is generally wiser to perform complete removal, with or without hysterectomy, according as the uterus also is diseased or not.

3. In cases of well-marked gonorrhea of long standing, especially if the patient is constantly exposed to reinfection, if both tubes are seriously diseased and closed, total removal with or without hysterectomy is the oper ation of choice.

4. In certain cases of this class where the patient thoroughly understands the likelihood that another operation may be necessary at some future time, and wishes to take the chances in the hope of preserving the function of menstruation, conservative operation is permissible.

5. If one tube is patent and healthy in appearance, and there is enough healthy ovarian tissue to preserve, a conservative operation ought to be performed even in the presence of gonorrhea.

6. With present methods of performing resection of the tubes, if both tubes are found closed at the time of operation subsequent pregnancy is not to be expected.

7. In severe grades of inflammation of the appendages, irrespective of causation, if the ostium abdominale of one tube is patent the prospect of subsequent pregnancy after the preservation of a portion of the ovary is about one in four and a quarter, or 231⁄2 per cent.

8. In the less severe grades of inflammation, under similar conditions of tube and ovary, the prospect of subsequent pregnancy is about one in two and a quarter, or 44 per cent.

9. In women who have borne children, in both classes, subsequent pregnancy may be expected in 35 per cent, whereas in the previously sterile it may be looked for in only 5 per cent.

10. If it is necessary to remove both ovaries it is of no advantage to preserve any portion of tubal tissue, but, except under the conditions just enumerated, some ovarian tissue should be preserved in every case.-- The Chicago Clinic.

AFTER-TREATMENT OF PERITONEAL SECTION. - Henry T. Byford (Amer. Gyn. and Obst. Jour.) gives his method of inducing peristaltic action as soon as possible after peritoneal section, for the purpose of preventing intestinal paralysis and adhesions. His success prompted him to use it in simple as well as complicated cases, in order to make the patient more comfortable and to render the convalescence more rapid. This method consists of four drams of fluid extract of cascara or some equivalent, two hours before the time set for operation, dram doses of sulphate of magnesia every hour from the time the patient awakes after the operation, and a high glycerine and water enema (3ii to 3iv) every two hours, beginning eight hours after. A high glycerine enema was given before the patient left the table after operations in which adhesions were separated and raw surfaces left. A prompt movement of the bowels and a free passage of flatus not infrequently resulted from this enema before the others

were given, and hence he began giving it as a routine practice in order to save, as far as possible, the trouble connected with giving a nauseated patient the salines and later enemas. The treatment must, as a rule, not be discontinued until the patient passes flatus, not only with the enemas, but also freely between enemas, i. e., efficient peristaltic action should continue at intervals. After the first day means must be taken to maintain frequent peristalsis and a daily evacuation of the bowels. To this end two drams of sulphate of magnesia or two or three ounces of Hunyadi water are given night and morning for two weeks, the dose being regulated according to the effect. The treatment may be modified somewhat to suit different cases. If a patient be in need of a stimulant, usually an ounce of whisky is added to the enema administered on the operating-table, giving what in the Woman's Hospital is called the one, two, three enema, viz: one ounce of whisky, two of glycerine, and three of water. In patients who have lost much blood, a large, high beef-tea enema is given instead, and repeated every four hours.-Pacific Med. Journal.

PRIMARY CARCINOMA OF THe Vermiform APPENDIX.-Elizabeth Hurdon (Johns Hopkins Hospital Bulletin) adds an instance of primary carcinoma of the vermiform appendix, and one of secondary extension from an ovarian tumor. Of the ten cases of carcinoma originating in this organ referred to in the literature, the author accepts only three as established by microscopic examination. All these were shown to be of the usual type of carcinoma of the intestines, colloid carcinoma, and adeno-carcinoma. An unusually large proportion appears to be of the colloid type. The case here reported was discovered accidentally during an operation by Dr. Kelly, and was very favorable for study, as the tumor had reached only the size of 1 cm. long.-The Chicago Clinic.

ON THE FORMATION OF AN ARTIFICIAL ANUS.-I. An artificial anus of a temporary character can be best established by Maydl's operation or by Bodine's modification.

2. Overslipping of feces may be prevented by proper spur formation, by narrowing the rectal opening, or by occluding the rectal end of the bowel, which may be fastened in the wound or dropped into the abdominal cavity.

