failure to oxidise the thrombi segregated from the original tumour, and against secondary 'growth' in general." The writer therefore recommends oxygen or ozone inhalations, correction of respiratory and cardiac defects (heart tonics, cold saline baths, etc.), improvement of blood (iron, potassium iodide, etc.), internal oxidants (cod liver oil), and quinine-both for its effect on metabolism and for its property of fluorescence or radio-activity. He also thinks that tissue contracting and inspissating agents such as ergot, adrenalin chloride, etc., are indicated. The use of hydrochloric acid and alkalies for aiding digestion is also mentioned. On the other hand, extensive operations are not advocated, and any incision into the "growing edge" is deprecated even for diagnostic purposes. The evacuation of pus and cleansing and "oxidative purification" of purulent foci (with hydrogen, peroxide, etc.) are, however, strongly advocated, and the "complete extirpation" is favoured "of such neoplastic internal organs not essential to life, as are not amenable to radio-therapy." P. R. COOPER. ROUTH (C. H. F.). On Some Directions and Avenues through which Cancer may possibly be more Successfully Treated and perhaps Cured. The British Gynecological Journal, 1903. Vol. xix., 66 p. 99. THE writer's first suggestion is the use of vibrations to destroy the cancerous mass. He says such a mass might be isolated from other parts of the body, so that the diseased part should be alone acted upon, and possibly a cure might follow." His second avenue" is the use of oxygen; his third, the preparation of anti-toxin by electrolysis; his last, the injection of devitalised cancer toxin-the living organisms being destroyed by immersion in liquid air (McFadyen). He also advocates a better system of drainage, and suggests the electrolysation of sea-water as being the most feasible method. Accounts of two cases are given in which cancer is alleged to have been cured by vaginal injections of peroxide of hydrogen. P. R. COOPER. RICHE (P.). Jejunostomy in the Treatment of Cancer of the Stomach. La Presse Médicale. Vol. xii., No. 18, p. 139. IN the surgical treatment of gastric cancer, radical measurespylorectomy, partial or complete gastrectomy-are to be advised whenever possible. In cases too advanced for this the usual treatment of the present day is either to perform gastro-enterostomy, or leave the case to medical measures only. Maydl strongly advocates jejunostomy, and especially "jejunostomie en Y," as the palliative operation of choice. Its advantages over gastro-enterostomy are its general applicability to all cases of cancer of the stomach, its ease of execution even without an anesthetic, its lower mortality, it gives a longer duration of life, it guarantees freedom from recurrence of symptoms due to stenosis of the outlet from the stomach, and it puts that organ in the best position for securing physiological rest, thereby diminishing the rate of growth of the neoplasm. Riche has performed the operation in two cases. ARTHUR H. BURGESS. MUSSER (J. H.). Abdominal Pain. American Medicine, 1904, p. 503. AMONG the general conditions other than lead poisoning which may cause abdominal pain the writer draws attention to uræmia; he states that such pain may precede the convulsions of puerperal nephritis. He does not consider that abdominal pain is at all frequently due to hysteria or neurosis. He enumerates the following causes other than disease below the diaphragm :-(1) Tabes; (2) spondylitis rhigomalique; (3) caries of the spine; (4) cancer of the vertebræ; (5) aneurysm of the thoracic aorta; (6) diaphragmatic pleurisy; (7) pneumonia; (8) certain cardiac conditions such as acute pericarditis. A. J. RODOCANACHI. NEVE (E. F.). Thyroidism after Excision of a Goitre. Recovery. Indian Medical Gazette, 1904, p. 95. THE writer reports a case in which symptoms of thyroidism were observed after the removal of a large goitre from a Kashmiri. Oozing was noticed from the cut isthmus. The treatment was by opening the wound and draining. A. J. RODOCANACHI. SAMPSON (JOHN A.). The Blood Supply of the Ureters. Johns Hopkins Hospital Bulletin, 1904, p. 39. THE writer, holding that hysterectomy for cancer of the cervix must leave metastases or extensions of the growth unless the whole of the parametric connective