in attendance. The impacted fetus had so shut off all circulation to the parts, that the labia was as dark as flesh could get. I gave her chloroform and examined her. Finding an impacted head I split the head open and removed the brain. After doing this I found the shoulders would not pass. I hooked up an arm and amputated at shoulderjoint. I then delivered. The placenta was adherent for a space of three inches. After making this delivery I simply thoroughly washed the parts with some very warm water and bichloride, put on a warm bandage, gave a hypodermic of morphia and atropia and let her alone for the night. I think during the night I gave her a drachm of Squibb's ergot. Next morning she ate some breakfast, drew her water, washed the parts and took the train for home. In about four weeks from that time she walked into my office. Now, how much better it would have been to have her sent to a hospital or to subject her to all the worry and useless trouble of thorough disinfecting. I cannot tell but one thing. I do not know it could not have been better than it was. I will admit that I always, where I can, have them use injections of very hot water every day so long as there be any discharge.

Some two years ago I made some experiments in this matter. I had twenty-seven cases of various character of surgery, from the removal of a common sebaceous tumor to the amputation of a leg, and in all these cases took particular aseptic precautions, and got for my results healing in all cases but one, without the formation of any pus, and in this one case I did not carefully take away all the bruised tissue. I removed a part of a foot yesterday, and under the strictest disinfectant manner, and am going to give it a thorough chance. Now, with these results in aseptic surgery I cannot tell how much better it would be under strict disinfectant procedure. Yet for a few fellows who are fortunate enough to get a position in a hospital, with but a limited experience outside, to endeavor to make us believe that every case of surgery or obstetrics should be sent to

them, and we, because we have no hospital to take them to, to put them in their hands, and we have nothing further to do with the case, is foolishness. I wish I was so situated that I could send all such cases to hospitals of which I had the whole control, but for some one else to look after them after they leave me does not suit me. But we in the country cannot do this now. What we want is for our city brothers to give us something that we can put to practical use in cabins where people. eat and live and sleep. I suppose we fellows who live where we have to resort to anything from a razor for ovariotomy to a tin pen-holder to draw off the urine, and still have good results, what would it be if we were situated differently? Now, what we want is something we can resort to in the country, where we have nothing. In writing up these cases in the city, give us country fellows something we can do, situated as we are.

Respectfully,

A. J. PARKER, M.D.

Syphilis and Paresis.

In a paper on hereditary syphilis and general paresis in the insane, by Dr. Williams, occurs the following most significant passage:

66

Practically 75 per cent. of all cases of general paralysis exhibit proof of primarily syphilitic infection." The history of all cases is "the typical man of the world," ambitious, fond of society and high living, a light sleeper, and a heavy drinker, then come delusions and well-marked paresis." Four cases are noted where syphilitic teeth were prominent, although no history of syphilis could be obtained. Each one had used spirits freely. The pathological conditions in chronic inebriety, syphilis, and paresis, are all alike. The thick. ened membranes and meningeal changes are the same. The neurosis which predisposes to insanity, paresis, or inebriety may be of syphilitic origin. A history of using alcohol exists in all cases of paresis, and it is significant of contributing causes not yet studied.-Quar terly Journal of Inebriety.

Bibliography.

THE GUIDE TO THE CLINICAL EXAMINATION OF THE BLOOD for DIAGNOSTIC PURPOSES.

By RICHARD C. CABOT, M.D. With four full-page plates in colors and numerous engravings; 8-vo., pp. 405. New York: Wm. Wood & Co.

This book, the first of its kind published in English, is exactly what its title indicates a clinical guide, a book written especially for the practitioner, who is so often confronted by knotty problems in differential diagnosis which an examination of the blood might speedily make clear.

It is the legitimate outcome of the enormous amount of study in humoral histology and pathology that has been done for the last ten years in this country, especially in the East, where, in the Massachusetts General Hospital, during the last four or five years, examination of the blood has become a matter of routine; it is largely from the work done at this hospital and in his own studies that the author has collected the data which make the clinical aspect of this book of such value.

The reader's time is not wasted, nor his patience exhausted, by extravagant theorizing upon obscure points in pathology; space is not even given for the discussion of the origin of the blood cells, chemistry of the blood or coagulation. It is in every sense of the word a clinical guide.

The author has divided his work into two parts, the first dealing with the clinical examination, physiology and general pathology of the blood; the second with the pathological changes occurring in the blood as influenced by a number of affections, the blood diseases proper, acute and chronic infectious diseases and constitutional diseases. In this manner no part of the subject essential for the clinician is left untouched.

