From all these facts he would conclude that injections of the serum of the renal vein could be employed with success against the uremic complications of nephritis, and could contribute to the improvement of the mala dies, as he had several times observed. They furnished to the organism the internal secretion wanting, and allowed the kidney to recommence its normal function of excretion and its antitoxic rôle.— Viginia Medical Semi· Monthly.

novelty of the method, but also, and what was more jection, became very abundant under its influence, with important, by the constancy of the results obtained. subsequent removal of the edema. The first case was that of acute nephritis complicated with uremia. The patient, a boy, 15 years of age, en tered the hospital suffering from anasarca, the result of scarlatins. The urine contained a large quantity of albumin, leucocytes, and cylinder. Vomiting was persistent. The symptoms became so grave that an in jection of six drachms of the serum was made in the right flank. The following morning the improvement was considerable; the violent headache had subsided as well as the vomiting, and four days afterward the edema had disappeared, while the urine, rare before the injection, returned with great abundance. All traces of the albumen had disappeared at the end of a fortnight, and the patient rapidly gained strength. Another case was that of woman, 60 years of age, who entered the hospital with signs of chronic nephritis (bruit de galop Vaginal Cesarean Section.- Medical Press, heart), a large quantity of albumen in the urine, dimin- February 22, 1899, contains an abstract of an address ished renal permeability. An injection of the serum by A. Duhrssen, Professor of Gynecology, University of the renal vein produced a very notable improvement of Berlin, delivered before the Berlin Medical Society, in all the symptoms, and in the general condition of the January 4, 1899, which appears worthy reproduction in patient. Here also the albumen disappeared. full. The details of the following case were furnished to the speaker by Prof. Turbure, of Bucharest:

Nicholas V., 27 years of age, entered the hospital with generalized anasarca; the legs were swollen to the abdomen and the patient complained of frequent mic turition. thirst, headache, pains in the back, and ting. ling sensation in the fingers. The lungs, heart, and liver appeared sound. The urine contained albumen, and was very abundant (5 liters). In a few days these symptoms grew much worse, the headache became ex cessively violent, dyspnea set in, and finally he was seized with tonic convulsions, in spite of the applica tion of repeated wet cupping. The quantity nor the quality of the urine could not explain the phenomena, what was wanting was the internal secretion of the kidneys, whose office was to neutralize the toxins accu mulated in the organism. This point was remedied by injecting under the skin of the patient three drachms of defibrinated renal venous blood, drawn from a strong and healthy dog. A few hours later the patient became calm, and asserted that he felt much better. Four days afterward the headache returned, but yielded to another injection, and the urine diminished by a third. A few days afterward the patient insisted on having another injection, and in all six were given with con stantly improving results, so that at the end of six weeks he left the hospital cured.

OBSTETRICS AND GYNECOLOGY.
BY C. R. DUDLEY, M.D., St. Louis.

Thanks to asepsis and Sänger's method of vaginal suture, the old Cesarean section has lost much of its terrors, so that indications for it are not confined to absolute obstacles to delivery, but are extended to cases of moderate obstruction.

A subtitute has been proposed for the operation in perforation and symphyseotomy. I have substituted vaginal Cesarean section in one case, and I repeated the operation last year. The description and the results of the operation have already been published in a monograph. It consists essentially in a sagittal splitting of the anterior and posterior vaginal culs de sac and separ ation of the bladder from the uterus and splitting of the uterine wall as far as the lower uterine segment is required. In this way, in the first case, I was able to extract at term a child weighing 4,700 grammes Puerperium normal.

In the monograph I have formulated the three fol lowing indications for the operation:

It was on this account that I operated last year in a In summarizing the effects of the treatment, M. Lig- case of mitral insufficiency and dilatation of the right nerolles said that the effects of injections of six drachms ventricle; in which the patient had passed several days. showed themselves in general a few hours after the in and nights sitting upright in a chair. There was still jection. The violent headache 'was the first to disap- some hope if the uterus could be promptly emptied; pear, while the nervous troubles, prostration, weakness, otherwise, it was evident she would die during the melancholy, delirium, gave place rapidly to gaiety course of the labor. The operation was performed as sometimes exuberant; the vomiting ceased after one described. The blood was almost black. Easy turning injection, and the oppression or dyspnea was eased in a and extraction of an asphyxiated female child; but imvery short time, while the urine, rare before the in- mediately afterward the pulse stopped, and, finally,

