points discussed here in extenso are given in a more condensed, though practically identical, form in the author's "System of Obstetric Medicine and Surgery," so that the review of that work, which has already appeared in these pages (Feb., 1866), can be in the points at issue applied to this.

To one who has the larger work of Barnes, this volume is a luxury, not a necessity; to one who is not fortunate enough to possess the former volume, this latter is invaluable.

BROOKS H. WELLS.

ABSTRACTS.

1. Farst: A few Cases of Tumor of the External Generative Organs (Archiv f. Gyn., XXVII., 1).—I. Polypoid Fibroid of the right Labium Majus. R., æt. 40; married eleven years, two children. During the first pregnancy noticed a slight elevation of the lower surface right labium. At end of this pregnancy, had attained size of a Malaga grape, was covered by skin, not sensitive. At the beginning of menstrual periods, this tumor became fuller, thicker, and more sensitive, returning to its former size after the period. When F. saw patient, the tumor was pediculated, the pedicle as thick as an average lead pencil, sensitive and pulsating. Tumor was 6 cm. long, and 13.5 cm. in circumference, not fluctuating, here and there eroded. The tumor was successfully removed, and examination proved it to be a soft polypoid fibroid. II. Sarcoma (myoma ?) of Left Labium Minus. G., æt. 38, eleven children, last delivery five years. For six years had noticed a tumor, size of hazelnut, apparently originating in inguinal region, and sinking between the labia. For two years, tumor had grown rapidly and had become excessively painful, and for six weeks had been blackish in color. This tumor did not alter at the menstrual periods, did not interfere with function of bladder. On examination by F., tumor occupied left lab. m., the size of an emu-egg. It apparently emanated from inguinal ring, but this was determined as free. It was hard and non-fluctuating, and gave to the finger the sensation of incapsulation. It was successfully removed, and microscopically it consisted of long, slender, spindle-form epithelial cells. These cells were arranged in nests, separated from one another by few vessels and little connective tissue. III. Prolapsed Vaginal Cyst. G., æt. 36; married eight years; six children. For five years had noticed a painless tumor springing from lower third of vagina, growing gradually to size of a goose-egg, and simulating a prolapse of vagina. This tumor had interfered more and more with her labors, and had latterly become painful. It sprang from post. vag. wall, and was slightly pediculated. Examination by rectum eliminated rectocele. The diagnosis of cyst was made, it was removed, and its contents were mucus, epithelial cells, fat, no crystals. That in this case F. was not dealing with an unobliterated Gärtner's duct, the absence of cylindrical epithelium and the site (post. vag. wall) prove.

E. H. G.

2. Fleischman: Two Cases of Use of Constant Current for Induction of Premature Labor (Archiv f. Gyn., XXVII., 1).—The conclusions

reached from these cases are: In both cases the constant current evoked contractions, although it was not possible to say what share, in this effect, the irritation (local) connected with galvanization had. The galvanization (even as in cases reported by Bayer) did not harm either mother or child, although in the second case the anterior cervical lip was slightly cauterized. In both cases the effect was most marked when cathode lay in posterior cul-de-sac and anode was placed over lumbar vertebræ―better, in other words, than when cathode was placed in cervical canal and anode over fundus. Possibly Frankenhauser's ganglion will account for this. In addition to other reasons for preferring galvanization to other methods of inducing labor, the danger of infection is reduced to the minimum. The use of the constant current for this purpose, it is hoped, will be put to renewed test.

E. H. G.

ITEMS.

1. DR. PIERRE BUDIN, who has entirely recovered from his severe illness of last year (he was operated upon by Lawson Tait for an echinococcus of the liver on May 7th, 1885), has received the well-merited distinction of the cross of the Legion of Honor. Prof. Budin is assisting Prof. Tarnier in completing his large work on "Obstetrics," of which Volume I. appeared in 1882, and the continuation of which was suspended by the death of the then co-editor, Prof. Chantreuil.

2. PROF. TARNIER has received the, in scientific circles, unusual compliment of being elevated to the rank of Commander of the Legion of Honor.

CORRECTION.

THROUGH Some unaccountable error, a sentence in Dr. Fry's paper on "The Value of the Antiseptic System in Private Obstetric Practice," which appeared in the April number of this JOURNAL (p. 339, line 28), was made to read, "The antiseptic 'plan so ably advocated by Paul Bar in France, and copied by Garrigues in this country," instead of, "and by Garrigues in this country."