The suggestions as regards technique are to be relied upon, while it is doubtful if there has yet been written so exhaustive a treatise upon the different phases of the various leucocytoses.

As a further aid to the practitioner, diagnosis has been taken up in a manner which might act as a suitable lesson for most of our text-books upon practice. Not only are the different points in regard to blood diseases proper, pernicious anemia, chlorosis, secondary anemia, leukemia, discussed at length and a table compiled as a ready reference, but throughout the volume the fact is ever kept in mind that the blood is being examined to assist in finding the nature of the peculiar ailment from which the patient is suffering; and in no way is this more exemplified than by the differentiation of the various affections characterized by severe pain in the right iliac region, together with constitutional reaction of varying intensity, such as typhoid, appendicitis, pyosalpinx, colic; so that the book is of no less interest to the surgeon than to the physician.

If there is any fault to be found it is in the article on malaria, for.which the author apologized by stating that his experience has been confined almost entirely to the study of the tertian forms, the quartan and other forms of malaria being extremely rare in Massachusetts.

The plates are of sufficient likeness to be of material aid to the student, although they are hardly true to the original.

Altogether the volume is singularly free from faults, is clear and succinct, and will undoubtedly become popular among all who are interested in the study of blood pathology.

MARK A. BROWN, M.D.

THE TENNESSEE CENTENNIAL EXPOSI

TION.-The managers of this representative exhibition have shown great wisdom and intelligence in providing a building for hygiene and education. The structure is 144 by 144 feet in dimensions, and has thirty-foot ceilings.

In no other direction can the civilization

of the past with the present be better exempli

fied than in the lines of education, medicine and sanitary appliances. Will quackery and charlatanism have a single inch of space? If not, why not? Simply because there is nothing to show from that quarter. This fact alone should be an educational object-lesson to all of the people who visit the Tennessee Centennial Exposition, which opens May 1, 1897.

New Series Vol. XXXVIII.

Original Articles.

excellent articles on the subject, and two that saved me some considerable work, I found almost last in my search. Both are by Englishmen, and both review the

BY P. M. ASHBURN, M.D.,

CINCINNATI.

Senn defines sarcoma as an atypical proliferation of connective tissue cells from a matrix of fibro-blasts of congenital or post-natal origin." Therefore those cases of sarcoma are most easily accounted for where it seems most highly probable that in the process of development, or as a result of a trauma, such a matrix has been laid aside where it might quietly await another trauma or some other excitant to bring about the condition favoring its growth. Such being the facts, we should not expect the vagina, where the developmental condition seems favorable, and where coitus and labor would seem to be able to furnish an abundance | of traumata, to be a rare seat of sarcoma. A perusal of the literature, however, seems to show that it is, and comparatively few cases are recorded. It is so rare that some of the standard text-books on gynecology of a few years ago did not mention it, and that some even of to-day do not deem it of sufficient frequency to merit more than a very slight mention. After a good deal of hunting in the Hospital Library, and with the aid of the Index Medicus, I have managed to find most of the reported cases, though I did not have access to nearly all of them. As a result of that search I do not think that more than about fifty cases have been recognized and reported. Two very

1 Read before the Academy of Medicine of Cincinnati, March 22, 1897.

writings. The first is by Wm. J. Gow, M.D., in St. Bartholomew's Hospital Reports, vol. xxvii, 1891, wherein he writes on the trouble as it occurs in adults; and the second is by D'Arcy Power, in St. Bartholomew's Reports, vol. xxxi, 1894, where he writes on the affection in children. Gow reported one case of his own, and tabulated twelve of other observers, as occurring in adults. I have found five other cases, overlooked by Gow, or not reported at the time of his writing, to which I had access, and without counting my own case. I also found that there have been five or six cases in adults to which I did not have access. Power reported one case of his own and reviewed twentyfive other cases. There have been, so far as I can find, three or four communications and probably reports of cases that he did not quote, but they were not accessible to me. I have, then, forty-five cases from which to attempt to draw a few conclusions. Not to tire you with an analysis of each case in detail, I will try to group them roughly according to age, social conditions, etc., after giving a short account of my own case.

Mrs. Chas. P., aged fifty-nine years, married, and has had four children and one miscarriage, in the twelfth week. Her father died at seventy-two, of a lung trouble; her mother died in childbed. So far as the patient knows, none of the family ever had a tumor of any kind. As a girl the patient was always healthy and strong until puberty. Afterwards she suffered from menorrhagia and dysmenorrhea, which was worse