largely constituted of dried pus. Duhring classes the skin lesion in this case among the erythematous keratodermias, and believes it to be a tropho-neurosis dependent on the faulty action of the degenerated nervous system. The case is, as far as I know, unique.

While going through the laboratory of the College of Physicians and Surgeons in New York, an efficient method of setting up scraps of tissue for cutting with the microtome was shown me. Instead of putting each individual piece of tissue on the cork they are all dropped into a paper box filled with fluid celloidin, where they naturally sink to the bottom. After the celloidin hardens the paper box is torn away, and so a block of celloidin is obtained, with all the pieces of tissue on its bottom side. This block is now stuck bottom side up on a cork, and the first cuts of the microtome necessarily include sections of all the pieces.

On the journey home I spent a considerable time in Toronto, and looked over A. B. McCallum's slides of the case of acute yellow atrophy of the liver, which he and Alexander McPhedran published in the British Medical Journal, Feb. 10th, 1894. In the cells of this liver spherical bodies with strongly eosinophilous protoplasm were found, similar to those described by Darier and Wickham in the affected epithelial cells in Paget's disease of the nipple. When occurring in Paget's disease of the nipple these bodies have been thought by some to be psorosperms, by others endogenous cell formations, and by still others inclusions of one cell by another. The point of great interest lies in whether they are parasites or not; McCallum thinks that in his case they are not, but are probably white blood corpuscles, and says of them, "We have considered the question whether these elements are parasitic or are endogenously formed. We have rejected both hypotheses, because it seems to be a matter of the last resort to call them parasites, and because no definite example of endogenous cell formation is known to occur in the animal kingdom; till such is found it is well to base explanations on well grounded facts only." He has called them endocytes, a name chosen "to designate them conveniently and without prejudice for any particular view as to their nature." This case is particularly noteworthy to San Franciscans at the present time, because of an interesting case observed by W. F. Arnold, also having intra-cellular bodies in the cells of the liver, certainly looking unlike any human cells I have ever seen.

SOME INTERRUPTED RECOVERIES FOLLOWING LAPAROTOMY.

A series of cases operated upon by Dr. H. KREUTZMANN in his Polyclinic service.

By J. M. MACDONALD, M. D., assistant to DR. H. KREUTZMANN at the S. F. Polyclinic.

During the year 1892, a large number of cases were seen at the Polyclinic in which abdominal section was considered necessary. Some of the patients were not satisfied with the advice given and did not return, while others were refused treatment at the clinic, since they were able to pay for surgical aid. Three of the latter entered the general ward of the German Hospital; eight were admitted to the polyclinic ward of the City and County Hospital for operation. None of these patients died.

Very interesting features were observed in all of the operations, but I wish to call particular attention in this paper to the interruptions in recovery in a few of the cases. I will first give a brief synopsis of all the cases operated upon. [See table.]

A majority of the operations were rendered very difficult by extensive and firm adhesions-the great extent of lacerated surface and in some cases the rupture of the cysts necessitating the use of drainage. While some of the cases, although difficult, made rapid recoveries, in others which were comparatively simple operations recovery was protracted by complications which were entirely unexpected.

Case 2 of my synopsis, was first operated upon in 1891 in the German Hospital. Adhesions were encountered between the cyst and intestines, and while attempting to separate them the bowel was lacerated to the extent of one and one-half inches. The tear was closed with silk sutures and further effort to remove the mass was abandoned. The cyst was incised and its walls stitched to the abdominal wound. Recovery from the operation was rapid, but the cyst remained open despite all methods employed (as injections of iodine and tamponing) to cause the obliteration of the cavity.

