patients, after great improvement, and in some cases apparent cure and return to work, relapsed once or oftener, and finally died, in spite of treatment. Other more recent cases are briefly referred to. In one patient leukæmia was succeeded by fatal pernicious anæmia. The author does not yet claim any of his cases as final cures, but considers that the X-rays are capable of effecting an improvement beyond anything seen from other methods of treatment, and may perhaps ultimately prove to have cured some of the patients. He believes that the rays produce in the system bodies which counteract the leukæmic process, but that these bodies themselves give rise to antibodies, which in some cases neutralize the favorable results of treatment and lead to a relapse.

Four examples of Pyelitis in Puerperium. this complication in pregnancy are given by Jeannin in Progressive Medicine. The onset varies from thirty-six hours to four or five days after the delivery. Sometimes the pyelonephritis appears during the pregnancy, but remains quiescent and only becomes aggravated after the trouble is ushered in with violent rigors and a sudden rise of temperature. However the illness comes. on, it always runs a uniform course, being divided into two stages, the presuppuraative and the suppurative. The presuppurative stage is occupied by that space of time which the bacillus coli takes to become virulent. This is the stage of general symptoms, high temperature, quick pulse, rigors and headache. Constipation is often very obstinate at this time. The urine during this stage is not very characteristic, though there is usually some albumin present. This stage has a variable duration; in the author's cases it did not exceed three or four days, though sometimes it is more than a week.

The suppurative stage commences at the moment when the infection, at first general, has fixed upon the urinary system. Clinically it is the period of local symptoms, troubles of micturition, vesical pain and polyuria. The urine has a sediment which consists of pus. The general symptoms now decline in severity, and the patient feels not unwell. During this stage there will be apparent relapses, when the patient is suffering again from all the signs of a general infection. These are due to a collection of pus in the pelvis, and when this collection is voided the general symptoms quickly disappear. There will be pain on palpation over the kidneys, and especially over the right kidney, which is much more frequently affected than the left organ. The suppurative stage remains of the same intensity for about a week, and then as the uterus, diminishing in size, ceases to compress the ureter the pyuria diminishes and the fever subsides. It is not, however, until five or six weeks have passed that all the symptoms have disappeared completely. The disease ends nearly always in a cure, but there is great liability of a recurrence of the trouble at the next pregnancy.

Wassermann's Test in A modification of Syphilis. Wassermann's method is suggested by Klausner, and is recommended for its comparative simplicity. Klausner obtains five c.c. of blood by scarifying the back of the patient and by the use of a small suction pump. The blood is then centrifuged, and two-tenths of one cc. of the serum, together with seven-tenths of one c.c. of distilled water, are placed in a glass tube one-half a centimeter in diameter and seven centimeters high. After thorough mixing, the solution is allowed to remain at room temperature. In all of 31 syphilitic patients a

precipitate from two to four millimeters in depth was formed in from two to fifteen hours. Most of these patients were in the second stage, though five were in the first stage and two showed syphilitic gummata. Sera from 23 non-syphilitic patients suffering from other diseases showed no precipitate at the end of 15 hours, and only a very slight one at the end of 24 hours. Two patients with croupous pneumonia and one with typhoid fever gave a positive reaction, i. e., a heavy precipitate in 15 hours, or less when the serum and distilled water were used. When, however, five or ten times as much water as serum was used these same patients showed a negative reaction, while the syphilitic patients still gave a positive one with these higher dilutions. The number of patients examined is too small to serve as a basis for positive conclusions as to the value of Klausner's test, but the method is so simple that it is worthy of trial.-New York Medical Record.

acetic acid. Five c.c. of the extract is treated with 25 c.c. of æther, or preferably with carbon tetrachloride, which is more satisfactory on account of its non-inflammable nature. The extract is then evaporated to dryness in a porcelain dish, and the residue is rinsed into a test tube with several cubic centimeters of glacial acetic acid. The reagent is prepared by adding a portion of powdered benzidin the size of a pea to several cubic centimeters of glacial acetic acid. This is added to the fluid to be tested, and the appearance of an intense green or blue color in a few seconds on the addition of several cubic centimeters of hydrogen peroxide indicates the presence of blood. Performed in this way, the reaction is far more delicate than the guaiac or aloin test, but it is necessary that the patients be placed on a diet completely free from meat for a period of two or four days before the stool is examined. Observations on a considerable number of patients suffering from various gastric disorders substantiated these views as to the reliability of the test. An interesting observation was the fact that in 12 cases of achylia a positive reaction was obtained seven times, a finding which leads the author to suggest that possibly the occult hæmorrhages so demonstrated may have something to do with the anæmia usually associated with this condition.

