awakening from the anesthetic. The wound was reopened and it was found that the suture of the fascia had torn, so that the muscle lay bare. This case suggested a certain line of reasoning. If the broken sutures had not been discovered, a hernia through the fascia would have resulted. Furthermore, if the muscle-sutures had broken, only peritoneum would have separated the intestines from the abdominal skin; and again if the peritoneal sutures had been broken also, the intestines would have been in direct contact with the skin. Any undue tension on the skin scar might cause it to separate after it had been deprived of the support of the sutures. If this line of reasoning is correct, at the time of separation of the wound the deeper layers of the abdominal wall would have to show evidence of previous separation, while the skin layer only would show freshly torn edges.

In five cases observed by the writer, definite observations were made along the lines suggested. In all cases the edges of the deeper layers showed that they had been separated sometime. The edges were smooth and glistening and had granulated over. The skin edge was raw in each case due to the recent rupture. The author's conclusions are that in all cases of separation of laparotomy wounds, the underlying cause is a separation of the deeper layers. This may be due to weakness of the suture material, tearing of the sutures through the edges of the deep layers, especially longitudinal tearing of the layers, where the sutures are all in one line. Also knots well tied become united and knots tied too tight may cause a necrosis of the bundle of tissue tied by the knot. The underlying principle in all these is the same -there is first a separation of the deeper layers of the abdominal wall; and later a little unusual strain will cause a rupture of the skin incision. Coughing, vomiting, and straining will cause a rupture of the wound only in cases where the deeper layers have in some way become separated.

G. K.

PRIMARY MELANOTIC SARCOMA OF THE OVARY. WINTERNITZ reviews the reported cases of melanotic sarcoma of obscure origin, and adds to the cases now recorded one of primary melanotic sarcoma of the ovary from the Johns Hopkins Hospital (Johns Hopkins Hospital Bulletin, Volume XX, page 314). The patient was twenty-six years of age and had complained of severe headaches with nausea and vomiting for six months. Within six months she underwent three cranial operations as follows: Subtemporal decompressive craniotomy in October after which. the headaches nearly disappeared and the choked discs largely subsided; suboccipital exploration for cerebellar tumor in February, findings negative; removal of a black melanotic tumor measuring seven by five centimeters and weighing one hundred grammes from the anterior portion of the right parietal lobe in April. About four months later she died and a most complete and thorough autopsy was done. Large and small metastatic growths were found scattered through the brain, one of them recurrent at the place where the tumor had been removed, and the largest one measuring

eight by ten centimeters. The finding of the large primary tumor of the right ovary, lobulated and of purplish black color, almost filling the pelvic inlet and occupying the entire area between the sacral promontory and the symphysis and extending as far as the ileopectineal line on the left was the surprise of the autopsy as the patient had never complained of any pelvic symptoms and no vaginal examination had been made. Other metastases were found in the left ovary and in the anterior mediastinal glands. Careful examination of the skin surface, the choroid coats of the eyes, and the choroid plexuses failed to reveal any possible conventional source of origin for the pigmented tumor cells. The literature is given and the article is well illustrated.

OBSTETRICS.

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

N. N. W.

PROFESSOR OF OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

NEAL NARAMORE WOOD, M. D.

DEMONSTRATOR OF OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.

EXPERIMENTAL PRODUCTION OF THE MATERNAL PLACENTA AND THE FUNCTION OF THE CORPUS LUTEUM.