whilst attempts at resusitation were being performed, tion for Color Blindness among Railroad Employes, sutures were inserted, the placenta was removed, and etc., have received attention in an appendix. In the the uterus plugged. The operation lasted, at most, five portion of the work devoted to the Ear-Its Anatomy, minutes before the child was available. The autopsy Physiology, Diseases, and Injuries, are discussed in showed that the operation had been entirely extraperi thirteen sections by fourteen authors. Diseases of the toneal. Nose and Throat are described in twenty sections by nineteen authors. The entire volume reflects the ad. vanced thought of experienced teachers and specialists whose aim it has been to supply the profession and stu dents of medicine with a practical guide in the respec· tive specialties. The work ranks equally with the other of the "American Text Book" series which has been ac corded a most appreciative reception The many illus. trations are of exquisite clearness and in many instances beautiful. The entire mechanical makeup of the work is of the best quality and in harmony with the wellearned reputation of the publisher.

In cases of carcinoma, extirpation of the uterus should follow extration of the child. That this would be successful was shown by a case of rupture of the uterus, which was followed by successful extirpation. The results of other operators who have adopted this method have been even more favorable than my own, when, as I recommended, the posterior vaginal wall was split up. The mortality was 27 per cent, a favorable result when one remembered that in eight out of the eleven cases carcinoma was the complication that called for the operation. Some, such as Olshausen, have a horror of the operation, because they believe that speedy delivery at term is incompatible with gentle handling, and that gentleman, recomended the classical Cesarean section with subsequent removal of the organ. But Olshausen's operation is a much longer one, and presents more dan ger of shock and infection, and more manipulation of intestines.

As regards hemorrhage, it is free in both forms of operation, but in the vaginal it ceases as soon as the hand is introduced. Drawing down of the uterus and plugging are effective means of arresting hemorrhage. The operation is also indicated when there is premature separation of the placenta with absence of pains, and when the cervix is not dilatable.- Virginia Medical Semi-Monthly.

BOOK REVIEWS

MISCELLANY

The Therapeutic Value of Fasting. — Domenicis (Wien. Med. Presse, No. 18, 1898; Brit. Med. Jour.) has completed a series of experiments on animals and human beings with regard to the value of fasting in treating acute infectious diseases. He is of opinion that within reasonable limits a diminution in the food sup ply helps the organism to withstant the attacks of mi orobes better than the opposite system of overfeeding. The author has also included some chronic diseases in his experiments. In pneumonia the careful study of one hundred and forty cases showed that the action of bac teria was favored by alterations in the quality of blood and in peculiarities of the cell protoglasm. Diseases of the alimentary canal proved to be the chief factor in giving rise to these blood changes. The virulence of An American Text-Book of Diseases of the the poison and also the anatomical lesions in the lung Eye, Ear, Nose and Throat. Edited by G. bore a definite proportion to the amount of disease in E. DESCHWEINITZ, A.M., MD, Professor of Oph- the intestinal tract. According to the author, improper thalmology in the Jefferson Medical College, etc., feeding is a very frequent cause of death in pneumonia, and B. ALEX. RANDALL, M.A., M.D., Ph.D. Clinical and one which is apt to be overlooked. The chief Professor of Diseases of the Ear in the University of points, then, in the treatment of pneumonia would be Pennsylvania, etc. Illustrated with 766 engravings, (1) to diminish the quantity of food, (2) to administer 59 of them in colors. Price, cloth, $7.00; sheep or antiseptics by the mouth. Renzi follows a similar half-morocco, $8.00, net. [Publisher, W. B. Saunders, method of treatment in arthritis. Philadelphia.]

This work is a text-book as well as a work of refer Mind and Disease.-Christian scientists declare ence to which the practitioner may turn for authorita that by the exercise of will power we may cure our tive instruction. The practical side in the specialties selves of any disease. We must simply concentrate our represented in the work has particularly been brought minds on the fact that we are not ill, and, presto! we into prominence. For the practitioner the work is a are well. Scientists are trying to prove that too much valuable reference hand-book. In the portion of the thinking about any particular part or organ may lead work devoted to the Eye-Its Embryology, Anatomy, Histology, Physiology, Diseases, and Injuries, are dis cussed in twenty-four sections by twenty four authors; its Operative Surgery in seven sections by as many authors; while certain practical details in the Examina

to a disease of that organ. Dr. Carpenter is believed to be the first to demonstrate by experience that concentrating the mind on a special part of the body will lead to a local hyperemia, with sensations of tingling and itching.