Ovarian Cyst in a Child.

Dr. Robert C. Loving, U. S. Army, of West Point, N. Y., says (Journal American Medical Association, April 25, 1908) that a search of the literature shows that this condition is extremely rare. The

unusual and peculiar symptoms in this case make it of sufficient interest to report. The history pointed to some obscure bladder trouble.

Patient. Six years old. On night of August 15 was suddenly attacked by pain

in the hypogastrium, accompanied by a pressing desire to urinate. She was up constantly during the night. Her mother applied hot fomentations to the meatus without relief.

Examination. When seen the follow

ing morning the child was in pain and was straining with violent vesical tenesmus. A few drops of normal urine were being constantly expelled. The abdomen was vapid and tender, pulse rapid and temperature normal. While she was not seriously depressed, she presented some slight shock. There was a prominent tumor in the hypogastrium. It occupied the entire pelvis and extended up to the level of the umbilicus. It presented all the physical signs of a distended bladder, except that it was a bit too narrow for its height. There was gut tympany on both sides and above it. It was firmly fixed in position, and manipulation intensified the expulsive efforts. Rectal and vaginal examinations were made without positively establishing the diagnosis. The pelvic viscera were so small and SO crowded by the cyst that they could not be outlined. All that could be felt was the rounded lower end of the tumor. Catheters were passed into the bladder without result, except that they were immediately crowded out by the expulsive efforts, which even produced considerable bulging in the perineum. With the exception of chronic enuresis, the child had been in good health till the attack of pain the night before. Her mother always bathed her and had never noticed any prominence of the abdomen. Although it may have no bearing on the case, it may be noted that the patient had always been easily nauseated and would vomit at the sight of her sister eating softboiled eggs, milk toast and such articles of diet, which she termed "sloppy." She

Pain in Pelvic Disease.

The Significance of E. Novak (American Journal Obstetrics, April, 1908) offers the following suggestions:

1. A careful physical examination is of first importance in the diagnosis of pelvic disease, but interesting information. will also be derived from the character and distribution of the pelvic pain. 2. The exact nature of the disease should be determined in a given case as nearly as possible, and not the advisability or inadvisability of an operation alone. 3. Pain in the pelvic viscera is governed by the same laws which apply to the causation of pain in the other abdominal viscera. 4. Neurasthenia may develop from neglected pelvic disease, with diffusion of pain and characteristic symptoms in other parts of the body. 5. Persistent neurasthenia following pelvic operations: is frequently responsible for the continuance of unpleasant symptoms. 6. Hysteria with pelvic symptoms has the same characteristics as when associated with other diseases. 7. The removal of nor

1908) refers to the lack of unanimity of opinion regarding the important question of the physiological arrest of post-partum hæmorrhage. He considers the teaching expressed in obstetrical text-books as unsatisfactory, because it gives no information as to whether in post-partum hæmorrhage the bleeding is arterial or venous. Those who recommend aortic compression for the arrest of the hæmorrhage do so to control the arterial supply of the placental area. Brock believes that the bulk of the blood in post-partum hæmorrhage flows from the maternal sinuses through the uterine veins by a backwash. from the inferior vena cava. He points

out that the maternal sinuses are situated in the superficial layer of the uterine mucous membrane, internal to the muscular layer, and, therefore, not directly acted on by the latter as is generally taught. The blood in post-partum hæmorrhage is invariably dark venous and does not pulsate, but in bad cases comes away in "an appalling torrent," unaffected by the direct hæmostatic power of the uterine muscular fibers. The treatment of severe cases resolves itself into the prevention of regurgitant venous hæmorrhage. This

may be accomplished (1) by direct pressure applied to the bleeding sinuses. This may be carried out by introducing one hand closed into the vagina, while with the other the fundus of the uterus is pressed down on it, through the abdominal wall. (2) By elevating the pelvis and compressing not the aorta, but the inferior vena cava. This method of arresting hæmorrhage depends for its suc

on compressing the inferior vena cava, and in this way stopping the backwash of blood from the latter.

