Dr. Hall: After the intra-abdominal pressure was relieved by the incision, the mass could be readily pushed out, yet not easily so, but it seemed to be molded to the contour of the pelvis so accurately that otherwise it could not be moved, is the only explanation I could give for it.

Dr. Chauncey D. Palmer: When one studies the specimen presented, it seems to me a forlorn case for myomectomy. Such a procedure would have required a prolonged operation, and would have greatly endangered the result. Myomectomy might have been done on the larger or less sessile fibroid, but it is very doubtful whether it could have been done on both.

Dr. Stark: I desire to express my disapproval of the operation of myomectomy. The modification of the Baer method in suprapubic hysterectomy is really a very simple operation, and one which yields ideal results in the hands of experienced operators. When we split open these fibroid uteri we find the uterine wall studded with small myomata, and what reason have we to believe that in time they will not develop into larger tumors? Our attention is only directed to the larger tumors in the operation of myomectomy, and we expose the patient to the dangers of an abdominal section, and probably to as much or greater danger as would be entailed by a suprapubic hysterectomy, and why not do that operation at once? Since the 1st of January I think I have made fourteen or fifteen supravaginal hysterectomies for fibroids, and all the patients have made prompt and perfect recoveries.

Dr. Johnston: The design of a myomectomy is to both make an easy operation and to preserve the uterus with its functions, which in this case can not well be attained. With this specimen before us it is difficult to determine what is uterus and what is tumor. On both sides of the uterus are nodules, which are so intimately associated with the fallopian tubes that they could not be removed without injuring the fallopian tubes to such a degree as to destroy their function.

Dr. Giles S. Mitchell: At the last meeting of the American Medical Association I had the good fortune to hear that prince of abdominal surgeons, Howard Kelly, read a paper on myomectomy. He related in his paper one or more cases where he had removed as many as fourteen growths from the uterus; indeed, to use his own language, scarcely any of the anterior uterine wall was left. It is hardly necessary for me to state that his paper was severely criticised. Myomectomy within.

certain limits is not only justifiable, but is to be preferred. Kelly, however, has reduced it to the absurd. Myomectomy, even in suitable cases, is a much more difficult and dangerous operation than hysterectomy. The latter operation ordinarily is not difficult, and the mortality is low. Granting that an operator as skillful as Kelly might be able to remove a dozen fibroids from a uterus and the patient survive, what possible service could an organ so mutilated render? During the past year I have made eight hysterectomies after the method of Baer, and have had no trouble following the employment of silk ligatures. Like Prof. Reamy, I believe silk is the safest ligature for this kind of work, and if it is not too large and is thoroughly sterilized, in time it is disposed of.

Dr. Rufus B. Hall (in closing): There are several things to take into consideration when we think of making a myomectomy, as has been indicated by some of the speakers to-night. One important consideration is the age of the patient; next is the number and location of the tumors. Now, as to the age of the patient, if the woman is forty years old or older and unmarried, or no prospects of an immediate marriage, it matters not a particle to her whether she has her uterus or not. If no other consideration would induce me to make the operation as made here in this case, other than the statistics of the mortality of the two operations, in a given patient before us I would make the operation done here. If the patient were a married woman or a younger woman, under thirty, and two tumors subperitoneal, with no indication of other fibroid tissue in the uterus itself, and she were anxious to bear children and were made aware of the increased danger in the operation of myomectomy and desired a myomectomy, then we should consider that operation. But if the woman were forty years old or older and were not particularly anxious to bear children, and the mortality greater in myomectomy than in hysterectomy, she should be given the best chance for her life. Few women who do not bear children under forty years of age bear children after with a healthy uterus. Then, to take a case like this, I do not believe the day will ever come that any man at the operating-table would make a myomectomy in such a case as this. I do not believe that day is here, nor within five nor twenty-five years of us. In such a case as this there would be no peritoneum adherent to the uterus when you got through, and then you probably would have a few fibromata in the body of the uterus left. But that would matter little, for the patient would almost

certainly die. I am not going to discuss the subject of ligatures in this case further than to say that a recent discussion in the Southern Surgical and Gynecological Association in St. Louis brought out a very important point, which was overlooked by one of the speakers this evening, that is, the sterile catgut, that is absolutely sterile under the culture tube, is capable in the body of forming what they describe as a chemical sepsis. Nature is not able to care for the catgut in all instances, and an abscess forms about the catgut that is buried in which the pus has no infecting germs in it. This they call a chemical process of suppuration. After all, we can not sterilize the catgut from the surgical standpoint. Dr. Kelly said, in Washington, that the mortality must always be very much greater in myomectomy than in hysterectomy, and I think if we emphasize that fact we are correct.

Abstracts and Selections.

THE COMPARATIVE PHYSIOLOGY OF THE Suprarenal Capsules. No. 381 of the Proceedings of the Royal Society contains a communication by Swale Vincent, M. B., in which he states that his attention has been devoted to the general physiological effects of extracts obtained from suprarenal capsules. The extracts were made separately from the cortex and the medulla, and injected subcutaneously into various mammals. It was noted, says the author, that the injection of medullary material was invariably fatal if a sufficiently large dose was administered, while the cortical extracts produced no appreciable physiological effects.

These observations have been corroborated, he continues, by testing the effects of the two kinds of gland in elasmobranchs and of the cortical suprarenals of teleosts, when extracts of them are injected subcutaneously into small mammals. Only very small quantities of material have been available for this purpose, but the effects upon mice have been quite definite.

