main meal to clear stomach of unnecessary secretions, and also to avoid clogging tube with food from last meal.

Lavage should not be done on those having aneurism, arterial sclerosis, severe valvular lesions, in later stages of pregnancy (if first introduction of tube causes much distress), esophageal cancer, gastric ulcer, or gastric cancer, when there is rapid disintegration of tissue, in those afflicted with spasm of glottis, enlarged tonsils (interfering or causing obstruction to respiration), or the severe asthmatics.

Cleanliness must be strictly observed in tube introduction; all solutions being ready and at a proper temperature, a fairly stiff tube is selected. Our patient is seated on a firm chair, with strong, straight, high back, and covered with a rubber apron (to prevent soiling clothing by vomitus, etc.), and over this a clean, white towel should be laid; head is tilted slightly backwards, mouth opened about one inch, the tube being lubricated is passed directly back; it turns readily in pharynx by just a little force. About this time patient gags, and it is necessary to watch that tube is not jerked out by them. Ask him to swallow. Assure him everything is all right (though most of them feel the first time as if they were going to strangle), then quickly pass tube to mark outlined for adults, now a moment's rest, have him breathe a few times after being assured that it has passed into stomach, pour in about 500 c.c. warm water, and the work from that time on is readily accomplished. Patients become so accustomed to its introduction after a few times that it is not looked on with any fear. In many cases of chronic gastritis, one washing has been of such benefit that it is not difficult to continue this form of treatment, which apparently seems at first impossible.

Ordinance Against Cocaine.-It is reported that the victims of the cocaine habit have become so numerous in Chicago that an ordinance has been introduced prohibiting the sale of remedies for catarrh and other diseases, which contain cocaine. In the last two months over forty victims of the drug have appeared in the police courts and elsewhere. Several of them have been well-known men and women, who say they were brought to their present condition by using catarrh cures.

AN ADJUNCT TO THE DIET IN DISEASES OF THE THROAT AND LUNGS. By J. C. H. LAWRENCE, M. D., Boston, Mass.

The question of diet in disease is at the present time engaging the minds of therapists quite as much as that of medication. Many have eagerly sought for and even exhausted their life efforts to find specifics for the cure of this or that disease, or remedies to antagonize this or that train of symptoms. Far be it from me to criticize the noble impulses that moved those minds, those doctors of the old school. How different they would find things could they but return as spectators from the past. They might sigh for many of their "good old stand-bys" that one by one have been discarded; perhaps shed a tear for the venerable poultice, cupping apparatus, emetics, great doses of calomel, venesection, and other depleting measures, formerly well-recognized and faithfully employed by them. Medicaments have been to a great extent superseded by a sustaining and supporting regimen, and the subject of dietetics has acquired an importance which formerly it never possessed. The specialist is unhappily prone to regard all the physical ills of human existence as emanating from the disorders that come under his special department, rather than to regard them often as a manifestation of general nutritive disturbances that may only be reached by supplying to the economy the only specific-properly selected food. Feed your patient not with the object of filling the stomach, but for conserving and building up the tissues.

No class of practitioners can better appreciate the value of food in an assimilable and concentrated form than those who make a specialty of the diseases of the throat and lungs; since the class of sufferers that come under their care not only require the most nourishing, but also the most condensed food. They are often unable to take large quantities, not only from the painful operation of swallowing, but also from the overpowering disgust induced by the sight and smell of most prepared dishes. Under these circumstances, I have recently resorted to somatose, a preparation already thoroughly known on the continent and throughout New England. I regard it needless to make more than a casual mention of this valuable dietetic agent, which contains a very high per centage of soluble albumoses (78 per cent.), is nonhygroscopic, and is not subject to deleterious changes. A feature that might be worthy of consideration is that no complicated

process is required on the part of the family for its preparation. Somatose is soluble in water or other vehicles in which it may be desirable to administer it. It can also be obtained mixed with cocoa-a most excellent combination-as well as in the form of wafers or biscuit. In this form it is relished by most patients. I have yet to find a case where it was necessary to give it per rectum, as it is wholly non-irritant to the most delicate stomach, and retained where ordinary food would be rejected or would cause distress. Following tonsillotomy or other surgical operations about the throat or naso-pharynx, it will be found that these wafers can be taken with much less discomfort than soups or other liquid food, which, after all the trouble and torture endured in drinking, really contain very little true nourishment. Considering its highly nutritious properties and concentrated form, somatose cannot be regarded as expensive. Thus it is readily procured under ordinary pecuniary conditions. The period of convalescence following acute febrile conditions, especially influenza with its sequelæ, bronchitis, laryngitis, rhinitis, otitis, media suppurativa, etc., calls for special attention in the scope of dietetics fully as much as in the line of medication, if not more. My experience in the employment of somatose has so far been most satisfactory.

