rather dense adhesions to the sterno-mastoid and sterno-laryngeal muscles and to the sternum. It consisted of a number of cysts containing clear fluid embedded in a thick wall of fibrous tissue. A. J. RODOCANACHI. Vermiform Appendix. NORRIS (C. C.). Primary Carcinoma of the Univ. of Pennsylvania Med. Bulletin, 1903. In the course of an operation for inflammatory disease of the appendages on a patient, aged 27, the writer, finding the appendix vermiformis adherent at its tip removed it. The lumen of the appendix was occluded by a yellowish white mass which on microscopic examination showed a carcinomatous structure. This disease has most often been discovered accidentally in the course of an abdominal section, as in this case, and for this reason probably it appears to be more common in women. The symptoms, and even the macroscopic appearances, may be those of appendicitis. About 65 per cent. of the cases occur before the age of 30 years. A. J. RODOCANACHI. MARCHAIS (M.). Displacement of the Uterus Causing Constipation. Gazette des Hôpitaux, Dec. 31, 1903, p. 1489. THE writer repòrts certain cases of obstinate constipation, in which all treatment by medicines, massage and injections had failed, which were cured by correcting malpositions of the uterus, even though the patients did not complain of any uterine trouble. A. J. RODOCANACHI. MORISON (RUTHERFORD). Abdominal and Pelvic Surgery. Edinburgh Medical Journal, 1904. New series, Vol. xv., p. 21. THE writer considers the signs and symptoms of use in the diagnosis of abdominal diseases and the indications for operation. He looks upon the tympanitic corona of an ovarian cyst as important evidence of the presence of an ovarian cyst as distinguished from an encysted collection of fluid. He thinks that a case of general peritonitis of more than 24 hours' duration due to perforation of the stomach or appendix has more chance of getting well if not operated upon. He holds a similar opinion concerning cases of intestinal obstruction after distension has occurred. His operations are performed in a building (the Newcastle Infirmary) without a single feature to commend it to the modern operating surgeon. He therefore practises antisepsis. The skin of the abdomen, after shaving and washing with spirit soap, is cleansed with turpentine, methylated spirit and perchloride lotion; a compress is kept on until the operation. In the operating theatre the assistants and nurses wear rubber gloves. The after treatment and complications are also fully considered. A. J. RODOCANACHI. HIGGINS (FRANK A.). A New Method of Closing the Abdomen after Laparotomy. Boston Med. and Surg. Journal. Vol. cxlix., p. 645. THE writer considers that a combination of the mass and tier sutures is advisable. The mass suture through all the layers of the abdominal wall is necessary in order to obliterate the dead spaces in which blood may collect, but introduced in the ordinary way the stitches irritate and cut through the skin, leaving unsightly scars. In order to obtain effective counter-pressure he uses a metal strip with straight parallel edges; it is about 1/3,in. thick, and can be bent and adjusted to inequalities of the abdomen. Three or more mass sutures of silkworm gut are first introduced, but not tied. The peritoneum is closed by a running stitch of plain catgut, the fascia with chromicized catgut, and the skin with fine silkworm gut or horsehair introduced subcutaneously. The mass sutures are then tied over the metal guard, which is separated from the abdominal wall by a layer of gauze. A. J. RODOCANACHI. LANE (W. ARBUTHNOT). On the Operative Treatment of Conditions of the Large Bowel which The Clinical Journal, 1904. THE writer holds that habitual distension of the cæcum and ascending colon determines an inflammation of the bowel of sufficient intensity to produce adhesions of the peritoneal coat to the parietal peritoneum. These adhesions, by dragging on the hepatic flexure, may produce a kink and so form a practical obstruction. They may also involve the appendix and produce in it an abrupt flexure and distension of its distal half. The transverse colon also may become inflamed and kinked if overloaded, and so adhesions may form between the dilated transverse colon and the empty descending colon, and an actual obstruction will exist, especially in the erect position. The same process in the sigmoid flexure ends in rotation of the loop and blocking of the gut. The volvulus thus formed is gradual, not acute, in its production. The writer does not believe that the colon plays an important part in the present state of civilisation, and therefore in severe cases of chronic obstruction he diverts the ileum direct into the rectum or sigmoid by a lateral anastomosis. Later the ileum is divided between the seat of anastomosis and the cæcum. A. J. RODOCANACHI. MEYER (FRITZ). On Gonorrhoeal Whitlow. Fortschritte der Medicin, 1903. Bd. 21, p. 1185. THE author says that lately the idea that the evil effects of the gonococcus are confined to the urino-genital system has been shown to be a very erroneous one, and in truth almost any organ may be affected by it. As a rule the route of infection is through the blood. The case which is quoted is that of a young woman, aged 22, who was admitted with gonorrhoeal rheumatism in the foot, elbow and ankle. This yielded to treatment, but the temperature kept up, and on the third day a blister was observed in the middle finger of the right hand; there were no inflamed lymphatics, and it was not tender; it was opened, and a yellow fluid let out, and a small loss of substance was found with sharply defined and somewhat raised edges. Gonococci were found in the pus, but in spite of antiseptic dressing the ulcer took 3 weeks to heal. Other cases have been reported, but it is doubtful whether the abscesses may not have been metastatic in origin. It this case the patient remembered having wounded the finger. PRIESTLEY LEECH. EWALD (C. A.). Tumours of the Sigmoid Flexure. Amer. Journ. of the Med. Sciences, 1903. Vol. cxx., p. 985. THE author divides these tumours into (1) fæcal accumulations; (2) carcinoma of the sigmoid; (3) spastic condition of the colon with obstipation, irregular movements, pain and disturbance of the general condition; (4) reflex spasm of the sigmoid with a tumour in another part of the bowel. The notes of two cases illustrating the two last conditions are given. In one case, a man of 30, a cord-like tumour was felt in the situation of the descending colon; on inflation only a small quantity of air could be injected and the patient complained of pain and the tumour remained unaltered; after a stay of eight days in hospital, as no