made so completely accessible, that the most complicated and difficult operations are performed with as much facility as if on the surface of the body.

Subjoined are the indications for the operation, space forbidding the author's comments on each :

7.

1. Diseases of the mucous membrane requiring diagnosis. 2. Stones and foreign bodies, (diagnosis and extraction). 3. Cauterization for inveterate vesical catarrh. 4. Urethral fissures. 5. In kolpo-kleisis with defect of vesico-vaginal septum. 6. Diagnosis of seat and extent of growths and tumors in that septum. Extirpation of tumors (especially papillomata) from vesical membrane. 8. Discovery, extraction or excision of renal calculi, from the vesical part of the ureter. 9. Opening of hæmatometra, when puncture is impossible or too dangerous between the bladder and rectum. 10. Cure of colo-vesical or entero-vesical fistula, by cauterizing the vesical orifice of the fistula.

Subjoined are the indications for kolpo-cystotomy: 1. Large stones with great sensibility of bladder. 2. Production of direct escape of urine, in inveterate vesical catarrh, with ulcerations of mucous lining. 3. Extirpation of tumors and excrescences, situated so high in the lateral parts of the bladder, that they cannot be made directly accessible through the dilated urethra alone. 4. Cure of colo-vesical or entero-vesical fistulæ, incurable by cauterization after urethral dilatation.

The probing and catheterization of the ureter from the bladder, after the dilatation of the urethra described above, is a procedure the credit of which Professor Simon can alone claim. At the risk of unduly prolonging this abstract, we give the ipsissima verba of the translation: "After the urethra is dilated in the above-described way, we search for the ligamentum interuretericum with the finger. This ligament is about one inch from the sharply-marked internal orifice of the urethra ; in the middle it is usually so little prominent that it can only be distinguished by experienced explorers. Around the

orifice of the ureter, which is one-half to three-quarters of an inch away from the middle of this ligament, the muscular coat of the ureter, which ends in the interureteric ligament, forms a kind of a pad, and is easy to distinguish. The orifices on these pads are very thin slits, and, since they have only very narrow edges of mucous membrane, they are imperceptible to the touch. On account of this, the third act, viz., the introduction of the probe, is rendered more difficult. In order to effect it we must fix the "Harnleiterwulst" (the vesical fold where the orifice lies) with the finger in that region where the orifice must be situated, and then push the head of the probe, which lies close to the side of the finger, toward this region in the direction of the ligamentum interuretericum from the inside and below, upward and outward. The handle of the instrument must be led to the opposite side and at the same time be raised up against the arcus pubis, in order that the head of it may not glide off from the very steep trigonum. By slightly pushing we try to introduce the head of the probe into the orifice of the ureter. If the probe does not go into the orifice, it will be arrested by the walls of the bladder; but if it enters, it can easily be pushed on in an upward and outward direction. The inlying finger tells whether the probe has remained in the cavum vesicæ, or whether it has really entered into the orifice. In the latter case, we feel the probe covered by mucous membrane for a few centimetres, and we can feel the borders of the orifice all around the probe. If we wish to sound the pelvis of the kidney, we have only to push the probe on in a lateral direction until at a height of seven to eight centimetres, and we strike the brim of the true pelvis (linea innominata). Now it becomes necessary to move the handle of the probe to the inner face of the thigh of that side on which the ureter is probed, and to incline it so that the inner end of it is placed parallel to the vertebral column, and the head directed more toward the anterior abdominal coverings. In this direc

tion the probe advances very readily into the upper end of the ureter and the pelvis of the kidney. If the catheter has been used instead of the probe, the urine will now ooze out drop by drop, or sometimes it will spurt out in a stream at intervals of a half to one minute.”

The probe and catheter used are as thick as common fistula probes, and are 25 centimetres in length. The handles are movable, and fastened with a screw to aid in lengthening or shortening them. The metal used in their construction should not be too flexible. Elastic instruments are proscribed. The probes are more easy of introduction than catheters.

The process may prove useful in nephro-lithiasis, and in diagnosis of unilateral renal disease, being an improvement upon the method of Tuchmann of London. The professor has now employed this method in about twenty-four cases.

