dressing, and also describes and figures some special instruments for doing this. The treatment is based on a simple and rational principle, it keeps the walls of the urethra separated, provides for drainage, and retains a medicated dressing in constant contact with the affected surface. He uses a solution of icthyol, resorcin, and balsam of Peru in castor oil. He claims that in acute gonorrhoea the discharge will stop in from two to five days. ARTHUR H. BURGESS. LE FUR. Prostatic Hypertrophy. Le Progrès Médical, May, 1904. Vol. xix., No. 19, p. 305. THE writer considers prostatic hypertrophy as the result of a chronic prostatitis reaching its maximum evolution. It has been urged against this conception of the inflammatory nature of enlarged prostate, that many of the patients have never had urethritis. Le Fur recognises a class of primary prostatitis in opposition to that consecutive to urethritis. Primary prostatitis may be either of infective origin-as in infective diseases, in diseases of the intestines, and especially in muco-membranous colitis or due to modifications of the prostatic secretion. To the latter the name "aseptic prostatitis" is applied, the modifications being induced by sexual excesses, masturbation, prostatorrhoea, or even exaggerated continence. It is the chronic aseptic prostatitis that later on in life leads to total or general hypertrophy of the gland, the infected prostatitis tending to produce rather a partial or segmentary enlargement. It may be said without exaggeration that all sufferers from chronic prostatitis are potentially cases of prostatic hypertrophy. This being so, it is very necessary to cure quickly and completely any inflammation of the prostate, and Le Fur believes that systematic dilatation of the prostatic urethra and massage of the gland per rectum are of great service. ARTHUR H. BURGESS. DUVAL, PIERRE and LENORMANT (CHARLES). The Treatment of Rectal Prolapse. Revue de Chirurg. Vol. xxix., No. 5, p. 728. THE rectum is normally held in place by (1) the external sphincter; (2) the recto-urethral and recto-coccygeal muscles, which pass from the proper musculature of the rectum to the membranous urethra and coccyx respectively; (3) the levatores ani; (4) the vascular pedicles of the hæmorrhoidal arteries; and (5) to a slight extent by the mesorectum. A very important factor in the production of complete rectal prolapse is insufficiency of the perineum, as shown by the atrophy of the levatores ani and external sphincter, usually sufficiently well marked to allow the whole hand to pass the anal orifice. Another, and equally important, factor is the abnormal enlargement of the ampulla of the rectum. In the treatment of complete rectal prolapse three indications should be fulfilled (1) the perineum must be reconstituted; (2) the ampulla must be narrowed; and (3) the fundus of Douglas' pouch must be suppressed when it is abnormally developed, and especially when it contains a hernia. The operation recommended is an addition to that of Gerard Marchant's procedure of posterior recto-coccypexy with posterior rectorraphy, and consists in afterwards making a prerectal transverse incision, separating the rectum anteriorly, folding its anterior portion on itself both in a longitudinal and transverse direction, excising any enlargement of the peritoneal pouch of Douglas, suturing the inner borders of the levatores ani together in front of the rectum, and closing the superficial structures to constitute a firm perineum. The whole procedure is analogous to anterior and posterior colpoperineorraphy for uterine prolapse. ARTHUR H. BURGESS. FRIEDRICH (PAUL). Subcutaneous Feeding in Practical Surgery. Archiv. f. klin. Chirurgie. Vol. lxxiii., p. 507. AN article dealing with the possibilities of feeding by means of subcutaneous injections. The experience of surgeons shows that a not inconsiderable number of cases, especially abdominal cases, suffer and die from general inanition and loss of strength, and these are chiefly to be considered, in which loss of blood, infection and loss of power to assimilate food go hand in hand, and vomiting and inability to retain. nutrient enemata render feeding in the ordinary ways impossible. The preparation used by the author is a watery solution of sodium chloride containing grape sugar and an absolutely pure peptone. An injection of this is made night and morning, and between whiles an injection of 20, 50, 100gms. of sterilised olive oil may be used. The author claims that these substances in the right proportions are assimilated and used up in the body and do not reappear as such