improvement took place, laparotomy was performed, and the colon was found thickened and hard, but no tumour was present; there were contractions of the muscular coat which drew the serosa inwards, making the colon look like a screw; adjacent to the colon were a number of slightly swollen glands; new growth, tubercle and dysentery were thought of, but nothing was found by which to make a diagnosis; the whole colon was excluded by an anastomosis with a Murphy button. On the third day the patient collapsed and died. Post-mortem, anastomosis perfect; no peritonitis, and the whole colon from the middle of the transverse portion to the flexure showed a dysenteric condition present, but most marked at the flexure. The symptoms had been distinct tumour, cachexia, passage of small amounts of blood and mucus, and absence of all symptoms of dysentery made the diagnosis of carcinoma probable. The case illustrating another condition was that of a man, 69 years old, with all the symptoms of a chronic ileus with a cord-like tumour in the lower left abdomen, and in the hepatic flexure a hard tumour, very movable, which seemed to disappear under massage, and was thought to be a movable kidney. Fæcal vomiting occurred, and on opening the abdomen no tumour of the sigmoid, but an inoperable carcinoma of the hepatic flexure was found. PRIESTLEY LEECH. WOOLSEY (GEORGE). Surgery of Cerebral Tumours. Amer. Journ. of the Med. Sciences, 1903. Vol. cxx., p. 955. IN an article on this subject the author comes to the following conclusions: (a) The sphere of operations for cerebral tumours may be, and has been, extended to those parts of the cortex where tumours are accessible and localisable, i.e., both prefrontal, parietal and occipital regions, in addition to the motor area. (b) The prognosis, both immediate and remote, is as good as, or even better than in, operations for malignant growths in some other locations. (c) The prognosis has improved with the improvements in localisation and operative technique and with the limitation of the radical operation to cases accurately localised. (d) The palliative operation is strongly indicated to relieve symptoms where localisation cannot be accurately made or the tumour cannot be removed. The exploratory operation is contra-indicated. (e) Practically all circumscribed growths of moderate size are suitable for operation. (f) The osteoplastic method should be employed and the most rapid and perfect technique adopted which the circumstances allow. MERTENS. PRIESTLEY LEECH. Treatment of Sarcoma by Rontgen Rays. Deutsche med. . THE author comments on the few cases reported in which Röntgen rays a full history of a case of a girl, aged 11, who was suffering from a large malignant growth of the scapula. An attempt was made to remove the tumour by operation, and though the main mass was removed, part had to be left behind, including some glands in the axilla. So soon as ten days after the operation a well-marked recurrence was visible. A microscopical examination of the growth showed it to be a spindle-celled sarcoma. Any further operation being considered inadvisable, a course of Röntgen ray treatment was commenced. After ten days a very considerable shrinkage of the tumour was observed, and at the same time the glands in the axilla and in the neck began to disappear, and at the end of twelve days were no longer palpable. After the twentieth sitting the treatment was discontinued, no evidence of the growth remaining, and six weeks after the beginning of the treatment no recurrence could be found. A month later there was a small recurrence, but after being subjected to a further short course of treatment this also disappeared. A second case is also described of a round-celled sarcoma of the scapula. Here, however, the same successful result was not obtained, for though the tumour at first shrank under treatment it soon recurred and rapidly disseminated, finally killing the patient. G. E. GASK. ISRAEL (JAMES). A New Operation to Expose the Under Surface of the Right Lobe of the Liver. Deutsche med. Wochenschr., 1904, p. 489. THIS operation was undertaken in order to expose and examine the kidney, supra-renal gland and the under surface of the liver in a case where the diagnosis was extremely obscure, the possibilities lying between a peri-nephric abscess, hydatid cyst or gumma of the liver. The method of the operation was as follows:-From the outer border of the erector spinæ muscle an incision was made parallel and close to the lower edge of the twelfth rib and the kidney exposed extraperitoneally. This was examined and found normal. In order to make all the organs of the sub-diaphragmatic space accessible to examination nearly the whole length of the twelfth rib was excised. The kidney was then freed from its surroundings and displaced downwards, so that the retro-peritoneal space below the diaphragm was freely exposed. The supra-renal body was found to be normal, but the parietal layer of the peritoneum was much thickened and firmly attached to the liver. This was cut into and a portion of it excised. The wound in the liver was then plugged with a strip of gauze and the liver replaced in position, and, in order to prevent any undue mobility, stitched to the capsule of the quadratus lumborum muscle, the wound being afterwards closed except for an exit for the gauze strips. Healing took place by first intention. Microscopical examination of the portion removed showed it to be a gumma. The surgical interest of the case lies in the fact that this operation gives an excellent exposure for all the structures in this region. G. E. GASK. LENGEMANN (PAUL). Thiosinamin Treatment of Contractures. Deutsche med. Wochenschr., 1904, p. 463. In the June number, 1903, of this Wochenschrift the writer described two cases of Dupuytren's contraction of the fingers treated with injections of thiosinamin. He did not then lay any great stress on the result owing to the limited number of observations made and the short time that had elapsed since the treatment. Now, however, he strongly recommends the method, his own cases having proved a success, and favourable reports having been received from other independent sources. Over a year has elapsed since the termination of the treatment of the two cases previously reported, and in neither of these has the contraction returned. He relates another case of a man with a marked contraction of a finger of ten years standing. After 40 to 45 injections, combined with massage, passive movements, warm baths and the application of thiosinamin paste the finger became straight and freely movable. The treatment extended over two months. A similar result is recorded in |