2. Hysterotomy in the Treatment of Uterine Fibroid Tumors. (Reviewed in Le Progrès Médic., Aug. 14.)

The following are the author's conclusions :

Pozzi, S.

1. Abdominal hysterotomy in the treatment of fibroid tumors of the uterus, is, though yet quite novel, perfectly justifiable in many cases, and deserves a definite rank among the operations of surgery.

2. There is no comparison between the indications for gastrotomy in cases of fibroid uterine tumors, and for ovarian cystic disease. The fatal tendency in the latter class of diseases, calls for and justifies an operation in the larger number of cases, which is not indicated in the immense majority of large fibroid tumors.

3. The operation should be reserved for fibroid, or fibrocystic tumors of rapid or excessively rapid evolution, and accompanied by dangerous symptoms.

4. The fibroid tumors, which are larger than those referred to above, even when they produce alarming symp toms, require less heroic treatment. Their natural tendency to decrease in size or to establish toleration of their presence, is well recognized. Experience has dem

onstrated that an expectant treatment in these cases, is followed by less mortality than operations for hysterotomy.

5. When, in consequence of an error in diagnosis, gastrotomy discloses a uterine tumor, and not an ovarian cyst, ablation is preferable to leaving the operation unfinished, even though the fibroid tumor be not pediculated.

Under the head of cervical hysterotomy, the author includes simple division of the neck; incision followed by enucleation where the tumor is developed in the tissue of the cervix; and lastly, complete amputation of the cervix when it encloses in its substance a largely developed fibroid tumor productive of true hypertrophic elongation.

Intrauterine hysterotomy first described by Velpeau, first practiced by Amussat, finding but little favor with the French and enthusiastically adopted by the English and Americans, is described according to the procedure of Marion Sims.

III. CUTANEOUS DISEASES.

1. Elephantiasis Arabum. FAYRER, JOS., C. S. I., M.D., F.R.S. E. (Practitioner, Aug., 1875.)

The disease is defined to be a non-contagious malady, endemic in certain localities, generally intertropical and near the sea-coast, characterized by recurrence of febrile paroxysms, attended by inflammation and progressive hypertrophy of the integument and areolar tissue, chiefly of the extremities and genital organs; and occasionally by swelling of the lymphatic glands, enlargement and dilatation of the lymphatics, in some cases by the coexistence of chyluria and the presence in the blood of certain nematode hæmatozoa; the hypertrophy of the integument resulting in enormous enlargements of the scrotum or labia, accompanied by an albuminous deposit in the cells of the areolar tissue, and by degeneration of the muscular and osseous tissues.

The outgrowths are viewed as local expressions of a constitutional disease, cases undoubtedly occurring where the reverse is true, as in Europe and elsewhere. Malarial influences are presumed to play an important part. Both sexes, and persons of all ages and conditions of life, are liable to the affection, which is, however; most common in adult and middle life. Sometimes the general health seems unimpaired, while again there is recurrence of fever once or twice in the month. The average duration of the disease, in 636 cases, was 11 years, the youngest patient being nine years of age and the oldest eighty. It had, apparently, but little tendency to shorten the duration of life, while not only in mechanical but in general cachectic influence, it diminished the power of procreation.

The author agrees with Lewis in referring to a common etiological origin, elephantiasis, chyluria and disordered conditions of the lymphatic system. The last named writer is disposed to believe that the Filaria sanguinis hominis, a small nematode entozoon, is intimately associated with the three classes of disorders when occurring in tropical latitudes. The parasite is enclosed in a tubular sheath, within which it elongates or shortens itself, having the average diameter of a blood corpuscle and an average length forty-six times that of its greatest width. It is smaller but more allied in embryo to the Filaria medinensis than to the larvæ of Trichina spiralis.

The microscope disclosed, chiefly, an hypertrophied areolar tissue in the sections examined.

2. Tar in Psoriasis. M'CALL ANDERSON. (Brit. Med. Jour.)

Objection is made to the conclusion reached by Balmanno Squire that "tar taken internally has no effect in curing psoriasis." After many years of experience the author has come to regard it in the light of one of the most valuable remedies we possess in the treatment of that disease. Not only in mild, but in obstinate cases, after