fragment retaining its relation to the trapezium. Crepitus may still be felt in untreated cases up to four weeks after the injury. The displacement of the metacarpal bone towards the dorsal aspect produces a marked prominence filling the hollow between the long and short extensors of the thumb. In recent cases the displacement can be easily corrected by making traction on the thumb in the abducted and fully extended position. The thumb should then be fixed in the reduced position for three weeks by means of a palmar splint. A. J. RODOCANACHI. CRAIG (DANIEL H.). Post-operative Adhesions and Paresis of the Intestines. American Journ. of Obstet., 1904. Vol. xlix., p. 449. To prevent adhesions it is essential to maintain peristalsis. The writer holds that it is not advisable to keep the bowel at rest unless it has itself been involved in the operation. Experiments show that stimulation. of the splanchnic nerves produces reflex inhibition along the whole intestinal canal; therefore to restore peristalsis we must counteract the spinal reflexes acting through the splanchnic nerves which have been excited by the operative manipulation. Dissatisfied with the use of calomel and salines after operation and cascara sagrada before operation (as advised by Murphy) the writer has used eserine salicylate, prepared from Calabar bean, in doses of 1/10th of a grain, given hypodermically. It begins to cause peristalsis in from a quarter to half an hour; as a spinal depresso-motor it counteracts the inhibitory reflexes of the splanchnics. In some cases the bowels move spontaneously in from 12 to 24 hours, but if they have been well emptied before operation no action occurs as there is not enough liquid to distend the colon and rectum and produce defæcation, and eserine does not cause transudation into the intestine like the salines. However, the presence of borborygmi and a soft abdomen show that the paresis has been overcome. an overdose of eserine be given, atropine is the antidote. In case A. J. RODOCANACHI. Carcinoma of the Colon. CLOGG (H. S.). The Practitioner, 1904, p. 525. WALLACE (DAVID). The Scottish Med, and Surg. Journ., 1904, p. 289. CLOGG gives an analysis of 25 cases. In six cases the growth was in the splenic or hepatic regions and the abdomen was uniformly distended in all these just as if the rectum or sigmoid were obstructed. Uniform distension must not be taken as an indication for opening the abdomen in the left iliac region. Though the patients may only come under observation during an attack of obstruction, he thinks there have always been symptoms such as colicky pains, even slight constipation and decline of the general health sufficient to make a diagnosis in a patient previously healthy and with regular action of the bowels. From the examination of specimens removed at operations and autopsies he concludes that the glands are usually already infiltrated before the symptoms are severe enough to bring the patient for treatment. Local recurrence he attributes almost entirely to infection of the glands, and therefore advocates the early removal of the nearest chain of lymphatic glands at the original operation, and he gives particulars of the glands affected according to the part of the colon where the primary growth is. Wallace describes ten cases that he has treated during the past year for chronic intestinal obstruction caused by annular stricture (malign) of the large intestine. A. J. RODOCANACHI. Appendicitis. MORISON (RUTHERFORD). The Medical Press and Circular, 1904. Vol. cxxviii., p. 357. BROOK (W. H. B.). The Clinical Journal, 1904. Vol. xxiii., p. 413. MORISON attributes perforation of the appendix to the following causes: (1) Ulceration due to the pressure of an enterolith; (2) the discharge of a follicular abscess into the peritoneal cavity; (3) the tension from inflammation and pent up secretion resulting from a stricture. He does not agree with the usual explanation that perforation and gangrene are due to the excessive virulence of the attacking organisms. He considers that a definite iliac tumour after the third day may safely be regarded as a collection of pus. In 90 per cent. of cases if the appendix is not excised, it is not destroyed after an abscess has been evacuated. It will recover and may subsequently cause a fresh attack. He further states that in perforation with general peritonitis, the abdomen being rigid and distended, the patient never recovers after operation. He mentions some cases of recovery from general septic peritonitis of more than 24 hours' duration without operation, the disease resolving to iliac abscess. Brook thinks that cases with suppuration do better if tided over the fifth day before an operation is performed. In the treatment of simple appendicitis during the attack he advises a simple saline mixture with hyoscyamus or belladonna and powders of salol to check flatulence. He allows a single dose of a quarter of a grain of morphia, and thinks that the bowels should be kept quiet till the fifth day. A. J. RODOCANACHI. BERARD (L.). Intestinal Tuberculosis Causing Intussusception. La Semaine Médicale, 1904, p. 129. THE writer reports two cases in which intestinal tuberculosis caused intussusception. Both were chronic and showed repeated attacks of colic with diarrhoea and the passage of bloody motions. In one in which he operated successfully there was thickening of the cæcum and appendix, which were invaginated into the colon, and enlarged glands in the ileo-cæcal angle. He demonstrated tuberculous lesions in the mucous membrane. In some reported cases there have been typhilitis and peri-typhilitis, and in others multiple ulceration and adenitis. He concludes that tuberculosis is not so rare a cause of intussusception as the small number of published cases would appear to indicate. A. J. RODOCANACHI. MAYO (WILLIAM J.). Gastric Ulcer and Cancer. 