Death of Professor Rutherford, M.D., F.R.S.-By the death of Dr. Rutherford, Professor of . Physiology in the University of Edinburgh, which took place on February 21 from influenza, medical science "Demonstration of Kidney in a Case of Cerebral loses a distinguished ornament and the University of Hemorrhage," by Dr. L. Bremer.

system. The men desire that an injured or sick man case, colored; Union City, Obion County, March 3–11, may be treated at his home by a local railway surgeon, seven cases, all colored. No deaths in a total of ninety. instead of being compelled to travel several hundred seven cases. miles to one of the Missouri Pacific hospitals.

The prominent symptom in a great majority of gyne. cological cases presenting themselves for office examina. tion is constipation, and obviously the first abnormality noticed by the examiner is the bulging of the posterior

Some Neglected Symptoms in Gynecologi- wall of the vagina, due to collection of a hardened mass

cal Examinations.*

BY JOHN A. HALE, M D., ALTO PASS, ILL.

of fæces in the rectum, which mechanically disarranges the physiologic relationship which should exist in the sourrounding tissues. All acknowledge the important rôle this condition plays in the production of pathologiGeneral practice affords many problems seemingly cal conditions, but I have found few who considered the unsolvable, and in no line of work is this feature so obstruction of sufficient interference in examination to prominent as in those cases of gynecology which as a matter of fact fall first under the care of the general practitioner and are by him referred to some specialist for diagnosis simply through unconscious negligence as

to detail in examination.

request a second examination, and diplomatically send the woman home with instructions to use a rectal injection immediately prior to the second examination. What may be said in this connection may be applied with equal import to the distended condition of the Everyone is not naturally endowed with the charac- bladder so frequently met with in these examinations. teristic personality of "inquisitiveness" which requires A rational treatment of any pathological condition the wherefore and the why of all effects, but a lack of can not be instituted until a thorough understanding of accuracy in gynecological diagnosis may be overcome the intricate and subtile anatomic and physiologic probby a careful consideration of many of the minor symp. lems pertaining thereto are established in the mind of toms easily discernible by tactile sensation and sight, the party applying the remedial measures, and the first and close application of the technique of examinations. essential is to determine the cause of the resulting My only excuse for prompting a consideration of hyperemia and inflammation of the pelvic organs so "some of the neglected symptoms in gynecological ex- common to the women of to-day. aminations" is this lack of attention to technique and a desire to call attention to some of the pathological signs which deserve more attention than the mere mention which they sometimes, but rarely receive, at the hands

of the authorities.

Permit me to point out that the family physician's advice to consult a specialist will add materially to the discomfort mentally present with this class of patients. Then why so advise them when a judicious investigation of seemingly insignificant details and close application to the technique of examination will present facts suf. ficient to retain the patient and cure her or send her to the specialist with a definite diagnosis in which he may

concur.

The time allotted me precludes the possibility of entering upon a full considera ion of the technique, preparatory to an office examination, but I can not refrain from casually calling your attention to some points which are considered of trivial importance.

*Read at the twenty-fourth semi-annual meeting of the Southern

Illinois Medical Association, held in Cairo, Illinois, November 17 and 18, 1898.

The conditions more frequently met with, especially among the women who have never borne any children is due solely to an improper metabolic change or chemical decomposition characteristic of the life incident to the varying conditions of the organs involved, and it is our province to remove abnormality and promote proper metabolism.

With a clear field of observation, the most striking characteristic presenting itself to the careful observer is that want of what has been so aptly termed "organic or respiratory rythm," that subtile rythm and thrill which extends over the whole body synchronous with the motions of the heart and lungs and which is plainly perceptible in the healthy abdominal and pelvic viscera. In no case presenting at the office does the general practitioner find this "rythm," for when this rythm ceases we find lost or perverted vitality, due to weakened vigor of the circulation, producing pernicious nutrition of the parts and a constant accumulation of excrementitious matter with concomitant engorgement, a feeling of fullness, and sometimes a very perceptible swelling with a tendency of the organs involved to gravitate downward.