supernumerary ovaries, which exist with sufficient frequency to require consideration.

Menstruation may or may not continue when ovarian tissue is left-this depending largely on the nature of the blood-supply to the ovarian tissue.

Hegar states that incomplete extirpation of the ovaries and the presence of a third Ovary are less frequently the cause of recurring hemorrhages following operation than is generally believed. A greater influence is exerted by vascular dilatations, stasis, and hyperemia of the pelvis, such as are often present before operation or may develop later. More pronounced pathological processes, such as inflammation of the pedicle, ligaments, other parts of the pelvic peritoneum, and connective tissue, and tuberculosis, produce periodical or irregular hemorrhages, partly by a direct influence on the circulation, partly by nervous agency. Olshausen agrees substantially with this view, but considers that the most frequent cause of psuedo-menstruation after operation is the persistence of pelvic inflammation, especially if more acute inflammation or ab scesses develop.

Persistent uterine hemorrhage is at times due to uterine disease, such as adenoid growths in the endometrium, fibroid tumors -especially of the sub-mucous variety polypi, or malignant degeneration.

Several practical conclusions are to be drawn from these well ascertained facts. As it is by no means positive that the complete menopause will be established' after double ovariotomy or the removal of the uterine appendages, patients undergoing such operations or certainly near friends of the patients should be told so plainly. Under existing circumstances the operator should feel only relatively disappointed when a complete menopause does not result after the double operation, and should set himself diligently to work to cure the particular morbid condition which is causing pelvic and uterine congestion. In the exceptional cases, in which the ovaries have not been entirely removed, or in which supernumerary ovaries exist, and true menstruation continues, a second operation and exsection of the remaining ovarian tissue may be necessary. Also, when infection of the pedicle causes abscess about the ligature, it may be necessary to evacuate the pus and remove the ligature by secondary abdominal section. More commonly, in cases which have been drained, pus is discharged through the drainage track until the ligature comes away or is removed. Pus formation about the liga

ture does not occur so frequently in cases which have not been drained, largely for the reason that death is likely to take place in these cases from sepsis or peritonitis before abscess results. Where the recurring metrostaxis is due to uterine disease, thorough curetting of the endometrium may suffice to cure it. When malignant degeneration of the womb exists, hysterectomy or exsection of the degenerated tissues is indicated.-Medical and Surgical Reporter.

PSOROSPERMIA (COCCIDIA) IN MAN.-AS will be seen from the report on another page, a large part of the time of the last meeting of the Pathological Society was occupied by the description of certain parasites which, although remarkably prevalent in some of the lower animals, notably the rabbit, have not been much recognized in the human subject. Indeed, the specimen shown by Mr. Bland Sutton suggested the notion that possibly its presence has been overlooked in many cases, for his specimen was obtained from the Middlesex Hospital Museum, where it had been mounted as an example of mucous cysts of the ureter. Mr. Sutton, however, correctly surmised the parasitic nature of this curious specimen, for on recently submitting the "cysts" to microscopical examination he found that they were really occasioned by the presence of psorospermia or coccidia, of which Leuckart has written so able an account. Of equal interest were the communications by Mr. Silcock and Dr. Delépine. the former dealing with a case in the human subject where these parasites were found in the liver and spleen, and to the presence of which it was supposed that the obscure febrile symptoms were due; while the latter gave a most careful account of the disease in the rabbit. Dr. Payne's remarks deserve consideration, for, referring especially to the peculiar bodies characteristic of molluscum contagiosum, and lately alleged to be psorospermial in nature, he pointed out the difficulty of distin guishing them from colloidal masses derived from cell degeneration. Moreover, Mr. Sutton admitted that it was possible to mistake the ova of some entozoal worms for psorospermia. Nevertheless the attention thus given to the subject is sure to bear fruit; and without admitting it to be conclusively proved that these minute animal parasites are responsible for eczema of the nipple or molluscum contagiosum, the question of their gaining entrance into the human body, and being there a source of danger to health and even of life, is too important to be lost sight of. The "gregarinidæ" are perhaps the most widely diffused of all animal parasites, since they infest insects and

other invertebrates, and their occurrence in man has hardly hitherto been seriously regarded. But they at once assume a most important position if they are to become responsible for tissue changes of a grave kind. The subject, however, from this point of view, is still in its infancy, and no good result will accrue from premature generalization on the few data at present forthcoming.-Lancet.

