BOOKS, ETC., RECEIVED.

Principles of Surgery. By N. Senn, M.D., Ph.D., LL.D., Professor of Practice of Surgery and Clinical Surgery in Rush Medical College, Chicago, etc. Second edition. Thoroughly revised. Illustrated with 178 wood-engravings and five colored plates. Royal octavo, pages xvi., 656. Extra cloth, $4.50 net; sheep or half Russia, $5.50 net. Philadelphia: The F. A. Davis Co., Publishers.

A Manual of the Practice of Medicine. By Geo. R. Lockwood, M.D. Nine hundred pages; seventy-five illustrations and twenty-three colored plates. Price $2.50. Philadelphia: W. B. Saunders, publisher, 1896.

Pediatrics, The Hygienic and Medical Treatment of Children. By T. M. Rotch, M.D., Professor of Diseases of Children, Harvard University. Illustrated. Nine hundred and ninety pages. Philadelphia: J. B. Lippincott Co., publishers, 1896.

A System of Surgery, Volume III. By American authors; edited by F. S. Dennis, M. D., assisted by John S. Billings, M.D., LL.D., D. C. L. Nine hundred and eight pages; two hundred and seven engravings and ten colored plates. Cloth, $6.00; half morocco, $8.50. Philadelphia: Lea Bros., 1895.

The Treatment of Symptomatic Anaemia. By W. Blair Stewart, A. M., M.D. Read before the Atlantic County, N. J., Medical Association, May 1, 1895.

ALUMNI AND SCHOOL NOTES.

[All former members of the Medical School are requested to send in items of interest for this department.]

1891. Dr. Harry A. Elcock, after some months' study abroad, viz., in England and Germany, has resumed his practice in this city, having opened an office at 226 Crown Street. Dr. Elcock will assist Prof. H. L. Swain in the Ear, Nose and Throat Clinic.

1892. John A. Hartwell, House Surgeon of the Presbyterian Hospital, New York, is convalescent from an operation of appendicitis performed December 9th by Doctors Chas. McBurney and McCosh.

1894. Dr. James Moore, who recently suffered a relapse of typhoid fever, is now convalescent.

1895. Dr. A. L. House has finished his service at the Bridgeport Hospital and has opened an office at Nichols, Conn.

1895. Dr. Vertner Kenerson is ambulance surgeon of the Hudson Street Hospital, New York.

1896. Ellis and Wadhams have taken a course at the Broome Street Lying-in Hospital, New York, during the Christmas recess. 1898. R. C. Paine has left the school on account of ill health. The Medical School closed Wednesday noon, December 18th, for the Christmas holidays. The winter term begins January 9th. The middle-year men are not to be examined in medicine at the end of this year, as was at first announced.

Dr. Lamb, of the surgical clinic in the dispensary, recently spent a ten days vacation in Buffalo.

Dr. Stearns will not lecture during the winter term.

Dr. Lusk has kindly offered the use of his physiological laboratory and apparatus to students who wish to do special work in this subject.

At two o'clock in the morning, October 22, 1895, I was called to see Mrs. J. N. I have been the family physician for the past twelve years. The patient is an intelligent Scotch woman, thirty-six years of age and of a delicate physique and nervous temperament. She has had two living children, the youngest now eighteen months old. Ten months ago she aborted at the third month; from this sickness she slowly regained her usual health and did not need further professional services till the date above mentioned. I found her on this morning suffering extreme pain in the right iliac region, with intense darting pain extending down the right thigh. The face was pinched, the entire surface of the body cold and clammy, the pulse at the wrist thready and feeble. She was as well as usual when she retired for the night; but a short time before sending for me she was awakened suddenly with an agonizing pain in the abdomen and thigh. Some remedies for the relief of pain had been tried before I arrived, but nothing could be retained by the stomach. Hypodermics of morphine mitigated the pain slowly and morphine was continued by the mouth in gradually decreasing doses. for the next thirty-six hours. The third day after this attack only tenderness remained where the pain had been, and as apparent menstruation began shortly after the attack of pain and

continued somewhat irregularly, the patient soon began to attend to some of her domestic duties, and professional visits were discontinued.

November 2 I was again summoned on account of another paroxysm of intense pain in the same region as of the first attack. The symptoms, although acute and marked, were not of the severe type of the first. There was sudden pain in the right iliac region extending down into the right thigh, nausea, disturbed cardiac action, and coldness of the extremities.

I now found that the supposed menstruation had not ceased and that in reality the discharge must be metrorrhagia. By careful questioning it was now ascertained that the last perfectly normal menstruation occurred the last part of July; the last of August there was a slight bloody discharge for a few days and no more till the last of September, when considerable more bloody discharge occurred for five or six days and then ceased till the night of the first paroxysm, October 22. During the time between the last of July and October 22, fairly good health had been the rule with no marked deviations.

A digital examination of the uterus and its appendages disclosed a mass in the right tube very sensitive and immovable without force. Bimanual palpation ascertained the mass to be about the size of a horse-chestnut. The clinical history of the case with the physical examination pointed to either hemorrhage in the tube or tubal pregnancy. In either case an operation seemed imperative. The case was carefully watched and studied for a number of days. The mass became less sensitive but seemed to increase in size. The patient became more comfortable and thought herself much better. I decided that the case was tubal pregnancy and ought to be operated on immediately.

November 6 I called Doctors Garlick and Godfrey in consultation. After a careful examination of the patient and thorough investigation of the clinical history, they both agreed with me that an immediate operation was imperative. The patient was removed to the Bridgeport Hospital for operation. While the patient was being prepared for operation, the urine was examined and ten per cent. of albumen was obtained. The operation was postponed for a time on this account, in order to investigate the condition of the kidneys more closely. Two days afterwards, further investigation revealed the fact that the mass in the tube. had enlarged considerably within the forty-eight hours, and inasmuch, as the night before, she had a severe paroxysm of pain in the same region as previously, it was decided for fear of a

This

rupture of the sac, to proceed with the operation at once. was the unanimous verdict of the physicians who had examined the case in consultation. All antiseptic measures having been carried out, I operated November 8. An incision two and onehalf inches in the median line was made, and the peritoneum opened, when the mass was quickly found and with difficulty separated from the pelvic floor. The adhesions were finally severed and the ovary and tube unrolled, including the mass. The anterior portion of the tube was so thin that it gave way in removal and some of the contents were evacuated into the abdominal cavity. After the ligature was applied, the tube, mass and ovary were removed. The peritoneal cavity was thoroughly flushed with a hot saline solution and the incision closed with silkworm gut

sutures.

The patient made an uninterrupted convalescence and returned to her home in three weeks after the operation. The albumen entirely disappeared from the urine within a week after the operation, thus demonstrating that the albumen was caused by the pregnancy. The patient, January 16, 1896, is attending to many of her household duties and seems to be in perfect health. My friend, Dr. Lynch, Microscopist of the Bridgeport Hospital, examined the mass given him from the case, and found the villi of the chorion, thus establishing the diagnosis.