in the urine. He does not claim at present great things for this method of feeding, but hopes rather that in calling attention to it interest may be awakened and so our knowledge of the subject improved. JORDAN. On Late Recurrences of Carcinoma. Wochnschr., 1904, p. 912. Deutsche med. AN article dealing with time of appearance of secondary deposits after the removal of a primary carcinoma. It is suggested that a longer time limit than three or five years should be set before a case is recorded as cured, seeing that frequently recurrences are noted after longer periods. G. E. GASK. KÜTTNER. The Iodine Reaction of Leucocytes and its Surgical Significance. Archiv. f. klin. Chirurgie. Vol. lxxiii., p. 438. CONSIDERABLE attention has of late been called to the granules found in leucocytes described by Ehrlich, which chemically seem to be identical with liver glycogen and which give the same reaction with iodine. This substance is present in small quantities in normal leucocytes, but becomes increased in certain forms of disease, especially those in which suppuration occurs. The author can give the results of 470 examinations which have been undertaken to enable a correct estimate of the practical value of the method to be formed. The chief interest is concentrated in the question, Can the presence of the iodine reaction in the leucocytes be taken as proof of the presence of acute suppuration? To this, in contra-distinction to others, the author answers shortly and decisively "No." The reaction is present in acute suppuration, but it is also present in cases in which there is acute inflammation without suppuration. In tuberculous affections it might be of some value, as when tubercle bacilli are present alone the reaction is absent, but when a mixed infection is found it may be present, but even this is sometimes doubtful. The conclusion arrived at is, that though the reaction is of great theoretical interest, it will prove of no service to the practical surgeon, and the labour expended on the investigations has proved useless except in so far that a definite negative result has been established. G. E. GASK. LOCKWOOD (C. B.). The Glands Infected in Malignant Disease of the Tongue. The Clinical Journal, 1904. Vol. xxiv., p. 113. THE writer points out that it is not always the nearest glands that are first infected. The infection is quite erratic and may be on the opposite side. He describes the following lymphatics and glands:-(1) Lymphatics from the tip and frænum of the tongue empty into a gland under the mental process of the lower jaw. (2) A gland lies on the hyoglossus close to the edge of the mylohyoid. To feel if this is enlarged it is necessary to place one finger inside the mouth and one outside in the sub-maxillary triangle. (3) A lymphatic arises from the tongue, passes down over the hyoid bone and thyroid cartilage, makes a loop and then enters a gland situated on the carotid artery where the omo-hyoid crosses it. (4) Glands on the deep side of the submaxillary salivary gland. (5) A chain of glands along the carotid sheath from the base of the skull to the root of the neck. Some of the lymphatics of the dorsum of the tongue cross the middle line, and so an epithelioma may infect the glands on the opposite side of the neck. There is also free communication of the lymphatics from side to side behind the pharynx. A. J. RODOCANACHI. TURNER (ALDREN). Tumours of the Spinal Cord. Clinical Journal, 1904. Vol. xxiv., p. 122. THE writer reports two cases which were successfully operated upon. In the one an echinococcus cyst and in the other a myxomatous tumour were removed from the spinal canal after laminectomy. Spinal cord tumours may be (1) intra-medullary; (2) extra-medullary, but intra thecal; (3) extra-thecal. The second and third groups are amenable to operation. Intra-medullary tumours commonly affect the anterior part of the posterior columns and the posterior horns. There is consequently the "dissociation of sensation," tactile sensibility being retained while sensibility to heat and pain is lost. Later there is muscular atrophy, and the Brown-Séquard symptom complex appears, that is, interference with the movements of a limb on the one side and with sensation in that of the other side. This occurs because the sensory fibres decussate at or shortly after their entrance into the cord, while the motor fibres decussate in the pyramids. In cases of extramedullary tumours there is pain of characteristic nature radiating along the nerve roots and progressive paraplegia, both motor and sensory. In the dorsal region the roots enter the cord two