(EbsteinChirurgie des prukt. Arztes, 1907). This disease consists in a congenital dilatation of the sigmoid flexure and the colon, sometimes of enormous extent, so as to fill almost the entire abdomen, with considerable displacement of the diaphragm. The clinical manifestations, severe obstipation and abdominal bloating either appear directly after birth. or they develop within the first few months and years of life. In exceptional

cases, the condition has been observed in adults. The disease in the vast majority of cases terminates in death, which is frequently preceded by acute colitis and the formation of numerous ulcers. A part of these cases present an abnormal width of the affected intestinal segment without any mechanical obstruction, whereas in other cases the cause was found at the lower end of the colon, where it passes into the rectum, in shape of a valve-like flexure of the bowel. In the first-mentioned form, surgical treatment has not

been followed by satisfactory results. Kredel proposed laparotomy and artificial stricture of the colon by the application of longitudinal folds. Brentano prefers to close the abdomen as soon as the existing conditions have been thoroughly inspected. In the presence of a flexure or valvular mechanism, however, surgical interference may prove beneficial, as shown by the cases of Perthes, Kredel, Kümmell and others. Either a colopexy may be performed by straightening out the flexure and stitching the colon to the abdominal well, as was successfully done by Kümmell, Frommer and Wooliner, or the dilated portion was circumvented by means of entero-anastamosis. Resection of the entire coil has also been performed (eight cases with two deaths). The seat of the flexure alone was successfully resected by Perthes. The temporary application of an artificial anus at the descending colon is essential to the successful outcome of resection, whereas no favorable results were obtained by the simple application of an artificial anus above. the dilated portions. F. R.

From Milk.

Scarlet Fever Epidemic H. B. Hemenway, Evanston, Ill. (Journal A. M. A., April 4), gives the history of an epidemic of scarlet fever that occurred in the city of Evanston, near Chicago, in the winter of 1906-7. He describes the conditions and shows, apparently conclusively, the connection between the extension of the disease and the use of milk from a certain source of supply. This source had been under suspicion on account of a number of cases of scarlatina occurring during the previous summer and fall, but the real epidemic began early in January, 1907, and was at its height between the fourteenth and nineteenth of the month. Whole families were attacked in a day, and a notable pro

portion of the patients were adults. Cases occurred also in the adjoining portion of the city of Chicago and in a village immediately north of Evanston, as well as in a western suburb of Chicago about the same time, in all of which regions a considerable portion of the milk was supplied from the same source. Nearly all the cases in Evanston occurred in usersof this milk, and the same was true in Wilmette and Oak Park, where it was also supplied from the same source. On the other hand, in the adjoining village of Winnetka, which did not receive milk from this source, there was but one case of scarlet fever, and that was clearly traced to contagion. In short, the distribution of the cases of scarlet fever showed throughout a close relation to this particular milk supply, which went to about one-seventh of the milk consumers in the territory. There was a sudden fall in the reported new cases when the supply from this source was discontinued by the orders of the local health commissioner, while they continued to increase in Chicago, where the milk refused at Evanston was delivered. Few cases were recognized as due to contagion except those traced back to users of the suspected milk, though this phase of the matter was carefully investigated. The epidemic in Chicago reached its height a little later than at Evanston, but followed a similar course, declining a little less suddenly after the discontinuance of the milk supply from the suspected locality. Investigation by the Evanston health authoritiesrevealed a number of cases of scarlet fever occurring in January in the locality from which the milk was sent, some of them in families supplying the milk or including employes of the milk company. The milk was bottled on the spot, and the chances of its infection in transit need hardly be seriously considered. Hemen