PROLAPSUS RECTI DUE TO STONE IN THE BLADDER.-At the last meeting of the American Pediatric Society (see Transactions, January, 1889), Dr. A. Caillé, of New York, reported the case of a female child, three and one half years old, with the following history About one year before presentation the child's gut was found prolapsed after each stool, and she appeared to be in great pain in passing her urine. She was taken to a number of physicians and dispensaries for treatment, and presented at almost all the clinics as a case of inveterate and severe prolapsus recti, and many methods of treatment were tried without affording the child the slightest relief or improvement.

At

his first examination Dr. Caillé found the child to be anemic, nervous, and cachectic in appearance, and suffering from diarrhea and bronchitis. The rectum was prolapsed two inches, and during the examination it came down fully seven inches and presented a slightly bleeding surface. A straining effort on the part of the child forced urine from the bladder, which was collected and found to contain pus and much epithelium, as evidence of cystitis. The sphincter ani was relaxed to such an extent that three fingers could be passed through it without an effort. The child was then anesthetized, and a more careful examination showed the presence of a large stone, free, in the cavity of the bladder.

Speedy removal of the stone was snggested, and the supra-pubic operation decided upon, on account of the large size stone and the facility of access by this operation. The bladder was first thoroughly irrigated with a warm solution of boro-salicylic acid, and, after division of the skin in the linea alba, the patient was put in Trendelenburg's position, with head low and raised pelvis, by which means it was comparatively easy to avoid the reflection of the peritoneum. It was not found necessary to raise the bladder by inflating the rectum, two fingers of an assistant passed into the rectum being sufficient to bring bladder and stone into a convenient position above the symphysis. The bladder was now incised and the large stone

removed with some difficulty, thereby producing slight laceration of the margin of the incised bladder.

Owing to this slight and unavoidable laceration primary union was not contemplated, but the bladder was sutured, nevertheless, and the wound filled with loose iodoform gauze, and the usual antiseptic dressing applied. The temperature of the patient was normal throughout the entire healing process, except on the third day after operation, when it rose to 102° F. for a few hours. The process of healing was all that could be desired, excepting a small leak in the suture, which was detected on the fourth day. At the end of three weeks the wound had closed and the child was discharged cured.

During the time of convalescence the rectum came down once, and not again afterward. The stone was twice as large as a pigeon's egg, and weighed twenty grams. Its presence in the bladder of the child had evidently caused the rectum to prolapse as a direct consequence of frequent straining, and its removal permitted the parts to assume their normal and natural condition.

CAUSE OF DEATH FROM ELECTRIC DISCHARGE. The deaths which have recently occurred in New York from electric discharge, and the post-mortem examinations made on those fatally stricken, have led to the conclusion that in the course of the electric current through the body the blood is the chief conductor. This is precisely what has been known in this country since the year 1869, when Dr. B. W. Richardson conducted his series of experiments on death by electric shock with the large electric coil set up by Mr. Apps at the Royal Polytechnic Institution. In those researches the experimenter, by passing electric currents of high tension through sets of glass tubes charged with different conducting animal substances, made the fact demonstrable that of all the animal structures blood was preferentially by far the best conductor. In the same researches it was also demonstrated, (1) That discharges which by their intensity kill most rapidly leave least mark of distortion or of external injury; (2) that on complete prostration from the shock the heart may continue in action for several minutes after what appears to be actual death; (3) that the injuries inflicted on a living body by the shock are superficial burns and ecchymosed spots on the outer surface of the body, darkening of the color of the blood within the body, congestion of the heart and venous system generally, and injection, in some instances, of the mucous surface of the alimentary canal. The