LOEB (Jama, October 30, 1909) reports quite at length his work on the production, experimentally, of the maternal placenta. He states that three factors upon which this experimental production depends are a chemical sensitizing, a mechanical stimulus applied to the uterus, and a certain condition of the body fluids of the animal, the chemical sensitizing substance showing the highest degree of specificity, the mechanical, the least. The placenta was produced experimentally in both guinea-pigs and rabbits without any specific action of the ovum, even without any pervious contact with it. The only tissue in the ovaries concerned in the production of the sensitizing substance, which enables the uterus to produce the maternal placenta, is the corpus luteum. This sensitizing substance is carried to the uterus through the circulation. In the guinea-pig the formation of the corpus luteum begins approximately six to ten hours after copulation but rupture of the follicles and the formation of the corpus luteum may take place spontaneously. The corpus luteum undergoes degeneration after an active growth of eighteen days. Only from the second to the ninth day is the uterus sensitized sufficiently to respond to mechanical stimulation. The size of the deciduomata varies according to the area of uterine mucosa exposed. Loeb found that the tubal mucosa could not be sensitized by corpus luteum substance as the uterine mucosa could. Because of this difference in the two tissues to react with the sensitizing substance he concludes that there must be certain distinct structural and biochemical variations between the two. It seems, therefore, that the substance from the corpus luteum has a special sensitizing effect upon the uterine mucosa and connective tissue only and that the latter throughout the body is not identical.

Because the ovum in itself cannot stimulate the production of the maternal placenta upon the peritoneum, tube, or ovary extrauterine pregnancies do not occur in the guinea-pig. As proof that the placenta formation is not dependent upon a nervous mechanism, decidual growth may be obtained upon transplanted uterine tissue. This decidual formation was not, however, obtained upon tissue transplanted in the male. In cases in which the uterus was transplanted the glands and connective tissue lived and at this point the deciduomata were formed, showing that the tumor probably arose from the transplanted connective tissue.

R. G. L.

SOME OBSERVATIONS ON A CASE OF EXCESSIVE
HYDRAMNIOS.

It is difficult to state just what constitutes hydramnios. The average amount of amniotic fluid in normal labors is about two pints and anything over five pints may be considered pathologic. Caie (Journal of Obstetrics and Gynecology, October, 1909), reports a case where the amniotic fluid amounted to twenty-six pints. The patient was a secundipara twenty-six years of age who during the seventh month of her second pregnancy suffered severe pain in her back and left side, together with a weighty feeling about the stomach. A month later an examination revealed a marked increase in the abdominal distention, orthopnea, edematous condition of the lower extremeties and vulva, irregular and intermittent heart sounds, scanty and highly albuminous urine. After draining the edematous labia with small trocars, a couple of sterilized bougies were passed between the uterine wall and membranes and the latter were punctured with a fine knitting needle. Owing to the feeble pains, forceps were applied and a nearly full-term, dead, female child extracted. The puerperium was practically normal with the exception of an irritating and persistent urticaria upon the abdomen and inner side of the thighs.

The pain in the side was probably due to pressure on the solar plexus and the condition of the urine to the same cause. The percentage of still births in cases of hydramnios is given as fifteen and those born of the female sex as seventy-five, while in twenty-five per cent the fetus is deformed.

PEDIATRICS.

ARTHUR DAVID HOLMES, M. D., C. M.

MEAT BROTHS FOR INFANTS.

2. P.

STOELTZNER has obtained excellent results (Medizin Klinik, February 7, 1909) in cases with gastrointestinal symptoms due to a diet of flour foods and sugar, by putting them on a mixture of milk and meat broth. He reports fourteen cases. The broth used was made of ordinary strength and from beef or veal. Sugar was never added to the mixture. The relative

strength of milk and broth in the mixture varied according to the case. The average age of the children was five months. Seven of the children had been on breast for an average of 2.7 months; the other seven had never been breast fed. The length of time of feeding on flour was not less on an average than two and one-half months. Eight of the fourteen had not been given any milk at all; six had received small amounts of milk with carbohydrates, and of these one was fed on Nestle's Food and three on Condensed Swiss Milk, eight of the fourteen suffered at the beginning of treatment from diarrhea; six children were in a specially serious condition. In nine cases the treatment was only carried on a short time, but in these the diarrhea when present quickly stopped. In six out of these nine the weight increase was most gratifying. The five cases which remained longer under treatment begun to gain weight almost immediately and continued to improve. The results were so clear that the author feels justified in considering that the symptoms due to a flour food diet forms an indication for the milk and broth diet.

THE URINE IN GASTROINTESTINAL DISEASES

OF INFANCY.

