continuous suture of fine cumol catgut. The fat is then dissected from the upper surfaces of the aponeurosis of the transverse muscles on the left side of the wound from one-third to one-half inch. The aponeurosis upon the right side of the wound is then separated for an equal distance from the rectus muscle. The muscles and fascice are then sutured by means of a medium weight chromicized catgut suture in the following manner : The suturing is begun at the lower angle of the wound upon the left side. The suture is passed from above downwards through the aponeurosis and rectus muscle. Then the separated bundles of the rectus muscle are united with a continuous suture until the upper angle of the wound is reached, when the suture is passed from below upwards through the aponeurosis upon the left side of the wound. The suture is then passed from below upward through the aponeurosis upon the right side of the wound, and an additional suture is taken above this point to fix the suture and take the strain off that part which has brought the muscle in apposition. The aponeurosis is then closed from above downwards by catching the aponeurosis upon the left side of the wound after the manner of the Lembert intestinal suture, and then passing the needle from below upward through the aponeurosis upon the right side of the wound. When this suture is drawn taut, it slides the aponeurosis of the right side of the wound upon that of the left side and holds the two in apposition; the amount of overlapping depending upon the distance from the edge at which the needle is passed through the aponeurosis upon the left side of the wound. The process is repeated until the lower angle is reached, when the two ends of the suture are tied. In long wounds two or more mattress sutures are placed to take tension off the lines of continuous suture. The fat is closed with a continuous suture of fine cumol catgut. The skin is closed with fine cumol catgut suture by the intracuticular method.

OBSTETRICS AND DISEASES OF CHILDREN.

Under the charge of D. J. EVANS, M.D., Lecturer in Obstetrics, Medical Faculty,
McGill University, Montreal.

THE PATHOLOGICAL ANATOMY AND PATHOGENESIS OF
THE TOXAEMIA OF PREGNANCY.

In this paper, Dr. James Living, in American Journal Obstetrics, Feb., 1905, demonstrates three clinical manifestations of the toxaemia of pregnancy and their associated hepatic lesions, briefly remarking the pathogenesis of these. Hæmorrhagic hepatitis, he states, takes place in 95 per cent. of all cases of any variety of eclampsia.

Acute yellow atrophy of the liver is, in his opinion, closely related to eclampsia, and is dependent on the toxins associated with pregnancy.

A case, four and a half months pregnant, is reported. Toxaemic symptoms were present for two weeks followed by fever, epistaxis, jaundice, muscular twitching, and one convulsion, two hours before death. The urine was free from albumen and casts, but contained leucin and tyrosin.

Autolysis of the liver cells is present in certain cases where the microscopic condition of the liver is apparently unaltered. In such cases the function of the organ is profoundly affected.

A series of cases of severe vomiting of pregnancy terminating fatally show the condition to be asssociated with (1) acute yellow atrophy of the liver; (2) the same necrotic process in a liver which is not reduced in size; (3) less marked degenerative changes indicative of extensive autolysis and profound disturbance of liver function. These lesions are thus identical with those found in eclampsia, therefore, the process in both series is one and the same.

One experiment on a rabbit, demonstrating the toxic effect of the blood from a case of pernicious vomiting, is mentioned. 10 c.c. of such blood, injected into the abdominal cavity of a rabbit, resulted in immediate muscular spasms, death following five days later. The liver showed well marked degenerative changes.

That leukæmia is occasionally close to the toxæmia of pregnancy. Living advances the following facts. Its frequent development shortly after pregnancy, and the frequent appearance of leucin and tyosin in the urine in both conditions.

Living has no opinion as to the exact identity of the poisons but suggests that they are various and not fully accessible to present clinical and biological methods.

He suggests that acute yellow atrophy of the liver may occur in mild form and, in fact, is present in all cases of vomiting of pregnancy, hence no doubt can exist that the occurrence of this condition is often followed

by recovery.

With regard to the urinary changes in the toxæmia of pregnancy, Living believes that the examination for various unoxidized proteid derivatives will prove a fairly reliable indication of the seriousness of the case. Not only must the precipitate be examined for leucin and tyrosin, but the filtrate must be tested as well.

He regards the toxæmia of pregnancy as being due to a "functicnal disturbance of the liver, usually but not necessarily attended by severe anatomical lesions of the kdneys and other organs. When albuminuria appears the disease is already far advanced."

As the disease is the result of a disturbance of function and the organic changes are only dependent on the presence of toxins, then in most cases where these can be eliminated recovery follows as cases have proved.

Saline irrigation and infusion seem to be the most effective agents. Ringer's fluid Living recommends as being more effective than plain saline. Its composition is as follows: Sodium chloride, seven grains; calcium chloride, two grains; potassium chloride, one grain; sodium bicarbonate, one grain; aq ad, 1000 c.c. The solution is best prepared with distilled water recently boiled, and the salts must not be heated enough to decompose the sodium bicarbonate.

OPHTHALMOLOGY AND OTOLOGY.

Under the charge of G. STERLING RYERSON, M.D., C.M., Professor of Ophthalmology and Otology, Medical Faculty, University of Toronto.

OPTIC NEURITIS AND FACIAL PARALYSIS.

