of the eye were followed by extensive inflammations. Subcutaneous injections of the killed cultures, practiced upon the author himself and two other persons, gave rise to local inflammation, with fever, and pains in the head and extremities during one or two days.

Repeated doses failed to show the development of any tolerance for the poison, and all experiments directed toward the production of an immunity were fruitless.

It is to be regretted that these "experiments" are not given in detail, for it would not be surprising if Wassermann should find that the serum of the men and animals under whose skins he injected the gonococcus toxin contains the antitoxin which ought to give the much desired immunity.

It is to be hoped that subsequent experiments will confirm the theory in the announcement of which, we believe, Dr. Bloom has the priority.

Notes and Queries.

ARREST OF HEMORRHAGE FROM LARGE VESSELS BY SUTURING.— Lindner (Berliner Klinik, April, 1898) reports a case in which, during an attempt to close a fecal fistula in the left groin, the common femoral artery and vein were both opened. The bleeding from the vein was arrested by resection of about three quarters of an inch of the wounded vessel and by double ligature. The arterial wound, on the other hand, was closed by two rows of fine silk sutures. The patient, an old and feeble man, made a good recovery. The author remarks that, while occlusion by ligature of a large arterial trunk alone, or of the accompanying venous trunk alone, is not likely to be followed by gangrene of the distal parts, simultaneous ligature of both vessels is, in this respect, attended by much risk, which is more likely to occur after wounding of both common femoral vessels than after a similar injury either of the axillary vessels or of the large vessels of the neck. Experiments on animals and the successful results of cases recorded by Schede have proved that under modern conditions of practical surgery a wounded vein may be sutured effectually without any risk of phlebitis. The indications for suturing are much more urgent in the case of a wound of a large artery, for, however small the wound may be, the prospects of closing it by compression are not 'so favorable as in a case of even a large venous wound. The practice of suturing an arterial wound must be subject to certain restrictions, as experience has proved that it would not be safe to apply a suture to a transverse wound involving more than one-half of the circumference of the vessel. In such cases it would be advisable to

resort to the practice advocated by Murphy of resecting the injured portion of the artery and bringing the ends together, the proximal end being invaginated into the distal one, and fixing them by fine sutures. In practicing arterial suture Lindner would transfix all the coats of the vessel, and in selecting the material of his suture would prefer fine silk to catgut.-British Medical Journal.

DIFFUSE LIPOMATA.-This disease is characterized by the symmetrical formation of diffuse fatty tumors in the neck and much less frequently in other regions, such as the front of the abdomen, the back, the mammary region, the groins, the suprapubic region, the buttocks, and the extremities. In the neck the growths may become so large as to produce considerable deformity. The disease was first described by Brodie in 1846, and only a limited number of cases have been recorded since that time. In a communication recently made to the Société Médicale des Hôpitaux, M. Launois and M. Bensaude stated that they were able to collect only sixty-five. The term "lipoma" seems to be a misnomer, as Mr. Roger Williams has insisted on; the growths are local hypertrophies of the subcutaneous adipose tissue, and may be regarded as a form of obesity. But the lymphatic system appears to be in some way specially concerned in their production. In an important paper published in the sixty-ninth volume of the Transactions of the Royal Medical and Chirurgical Society by the late Mr. Morrant Baker and Mr. A. Bowlby the writers remark that the fatty masses are prone to develop in regions occupied by lymphatic glands-viz., in the neck, in front of the pinna, and in the inguinal region, but they could not say for certain whether the glands were involved. M. Launois and M. Bensaude have brought forward further evidence in favor of the view suggested by Professor Hayem, that the affection has its origin in disease of the lymphatic glands. To the objection that the growths form sometimes in regions where no lymphatic glands are supposed to exist they reply that glands have been described in such regions-for example, in the external aspect of the deltoid, on the internal surface of the forearm, on the thorax, and on the abdominal wall-by Sappey and Cloquet, and recent researches show (see the thesis of Petit) how numerous are the groups not described by the authorities. A more important argument than the situation is the presence in the growths of glands more or less voluminous. Again, lymphangitis and splenic enlargement have been found and also alterations in the number of leucocytes in the blood. Virchow has already stated that the lymphatic glands may be the starting-point of lipomatous formations. Analogous to the disease, according to this view, is the perirenal accumulation of fat which may occur with renal disease. But in speculating on the nature of the disease the writers, strange to say, do not refer to his etiology. In England the disease has been observed almost without exception in persons addicted to alcohol; and general obesity is a well-known effect of the same cause. Possibly the reason is that alcohol does not, or has not been

