells or epithelial cells. His general conclusions are as follows: I. Effusions of tuberculous origin contain a large per cent. of small lymphocytes, ranging from 59 to 100 per cent. 2. Ef

fusions of acute inflammatory origin, a large percentage of polymorphonuclear cells, ranging from 64 to 97 per cent. 3. Mechanical effusions contain chiefly endothelial cells. 4. Effusions due to ma

lignant disease can rarely be diagnosticated by count methods alone, but when such a condition is suspected to be present, the predominance of endothelial cells. would greatly support that view.

Operative Tendencies Dr. Arthur Stein of in Modern Obstetrics. New York (New York Medical Journal, March 7, 1908) says that a study of the development of the art and science of midwifery during the many centuries up to modern times shows a decided neglect in the direction of the evolution of the operative field. In spite of the fact that operative obstetrics originally was taught by surgeons and was regarded as a part of surgery, this branch of medicine drifted far away from its mother science. In the second half of the last century, while great strides were being made in operative gynecology, chiefly under the guidance and co-operation of prominent surgeons such as Billroth, Simon, Czerny and Mikulicz, the opinion still prevailed that operative obstetrics had reached its full development. Only when modern gynæcologists began to apply the knowledge they had acquired in the diagnosis and treatment of the female genital organs to the functional activity during the period of gestation did operations become more frequent in obstetrics. And even then the advances were few, for the gynæcologists were still too wrapped up in their own subjects, so that operative obstetrics only began to keep pace with the advances in gynæcology during the last two decades.

The Doctor then considers Bossi's method of dilation and then speaks of

Dührssen's vaginal section. Dührssen first described his method under the name "deep cervical incisions," and finally, after improvements in technique, changed it to "vaginal Cæsarean section," under which name it has attained an undisputed place among modern obstetrical operations. He showed how, by means of four deep cervical incisions, combined with episiotomy (Scheiden-Dammincision) if the vagina was small, it was possible to deliver even a primipara with closed cervical canal of a living child, provided, however, that the supravaginal portion of the cervical canal was obliterated. This proviso became unnecessary in the vaginal Cæsarean section, as the lower uterine segment was now included in the field of operation. The introduction of this operation represented a real advance in modern operative obstetrics, for it was now possible during pregnancy or labor to bring about an immediate delivery if the condition of mother or child demanded it, even when no part of the cervical canal was obliterated, and then without imperiling the life of the mother. The operation was therefore also a means by which an abdominal Cæsarean section could be avoided. This operation, in my belief, is also destined to take the place of the classical Cæsarean section in the

dying woman. In this case we operate entirely in the interest of the child.

ternal genitals-Incision of hæmatoma, extirpation of clitoris and labia, extirpation of Bartholin's glands, perineorrhaphy, periurethral sarcoma, fistula-in-anohæmorrhoids. Vagina and cervix-Excision of cicatricial stenosis, curettage of cancer of cervix, scarification of cervix. Upon the pregnant uterus-Retroflexed incarcerated uterus, adhesions; curettage of bladder, exploratory laparotomies, nephrotomy for pus, for stone and other kidney operations; amputation of breast, inguinal hernia, umbilical hernia.

In many of these cases in which abortion followed it was at so appreciable an interval that it may be questioned with propriety whether it was caused by the operation; in fact, some writers hold that in no case is the operation the direct cause of miscarriage, but merely determines a miscarriage that is bound to come anyway. An examination, then, of the foregoing list will show that operations of the most varied nature can be performed with very little danger of interrupting pregnancy, with two exceptions-in 9 opera

tions for vesico-vaginal fistula abortion. followed in four, and in 25 operations for crural hernia it took place six times.

centa.

Cause of Premature Dr. Samuel RobbinSeparation of the Pla- ovitz of Brooklyn (New York Medical Journal, March 14, 1908) says that he has arrived at the conclusion that the most frequent and predominating cause that may be assigned to the premature separation of the placenta is traumatism. He bases his conclusion on clinical experience received at a private charity organization for treating poor women in confinement, and most of his cases have been seen during the past six months. So far, in every case, without exception, the Doctor has found accidental bleeding. either before labor, directly or during the last month of gestation a history of traumatism. Several patients were beaten by their husbands, thrown to the floor violently or had been kicked or pushed in the abdomen. One woman fell down stairs, another met with some accident in the workshop.

reason that nothing but very carefullyprepared gelatine is employed for the sensitive plates. The gelatine is dissolved. in water, in a proportion of 1:10, and is then sterilized in the autoclave at a temperature of 120°. After careful filtration the solution is filled into glass tubes, and these are closed with cotton pledgets. Before using, these glasses must be heated in the water-bath, and the required amount is then poured into the baby's milk, so that about 10 g. gelatine are ad