Being of vegetable composition, it will be readily digested to such an extent as to allow it to pass down the alimentary canal without giving notice of its movements. The anastomosis being completed, the gauze pads are removed from the peritoneal cavity and the bowel replaced. The abdominal wound is closed, and I would suggest by the method of Richelot, of Paris; an ordinary cat-gut suture is passed through the upper angle of the peritoneal wound and tied, leaving the end of the suture long. The peritoneum is then closed with a continuous suture. When the lower angle of the wound is reached the same suture is carried through the edges of the recti muscles, and they are closed with a continuous suture to the upper end of the wound and tied. The skin and cellular tissues are closed with silkworm gut sutures, and the wound dressed with iodoform, sterile gauze, cotton, and bandage. Allow me to state that I believe cylinders of gelatine or spermaceti could be used for this purpose with perfect satisfaction. Any objection offered to the instability of the cylinder is refuted by actual observation, as in a case observed in the city of New York. A patient in almost a moribund condition upon whom this operation was performed survived but a few hours, and on opening the abdomen it was found that plastic material had been thrown out in such quantities that the stitches were completely hidden. If under the decidedly unfavorable circumstances above cited sufficient vitality exists to deposit lymph to that extent, how much better result may we hope to attain when the condition of the patient is more auspicious? Gentlemen of the surgical jury, Johnson's end-to-end anastomosis is before you. Judge it in your wisdom, and as you are strong be merciful. LOUISVILLE. DIAGNOSIS OF EARLY PREGNANCY. BY ALBERT BERNHEIM, M. D. In the American Practitioner and News, May 15, 1898, No. 10, page 373, in an article on "Laparotomy During Pregnancy," Dr. Turner Anderson speaks about the difficulty of a diagnosis of early pregnancy, saying: "This, I take it, should not create any great surprise when we consider how difficult it is to diagnosticate early pregnancy even when uncomplicated; but when pregnancy is associated with intrapelvic or abdominal disease, the diagnosis is often impossible. "It certainly is very important to know that pregnancy does exist in a surgical case; but the rational signs of pregnancy are so unsatisfactory that they may tend to confuse rather than assist in diagnosis, and even after the sensible signs become possible, they, too, are often so obscured by co-existing diseased conditions as to prevent diagnosis." That this is often true of many instances must not be denied. In general we distinguish sure signs of pregnancy and probable signs. We call a sign sure if it by itself would be satisfactory to establish an absolute diagnosis, such as fetal heart-sounds and quickening. Among probable signs there are the changes of the sexual organs and other organs, and finally the nervous symptoms. The so-called probable signs are of different importance; one of the most important signs of these probable ones is the bluish color of the vaginal mucous membrane. The general view that an absolutely sure diagnosis of pregnancy may be made out only in the later months, but not in the early stage, is certainly justified. One of the most absolute signs of pregnancy we must, so we should think, find in the uterus itself; and, indeed, we do find one symptom that was emphasized as the surest sign of early pregnancy quite particularly by my teacher in obstetrics and gynecology, Prof. Dr. Alfred Hegar, in Fredburg, Germany. He, indeed, considers this sign as a particular characteristic to pregnancy. Hegar calls it the compressibility of the pregnant uterus. If you make a bimanual examination, one finger of your one hand in the vagina, or better in the rectum, and the other hand on the exterior abdominal wall, you will be able to compress the part of the uterus a little above the internal mouth, where the body of the uterus begins, and quite especially in the median line of the uterus, not so much on the two sides. The term "compressibility" is preferred by Hegar to the term "softness of the tissue," because it is not so much the softness, well-known for a length of time, but the very compressibility that Hegar regards as characteristic. The evidence of compressibility is given, the uterus being in normal anteflexion, by introducing the index-finger into the anterior vaginal vault and putting the fingers of the other hand on the abdominal wall, reaching over the fundus to the posterior uterus wall. The fundus should then be pushed downward by pressure exerted through the abdominal walls. The fingers will be brought within the reach of the index-finger. If the uterus is in retroversion, you must introduce your index-finger into the posterior vaginal vault and put the fingers of the other hand so to reach the lower part of the anterior wall. You find the evidence of compressibility the best by introducing your index-finger of the one hand into the rectum, and that as far as above the sphincter tertius ani. As already mentioned, the medial part is most compressible. The layer of tissue between your fingers appears sometimes as thin as a playing-card, at other times about a fifth of an inch. Very striking is the difference of the cervix to be felt as a solid cylinder compared to the relaxing tissue above the isthmus, which, if compressed, opens like an expanded fan. Dr. Dickinson ("The Diagnosis of Pregnancy between the Second and Eighth Week by Bimanual Examination," American Journal of Obstetrics, 1892, Vol. 25, p. 384) discusses a new symptom, alike, to a certain extent, Hegar's sign-a formation of a fold on the lower uterine segment. Dr. Landau asserts that this greater compressibility may be observed in the tubes too. Hegar himself made the remark that by a too brisk and repeated pressure abortion may be brought about. When fibroma or myoma is existing, you might be able to make a differential diagnosis by a second exploration. Sometimes it might be that the uterus is a little less soft, or the myoma might be soft; if so, at a second examination a few weeks later you will be able to make out a pretty certain diagnosis, because myoma or fibroma does not grow so fast as a uretus does during the first months of pregnancy. LITERATURE. HEGAR, Deutsche Med. Wochenschrift, 1895, No. 35. REIUL, Prager Med. Wochenschr., 1884, No. 26. COMPES, Berliner kl. Wochenschrift, 1885, No. 38. SONNTAG, Sannulung klin. Vortraege Neuefolge, No. 58. PADUCAH, Ky. BONY CHANGES IN CHRONIC JAUNDICE.