conclusion arrived at from these observations in regard to the cause of death from the electric shock was that the cause is a sudden expansion of the gases of the blood, with liberation of free gases from instant decomposition of the blood and the other fluids. Under the tension produced from the internal gaseous pressure, distension occurred in the venous canals, and the escape of bubbles of gas from the cavity of the cranium, on laying it open, was a frequent phenomenon. In one instance the right side of the heart of a sheep was ruptured from the cause named on the administration of the shock. But it was also observed in other instances that the whole of the discharge seemed to be conducted solely by the external surface of the body, under which condition there was extreme shock and prostration without death. It was this last observation that led Dr. Richardson to discard the idea of utilizing the electric shock for the painless extinctinction of the lives of the inferior animals, and to substitute the lethal chamber for that humane purpose.-Lancet.

LEPROSY IN SPAIN.-Dr. José E. Olavide, of Madrid, the well-know Spanish dermatologist, has recently published some particulars of leprosy as it is found in Spain at the present day. His remarks apply solely to Spain proper, neither the Spanish colonies, the Canaries, nor the Philippine Islands being included in the scope of his paper. He says that there are always from six to eight lepers in the Hospitals de San Juan de Dios at Madrid, who have come there from some of the infected districts; they remain in the hospital till their death, as according to recent legal enactments, they are not allowed to leave. In no case

have these sufferers communicated the disease either to the other patients among whom they live, or to nurses or medical attendants, nor has Dr. Olavide, during twenty-five years of practice, seen any evidence of the transmission of leprosy by contagion. He adds that of the five hundred lepers whom he has had under his care during that period, only one attributed his disease to that source. It should be noted that Dr. Olavide is not an anti-contagionist; he accepts the bacillary origin of leprosy without reserve, and thinks, to use his own words, that the disease "ought to be contagious and inoculable." So far, however, neither clinical observation nor experiment has, in his experience, furnished any evidence in confirmation of this a priori view. Leprosy is rare in the inland districts of Spain, and is chiefly found in the provinces of Almeria, Murcia, and Granada on the south coast, and in Galicia and Asturias on the north coast. The disease is not known

to exist in the Basque provinces, or in that of Santander, although there is free communication between these parts and America, the Malay Archipelago, Australasia, and Polynesia. It is a curious fact that in the maritime provinces, where leprosy is indigenous, it is not found so much on the coast itself as at a distance of some leagues from it. According to Dr. Olavide, the only inland provinces in which there are a few foci of leprosy are Jaén, Cordova, and Guadalajara, and in these most of the sufferers are missionaries or soldiers who have been in America or the Philippine Islands. The former generally attribute the disease to bad food, and the latter to intercourse with native women. In cases that have not been imported from abroad, the disease is looked upon in Spain as hereditary. Two or three years ago it was proposed by the government that an official census of lepers should be taken, but the project fell through, owing to difficulties of diagnosis, which Dr. Olavide attributes to the want of instruction in dermatology in Spanish medical schools. He estimates the total number of lepers in Spain at the present time as from 1,000 to 1,500. Dr. Olavide concludes by urging on all governments the propriety of sending commissions of microscopists and dermatotogists to study the disease in the West Indies, China, and the Philippine Islands, and of having exact statistics drawn up of the number of lepers in Europe and the colonies.-— British Medical Journal.

THE EARLIEST PHYSICAL SIGNS OF PHTHISIS. The extreme difficulty and the urgent importance of a definite diagnosis of phthisis at the earliest possible period are universally acknowledged. Both with a view to either calming or confirming the patient's fears, and of insisting upon such an alteration of the mode of life and such remedial measures as offer the best prospect of arresting the tubercular process, an early and confident diagnosis is eminently desirable. Hence Dr. Harris' recent contribution to the subject in our columns has no doubt received the careful attention of our readers. On some of his points there will be general agreement. That a history of hemoptysis, especially of repeated slight hemorrhages, is of great significance, no one will question. If we can certainly exclude the spurious forms of hemoptysis, such as those from the gums and pharynx, and if the patient be not a "bleeder," the fact that he has repeatedly spat blood raises a very strong presumption that he is the subject of tuberculosis. That family history is also very important, most authorities, in this country at

least, will allow. There is at present a tendency among continental writers, who are usually adherents of the bacillary and contagionist view of phthisis, to minimize the hereditary factor in its causation; but this is probably only a temporary swing of the pendulum, the clinical evidence that phthisis is strongly transmitted being apparently irrefragable.