American Pediatric Society.-The Ninth Annual Meeting, to be held in Washington, May 4th, 5th and 6th, 1897.

Congress of American Physicians and Surgeons.-The preliminary program for the Fourth Session, to be held in Washington, D.C., May 4th, 5th and 6th, 1897. President, William H. Welch, M.D., LL.D., Baltimore, Md.

American Medical Association.-The Forty-eighth Annual Session (fiftieth anniversary) will be held in Philadelphia, Pa., on Tuesday, Wednesday, Thursday, and Friday, June 1st, 2nd, 3rd and 4th, commencing on Tuesday at 10 a. m.

Addresses: "The Presidential Address," Nicholas Senn, M. D., Chicago. "Address in Surgery," Wm. W. Keen, M. D., Philadelphia. "Address in Medicine," Austin Flint, M. D., New York. "Address in State Medicine," John B. Hamilton, M. D., Chicago.

CASE I.

DOUBLE UTERUS, WITH CONGENITAL CLOSURE OF ONE CERVIX, UTERUS DISTEnded with MENSTRUAL FLUID.* BY DR. Rufus B. HALL, of Cincinnati, O.

This case is out of the usual, and has many interesting features connected with it, both to the specialist and general practitioner. The subject of the report, Miss H., is a strong, vigorous girl, aged thirteen, well developed for one of her years. She was seen in consultation with her physician, Dr. C. C. Agin, of this city, October 25, 1896. The following history was elicited:

About two months prior to this visit Dr. Agin saw her and prescribed for rectal tenesmus. He did not make any physical examination at that time. She did not get entire relief, and the neighbors advised the family to consult a physician in the city who advertises. This they did, he having her in charge until a few days before my visit. Her condition then became so alarming they again asked Dr. Agin to see her. She had been confined to bed for about three weeks with pain in her abdomen; this had gradually grown worse. She first menstruated seven months ago, without much pain; the flow lasted three or four days, and recurred regularly every four weeks after that time, the last period being from October 15th to October 20th. The flow was always free. She says she has never felt perfectly well in her abdomen since the second time she menstruated, and for three or four months has felt uncomfortable, with a full feeling in her pelvis. For three weeks past she has had rectal tenesmus, and it was well marked at the time of my visit. She had a constant desire to go to stool. About two months before my visit, while learning to ride a bicycle, she sat down heavily on the saddle, and, as she says, hurt herself. She located the seat of the injury over the right tuberosity of the ischium. She grew worse rapidly from this on, and believed it to be the whole cause of her illness.

The patient being a very unruly child, anything like a satisfactory physical examination of the abdomen or pelvis by rectal examination could not be made. As the hymen was intact, I made no attempt at vaginal examination. On attempting to pass my finger into the bowel I could make out, in spite of her cries and struggles, a tumor of some kind filling the entire pelvis

*Read before the Cincinnati Obstetrical Society. November 18, 1896.

and extending above the pubic arch, even pushing the perineum forward. The child was in great agony, with rapid pulse and great tenderness over the abdomen. There could be no doubt about the presence of active peritonitis, and it was evident to all that she must have immediate relief. It was agreed to send her at once to the Presbyterian Hospital. She entered there at noon October 25th, and was prepared for operation.

At 11 o'clock on the morning of the 26th she was given an anesthetic. Assisting: Drs. Colter and Rousch. Present: Drs. Agin and Hamma, of this city, and Drs. Finley and McClellan, of Xenia, O. Rectal examination revealed the tumor, as before described, filling the entire pelvis and extending into the abdomen more to the patient's right. It could not be pushed up, and the finger introduced into the bowel passed behind the tumor and somewhat to the patient's left. Nothing definite could be determined by this examination. I passed my finger into the vagina. It was very narrow, and fitted closely around the index finger, but the cervix could not be felt; it was beyond the reach of the finger. The vaginal canal was pushed far to the left side of the pelvis. I could pass a probe two and one-half inches beyond the end of the finger, demonstrating that the vagina was elongated. Above this, and to the patient's left side, apparently firmly attached to the tumor, could be made out a small, hard lump. This was believed to be the uterus. By a little manipulation the sound was carried into this lump, confirming our belief. What the tumor was was very uncertain. No manipulation could move it from the pelvis; neither could any manipulation bring the uterus nearer to the examining finger. The question of dermoid tumor of the ovary, rapidly-growing sarcoma, and a number of other conditions, were all mentally discussed while making the examination. Yet I was wholly at sea as to the true condition, and at once determined to make an exploratory incision and be governed by what that revealed.

The abdomen was opened in the median line with a three and one-half inch incision. The omentum was adherent over the top of the tumor to the patient's right, and a portion, two and onehalf inches by three and one-half inches, was discolored almost black. It was ligated and removed. The tumor occupied the entire pelvis, extending two and one-half or three inches into the abdomen. The small lump, previously described, to the left.