observed to, play the same part in the French cases, for the habit is not mentioned in the very complete analytical table which accompanies the paper, while it is frequently referred to in the English cases.-Lancet.

ACCIDENTS IN LAPAROTOMY.-Poroschin (Vratch, No. 19, 1898) relates two cases of injury to the urinary tract occurring in the course of laparotomy. The first case was that of a woman, aged 53, who was operated on for a cystic tumor of the right ovary and a cyst of the broad ligament on the same side. In separating the latter from its adhesions the right ureter was cut across. This was noticed during the operation through the escape of urine from the renal end of the duct. The two ends were therefore freed from the adherent tissues and joined together by four fine silk sutures. The stitches were passed through the serous and muscular coats only, leaving the inner layer intact. For greater security a piece of peritoneum was put round the ureter and fixed in position by a few stitches. The abdomen was closed in the ordinary way, no drainage being provided. The patient made an uninterrupted recovery, getting up on the twentieth day and leaving the hospital on the thirty-seventh day after the operation. The other case was that of a peasant woman, aged forty-three, who underwent laparotomy for a large subserous fibromyoma uteri. In this case the fibromyoma was firmly attached to the bladder walls, which were torn in the attempt to separate the tumor from them. After the removal of the growth the rent in the bladder was repaired by uniting the edges by a series of sutures in layer. The mucous coat was stitched together by a continued suture, while the edges of the muscular and serous coats were united by interrupted sutures. A catheter was left in the urethra for the first four days. This patient also made a good recovery.-British Medical Journal.

VENESECTION IN CHILDREN'S DISEASES.-A. Baginsky (Berl. klin. Woch., May 23, 1898) first refers to the history of venesection, and discusses the question as to whether there are not some diseases in which it might be used with benefit. He gives details of two cases in which it was successfully employed: the one in a child aged seven and a half with uncompensated cardiac disease, and the other in a boy aged nine with cirrhosis of the lung and bronchiectasis. In these cases the author thinks that the venesection exercised a life-saving effect in the dangerous suffocative attacks. Details are then given of a third case of broncho-pneumonia in a child, aged seven, who was in extremis. As no blood could be obtained from the median veins, the left radial artery was opened and 30 c. cm. of blood let out. The effects of the venesection in these cases is a mechanical one of relieving the circulation. Baginsky has not always had the good results noted in these three cases, but there were then other dangers present besides the mechanical hindrance to the circulation. Venesection is more difficult in children than adults. It is better to lay bare the vein under

aseptic precautions, and then to open it. The author refers to the more local blood-letting, as by leeches. There are particularly two forms of disease in which such blood-letting may be of use, namely, simple eclampsia in the child and uremic eclampsia. There are many valuable remedies for simple eclampsia, so that it is less necessary to perform venesection here unless these remedies fail. Here also venesection acts in a mechanical manner. The author says that he has employed this measure in a considerable number of cases of eclampsia, and he gives details of one in which it was used with the best results. In this case of uremia, baths with douches, chloral hydrate, chloroform, injections of camphor, mustard, etc., had been employed without effect. The child was deeply comatose, with Cheyne-Stokes breathing. It was also cyanosed and pulseless. Six leeches were applied to the head. The convulsions became less at once, and the child slowly recovered. Thus in uremic eclampsia where other treatment has been used in vain, venesection should be tried. Baginsky concludes that blood-letting is not only indicated, but necessary, in the conditions above referred to.-Ibid..