It is when we come to define the earliest positive physical signs of phthisis that we find it difficult to lay down any rules that do not admit of large exceptions. Dr. Harris attaches weight to impaired movement at one or both apices, and no doubt when present this is very important. It may be recognized, not by simple inspection, but by the examiner standing behind the patient, placing his hands upon the subclavicular region of each side, and noting whether both sides risc equally and readily during inspiration, or whether there is, at it were, a delayed rise on one side. Dr. Harris points out another sign which, he says, has not received in this country the attention which it deserves. This sign is the lower limit of pulmonary resonance in the supraclavicular and supra-scapular regions on the affected as compared with the sound side, which may be detected in cases where no dullness is present. This sign may, however, be obliterated by the presence of emphy. sema in the neighborhood of the diseased patch of lung. Any dullness or tonelessness on percussion at one apex must, in a doubtful case, be regarded as of great signifi

cance.

The auscultatory signs present at a very early stage of phthisis offer great variety, and need a very careful estimate to determine their true significance. In some cases where, on general grounds, the diagnosis of phthisis seems practical y certain, the most careful and diligent auscultation fails to detect any abnormality. This is by no means so surprising as at first sight it appears to be. We know that it is not very rare for all auscultatory signs to be absent during the first two or three days of pneumonia, although we feel certain that consolidation is going on. This is very probably explained by the hypothesis that in such cases the process is deepseated in the lung, and that the sounds produced by the consolidation are masked by the normal vesicular murmur. In like manner, early phthisis may be attended by a scanty deposit of tubercles, not sufficiently superficial to produce auscultatory signs which can be heard above the normal breath sounds.

Great importance must be attached to the character of the breathing in these cases. If the vesicular murmur be feeble, or somewhat harsh or bronchial in quality, or if expiration be much prolonged, we are justified, in the absence of any other cause adequate to produce these signs, in regarding them as probably tubercular in origin. It is of the first importance, however, to make certain that these signs are present, either solely, or at least in a more marked degree, on one side. The puerile breathing of children and the somewhat bronchial breathing normally present under the right clavicle are fruitful sources of error with beginners. Dr. Harris utters a caution against relying too much upon prolonged expiration, if no other sign be present; and no doubt it is insufficient of itself to warrant any safe inference. That peculiar form of interrupted breathing, called by French writers respiration saccadée, was formerly generally relied upon as a sign of some value in early phthisis, but probably most authorities will now admit that this phenomenon is often of neuro-muscular origin, and can not therefore be depended upon to give us any satisfactory indications of the condition of the lungs.

Adventitious sounds form the last group of the physical signs of early phthisis. There can be no doubt that they vary much from day to day, which is not surprising when we reflect that they owe their orgin to the varying degree of bronchial catarrh present in the neighborhood of the tubercular deposit. The supra-scapular region should be as carefully investigated as the subclavicular, as many observers are of opinion that it is, on the average, the earliest seat of the deposit. The most characteristic adventitious sign of the earliest stage is the presence of a few dry crepitations, which do not disappear on taking deep breaths and are rather accentuated by coughing. There are cases, however, in which the earliest adventitious sign is a musical râle or rhonchus, identical accoustically with that heard in bronchitis, but deriving its grave significance from its distribution. Pleuritic friction may also be one of the earliest signs of phthisis, and if apical in distribution should excite our suspicion. As regards the diagnosis value of the presence of the bacillus in the sputum, we are in this position. Its presence is pathognomonic of tubercle, but failure to find it is of very little value, as the bacilli may be few in number and may escape detection, even at the hands of a careful observer.

