causing intussusception was.found fourteen times in the small and fifteen times in the large intestine. Any form of invagination may occur according to the location of the growth.

The diagnosis is difficult and in many instances may only be suggestive of a possible cause of the obstruction. When located in the rectum the tumor may be felt or seen. A tumor of the small intestine may be felt through the anus. Except for those conditions which may lead to operation, the prognosis is favorable.

C. G. D.

GYNECOLOGY.

REUBEN PETERSON, A. B., M. D.

PROFESSOR OF OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

NEAL NARAMORE WOOD, M. D.

ASSISTANT IN OBSTETRICS AND GYECOLOGY IN THE UNIVERSITY OF MICHIGAN.

A CASE OF PREGNANCY COMPLICATED BY MULTIPLE FIBROMATA OF THE UTERUS CAUSING COMPLETE INTESTINAL OBSTRUCTION.

STANTON ("Proceedings of the Royal Society of Medicine," Volume II, Obstetrical and Gynecological Section, page 87) reports a most interesting case of a woman of thirty-three years, only recently married, who was thought to be pregnant and had had complete obstruction for eight days. Her abdomen was rigid and tender and she had vomited incessantly for days. Enemata and purgatives had been tried but without results. She had a very rapid pulse, her temperature was rising, and immediate operation was advised.

The lower portion of the ileum was found firmly compressed against the large fibroid uterus by a large, pedunculated, overhanging, subserous growth. The proximal portion of the bowel was purple and distended but not gangrenous, while the distal portion was empty. The uterus contained a two-and-one-half-month fetus. After relieving the constriction supravaginal hysterectomy was done. Unfortunately the patient did not rally, but grew steadily weaker and died thirty-six hours after the operation.

N. N. W.

A CASE OF PRIMARY SARCOMA OF THE VAGINA. MACLEAN (The Journal of Obstetrics and Gynaecology of the British Empire, Volume XV, page 245) reports a case of primary sarcoma of the vagina occurring in a single girl, fifteen years of age, who had not yet begun to menstruate.

Dysuria and shooting pains in the lower abdomen were the symptoms most complained of, and the patient stated that for about one month she had. noticed a soft swelling at the ostium vagina. Practically no loss of nutrition was recognizable. Pelvic examination revealed a soft, dark-red, nonfriable, papillomatous growth of the size of a tangerine orange projecting

from the introitus. This tumor, with its irregular nodular surface suggesting the appearance of a cluster of currant berries, is well shown in the accompanying illustration. The cervix and uterus were not involved, the latter being retroverted and freely movable.

The growth was excised and its base on the anterior vaginal wall curetted and cauterized.

Six months later the patient returned very much weakened and emaciated. The abdomen was enlarged, there were signs of ascites and hard masses could be palpated through the abdominal wall. Death occurred a few months later.

Microscopic examination showed the growth to be a rhabdomyosarcoma.

OBSTETRICS.

GEORGE KAMPERMAN, M. D.

N. N. W.

DEMONSTRATOR OF OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

SCOPOLAMIN-MORPHIN IN LABOR.

CROOM (Journal of Obstetrics and Gynecology of the British Empire, July, 1909) reports his experience with scopolamin-morphin narcosis in sixty-two cases of labor. Various doses were used. With one-four-hundredth grain of scopolamin and one-sixth morphin, the results were uneven and unsatisfactory, although the pain was diminished. With one-twohundredth grain scopolamin and one-sixth morphin he had better results, but his best results were obtained by using one-one-hundredth grain scopolamin and one-sixth grain morphin. With this latter the painfulness of the contractions was markedly lessened, and in some cases entirely abolished. The patients slept soundly in the intervals between the pains and in many cases for an hour or two after the completion of labor. In only two cases was a thorough resuscitation of the child necessary, and none were lost. In fully one-half of the cases only one injection was necessary. If repetition was necessary his experience shows that only the scopolamin should be injected the second time. The drug was given mainly in the second stage and the effects were, (1) soporific, (2) narcosis and anesthesia, and (3) amnesia, the remembrance of suffering being abolished. In two cases forceps were applied after two injections, and the patient delivered without suffering. In a few cases where the drug was given during the first stage the os dilated very rapidly, although the patient was very sleepy and just conscious. Chloroform was given in ten cases. Of these, four were forceps cases, in two it was given to pass perineal stitches, on one version was performed, one was a breech case in a flat pelvis, in one there was extreme pain at the end of the second stage, and in one it was necessary because the patient became extremely noisy under the influence of the drugs.

There were no bad effects in heart, respiration, or pulse. The only untoward result is that the child is born sleepy and does not breathe well or cry, but in all cases the ordinary methods of reviving are sufficient.

There is perhaps a slight tendency to postpartum hemorrhage. Patients vary considerable in their susceptibility to the drug.

The cases most suited for this form of treatment are primiparæ of highly nervous temperament. The drug can be given earlier in these cases than chloroform. Whenever anything in the nature of operative interference or manipulation is necessary, it is distinctly desirable to give chloroform in the ordinary way. The drug does not seem to hasten or retard labor. It should not be given to patients with irregular and feeble pains, and in patients physicially weak and unfit it should be given with caution. On the whole the writer is of the opinion that in scopolamin-morphin narcosis we have an efficient means of controlling the pain of labor, and that it is practically safe when ordinary precautions are taken.

EDITORIAL COMMENT.

THE PHILIPPINE BUREAU OF SCIENCE.

