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were not present. A fetus, 12 mm. in length, surrounded by amnion and chorion, lay within the ovisac. Numerous chorionic villi, some in contact with maternal tissue, could be demonstrated between the chorion and the maternal wall of the sac. The conclusions arrived at are: (1) That ovarian pregnancy is a fact which can no longer be disputed; (2) that ovarian pregnancy signifies pregnancy in a Graafian follicle; (3) that as in this specimen the follicular wall does not show any transformation into decidual tissue, the conclusion must be drawn that Webster's decidual reaction is not a sine quâ non for the implantation of the ovum; (4) that the regular development in this specimen of normal syncytium constitutes a new and incontestable proof that the syncytium has no connection with the uterine epithelium, but is a derivative of the fetal epiblast. The importance of this case is enhanced by the fact that it shows the conditions existing at an early stage. Previously described specimens have generally been too advanced to allow of any certain deductions as to their primary origin or the true relationship of the parts. It would, indeed, appear doubtful whether a true follicular gestation could reach an advanced stage of development if there is no decidual change in the maternal tissues, as this case would indicate. The paper is illustrated with very clear colored drawings of microscopical sections and a photograph of the entire specimen.

lation to the original scar. lation to the original scar. This I removed again, and remembering the action of resorcin on rodent ulcer, I put some of the powder into the wound. The result was that there was no immediate union, but delayed healing from a ragged ulcer with a better result than I anticipated. Since that date my patient has had no recurrence, and the cicatrix in the lip causes him no trouble.

There can be doubt as to the value of resorcin in rodent ulcer. I have lately had a typical case, which was cured in five or six weeks by rubbing in the powder every night after removing the crusted covering and ceasing the application when the reaction was excessive.

The Catarrh Produced by a 2-per cent. Solution of Silver Nitrate in the Eyes of Newly Born Children.

It must have happened to many practitioners who follow Credé's teaching and introduce one or two drops of a 2 per cent. solution of silver nitrate into the eyes of newly born children to find that the application sets up a good deal of catarrhal conjunctivitis. The question as to whether the occurrence of such an inflammatory reaction is the usual result of the treatment or not has aroused a considerable amount of controversy. Professor Leopold attributes the catarrh to a faulty technique; other authorities hold that it is the usual sequel and consider it a serious drawback to the treatment. With a view to settling the question Dr. H. Cramer has investigated the

Resorcin in Rodent Ulcer and Operations for effect of a 2 per cent. solution of silver nitrate

Cancer.

JAMES E. BLOOMFIELD, M. B., ΟΧΟΝ.

Sevenoaks.

After reading the very interesting lectures of Sir William Banks, I feel induced to record the following short experience, as it bears on the question of local infection of wounds in removing malignant growths.

In the year 1891 a patient presented himself with a typical epithelioma of the lower lip. This was removed in a London hospital in May of that year. In June, 1892, the growth recurred, but I was struck with the fact that it did not originate in the original linear scar, but about 1-8 of an inch off. This I removed with the usual V incision. In September of the same year there was a second recurrence, but I do not recollect its exact re

upon the eyes of 300 newly born children. One drop of the solution is placed in each eye while the child is lying upon the back. The baby is then rolled over on either side alternately and by the successive opening and shutting of the lids the lotion is spread all over the conjunctival sac. The eyelids and the surrounding parts are then carefully wiped dry with cottonwool. In all the cases the conjunctiva was found to react to a greater or less degree, varying from simple congestion and swelling to an acute inflammation. In five cases only out of 100 which were carefully observed were there no discharge, the effect being limited to some redness and swelling of the mucous membrane. In the remaining ninety-five cases there was an abundant discharge. In seventy-three cases it lasted about five days, while in twentyseven it continued for a longer period of time. In eleven cases a secondary infection occurred,

with a recrudescence of the symptoms. Dr. Cramer is inclined to believe that the reaction is more marked in children who have been born after a difficult labor, or who have presented by the face. In two cases of ectropion of the upper lid the inflammation was extremely marked. The length of time the discharge lasts appears to depend upon the presence or absence of organisms in the conjunctival sac. For the first twenty-four hours the discharge is aseptic, but after the second day it contains numerous organisms of various kinds. In all the cases of secondary infection staphylococci or streptococci were found to be present. These investigations tend to confirm the view that the use of a 2 per cent. solution of silver nitrate is normally followed by a certain degree of conjunctivitis which tends to spontaneous cure and gives rise to no bad results. The fact that such a reaction does occur is no doubt the explanation of the unpopularity of this mode of treating the eyes of newly born children with some medical men and with a great many monthly nurses. The dangers of ophthalmia neonatorum are, however, so great that there is no justification for neglecting any precautions that may tend to prevent the occurrence of this dread disease. There can be no doubt that the use of a 2 per cent. solution of silver nitrate is one of the most certain means of prevention, and its more general use would be of the greatest value in tending to diminish the very large number of cases of ophthalmia neonatorum which at the present time occur in midwifery practice.