1904. Vol. lxxxiv., p. 721. The Medical News, THE writer considers that surgical treatment for gastric ulcer should be adopted in acute cases not cured by four or five weeks of medical treatment and in all chronic and relapsing cases, especially if obstruction, dilatation, adhesions and deformities are present. Surgical treatment is essentially drainage of the stomach carried out by (1) pyloroplasty; (2) gastro-duodenostony; (3) excision of the pyloric end of the stomach, that is, the ulcer bearing area; or (4) gastro-jejunostomy. The last is the most generally applicable method. Cancer of the stomach is the most frequent cancer in the body, and the writer thinks that more attempts to cure it should be made. He states the mortality at 10 per cent. for early cases, and 20 to 25 per cent. taking good and bad cases as they come. Medical means being unreliable, the diagnosis must be made by exploratory incision. Only tumours located in the pyloric region are amenable to surgery, and these may often be palpated and early cause obstructive symptoms. The stomach must be removed with its regional lymphatic structures-the whole of the lesser curvature must be removed in all cases, but as the glands of the greater curvature are near the pylorus it is not necessary to be so radical on this side. A. J. RODOCANACHI. Pathology. VIGLIANI (R.). A Contribution to the Study of the Development of Elastic Fibres in Cartilage. Lo Sperimentale. Archivio di Biologia normale e patologico. Anno lvii., Fasc. ii. THE historical survey which Dr. Vigliani includes in the account of his investigations shows that there is considerable difference of opinion amongst histologists with regard to the mode of formation of elastic fibres in cartilage, the differences of opinion including both the place and the mode of formation. Thus it has been asserted that the fibres are modified prolongations from the cartilage cells; that the elastic fibres are modified from ordinary connective tissue fibres; that the elastic fibres appear in the inter-cellular tissues (a) as granules, (b) as fibres; that the nuclei of the cells do, and that they do not, take an active part in the formation of elastic fibres. As the result of his own researches, in which he utilised the various forms of differential stains, Dr. Vigliani concludes that elastic fibres appear in cartilage as fine homogeneous fibrils which react but slightly to differential stains and which may, therefore, be termed elastoid. They are formed by an elaboration of the peripheral protoplasm of the cells, from which they are gradually isolated, and after the separation they increase in size and anastomose with each other to form a reticulum; in the meantime. however, they have assumed true elastic characters, as demonstrated by their reaction to the differential stains. ARTHUR ROBINSON. LUZZATTO (R.). Histological Research on the Para-Thyroid Apparatus of Animals fed with Halogenated Fats. Lo Sperimentale. Archivio di Biologia normale e patologico. Anno lvii., Fasc. ii. DR. LUZZATTO's investigation on the action of halogenated fats, bromides and iodides, thyrodine and thyro-iodine on the histological structure of the thyroid body, were instigated by Prof. Cornedi's observation on the relative immunity conferred on animals completely deprived of their thyroid and para-thyroid tissues by the administration to them of bromated and iodated fats. Dr. Luzzatto's experiments were made on dogs and rabbits, and as a result he is able to assert that the halogens in general, and the bromated and iodated fats in particular, have a special and interesting affinity for the thyroid tissues. Iodated fats produce a slight increase of the colloid material and an augmentation of the compact cell masses of the thyroid tissue. Bromides have a similar effect, except in large doses when they give rise to a notable increase of the colloid secretion and produce interstitial and cellular lesions. The iodates, thyrodine and thyro-iodine give rise to alterations which pass from a simple increase of the colloid to the production of colloid goitre. ARTHUR ROBINSON. BOVAIRD (DAVID). The Pathology of Lobar and Broncho-Pneumonia in Infants and Children. Medical News, April 30th, 1904. Vol. lxxxiv., p. 820. THE writer describes at some length the macroscopic and microscopic morbid anatomy of the various kinds of pneumonia in infants and children. His descriptions are based on 216 post-mortem examinations, 191 of these (or 40 per cent. of the autopsies at the Foundling Hospital, New York) being broncho-pneumonia, and 25 lobar. His findings agree with those of other observers. The writer has been impressed by the frequency with which empyema is associated with pneumonia. a study of the pathology of empyema in infants the writer found that among 101 cases there was more or less consolidation of the lung in 56. Of these 56 cases, 10 showed lobar pneumonia, 27 broncho-pneumonia, 15 were indefinite and 4 showed tuberculosis. This frequency of broncho-pneumonia in association with empyema is, I believe, rather in contrast with the findings in the later years of life." The present position as to the nature of the infection is reviewed. In lobar pneumonia the view that the affection is to be regarded as a general infection with a local lesion is strengthened by the demonstration by recent workers of the presence of the micrococcus lanceolatus in the blood in these cases. The results of Prochaska and of Rosenow on this point are quoted. The former reported 50 examinations with positive results in all, while the latter reports 77 positive results in 83 cases. With regard to broncho-pneumonia, Dr. Bovaird says: "Whether or not there is a blood infection in the primary cases has not yet, to my knowledge, been proven. That such will be found to be the case seems highly probable, and we are very likely to arrive at a conception of the disease similar to that entertained for the lobar affection. The tendency of the present time seems to be to diminish the importance attached to the local lesion and to increase the importance of the nature of the infecting organism and of the powers of resistance of the infected individual." S. VERE PEARSON. LAU (H.). On the Question of Scrofula. St. Petersburg. med. Wochnschr., 1904, No. 13. THE idea of scrofula is a very obscure one, although it is very often used. Even if recently a slight decrease can be noticed, still there are by no means signs that this expression is dying out, for clinical physicians would be unwilling to do without scrofula, since they often come across the combination of symptoms which they understand by it, therefore this expression is a useful one. But in spite of this they cannot state of what scrofula consists, by what symptoms it is characterised, whether it is a general complaint or in one part only; in short, one has no clear conception when one reads or hears the expression scrofula. Some authors consider it tuberculosis, others a |