On the whole, while the ear diagnosis of phthisis is admittedly difficult, few mistakes will be made by the practitioner who balances signs, symptoms, and history (personal and family) carefully and guardedly, and who does not allow himself to be led astray by any single indication. Needless to say, finally, the use of the thermometer is imperative, and may serve to clear up many doubtful cases.-Lancet.

TREATMENT OF GOITRE BY INTERSTITIAL INJECTIONS OF TINCTURE OF IODINE.-Several years ago, Luton, of Rheims, proposed the treatment of goitre by the intra-parenchymatous injections of undiluted tincture of iodine. This method was afterward adopted and commended by Prof. A. Lücke, and by Duguet; the latter has published a memoir on the subject, in which he has reported numerous successes.

Terrillon, surgeon to the Salpêtrière, has published, in the Bulletin Général de Therapeutique, a communication in which he advises the iodine injections in bronchocele as more likely to give curative results than those of tincture of iron or of ergotin, counseled by former surgeons; and he gives minute directions how to carry out this treatment successfully.

In order properly to practice this injection, says Terrillon, there are three points indispensable to know:

1. The operator must be sure that he has penetrated the substance of the tumor before pushing the injection.

2. He must avoid, as far as possible, transfixing the veins which ramity in the cellular tissue in front of the neck.

In fat patients the veins are not very apparent, and it is desirable before inserting the needle to find a place where no veins shal be in the way. The patient should be made to take a full breath, during which the swollen jugulars become prominent, and they can then be very easily avoided.

8. The third important point is to have a hypodermic syringe that is perfectly clean, in order to avoid the introduction of infectious germs. Terrillon recommends that the syringe with its needle should be lett a certain time in boiling water before being used.

After having taken these precautions to obtain asepsis of the instrument, and after having chosen the place to make the injec tion, the operator takes the needle and plunges it slowly but withou hesitation into the hypertrophied thyroid body. To avoid the infiltration of liquid in the celiu

lar tissue of the neck, it is necessary to insert the needle to the depth of at least two or three centimeters, and to be assured by the movements impressed on the tumor and by the feel of the needle, that the latter has penetrated the glandular substance. Having introduced the needle deep into the thyroid body, the surgeon unscrews and removes the syringe before making the injection, in order to see whether any blood flows by the canula. This precaution is needful in order to avoid the injection of iodine into the interior of a vein. If blood should flow at the point of puncture, another place is chosen, and the same maneuver is repeated.

After being assured that a vein has not been pricked, the syringe is readjusted, and half a gram of pure tincture of iodine is injected into the tumor. If this injection is well supported, if the patient experiences no other symptoms than a slight pain with a little swelling, the next time a whole syringeful is injected. After having made the injection and introduced the desired quantity of liquid into the tumor, the needle. is not immediately removed, but is left a few seconds, in order that the liquid may be sufficiently diffused into the parenchyma of the gland, and that it may not flow into the subcutaneous cellular tissue.

Terrillon recommends to make but one injection at a time, and to have four or five days' interval between the injections, in order to guard against the danger of iodism. A little pain immediately after the operation at the site of the puncture, followed by shooting pains into the back of the neck, the lower jaw, or even the shoulder, should not give alarm, as these pains are rarely of long duration. Sometimes the patients taste iodine in the mouth after the injection, due to the elimination of iodine in the saliva. A little swelling follows the injection; this rarely goes on to suppura

tion.

Cases have been recorded where goitre has been benefited and even cured by one injection of tincture of iodine. Ordinarily the injections have to be repeated several times, and sometimes as many as twenty are required to bring down the thyroid body to its normal volume. At the point where the iodine is injected there takes place a destruction of the tissue elements, which undergo fatty transformation, and end in being absorbed. The irritation of the tis sues causes the formation of a point of cicatrical tissue, which in undergoing retraction little by little produces shrinkage of the tumor. The injection of iodine acts, then,