A Case of Rigid Os Uteri Treated with Cocaine.

E. F. CLOWES.

A multipara, aged thirty-seven, was taken in labor at 11:30 p. m. on December 17, 1899. She had had seven children. Her previous labors had always been lingering, but there had never been any call for operative interference. The pains were severe, but not frequent, only one or two taking place in the hour. She remained in this condition until December 19, when at 3:30 a. m. the waters broke," and a midwife was sent for. The midwife examined and found the os about the size of a shilling, and then left the patient for another

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At 1 a. m., December 19, I was called to see her. I found her tired and rather worn

out; the pains were severe, and coming every four or five minutes; her pulse was good and regular, and beating at the rate of ninety per minute. I found the os uteri dilated to the size of a half crown; the walls were thin and tense. No bag of membranes presented. The position of the occiput was in front and to the left. I waited for several pains, but finding that the os was very unyielding, I decided to apply cocaine (a 10 per cent. solution) on a piece of cotton wool; the head came well down, and easily compressed the pledget of cotton wool between it and the walls of the os. After the occurrence of two pains I again examined the patient, and found the os fully dilated and the walls quite soft. I could easily sweep my finger round the presenting head (which was a small one) and between it and the pelvic walls, but to my surprise the head did not advance with the pains.

I now introduced my hand into the vagina, and found that the neck of the child was securely gripped by the lower part of the body of the uterus; the part below this situation, extending to the external os, was soft and flabby. I tried to pass my finger between the neck of the child and the band, but failed to do so. I now applied forceps (without an anesthetic), and by steady traction on them for a minute or so overcame the resistance of the band, and the child was quickly delivered. The placenta was removed without any trouble, and the patient made an excellent and uneventful recovery.

I have now used cocaine in a good number of cases of slowly dilating, or of rigid os. and all cases so far have been most successful, this being the first case in which any difficulty arose.

A Case of Multiple Papilloma of the Vaginal Surface of the Cervix Uteri.

JAMES OLIVER, M. D., LONDON,

Physician to the Hospital for Women.

Papilloma of the vaginal surface of the cervix uteri is an extremely rare disease. A patient suffering from this affection who came under my care was forty-one years of age. She had had two children, and had been a widow for ten years. She consulted me on account of a slight hemorrhagic discharge from the vagina which she had noticed occasionally for five months. At no time had any alteration in the frequency or amount of the menstrual dis

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charge been noted, and during the inter-menstrual period preceding her visit to me there had been no hemorrhage, but merely a profuse white discharge from the vagina. A digital examination of the vagina detected a shaggy polypoid growth of the size of a small hazel nut, springing from the vaginal surface of the left half of the cervix about 3-8 of an inch from the os uteri. There was no evidence of any infiltration of the cervical tissue either in the neighborhood of the growth or around the os. The examination caused the tumor to bleed freely.

After snipping off this growth with scissors two smaller growths of the same character of about the size of millet seeds, which had been concealed by the main growth, were revealed. Each growth possessed a small arterial vessel, which spurted bright blood immediately its continuity was severed. The site of each growth presented the appearance of a highly vascular spot from which the mucous membrane might have been removed by a circular punch of the size of a small goose quill. These islets were separated from each other by apparently healthy mucous membrane, and there was no evidence of induration of the cervical tissues. To include the bases of all three growths I removed a wedge-shaped piece of tissue from the left half of the cervix and brought the wound together with deep catgut sutures, creating thereby a linear wound one and a quarter inches in length. The operation did not interfere in any way with the integrity of the os uteri or the cervical canal. Union was effected by first intention. (Note.-If my patient had been living a marital life vaginal hemorrhage would have been observed more frequently and would probably have been more profuse.)

Microscopic sections of the growths presented generally the appearances of a simple papilloma, but sections of the base of the largest growth revealed the presence of a few cells of such a character as to arouse suspicion regarding the innocency of the tumors.

Obstetrical Society of London.

HEART DISEASE AND UTERINE FIBRO-MYOMA.

Dr. Thomas Wilson (Birmingham) read a paper on the relations of organic affections of the heart to fibro-myoma of the uterus. He called attention to the necessity for observing the possible evil effects produced on the other

organs of the body by the growth of the uterine fibro-myomata. He showed that the conjunction of serious organic affections of the heart with the presence of a fibroid was sometimes casual, but in a much larger number of cases the connection between the diseases of the two organs was causal, the heart affection being set up by the growth of the fibroid, or both being dependent on a common cause. Occasionally the heart might be affected directly by the pressure of a very large cystic fibroid, or indirectly by a tumor pressing on the ureters, and so leading to renal degeneration; that in its turn led to cardiac changes. Much more commonly a fibroid of moderate size led through menorrhagia to anæmia, and thus to cardiac dilatation or degeneration; or, again, in the early stages of the growth of a tumor cardiac hypertrophy might be found, and this latter might give place to dilatation and degeneration. It was not at present understood how the hypertrophy was brought about, but the condition was in some degree analogous to the enlargement of the heart found in pregnant women. There was the important difference, however, that the causing affection, pregnancy, in the latter case was definite in duration, whereas the period of active growth of a fibroid was indefinite.