In 1892 the patient was removed to the City and County Hospital and the abdomen again opened. The sac was separated with great difficulty but without apparent injury to the bowel. A rubber drainage tube was inserted, but was removed within two days. The patient did well until the eighth day when focal matter was discharged freely from the abdominal opening. Within two weeks the focal discharge ceased without special

treatment but was afterwards renewed for a few days. In fifteen days after the focal matter finally disappeared from the discharge, the fistula was completely closed and the patient discharged cured. A very interesting article on fœcal fistula bas been written by Dr. Dudley, of New York, in the Am. Journal of Obstetrics for February, 1892.

In Case 3 of my synopsis, abdomenopelvic fistula and ventral hernia resulted. She was first seen at the Polyclinic in 1891; a diagnosis of double pyosalpinx was made but she was not willing to submit to the operation as advised. She consulted another physician who performed trachelorraphy without improving her condition. She returned to the Polyclinic and was

admitted to the German Hospital for operation.

In this case also adhesions made the operation exceedingly difficult; both tubes were ruptured, necessitating the employment of a drainage tube. Four days after the operation extensive infiltration about the stumps and gangrene of the abdominal wall appeared. In time the wound closed, but the weakening of the abdominal wall by sloughing of the fascia resulted in ventral hernia. A month after the patient was discharged a gathering which appeared at the lower end of the abdominal scar opened and discharged pus and a ligature. The patient has been seen since at intervals and although the fistula still persists it gives but little annoyance. The infiltration has diminished greatly and the patient has improved in strength and appearance. In this case dissemination of germs from the contents of the ruptured sacs was the cause of the suppuration.

The practice of considering, without having made a thorough examination, that the laceration of the cervix accounts for all the complaints of the patient is well illustrated in this case. During the year in which she was awaiting the promised cure the adhesions were becoming more extensive and firm.

In the June number, 1893, of the American Journal of Obstetrics, Dr. Gunde asserts that the material used for drainage is the exciting cause of a majority of these fistulæ.

Early in 1892, Case 4 of synopsis, who had been operated upon in New York eight months before for pyosalpinx on the right side, was examined at the Polyclinic and a diagnosis of ovarian cyst made. The operation disclosed a thickened tube and cyst of left ovary. Adhesions again necessitated the use of the drainage tube, and the severe infiltration following pro

tracted the case considerably, but appropriate treatment finally produced complete recovery.

The operation in Case 7 of synopsis, was very simple; the ovarian cyst, the size of a goose egg, being perfectly free of adhesions. After the operation the patient complained of severe pain in the left side for which morphine was administered hypodermically. Collapse followed, which required the most prompt and continued efforts of the attendants to overcome, the pulse remaining about forty for several days. The patient complained of numbness and gradually increasing pain in the left leg, which became swollen, hard, white and immovable, being very tender, especially along the line of the femoral vein. The patient still complains of numbness and cold in the limb and slight pain when fatigued. Although phlegmasia alba dolens following severe operations on the uterine appendages is not so very rare, yet that it should result from an operation so simple and easily done is unusual; the only similar case that I can find an account of is one reported by Dr. Atlee, of Philadelphia.

In Case 11 of synopsis, the peritoneum was split for a considerable extent during the removal of the cyst, and a number of stitches were required to close the wound. Other than this the case was not complicated. The patient was in excellent condition until the tenth day, when the temperature rose to 102° F., and severe infiltration and pain appeared in the right inguinal region; evidently an appendicitis. After continuing a couple of weeks the infiltration gradually disappeared, the patient regaining perfect health.

A SUCCESSFUL CÆSARIAN SECTION.

Performed by W. S. THORNE, M. D., Physician to St. Mary's Hospital. (Reported by W. M. THORNE, M. D.)

Mrs. A., age 28; native of Italy; primipara. Patient entered St. Mary's Hospital May 24th, having been in labor since May 20th. An examination revealed a typical flat pelvis, the anteroposterior diameter of the superior strait about 1 inches. The sacrum was crowded down into the pelvis. The superior strait was filled by the right arm of the child. The bag of waters had ruptured two days before.

An operation was advised, and after the patient had been atherized an incision was made in the median line extending

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