3. Continuance of the abnormal outlet is aided by muscle separation (Maydl), or by muscle bridging (von Hacker and Hartmann), or by the use of inflatable or moulded plugs or other apparatus.

4. It is only, however, to be satisfactorily effected (though large experience in this is desirable) by an extra abdominal iliac outlet (Witzel's iliac colostomy) to be made by opening the bowel outside and behind the iliac spine. In this procedure the bowel is compressed between the edge of the bony pelvis and the skin.

Many other methods have been proposed. Some, like Witzel, have made the outlet externally, but by gouging a hole through the iliac bone.

Other schemes have been tried and have failed. A few are so unsurgical that they have fallen stillborn. Perhaps some have yet promise, and may in time, their value not now being recognized, develop into methods of note. The author has resorted to the formation of an artificial anus thirty times, with nine deaths, of which there were two from cancer, three ulcerations, and four obstructions. Of these, sixteen were for malignant disease, either inoperable or preliminary to operation, nine were for chronic ulceration, and five were for intestinal obstruction. Among eighteen cases in which colostomy was a preliminary to operation or was a curative agent, were seven instances in which the opening was absolutely closed, five by the intra-peritoneal method and two by extra-peritoneal suture.-Med. Rec.

DIPHTHERIA ANTITOXIN.-McCollona's article shows the effects of the antitoxin treatment in several cities, the ratio of morbidity from diphtheria in Boston, and the percentage of mortality by age in London and in Boston. His conclusions from the observation of nearly 8,000 cases are as follows: I. That the ratio of mortality of diphtheria per 10,000 of the living was very high in Boston previous to 1895. 2. That the ratio of mortality per 10,000 has been very materially reduced since the introduction of anti

3. That the percentage of mortality in the South departments is lower than that of any of the hospitals taken for comparison. 4. That since larger doses of antitoxin have been given the death-rate has been materially reduced, this reduction having occurred in the apparently moribund cases. 5. That no injurious effect has followed the use of the serum. 6. That to arrive at the most satisfactory results in the treatment of diphtheria, antitoxin should be given at the earliest possible moment in the course of the disease.—Journal American Medical Association.

HEMORRHAGE OCCURRING AFTER THE MENOPAUSE.-E. C. Davis writes that at the time of the menopause atheromatous changes are likely to take place in the blood-vessels, malignant diseases make their appearance, and the atrophic changes of the tissues become observable. After menstruation has ceased any hemorrhage from the uterus is always pathological, the causes of hemorrhage at this time being granular endometritis, atheroma of uterine blood-vessels, vasomotor relaxation, uterine polypus, uterine myofibromata, and carcinoma of the uterus. Of this last new growth hemorrhage is the danger-signal which, if appreciated by the physician, may result in years of comfort and health to the victim. If neglected, however, a horrible death awaits the patient. During the early history of carcinoma the tumor is local and circumscribed, but later becomes hopelessly disseminated. The cervix is the most frequent seat and epithelioma the most common form of malignant tumor. The history of hemorrhage after the menopause with offensive discharge is almost pathognomonic of malignancy. The most rational treatment is complete removal of the diseased uterus, with appendages, before extension has taken place into the surrounding tissues.-Medical Record.

THE EARLIEST SIGNS OF TUBERCULOSIS.-Professor Bozzalo, of Turin, in a paper read at the recent International Congress of Tuberculosis at Naples, has conveniently summarized the following eleven important points which are of assistance in forming a diagnosis of pulmonary phthisis in its earliest stages. They are: 1. Albuminuria alternating with phosphaturia. 2. A pseudochlorosis distinguishable from true chiorosis by the slighter degree of reduction of the hemoglobin and by the less-marked vascular and cardiac disturbances (palpitation, soft pulse, pulsating arteries, etc.). 3. The presence of gastric disturbances like gastralgia, anorexia, nausea, and vomiting. 4. Tachycardia in the absence of fever. 5. Diminution of blood-pressure. 6. A rise of temperature following bodily or mental exertion above the slight rise proper to health. In women a rise of from 0.3° to 0.4° C. is observable before the onset of each menstrual period. 7. An undue tendency to sweat after exertion, mental or bodily; also night-sweats. 8. Pain in the supra-orbital regions and in the neck. 9. A slight inequality of the pupils with a tendency to dilatation (mydriasis). 10. The occurrence of herpes zoster. 11. Enlargement of the spleen. Of these, the first seven symptoms are the most frequently met with and possess considerable diagnostic value.-Lancet.