MORSE (Archives of Pediatrics, August, 1909) examined three hundred consecutive cases within twenty-four hours after admission to his service at the Infants' Hospital and Floating Hospital, the sediment not being examined unless albumin was found, in order to determine if possible the importance of urinary findings in prognosis, and to show something as to the relation between some of the other symptoms, such as stupor, restlessness and edema, and the urinary findings. Albuminuria was found in about eight per cent of babies suffering from chronic disturbances of digestion. It was only a trace and seldom accompanied by casts. It was never accompained by edema, and vomiting was no more common in the babies with albuminuria than in those without it, and it did not affect the prognosis.

Albuminuria was present in about ten per cent of acute diseases of the gastroenteric tract. The albuminuria had no effect on the prognosis in the acute gastric cases. The mortality was, however, considerably higher in the intestinal cases with albumin than in those without it. Symptoms of disturbance of the nervous system, such as restlessness, convulsion, and stupor were possibly a little more common in the babies with albuminuria than in the others. There was, however, nothing to suggest any direct connection between these nervous symptoms and the albuminuria.

Judging from the examination of the sediment the pathologic condition in the kidney seldom progresses beyond that of acute degenerative nephritis; edema occuring in the course of diseases of the gastroenteric tract is not connected with the condition of the kidney, and there is nothing to suggest any positive relation between the affection of the kidneys and such symptoms as restlessness, convulsions, and stupor. These are due to toxemia and not to uremia.

OPHTHALMOLOGY.

WALTER ROBERT PARKER, B. S., M. D.

PROFESSOR OF OPHTHALMOLOGY IN THE UNIVERSITY OF MICHIGAN.

THE OCULAR SYMPTOMS IN PELLAGRA.

WHALEY (Ophthalmic Record, Volume XVIII, Number II) gives the result of the ophthalmologic examination in thirty-five cases of pellagra, fifty per cent of whom were insane, making the nervous element much in evidence. Examination for the visual fields was not made.

The only ocular symptom that was found at all constant was a thickening of the retinæ, associated with a dilatation of the veins, giving the fundus reflex a peculiar indistinct yellowish color. The dilatation of the pupil was not so prevalent as has been reported by others.

The cases examined varied in age from eight to seventy-six years, and of the entire number examined only two showed normal eyes. Drooping of the upper lid, not due to paralysis, but rather intolerance of light, is noticed. If the pellagrin look up he will not correct the lid droop by throwing his head back unless an involuntary ptosis be present. Hypersensitiveness to light contracts the pupil as a rule.

The findings are tabulated as follows:

Lids.-Paretic, one; lachrymation, two; dacryocystitis, two; conjunctivitis, two; muddy conjunctivæ, two; jaundiced conjunctivæ, three; obstruction of lachrymal duct, five.

Corneal Abnormalities.-Ulcer, four; superficial inflammation, two; increased sensibility, two; subnormal sensibility, seven.

Muscles.-Paresis (right rectus), one; nystagmus, one.

Anterior Chamber.-Shallow, twelve; deep, one.

Iris.-Iritis, serous, one; sluggish reaction to light, six; hypersensitive, four; photophobia, six; reaction to homatropine, slow, four; prompt, one; spastic reaction to light, two.

Pupils. Unilaterally dilated, two; bilaterally contracted, three; bilaterally dilated, three; Argyle Robertson, one.

Tension. Plus bilateral, one; plus unilateral (oculus sinistra), two. Fundus. Retinitis, two; detached retina, one; optic atrophy, three; optic neuritis, three.

Lens. Cataract bilateral, three; unilateral, two; cloudy lens, one.
Arteriosclerosis.-Fifteen.

The arteriosclerosis which appeared in fifteen cases, occurred at every stage, in the young as well as the older.

The author also gives an extract from the report on "Pellagra" by Professor A. Marie, of Paris, prefaced by Professor Lombroso, as follows: "Remarkable peculiarities are found in the eyes of the pellagrous; a falling of the superciliary fold is very frequent. In many cases is found also a marked unilateral injection of the conjunctivæ. These are observations which remind one of general paresis, and show, along with other manifesta