inches above their entrance into the spine; for example, if the upper limit of anææsthesia corresponds to the fifth dorsal nerve the tumour is probably under the third dorsal arch. In operating the incision is generally made too low. A distinguishing point between intra- and extra-thecal tumours is that in the former the destruction of the cord is greater, and therefore spasms, contractures and rigidities are more frequent. A unilateral paralysis, subsequently becoming bilateral, is very characteristic of spinal tumour. A. J. RODOCANACHI. Intestinal Obstruction. TAYLOR (WM.). Dublin Journ. of Med. Science, 1904, p. 321. BIRD (F. D.). Inter-Colonial Med. Journal, 1904, p. 127. CHUTE (ARTHUR L.). Boston Med. and Surg. Journal, 1904, p. 476. TAYLOR believes strongly in gastric lavage after the obstruction has been relieved as well as before operation. For the purpose of emptying the distended small intestine after the obstruction is removed he proposes intestinal lavage as used by Kocher in the treatment of acute septic peritonitis. A loop of the upper part of the jejunum is brought out and after making a small opening the nozzle of an irrigator is introduced. A loop of ileum is opened low down and the whole length of the small intestine is washed out from the upper opening to the lower. All the septic decomposing contents are thus removed. Bird reports three successful cases of resection of the bowel. Two of these were cases of strangulated hernia, and the third a case of obstruction by a band the result of adhesions due to chronic constipation. The patient had never had acute or chronic peritonitis or hernia. He used Murphy's button in one case and direct suture in the other two. Chute records a case of chronic obstruction due to a band attaching the sigmoid colon to the abdominal wall near the umbilicus. The band was formed by an appendix epiploica, and from the patient's history and condition at the operation the writer attributes its formation to a mechanical non-septic injury during parturition. A. J. RODOCANACHI. CORNER (EDGAR M.). Acute Gangrene in Strangulated Hernia. Edinburgh Med. Journ., 1904, p. 393. THE writer describes an acute infective necrosis occurring in strangulated hernia which is analogous to gangrenous appendicitis. It may be partly due to phlebitis and thrombosis of the vessels of the mesentery involved by the strangulation, but in the absence of microorganisms thrombosis is not necessarily fatal. In the cases described the bowel is dark or black, the arteries and veins are both occluded, therefore there is little or no fluid in the sac, the gut is not oedematous, but thin and inelastic. It may contain blood but no gas. The consequences of this acute infective necrosis if not recognised may be: (1) General infective peritonitis after the gut is replaced; (2) general peritonitis and gangrene of the strangulated loop after the return of apparently healthy gut; (3) the occurrence of gangrene in strangulation within 24 hours of the onset; (4) spread of the pathological process, especially upwards in the distended bowel. The only treatment possible is resection of the intestine and this must be free. A. J. RODOCANACHI. Appendicitis. BALDY (J. M.). American Medicine, 1904, p. 629. BALDY considers that infection of the peritoneum starting from the pelvic organs and that starting from the appendix constitute entirely separate diseases. He therefore does not agree with the practice of removing the appendix in the course of a pelvic operation, if it should be adherent. The adhesion does not signify appendicitis, and the appendicectomy introduces an unnecessary element of danger. He has never found appendicitis causing pelvic disease nor the latter causing appendicitis. Gloninger reports two cases in which he found the appendix in the hypochondrium. A. J. RODOCANACHI. Resuscitation after Apparent Death in Chloroform Anæsthesia. KING (EMIL). American Medicine, 1904, p. 630. KEEN (W. W.). Therapeutic Gazette, 1904, p. 217. KING states dogmatically that chloroform kills through the respiration. and not through the heart. He attributes fatalities to overdose, shock, loss of heat or fear. In the treatment of a case he has the patient's legs lifted so that the body rests on the shoulders and the head hangs over the edge of the table. Artificial respiration is performed according to a method of his own which he describes, and is combined with tongue traction and tickling of the posterior surface of the epiglottis. He records two cases which were resuscitated after nine to twelve minutes by precordial pressure made thus: The ball of the E |