He described the case of a patient who had an intestinal fibroid for four and a-half years; there had been several attacks of retention of urine and the symptoms of cardiac weakness were decidedly increased by ergot. Double oöphorectomy was performed, and was followed by alarming heart failure lasting several days. The patient eventually made a good recovery, and the condition of the heart showed a gradual but very marked improvement. Six other cases in which organic disease of the heart was apparently caused by the growth of fibroids were shortly related. The nature of the cardiac affection, the varieties of uterine fibroids which were present in the cases, the cardiac symptoms and signs, and the course and prognosis were then in turn considered, and it was pointed out that after a successful operation the heart tended to recover its tone in a really remarkable degree.

The presence of the cardiac disease favored the occurrence of thrombosis both before and after operation; it formed a contra-indication to the use of ergot in the treatment of the fibroid, but it might be an important and even urgent indication for operative interference. When an operation was undertaken, every effort must be made to reduce as far as possible

the severity of shock and the risk of subsequent heart failure, and ether should be the anæsthetic administered.

The President had himself frequently observed circulatory troubles, independently of anæmia, in patients with fibroid tumors. One was subject to attacks of syncope at every menstrual period for two years; three years ago he removed the tumor, as it was growing rapidly, with both ovaries. Since then no attacks of syncope had occurred. A year ago he removed a uterus with suppurating fibroid, leaving one ovary. The pulse, irregular before the operation, had been regular ever since. Chavannaz and Fieux, of Bordeaux, had recently reported a somewhat similar case, in which, after removal of a fibroid uterus and both ovaries, the pulse, previously very intermittent, became and remained perfectly regular.

Dr. Amand Routh recalled a case which proved the serious action of ergot in the cases under discussion.

He had elevated a large impacted pelvic fibroid by hydrostatic pressure, in a patient aged forty-six years. Her only symptoms had been due to pelvic pressure, and these were at once relieved. Her heart's action was feeble. Against his advice she took ergot in pills, and soon became very weak and ill, and stated that within an hour of taking a dose, she had pains over the cardiac area, with breathlessness and palpitation. She was seen by Sir William Broadbent, who stated that he found her arteries were much tightened, and his previous experiences of such cases enabled him to fix on the ergot as the cause of the heart trouble, and of the pseudo-angina. The patient slowly improved when the drug was discontinued.

Inasmuch as ergot was so generally given in cases of uterine fibroids, he thought it not unlikely that unsuspected cardiac debility in such cases would be aggravated by the drug, and would explain the asthenia which was not infrequent.

Dr. Herbert Spencer thought that many of the symptoms of heart disease and the murmurs were due to the anæmia caused by the uterine hemorrhage. Anæmia, thus caused, was an urgent indication for operation, especially in young subjects. It was remakable how rapidly in some cases the symptoms disappeared, and health was restored even after the removal of the ovaries only, the tumor remaining. He doubted whether fibroids often gave rise to hypertrophy of the heart. In

pregnancy the heart was very frequently not hypertrophied.

Dr. Blacker thought that there were considerable difficulties in determining the casual relationship between a fibroid tumor and organic heart disease. He wished to know upon what number of cases of fibroid tumor Dr. Wilson based his experience. With influenza so common, and so often followed by cardiac mischief, the previous histories of the cases under discussion were of great importance, for otherwise it would be difficult, in any given instance, apart from cases of grave anæmia, to say that a dilated heart was due to the presence of a fibroid tumor. He also asked why Dr. Wilson thought that the presence of cardiac hypertrophy with a fibroid tumor was an indication for operation.

Dr. Heyward Smith, in reference to Dr. Spencer's view that hypertrophy and dilatation of the heart were probably due to the anæmia produced by the loss of blood, contended that it was more probably due to the heart having to overcome increased resistance caused by the extended area of circulation produced by the tumor, as well as the resistance through a tissue so unyielding as a fibrous tumor. Dr. Bedford Fenwick some years ago called attention to the fact that a similar hypertrophy and dilatation of the heart was to be observed in many cases of large ovarian cysts, where a large increased area was added to the circulation, giving a greater stress of work to the heart.

Dr. Thomas Wilson, in reply, said that in the cases recorded in the paper the presence of fibroid tumors appeared to be the only probable exciting cause of the cardiac condition. In none of the patients was there a history of influenza or other of the common causes of derangement of the heart's action or nutrition; none of the patients were neurotic in the sense in which the term was generally applied. In many of the cases chronic anæmia seemed to be an important factor, but in several of the cases there was no anæmia. With regard to the relative frequency of heart affections in cases of fibroids, Dr. Wilson was not in a position to give statistics at present.

Unless there are special indications aseptic wounds do not need redressing for eight or ten days.

Wounds about the face may be closed by a subcutaneous ligature, and thus render a scar less likely.

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