PRIMARY DEMENTIA OF PUBERTY.-J. Wideroe (Norsk Mag. for Laegevidensk., April, 1898) describes two cases of what may be called the primary dementia of puberty or dementia precox-one in a girl of seventeen and the other in a boy of fifteen years of age. In such cases the beginning of the disease is very insidious; there is a gradual diminution in the intellectual powers and a modification in the character and manner of life of the affected individual. In some instances the degenerative process is arrested and the individual is left in a condition still fitted to occupy an independent and even useful position in society; but in other cases the process goes on to complete intellectual ruin, although this is rarer than in secondary dementia or in general paralysis. The patients may show now and again acute attacks, which, if the first symptoms have not been noted, may be mistaken for acute mania or melancholia. Heredity plays a great part as the primary cause of these cases; and accidental causes are venereal excesses, the abuse of tobacco and alcohol, and mental exhaustion. Overpressure in schools acting upon brains of low resisting power may thus come to be a danger. As far as complete recovery is concerned, the prognosis is not good.-Ibid.

EXTRAUTERINE PREGNANCY DATING TWEnty-four Years Expelled by the BoweLS.-Demonnier (Bull. Soc. Obst. et Gyn. de Paris, No. 3, 1898) relates the following case: In July, 1896, a patient brought him two bones, one of which appeared to be a fetal frontal bone; they had been expelled by the bowel in the preceding March. Her general health had been good, and she had had neither rigors, fever, abdominal pain, tenesmus, nor bloody or purulent stools. Examination showed a hard tumor the size of a turkey's egg in the region of the left adnexa. The uterus was fixed. Inquiry

showed that in 1872 she had an apparently normal pregnancy; at term labor pains came on, which were ineffective. She consulted two doctors in Paris, who diagnosed extrauterine pregnancy, and advised that no operation should be performed. According to the patient's account they further affirmed that she would not become pregnant again. Nevertheless, two normal confinements at term, followed by normal puerperia, occurred subsequently, one in 1878 and one in 1881. When seen in July, 1896, the general condition was too bad to justify operation. Antiseptic douches led to no diminution in the size of the tumor, and it was concluded that the lithopedion had not been completely expelled. The author points out the rarity of the occurrence of inflammatory troubles supervening in a lithopedion twenty-four years from the onset. The opening of the fistulous tract into the bowel gives much better results than one in connection with bladder or vagina. He regarded the case as an argument for early surgical intervention in these cases. The occurrence of two subsequent confinements at term is noteworthy.-Ibid.

THE OLEANDEer as a Drug.-In the Indian Medical Record for May 1st Assistant Surgeon H. D. Pant, of Gonda, reports a case of poisoning with the leaves of the oleander (Nerium odorum). A Mussulman coachman pounded seven leaves of the plant with water and sugar candy, and drank the sherbet, having been advised by a quack to take it as a diuretic for gonorrhea. Severe vomiting set in, with violent retching and slight pain in the stomach. The pulse was extremely slow, only 36 to the minute, and feeble. The man recovered in the course of a day or two. The author likens the action of oleander on the heart to that of digitalis, and suggests the medicinal use of a mild tincture on account of its rapid action and its sustained effect.-New York Medical Journal.

PERIODIC MENSTRUAL PSYCHOSES.-Trenel (Ann. de Gynec. et d'Obst., March, 1898) relates a case of delirium with hallucinations occurring at the menstrual periods in a woman thirty-seven years of age, who had given birth to a child some years previously. The attacks took place in January, March, April, and May of 1896, and on the two last occasions were followed by melancholic depression lasting for a few days. Such cases are rare, but may be met with either in early, late, or middle menstrual life, and may be acute, subacute, or chronic. The intervals between the menstrual periods are generally free from mental symptoms. The prognosis is relatively favorable, sixty eight per cent ending in cure, but the condition may become chronic, or may be followed by dementia, or may be transformed into ordinary insanity or perhaps into true periodic insanity. When there are coexistent lesions of the genital organs, removal of the ovaries may be indicated, and may sometimes give good results, but recourse to operation should be had only after a long period of observation. Treatment in the attacks should usually be carried out at home, and not in an asylum.British Medical Journal.