A long rectal or colonic tube for administering the injection is unnecessary. After the suspension is injected the patient lies on his right side for a few moments so part of the menstrum may pass into the cecum. He is then placed in either dorsal or ventral position on the radiographic table and the picture taken.

PROPHYLAXIS AND TREATMENT OF POSTOPERATIVE RETENTION OF URINE.

FRANK C. YEOMANS, M. D.

NEW YORK CITY.

Ascertain and correct, if possible, lesions of the urethra and bladder in advance of operation.

Physiology of urination-factors that interfere with it after oper

ation.

Prophylaxis-urinary antiseptics and posture.

Treatment.-Suggestion, local applications, medicine, standing. Aseptic catheterization.

SOME PRACTICAL POINTS GLEANED FROM THE OBSERVATIONS OF A PROCTOLOGIST.

SAMUEL T. EARLE, M. D.

BALTIMORE, Maryland.

Doctor Earle reported a case of primary tubercular ulceration of the right buttocks, which was not connected with the rectum by a fistulous tract. In this respect it differed from the one reported by him, in his work, on "Diseases of the Anus, Rectum and Sigmoid," Figure LXII, page 201. It was excised by the thermocautery knife, after which, it healed very promptly.

Doctor Earle also reported a very aggravated case of pruritus ani, which had resisted local applications, autogenous vaccines and treatment by the x-ray. Under local anesthesia he found an ulcer over the posterior commissure just above the internal sphincter, which connected on each side with numerous submucous and subcutaneous superficial fistula which enveloped the entire anal margin and connected with each crypt of Morgagni. The ulcer was incised, the scar tissue, at its base removed, and, the fistulous tracts were all opened up. There was only an occasional twinge of itching following the operation, and he made a speedy recovery.

THE THREE-STEP OPERATION IN TUMORS OF THE SIGMOID AND COLON.

JAMES P. TUTTLE, M. D.
NEW YORK CITY.

Doctor Tuttle described the operation as follows: Incision is made in the outer border of the left rectus. The tumor is brought out on the abdonimal wall. Peritoneal layers of the mesosigmoid are incised well above and below the tumor, and stripped back so as to expose the

blood-vessels, fat, and glands, which may be in the mesosigmoid; the latter are stripped toward the intestine until the blood-vessels are bare and the supply to the bowel is easily visible. The sigmoidal artery is tied in two places and cut between and the proximal stump dropped back into the abdominal cavity. The raw surface in the abdomen is covered over by suturing the two peritoneal layers of the mesosigmoid together over the arterial stump. The two legs of the sigmoid are sewed together laterally to make a spur, after the method of Bodine. The peritoneum is sewed around the bowel; the muscles drawn together; the skin wound closed, attaching it to the bowel. In fortyeight hours the tumor is excised by a V-shaped incision. Two days later, the spur is cut away by pressure-forceps. After this is completed a long rectal bougie is passed up through the bowel beyond the artificial anus, in order to press the spur back and obtain a large caliber at the site of the resection. When the wound made by the pressure-forceps is healed, the artificial anus is closed by the extraperitoneal method of the author.

ORIGINAL ABSTRACTS.

MEDICINE.

ALBION WALTER HEWLETT, B. S., M. D.

PROFESSOR OF MEDICINE IN THE UNIVERSITY OF MICHIGAN.

DAVID MURRAY COWIE, M. D.

CLINICAL PROFESSOR OF PEDIATRICS IN THE UNIVERSITY OF MICHIGAN.

"LE RHEUMATISME TUBERCULEUX" OF PONCET. UNDER the above caption in the Annals of Surgery for May, 1912, Lyle gives a résumé of findings which are gradually relegating the term rheumatism to the domain of symptomatology. He cites many instances of "rheumatism" occurring in the course of tuberculosis and takes up in review Poncet's communication entitled "Pseudochronic Tubercular Rheumatism" presented to the French Surgical Congress in 1897. Poncet's and his pupil's extensive studies upon this subject. were practically ignored for many years. Previous to their time, however, Charcot had cleared up some vague ideas of the relationship of rheumatism and tuberculosis joint affections prevalent in his day. In 1854 he called attention to the great mortality from tuberculosis among patients suffering with chronic rheumatism and ten years later "he emphasized the important part scorfula played in the family history of patients suffering from progressive rheumatism, and remarked on the slowness with which phthisis developed in such cases." There still remains throughout the medical world a great difference of opinion as to the relationship of these supposedly two diseases.

It has long been known that certain pathologic states of the tissues of the body not exhibiting the well defined characteristics of tuberculosis, that is, tubercles, giant cells, tubercle bacilli, et cetera, may have a tuberculous basis, such as for example, amyloid kidney and sclerosis of the pancreas. It is also well known that the toxin of the tubercle bacillus may produce lesions similar to ordinary chronic inflammation. These are Poncet's views. He believes that "tubercular rheumatism is a manifestation of tubercular inflammation as distinguished from specific tuberculosis." Thus we have rheumatic affections divided into. the well-known gonorrheal rheumatism, diphtherial, pneumonal, scarlatinal, and "tonsillar," all of which are more or less dependent upon the toxic products elaborated by the invading organism.

The many facts gathered together in Doctor Lyle's paper convince one of the immense importance of recognizing tuberculosis as a common cause of affections characterized by the toxic group of symptoms usually called rheumatism. Doctor Lyle's article may be read with profit by all.

SURGERY.

FRANK BANGHART WALKER, PH. B., M. D.

D. M. C.

PROFESSOR OF OPERATIVE SURGERY IN THE DETROIT COLLEGE OF MEDICINE.

CYRENUS GARRITT DARLING, M. D.