ACUTE OSTEOMYELITIS OF THE STERNUM.--There exist in medical literature but eight cases of acute osteomyelitis of the sternum. Five of these cases terminated in death. In the case described by Dr. Koch recovery took place. The patient was a man, thirty years of age, free from personal or hereditary antecedents, who was suddenly attacked by violent pain in the epigastric region, with vomiting, high fever, and delirium. A physician, called two days later, diagnosticated left-sided pneumonia. At the end of eight days, however, the pain localized itself especially in the sternal region, while at the same time the skin became red and a fluctuating tumor appeared over the xiphoid appendix. The abscess was incised, and gave vent to greenish pus. Several days later another abscess formed near the right nipple and was opened in its turn. Fistula were produced and gave issue to a large quantity of pus. An operation, fifteen days after the commencement of the manifestations, showed that almost the whole body of the sternum was infiltrated with pus. The bone was removed entirely, and the wound, in which the pericardium could be seen, was tamponed with gauze. Bacteriological examination of the pus and sequestra revealed the presence of staphylococci. The patient recovered.-La Tribune Médicale.

Special Notices.

FOR Shaking palsy nothing excels tinct. Aesculus Glabra, one-half drachm, Celerina, eight ounces. Teaspoonful every two or three hours.

IN prescribing the products of manufacturing pharmacists, we should be guided to a great extent by the business standing of the manufacturers. No other house in the South or West has a better reputation for strict integrity than the Robinson-Pettet Company, Louisville, Ky. We do not hesitate to recommend the preparations advertised by them on another page of this issue.

DR. SMITHWICK, of La Grange, N. C., in January, 1901, number of the Maryland Medical Journal, says: When, in disease, bed sores occur, we must use the best means for healing them and making the patient comfortable. In my experience I have tried a great many things, but have come to the conclusion, which is substantiated by clinical results, that I obtain the best results by thoroughly washing the parts with warm normal salt solution, bathing in peroxide of hydrogen, and dressing in pledgets of cotton or strips of gauze soaked in Ecthol. This dressing is repeated once, twice or thrice daily, as the urgency of the case seems to demand.

TREATMENT OF A CASE OF FACIAL, NEURALGIA.-Bernays ("Report of a Surgical Clinic") cites a peculiarly obstinate case of facial neuralgia with treatment. The patient was a lady, aged fifty years, who showed a good family history, and whose previous health was also good. The trouble began with a severe neuralgic toothache of her lower right molars, and was paroxysmal at first, but after two months became continuous. The paroxysms generally occurred in the early morning, and entailed much acute suffering. The pain was relieved by biting strongly upon some firm object, but returned immediately when the pressure was removed. The touch of any thing cold or hot promptly excited a paroxysm. A moderate heat when sustained produced the opposite effect. In the effort to afford relief four molars were extracted, but without success. The patient strenuously held out against the use of narcotics in any form throughout the entire course of the disease. Antikamnia in ten-grain doses (two fivegrain tablets) was found efficient as an obtundant, and was relied upon exclusively. Eight weeks after section of the nerve, when the report was written, there had been no return of her former trouble in any degree.-The Medical News, January 13, 1900.

THE "PAPYRUS EBERS."-Believing that physicians, of all men, are most interested in the history of their art, the makers of hemaboloids are now prepared to present to their friends in the medical profession a fac-simile reproduction of the beginning of the earliest medical treatise extant, together with transcription into hieroglyphics and translation of a portion of the text.

The famous" Papyrus Ebers," which was written during the reign of the Egyptian king Bicheres, 3.500 years ago, was discovered by the celebrated archeologist, Georg Ebers, in 1872, when an Arab brought him a metallic case containing a papyrus roll enveloped in mummy cloths, which he claimed had been discovered between the bones of a mummy in a tomb of the Theban Necropolis. A complete description of the papyrus and its history is included in the reproduction, and is certainly extremely interesting to physicians and antiquarians generally. A copy will be forwarded by the Palisade Manufacturing Co., Yonkers, N. Y., to any physician who may have failed to receive one.