Bar's book, published in France in the latter part of 1883, did not reach America until 1884, while Garrigues' plan was instituted in the New York Maternity Hospital October 1st, 1883, and his first experience with it related to the New York County Medical Society, December 21st, 1883, and published in the New York Medical Record, December 29th.

It had long been my intention to complete my knowledge of the methods of the most prominent laparotomists of Europe, derived from their writings, by seeing as many of these gentlemen operate as my necessarily limited absence from home would allow; and, by comparing their methods, to endeavor to explain why our results in America have not yet, as a rule, reached the high rate of success attained by the best operators abroad.

With this object, I sailed from New York on May 26th last, and on my arrival in Bremen on June 5th, found a letter from Dr. L. Prochownick, of Hamburg, whom I had apprised of my visit, informing me that he and Dr. Max Schede, of the same city, had each arranged for a laparotomy for me on June 8th.

Proceeding to Hamburg, I was cordially welcomed by Dr. Prochownick, who showed me his private hospital which, in location (fronting on the beautiful Alsterbassin, the pride of Hamburg, and with a large garden in the rear) and in the neatness and convenience of its internal arrangements, surpassed anything of the kind I saw during my trip. Although it is my purpose to limit my description almost entirely to abdominal

section, I shall occasionally mention one or the other operation or contrivance of peculiar interest. Thus I will briefly describe the arrangement of the examining-room in Dr. Prochownick's private hospital, which I found reproduced substantially in most other clinics in Germany. First of all, the examining-chair attracted my attention. It is the device of Prof. Schatz, of Rostock, and while the attitude it compels the patient to occupy is not exactly graceful, it certainly relaxes the abdominal walls so as to most thoroughly permit bimanual examination.

Indeed,

I almost fear that the exceeding facility with which it enables the examining fingers to reach the pelvic viscera is due to a more or less abnormal depression of those organs toward the pelvic floor. But I do not think that, without an anesthetic, I ever felt the uterine appendages quite so plainly as in Schatz's chair; and I should deem it of special utility in mapping out the ovaries and tubes in those difficult cases in which not every operator nowadays feels disposed to follow the rash counsel "when you do not know what is the matter, open the abdomen and find out." I think the majority of us will prefer to exhaust all safe means of making a diagnosis before resorting to the last expedient. I need hardly say that Schatz's chair permits examination in the dorsal position only, Connected with the wash basins are several large porcelain jars, containing either solutions of corrosive sublimate 1 to 1,000, or carbolic acid 2%, or boiled water.

Scrupulous care was exercised in scrubbing and disinfecting the hands before each examination. Close by the examining table was suspended a glass jar containing corr. subl. solution, 1 to 10,000, with a long rubber tubing and a vaginal nozzle attached, through which the vagina was carefully irrigated before and after each digital examination. So far as practicable, tables, washstands, and instrument-stands were made of galvanized iron, with no unnecessary ornamentation.

The hour fixed for the laparotomy was 6:30 A.M., on the second day after my arrival. The early hour may surprise my readers, as it certainly did me. But I found it to be the universal custom among laparotomists in Germany, the reasons given for their choice being that they are most fresh in mind and body, and having just left their beds, taken a bath, and dressed in clean clothing, are sure of being perfectly aseptic; further, the operation being completed, the rest of the day is free to other occupations; and lastly, if any unforeseen secondary complication ensues after the operation, it is most likely to occur within the twelve hours of daylight.

As neither August Martin, Tait, or the other successful English operators find it necessary to inflict such early hours on themselves, their patients, and the spectators, it would seem that the general habit of early rising in Germany might account quite as much for the hour chosen for laparotomy as any other single reason.

Having complied with the operator's request as to punctuality and clean linen and clothing, after coffee and rolls in the garden we proceeded to the laparotomy room on the top floor (a room used only for this purpose). There were but two assistants, one to give chloroform, the other to assist the operator; and two nurses. No spectator but myself. Sponges were used, prepared and sublimated in the usual way. The table was of galvanized iron, a mere skeleton; the instrument-stands were of the same material on rubber rollers, the pans of thick glass, let into the stands. The floor of cement, walls and ceiling painted. No spray.

CASE I. June 8th. Multiple Carcinosis of Visceral and Parietal Peritoneum.

Girl, 16 years of age. Probable diagnosis, malignant ovarian tumor. As a possible, but not probable, chance an exploratory incision was decided upon.