CLINICAL PROFESSOR OF SURGERY IN THE UNIVERSITY OF MICHIGAN.

AN OPERATION FOR POTT'S DISEASE OF THE SPINE. HIBBS, of New York, has made a second contribution to this subject in Annals of Surgery, May, 1912.

The purpose of the operation referred to is to produce "a fusion of the posterior aspects of the vertebræ, to obliterate motion of the vertebral articulations over the diseased area, and to relieve pressure on the involved bodies, thereby hastening the cure of the disease and preventing deformity."

The operation was suggested to him, he states, by his "experience in the use of an operation involving practically the same principles for stiffening the knee-joint, by mortising the patella into the joint after it was denuded of periosteum. The patella periosteum was carefully preserved and sutured to the periosteum of the femur above and to that of the tibia below. In these cases continuous bone was produced between the femur and the tibia, obliterating the joint.”

He thought that in the spine the careful removal of the periosteum of the spinous processes and the laminæ, with the spinous processes transposed to bridge the gap between the vertebræ, would lead to formation of bone, fusing the vertebræ, and eliminating motion between them.

"In performing the operation, a longitudinal incision is made directly over the spinous processes, through skin, supraspinous liga

ment, and periosteum, to the tips of the spinous processes. The periosteum is split over both the upper and lower borders of the spinous processes and the lamina, and stripped from them to the base of the transverse processes."

ment are brought together over these processes by interrupted chromic catgut sutures." The wound is closed and a steel brace applied so as not to make pressure on the wound.

The number of vertebra to be included in the operation will depend upon the extent of the disease. The author insists upon the necessity of attaching the diseased vertebræ at either end of the involved area to healthy ones above and below.

The stiffening of a small segment of the spine is not a serious matter since the remaining healthy joints compensate for the loss of function of the few.

The author reports three cases treated by operation and illustrates with drawings and photographs showing technique and before and after views. He states that he has operated on thirty-three other patients, making a total of thirty-six, twenty-one in the dorsal, four in the lumbar, and eleven in the dorsolumbar region.

GYNECOLOGY.

GEORGE KAMPERMAN, M. D.

F. B. W.

INSTRUCTOR IN OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN,

BENJAMIN ROBINSON SCHENCK, A. B., M. D.

CONSULTING OBSTETRICIAN TO THE WOMAN'S HOSPITAL OF DETROIT.

CORPUS LUTEUM EXTRACT.

BURNAM (Journal of the American Medical Association, August 31, 1912) reports a series of cases in his personal experience which are of unusual interest to the practitioner. Although it is a recognized clinical fact that there is a definite relation between the functions of. the hypophysis, thyroid, adrenals, pancreas and ovaries, it is not yet determined whether disturbances in the other glands exert an inhibitory effect on the ovary or whether the ovarian secretion, in the effort to replace others, fails in its own mission.

Extreme cases of ovarian insufficiency, leading to genital infantilism, et cetera, are uncommon, but partial insufficiency leading to delayed, irregular, scanty or painful menstruation is only too frequent; and the nervous phenomena of deficient secretion, as seen at the menopause, are familiar to every practitioner,-indeed, the nervous symptoms may occupy the whole foreground of the picture whatever the age of the patient may be.

For the past eight years Doctor Howard A. Kelly and the writer have employed lutean extract in these varied conditions and have found their results very much better than with the ordinary ovarian extract. They now use tablets representing twenty grains of the

fresh corpus luteum of the sow, giving from three to eighteen or twenty tablets a day; the patients who are relieved usually show progress within a day or two and a few weeks treatment is frequently sufficient for relief for many months. It is the writer's custom to give nine tablets a day for the ten days preceding the expected date of menstruation, to give six a day after the flow begins, and in the following time to give three tablets a day. The symptoms of the real or artificial menopause are greatly lessened in about ninetly per cent of the writer's cases; those cases of amenorrhea in which the patient rapidly takes on fat are restored not only to their normal periods but frequently return to their normal weight also; the treatment of dysmenorrhea has been much less successful.

It is noted especially that the gland, which deteriorates with age is nontoxic when taken by the mouth and that large doses are frequently efficient when smaller ones fail.

In the discussion which followed the reading of Doctor Burnam's paper, Doctor Charles Mayo, of Rochester, Minnesota, added the interesting note that the vomiting of pregnancy is perhaps best treated by lutean extract.

OBSTETRICS.

HOWARD HASTINGS CUMMINGS, M. D.

F. M. L.

INSTRUCTOR IN OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN. LESLIE HIGLEY STARK DEWITT, M. D.

INSTRUCTOR IN OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

VACCINES IN PUERPERAL, SEPSIS.

ROWLETTE (Journal of Obstetries and Gynecology of the British Empire, June, 1912) reports a series of cases of puerperal sepsis treated by vaccines. His method of making a bacteriologic diagnosis, which is first necessary, is that of Döderlein. He introduces into the uterus

through a speculum, a sterile bent glass tube and applies suction by means of a syringe. The tube is then withdrawn, sealed, and sent to the laboratory for diagnosis. Smears are first examined, and if either staphylococci or streptococci are found, the case is treated as one either of staphylococcal or streptococcal infection. The diagnosis is confirmed by cultures. In many cases only diplococci were found in the smear. This is a great hindrance to diagnosis. However, only cases of streptococcal and staphylococcal infection required vaccine treatCases in which bacilli are found are usually of mild sapremia and clear up after douching.

With the exception of a few early cases, the vaccines employed were obtained from puerperal infections in the hospital. As soon as bacteriologic diagnosis was made the vaccine was administered. In judging the effect of inoculation, attention is directed to temperature and pulse particularly. In many cases the temperature falls two or