tissue be dissected out and that if this is done there is danger of ureteral necrosis, has studied the arterial supply of the ureters. The ureter is nourished by a peri-ureteral arterial plexus formed by branches from the aorta, renal, ovarian, iliac, uterine and other arteries. These anastomose freely, and the whole plexus may be injected through any one of them. The ureter and its plexus are protected by a sheath derived from the surrounding tissue. Clinically and experimentally it is found that the ureter in its sheath may be dissected free from end to end without necrosing, but if the plexus is injured over even a short length necrosis follows. The writer considers that resection of the lower 3-4cm. of the ureters and implantation of the renal ends into the bladder offer the greatest chance of cure of the cancer and the least danger of necrosis as the upper end of each can be brought down with its plexus and sheath intact. There is, however, danger of cystitis and renal infection, and he thinks that this may possibly be guarded against by forming a vesico-vaginal fistula. A. J. RODOCANACHI. PATEL (MAURICE). Benign Tumours of the Thyroid Body with Metastases. Revue de Chirurgie. Vol. xxix., No. 3, p. 399. METASTASIS is usually considered as an essential character of malignant tumours, but it has occasionally been met with in benign growthslipoma, myxoma, chondroma and cystic adenoma of the ovary. A certain number of cases have now been reported of patients, the bearers of an ordinary goitre of many years' duration, in whose internal organs, especially the bones and lungs, secondary growths have developed, of a structure similar to the normal thyroid, without the goitre having undergone any apparent modification. Patel has collected and analysed 18 such reported cases. Histological examination of these growths shows them to belong to one of two types-(1) the benign, with the typical structure of the normal thyroid, (2) the malignant, where, in addition to the normal thyroid vesicles, there are columns of epithelial cells running between them, composed of cells similar to those lining the vesicles. The symptoms caused by these secondary growths vary considerably according to their site, but they constitute the whole of the malady, the thyroid gland either being of normal external appearance, or the seat of an obvious goitre, but one which has not undergone any apparent modification for a long time past. Two hypotheses have been advanced in explanation of these growths (1) that they represent accessory thyroids, (2) that the goitre from which they arise, in spite of its apparent benign character, is really of a malignant type. Patel, however, concludes that a truly benign goitre may give rise to metastatic deposits. Cohnheim says that this dissemination is due to a diminished resistance on the part of the organism against the thyroid tissue. Bontsch, noting that in all the recorded cases the thyroid gland itself was diseased, sees in these metastases a phenomenon of regeneration—a defence of the organism against the danger of the loss of thyroid tissue. It is chiefly in the colloid forms of goitre that this metastasis has been observed. ARTHUR H. BURGESS. Invasion of the Trachea VIANNAY (CHARLES) and PINATELLE (LOUIS). and Esophagus by Malignant Goitre. Revue de Chirurgie. Vol. xxix., No. 3, p. 429. THESE are rare complications of malignant goitre, symptoms referable to the trachea and oesophagus being usually due to compression and not to actual invasion of these canals. Of 173 cases of malignant goitre only 14 (8 per cent.) showed tracheal involvement, and 7 (4 per cent.) involvement of the oesophagus. The trachea is most frequently attacked from its posterior aspect that not protected by a cartilaginous skeleton. Intra-tracheal vegetation soon takes place, and perforation follows, resulting in a tracheo-oesophageal fistula. The symptoms of tracheal invasion are dyspnoea, wheezing, cough, slight hæmoptysis, and later on convulsive attacks of dyspnoea and suffocation, especially if the intratracheal growth is pediculated. Esophageal invasion causes dysphagia, partly of mechanical and partly of nervous origin from compression of the vagi, hæmorrhages from the oesophagus, and the regurgitation of glairy mucus, sometimes bloodstained. ARTHUR H. BURGESS. WEAVER (ALBERT P.). An Unusual Foreign Body Removed from the Bladder. American Medicine, April 30th, 1904, p. 699. THE case was that of a female, pregnant two months, upon whom an attempt was made to procure abortion by means of a sponge-tent. Through ignorance this was introduced into the urethra in mistake for the cervical canal, and passed on into the bladder. Fourteen hours later severe bearing down pains set in, accompanied by hæmorrhage, and medical advice was sought. The urethra was dilated and a coneshaped piece of coarse sponge, 22in. long, 1ğin. across at the base, and and in. across at the apex, was removed saturated with blood, and very offensive. Incontinence followed for 48 hours, but the pregnancy was not interrupted. ARTHUR H. BURGESS. TEXIER and GAUTIER. Pelvic Appendicitis. Archiv Gén. de Méd., 1904. Vol. i., p. 1153. IN recording four cases of pelvic abscess of appendicular origin the writers strongly advocate incision through the rectum or vagina, in preference to a laparotomy. Three of their patients were operated upon by the rectal route, and one by the vaginal, one of the former being a secondary operation after a previous iliac incision. All made good recoveries, and in none was the appendix removed. A prominent symptom was a pseudo-diarrhoea, due to the incessant mucoid discharge. from the inflamed rectal mucosa overlying the abscess. In the rectal operation the sphincter is first firmly stretched, and the rectal wall incised over the abscess, preferably by a longitudinal incision thereby injuring as few vessels as possible. Drainage is carried out through a rubber tube, and must be maintained for some time. In the female the vaginal route is to be preferred. ARTHUR H. BURGESS. SOUBEYRAN (P.). Pure Myxoma of the Bones. Revue de Chirurgie. Vol. xxix., No. 2, p. 239. THESE tumours are rare in the pure state, much more commonly are they associated with chondroma, lipoma, or sarcoma. Only six cases are reported in surgical literature. The tumour does not attain large dimensions, and possesses a hard bony shell at first, which may ultimately disappear as the growth increases. The consistence of the tumour itself is compared by Virchow to that of the disc of a jelly-fish. Structurally, it is formed of typical mucous tissue, and possesses very few vessels. It may undergo mucoid degeneration, resulting in its transformation into a cyst with a hard bony shell, which may be thinned out or wanting in places. The upper jaw has been the commonest site for these tumours, though they have been seen elsewhere the femur, tibia, and lower jaw. They are usually primary, but in one case were apparently secondary to a myxoma of certain nerves. They may cause very few symptoms, and their existence is readily overlooked. Their progress is slow, and their duration long. They may recur locally after removal, but no instances of generalisation have been noted from primary myxoma of bone. They require free local removal, but not by any means necessarily amputation if situated in connection with a limb. ARTHUR H. BURGESS. GANCLIANA (V.). The Bursting of a Breaking Down Tuberculous Abscess into the Trachea. Deutsche med. Wochnschr., 1904, p. 874. COMMENTING on the great frequency of the occurrence of tuberculous changes in the peri-bronchial and peri-tracheal glands, as found postmortem, the author calls attention to the surprisingly few cases in which grave symptoms occur, and he relates a case in which sudden death took place owing to ulceration from a breaking down tuberculous gland into the air passages. A child, aged three was taken suddenly ill with cough, fever and difficulty of breathing. The fauces were somewhat reddened, though otherwise nothing noteworthy was noticed. The case was diagnosed as one of diphtheria, and treated accordingly. A few days later the child became suddenly worse, with intense dyspnoea. Tracheotomy was performed, under the impression that possibly some diphtheritic membrane was blocking the trachea. The child, however, died almost immediately, and post-mortem it was found that the bronchial glands. were much enlarged and caseous; ulceration into the trachea had taken place and the left bronchus was completely blocked, and the right bronchus nearly, by caseous material. The difficulty of arriving at an accurate diagnosis of the position |