-F. Obermayer (Wiener klinische Rundschau, 1897, Nos. 38 and 39; Centralblatt für innere Medicin, August 27, 1898) reports five cases of hyperplastic osteitis following chronic cterus. In four of them there was cirrhosis of the liver, and they might sustain Gilbert and Fournier's theory that the toxines that produce cirrhosis give rise to the bony changes also; but in the fifth case the jaundice was due to cicatricial closure of the ductus choledochus, so that the chronic cholemia must alone have been the cause of the bony changes.-New York Medical Journal. Reports of Societies. LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.* Stated Meeting, October 7, 1898, the President, Thomas Hunt Stucky, M. D., in the chair. Exhibition of Pathological Specimens. Dr. A. M. Cartledge: The pathological specimens I shall exhibit are not themselves of any especial interest, yet there are two or three features in connection with them to which I desire to call attention. They represent exaggerated stages of pelvic inflammatory disease, and as types of that class of cases the specimens are of interest. I also desire to speak of the manner of dealing with such cases. Case 1. Double pyosalpinx. Mrs. G., aged nineteen years, operated upon July 24, 1898. Patient had been married six months; had been complaining a short time before coming to the infirmary, but had no special pain or discomfort except at her menstrual periods, when pains were much increased. On July 6th an attack of pelvic peritonitis began, for which she was admitted to the hospital. On section both tubes were found very much thickened, enlarged, and little more than sacs of pus. Several large inflammatory cysts present. Both tubes and ovaries enucleated unbroken. Intestinal adhesions extensive; for this reason a glass drain was inserted, which was left for twelve hours, aspiration being frequently practiced. There was only a small amount of exudate. Convalescence smooth. She went home on August 29th in good condition. I want to particularly call your attention to the method of preservation of these specimens-the Kaiserling method. You will see they are preserved perfectly as to size, color, shape, etc., and look to-day just as they did when removed. It is not even necessary to take them from the jars in order to determine what they represent, as the natural coloring has not been disturbed. Case 2. Double pyosalpinx. Mrs. S., aged thirty-two years, operated upon August 18, 1898. Patient has been a widow for four years; has two children, youngest eight years old; had a miscarriage six years ago, and has never been well since. For the past six years menstrua Stenographically reported for this journal by C. C. Mapes, Louisville, Kentucky. tion has been more painful and has lasted longer each time than previously, and during this time she has been practically a semi-invalid; she also has a lacerated perineum. Operation in the Trendelenburg posture gave first of all a most beautiful picture: The uterus was lying in retroversion, and in front of it and covering it almost were the thickened distended tubes; several inflammatory cysts with clear serous contents also presented. Enucleation was effected without accident; there were extensive adhesions to the bowel and between the uterus and intestines, and the raw surface left after separation seemed inclined to ooze a great deal; for this reason a diaphram of gauze was put between the uterus and intestines, and two pieces of gauze (iodoform) packed anteriorly to either side. Removal of this in twenty-four hours was accompanied by the escape of considerable quantity of sero-sanguinolent material. A small piece of gauze drain was reinserted; there was no further escape of discharge. Convalescence thereafter perfectly smooth, and she left the infirmary in three weeks. By looking at the specimens you will observe that they seem to have been perforated, but they were not; what you see here is simply the fimbriated ends of the tubes. The inflammatory adhesions were very extensive. As much as eighteen or twenty inches of the bowel had to be separated. These specimens also show at present exactly the same coloring and condition that they did when removed. Of all the specimens that we have preserved in this manner, none have been changed in the least, although we have kept some of them for a long time. They may be taken down at any time, and their physical appearance will be found the same as the day they were removed. Case 3. Tubo-ovarian abscess. Mrs. M., aged thirty years, operated upon September 20, 1898. Patient has been married six years; has never borne any children, nor has she had a miscarriage. Trouble in the right side began soon after marriage-tumor, pain, etc. Upon section the omentum and intestines found adherent en masse, obscuring the uterus and tubes. Adhesions divided sufficiently to liberate right tube and ovary, which lay behind the uterus, deeply, in contact with the rectum, and ovary surrounded by pus. The ovary was pulled out, separating from its attachments a sloughing mass. This ovary was in a state of acute necrosis or mortification, as the specimen will show. It was gangrenous like a carbuncle throughout. The tube was then tied off at the uterine cornu. Behind the uterus, occupying Douglas' pouch, there was found a pocket of pus the size of a duck egg where |