E. A. SHUMWAY, Philadelphia (Journal A. M. A., February 11), reports a case of postpapillitic optic atrophy with a history of prior rightsided facial paralysis with pain in jaw and with a noticeable flattening of the right side of the face from loss of sub-cutaneous fat, together with enophthalmus, all on the right side, while the optic atrophy was bilateral, most marked on the left. He finds in the literature only seven similar cases of this association of facial paralysis and optic neuritis, though a number of cases of optic neuritis have been reported in connection with polyneuritis. The atrophy and sinking of the eyeball is evidently rarer, as he has found no reports of a similar case. He has, however, been able to examine a case of Dr. Spiller's with flattening of the face and enophthalmus following rheumatic facial paralysis and implying, he thinks, as in his own case, some involvement of the seventh nerve. There were chloroanemic and disordered menstrual symptoms in Shumway's case, but he does not attribute to them the optic atrophy. His conclusions are given as follows: "1. Optic neuritis is occasionally associated with facial paralysis, either alone or as part of a multiple neuritis; the etiologic factor may be rheumatism, but at times appears to be infection, the nature of which is as yet undetermined. The optic neuritis is usually of the retrobulbar type, but a decided papillitis may be present, and be followed by more or less marked atrophy. In cases of multiple neuritis of the cranial nerves, the eye grounds should be examined for possible optic nerve complication. 2. In facial paralysis, flattening of the face and enophthalmus may appear, and are to be considered as due to a neuritis of the fifth nerve, and not to involvement of possible sensory fibres in the facial nerve."

THE ATTRACTIVE FEATURES OF GRADUATED TENOTOMIES

UPON THE EYE MUSCLES.

A. L. Ranney gives the histories of twenty illustrative cases in which by graduated tenotomies he has restored to perfect health patients apparently suffering from incurable maladies. His experience leads him to consider eye-strain, which may exist without any refractive error. capable of inducing conditions of the utmost gravity, often apparemuy having little or no association with the eyes. Among these are asthenopia, epiphora, wry neck, epilepsy, insanity, nervous prostration, chorea, progressive muscular atrophy, loss of the intellectual faculties, uncontrollable neuralgia, insomnia, and uncontrollable vomiting. Even glycosuria may be relieved by correction of heterophoria, as apparently the close anatomical relationship of the diabetic center and of those controlling the eyes caused irritation of the former when the latter are called upon for abnormal activity. These cases require careful study, and frequently demand the methodical use of prismatic glasses for purposes of diagnosis in order to ascertain latent muscular errors. Tenotomies should never be suggested or performed too bastily, and those who have the largest experience are the slowest to operate, but the author condemns efforts to cure genuine heterophoria by the use of prisms.-Medical Record, February 11, 1905.

LOSS OF SIGHT FROM DISUSE OF THE EYE. (AMBLYOPIA EX ANOPSIA.)

D. B. St. John Roosa believes that the term amblyopia ex anopsia should be limited to those cases in which the use of the eye has been given up because to use it involves double vision, the maculae luteae being no longer in exactly corresponding positions, as is the case in any form of strabismus. Amblyopia due to obscuration of the media does not belong in this category. The case reported illustrates the fact that amblyopia in the deviating eye in strabismus is functional and not organic, and that it may be recovered from perfectly. The patient was a man of forty-six, whose right eye was amblyopic owing to suppression of the image accompanying divergent strabismus following overcorrection of a convergent strabismus. Five years ago the left eye, on which he was dependent for vision, was put out of function by an accident. Vision in the right eye was at this time 20-200 with a cylindric glass of +4D., but with suitable correction and practice, in the course of five years he gradually regained the function of the organ until now his vision with the formerly amblyopic eye is 20-30 with an appropriate glass. The vision for fine type improved much more quickly than that for distance.-Medical Record.

CURRENT CANADIAN MEDICAL LITERATURE.

The Canadian Practitioner, March, 1905.

EXCISION OF THE WRIST.

This paper was read by Dr. F. W. Marlow at a recent meeting of the Toronto Medical Society. He referred to Lister's operation as advocated by that surgeon in 1865, in which the carpal bones and the ends of the radius and ulna and the bases of the metacarpal bones are removed. This operation may be required for tuberculosis of the joint, infection resulting in necrosis, severe wounds and injuries, ankylosis in faulty positions, irreducible dislocations.

Of the methods of operating the most frequently employed are those of Lister, Ollier, Langenbeck, Konig, and Kocher. The first two are characterized by a metacarpo-dorso-radial and a metacarpo-carpoulnar incision. Ollier's method adds a short incision on the radial side for drainage. In the latter three methods there is only a single dorsal incision, Langenbeck's being a metacarpo-dorso-radial, Konig's having a similar one though not so extensive in an upward direction, while Kocher's is a metacarpo-dorso-ulnar one. All the operations are tedious and often difficult. No diseased bone or synovial membrane should be left. In Lister's method the insertions of the radial and ulnar extensors and the ulnar flexor of the wrist and the origin of the thenar and hypothenar group of muscles are divided. A better result is likely to ensue if it is possible to preserve some of these structures. If it is possible to complete the removal of the diseased parts without sacrificing more than the upper and lateral articular cartilages and surfaces of the metacarpal bases, and at the same time to leave the trapezium, the pisiform and the hook of the unciform, such preservation may be accomplished.

Before the operation an attempt should be made to freely flex and the hook of the unciform, such preservation may be accomplished. extend the fingers. During the operation the tendon sheaths should be preserved as far as possible, and also all the healthy periosteum. But great care should be taken not to leave diseased periosteum.

The parts are dressed with plenty absorbent and the forearm and hand put in a splint. An ordinary straight splint answers the purpose. The hand is slightly extended and the forearm flexed and semi-pronated. To allow the approximation of the bones the splint should be removed and adjusted every two days. At the end of one week passive motion