THE seventh annual report of the Bureau of Science by its director, Doctor Paul C. Freer, is exceptionally interesting to the medical profession, since it contains a statement of the growth of the Philippine Medical School, which completed its first academic year on February 17, 1908. Doctor Freer's work as head of this important bureau has been closely folowed by his many friends in Michigan. For many years professor of chemistry in the University of Michigan, and a member of the faculty of its medical department, Doctor Freer had acquired a most enviable reputation as a scientist and teacher. Hence it has been no surprise to those who knew him, that his directorship of the Bureau of Science in our newest possessions is proving so satisfactory and is accomplishing so much.

Reports and statistics are rather dry reading, and abstracts of the same. as they appear in the daily press are far from thrilling and are apt to be skipped by the average reader. Yet the report before us is interesting reading and astonishing to one who has not followed the work the Government is doing in the Philippines, through its bureau of government laboratories. Judging from the titles of the thirty-six monographs issued from the biologic laboratory since 1902, covering a great variety of subjects, the head of the laboratory and his coworkers have been far from idle. The so-called hookworm of the south certainly has not fastened itself upon them during this time. And in other directions we see evidences of equally good work. The department of ethnology has accomplished a great deal, while the work of the chemical laboratory in its routine analysis of milks, waters, cement and clays must be of immense advantage to a country where natural resources need exploiting.

The physician will be most interested, perhaps, in that section of the report which deals with the Philippine Medical School. It seems as if the faculty of the school are to be congratulated upon their success and what they have been able to accomplish under new and far from favorable conditions.

The school now has sixty-seven students, one-third of whom are freshmen. These students are Filipinos who have been educated in the govermental, private, and ecclesiastical schools throughout the Islands. Naturally in the comparatively short time in which American educational methods have been in vogue in the Philippines, it would be unwise to have the entrance requirements of the medical school too high. All that is necessary at the present time is for the students to possess the minimum knowledge requisite for modern medical education. It shows that the members of the medical faculty have that common sense which is so essential to the successful inauguration of new movements under new conditions. The problem before the school is to educate and send forth in as short a time as possible, practical native physicians, who will work among and for their own people. Later on will come the higher type of physician who will do research, as well as practical, work. But at the present time with only one physician to every four hundred thirty square miles of territory in the Philippines, the crying need is for able practioners, men well grounded in the fundamentals of medicine, surgery and sanitation. Through the ministrations of such as these will come the physical uplift of a people, who, wisely or unwisely, we have become responsible for.

The report shows that the facilities for clinical instruction in the medical school are exceptionally good. The faculty now have one hundred beds for teaching purposes under their complete control, and the number will be decidedly increased in the new general hospital which is now under construction. The fact that these beds will be in an institution entirely controlled by the school, where every patient can be used clinically under proper supervision by the members of the clinical staff, will prove an immense advantage to the new school. Through a system of undergraduate interneships the student can be brought into close touch with the patients, and with proper instruction from the clinical teaching force, may be better prepared for the actual work of his profession than is the case with some older institutions where more theoretical methods prevail.

The Government should heed the director's appeal for more funds and more assistants. The biologic laboratory staff should continue to have access to certain hospital beds, so that the research work on various tropical diseases can be advantageously carried out. But the report shows that under the present system the laboratory workers are attempting too much. No set of men can successfully teach, engage in private practice, and carry on elaborate research work in a laboratory. Necessarily they must neglect one portion or the other of their work. And it follows that this neglected field could be much better carried on by one who devotes his entire time and attention to it. Hence, where it is so highly essential that much time and labor be devoted to research work on tropical diseases, there must be men for this alone. These men should be paid salaries commensurate with their ability and the importance of their labor. If to this be added frequent leaves of absence with full pay to counteract the evil effects of a tropical climate, the government will be able to secure and retain the services of scientific workers, the result of whose labors will be of inestimable value.

ANNOTATIONS.

THE ANNUAL GATHERING OF THE VALLEY GUILD.

THE largest independent association of physicians in America will assemble in Saint Louis on October 12, 1909, in response to a call of the Mississippi Valley Medical Association, and continue its sessions during three days. The territory comprising the Mississippi Valley extends from the Lakes to the Gulf and from the Alleghenies to the Rockies. As many prominent medical men practicing within these borders are identified with this flourishing organization, a profitable meeting may be expected. Because of the central location of Saint Louis and the railroad rate of one-and-onethird fare the forthcoming meeting is likely to register a large attendance.

AMERICAN ASSOCIATION OF CLINICAL RESEARCH.

THE promotion of scientific clinical research is the purpose of establishing an association to be designated by the above caption. Physicians and surgeons interested in advancing clinical medicine are requested to attend a meeting announced for the 27th of October, 1909, at the Boston Medical Library, 8 Fenway, Boston, Massachusetts. The object of the meeting is stated specifically to be-first, to establish an American association of clinical research; secondly, to establish clinical research on an incontrovertible scientific basis in hospitals; and thirdly, to institute an American journal of clinical research, in which the work of members of the American association and of others doing clinical research work in a scientific manner shall be published. Notwithstanding the medical profession would seem to be fairly well provided for, as regards general and special societies, the claim is advanced that there is still a niche for one devoted to scientific clinical research. The movement to create a guild of this kind is not intended to disturb existing medical society affiliations. The circular call sets forth that "It is of the utmost scientific importance to establish conclusively all that is at present true in medicine and surgery, and only upon such proved knowledge, to base any further advancement. The clinic deals. with clinical entities and not, like the laboratories, with parts as entities. Therefore, clinical research differs, and must differ, from experimental laboratory researches. Clinical research must consider clinical entities, and when considering parts, it must consider them only as parts and not as wholes. All that subserves the object of obtaining and investigating clinical facts and principles belongs to clinical research and the laboratory is a part of the means of clinical research, but only a part." The chairman of the invitation committee is Doctor James Krauss, 419 Boylston street, Boston, Massachusetts.