The suprarenal bodies obtained from six specimens of Gadus morrhua, weighing in a moist state six grains, were extracted by boiling. The filtered extract was then injected beneath the skin of the back of a mouse, and no effects whatever supervened. Again, the author continues, the paired bodies from seven specimens of Scyllium canicula, weighing when moist four grains and five tenths, were extracted in the same way, and the filtrate administered to the same mouse (which had remained in perfect health) a few days later. The animal was immediately and powerfully affected. The breathing became very rapid, the limbs became weak, the

temperature sank, and death ensued after convulsions in less than five minutes.

The interrenal gland produced no effects when administered in the same way.

A further experiment, the author goes on to say, with material obtained from Raja clavata was performed. The axillary hearts (anterior paired bodies) were removed from three fair-sized specimens, and found to weigh in a moist state three grains. The interrenal bodies were also removed, and weighed three grains. Extracts were then prepared of each of these, and injected subcutaneously into two mice of as nearly as possible the same weight. The mouse which was treated with the extract from the paired suprarenals was affected in a few minutes. The respirations were very quick at first, afterward becoming slower and slower. Paralysis quickly came on, first in the hind limbs. All the four limbs were distinctly stiffened before death, which supervened in two hours after the injection.

The other mouse, treated with extract of interrenal, died about twentyfour hours after the injection.

These experiments, says the author, afford further positive evidence of the homology of the paired bodies of elasmobranchs with the medulla of the mammalian suprarenal. The direct evidence in favor of the homology of the interrenal with the cortex of the suprarenal is mostly morphological and histological.-New York Medicdl Journal.

HEREDITARY ALBUMINURIA.—Jules Ranault (Jour. de Med., October 25, 1897,) draws attention to this subject. He points out that the child of an eclamptic woman may be born with albuminuria and die in convulsions, and that on post-mortem examination profuse intratubular hemorrhage may be found, and he also believes that albuminuria is not infrequent in breast-fed children of mothers who are the subjects of nephritis. There is also another variety of hereditary albuminuria-that which declares itself from twelve to twenty years of age in the children of parents who themselves suffer from albuminuria or who have died of nephritis. In certain of these cases the mother showed albuminuria during pregnancy, and the question may be asked whether albuminuria discovered at twelve or thirteen does not date from birth, but in several instances it is certain that previous to its discovery at that age it was not present. In other cases albuminuria appeared in the parents after the birth of the child, from which it would seem that a certain renal susceptibility was transmitted, which declared itself during adolescence as acute nephritis. The author quotes several cases in support of this fact, showing that several members of a family may be affected with albuminuria through as many as three generations, and that it may vary in its features, being cyclic in some cases, while in others the symptoms are those of well-marked acute nephritis. It is pointed out that in this the kidney is merely on a par with other organs, such as the lung, stomach, etc. The author puts in a class by themselves these cases of

inherited gout where the parents suffer from gouty nephritis. In these instances he states that the albuminuria is often of the cyclic variety; in others the children proceed to renal disease having the same characteristics as their parents. Children in whom albuminuria is discovered are dyspeptic, pale, and anemic, and have little muscular energy. It is slight in degree and may diminish under the influence of proper diet, but does not show any tendency to disappear. On the other hand, the albuminuria tends to increase after exercise, muscular strain, mental work, or strong emotions. Provided no infectious disease occurs to aggravate this form of albuminuria, it continues to progress slightly but constantly, and in from six to fifteen years patients have become typically nephritic with small, contracted kidneys, and succumb to uremia. Thus, the prognosis of hereditary albuminuria is bad, for if the patients do not fall victims to their first infectious disease, they develop pronounced nephritis.-British Medical Journal.

THE TREATMENT OF CARBOLIC-ACID POISONING WITH VINEGAR.The following case is related by Dr. A. Paget Steavenson in the Indian Medical Record for December 1st: The patient was a girl, eighteen years old, who said she was subject to "fits." On August 3, 1896, she was taken with one, and when the physician saw her she was in a semi-conscious condition and frothing at the mouth. She had vomited slightly, and the vomited matter had a sour smell, but no carbolic-acid odor was observed. She regained consciousness, and a bromide draught was administered. She gradually became worse, and another physician was called to see her. He diagnosticated the case as one of carbolic-acid poisoning, and, as he could not rouse her or get her to swallow any thing, he ordered her to be taken to the hospital.

When she was admitted she was quite unconscious, cyanosed, and nearly pulseless. The lips and the tongue were discolored, and the breath had a slight carbolic-acid odor. The author gave her a hypodermic injection of strychnine (one eightieth of a grain). He then passed a soft stomach-tube, washed the stomach out with equal parts of vinegar and water, and followed this with about six pints of warm water. He then gave her five ounces of milk and an ounce of brandy. She was then put into bed and kept warm. She gradually regained consciousness, and a few hours afterward she was able to speak. She was fed on Benger's food, milk, and soda water for the next three days. She did not vomit or complain of any pain. Carboluria was present for two days. The author states that he was led to use vinegar in this case by Professor Carleton's suggestion in the Practitioner of August, 1896. He can not state definitely how much carbolic acid was taken. The long period of unconsciousness, the rapid recovery, and the absence of discomforting after-effects speak well, he thinks, for the vinegar, and he is of the opinion that it should be given a fair trial, especially as it is a remedy easily obtained.-New York Medical Journal.