The growth was extremely mobile during respiration, and was easily displaced, either to the right or left. On inflating the woman's stomach, the tumor was found to be fixed, but perhaps a trifle less distinct in outline. As to the question of diagnosis: The speaker said the woman was 49 years old. She had a tumor which undoubtedly was affecting her general condition, because she was rapidly losing weight. In both iliac fossa she had enlarged glands, which were very hard. The mobility of the mass excluded the question of involvement of the pancreas. There were no urinary symptoms, nor anything about the tumor to suggest kidney trouble. The only two organs that remained, outside of the omentum, which he excluded on account of the rarity of the diseases of this type, were the transverse colon and the stomach. An examination of the stomach contents proved that the amount of acid was approximately normal. The woman had not vomited, and had absolutely no gastric symptoms. If it were a a pyloric tumor, it would hardly be of this shape, and one would expect gastric dilatation. The anterior stomach surface and the transverse colon were the only remaining sites. A differential diagnosis without further investigation would be impossible, but the main facts pointed to the transverse colon, rather than to the stomach as the site of the growth, on account of the lack of gastric symptoms. He believed, however, that on thorough examination of the secretions and excretions, and on inflation of the intestines and stomach, one could make a positive diagnosis.

"RADICAL OPERATION FOR THE CURE OF VARICOSE VEINS."

Dr. J. A. Bodine showed a patient upon whom he had operated for varicose veins. He said that the operation which he had performed had, in his opinion, many advantages over both the Trendelenberg, which is employed by most surgeons, and the Shede, which was recommended. by Dr. Dawbarn, and which he had tried in one case, but would not employ again. The patient present illustrated the open method of removing the entire internal saphenous vein for varicosities. This method was first written up in this country by Dr. Russell Fowler, several years ago. Since the publication of this paper, the speaker had operated eight or nine times by this method. The entire vein trunk

is removed through three one-inch incisions, the first incision being made just below the internal saphenous opening, the vein being ligated and cut in two. The end of the vein to be removed is then held in the grasp of forceps, and with the fingers and knife-handle is dissected subcutaneously from the surrounding areolar tissue, all afferent veins being torn in two. The second incision is then made on the inner side of the knee, in the course of the vein, and with knife and handle and fingers a similar subcutaneous dissection is made upward, and this part of the vein withdrawn through the second incision. Dissection is then made downward under the skin toward the ankle as far as possible, the third and last incision being on the inner side of the leg just above the ankle. Through this incision the entire length of vein is withdrawn. There is no afterbleeding under the skin when the tourniquet is removed, if a tight, snug dressing is applied. The only objection to this operation is the possibility of sepsis, which can most certainly be obviated to a great extent if the operator wears rubber gloves. Remarkable as it may seem, only one ligature is applied during the entire operation. The entire vein is removed without a single afferent vessel being tied. The vein removed from the patient was exhibited. It was a perfect specimen of extreme calcification. The large afferent branch, which was torn in two without ligation was distinctly evident. The speaker expressed the opinion that as soon as catgut can be eliminated from these operations, so soon will all danger of sepsis be done away with, for each and every piece of catgut is a potential in the production of sepsis.

Before operation for the removal of this vein, he had succeeded in healing an extensive ulcer of the leg, which had resisted all efforts at cure for 20 years. The method by which this was accomplished was first described by Dr. Hodgen, of St. Louis, away back in the seventies. After confining the patient in bed for a week or two and applying stimulating dressings to the granulation bed of the ulcer, it was in proper condition for operation. The soles of the patient's feet were partially sterilized by the application of a 10 per cent boric acid ointment, after repeated washings. The epithelium was then scraped from the soles of the feet, dried in a warm sand-bath, and sifted over the bed

of the ulcer twice each week until healing was complete. It was an efficacious and ready method of skin grafting. What is remarkable is that dried, dead epithelium scraped from the soles of the feet will become vivified and will proliferate and unite upon a proper granulation bed. It would seem that the life of the epithelial cell is almost indestructible.

Dr. L. L. Roos opened the discussion by saying that he had seen four cases in which this operation on the saphenous vein had been practiced with perfect success, and he had seen one which had disappointed both Dr. Fowler and his patient. All he could say was that this method, which Dr. Fowler had reported in 1899, had been successful in a number of cases, but probably Dr. Packard, who had been House Surgeon in the Brooklyn City Hospital under Dr. Fowler, could tell something about it.

Dr. M. Packard said that Dr. Fowler has given up the operation entirely, and is now performing the Trendelenberg and Garter operations. He performs the Garter operation at the lower third of the thigh, and insists on careful postoperative treatment. He places the patient in bed, with his leg in a Volkman splint, and keeps him there for ten days before he removes the sutures of silkworm gut, and then for ten days longer, if necessary; then, after massage treatment, he allows the patient to get up. Seven patients have been operated on recently in the Brooklyn Hospital, with seven successes, but, with the other operation, the last four patients had sepsis.

Dr. R. H. M. Dawbarn said that he did not feel that he had a brief for upholding Shede's method of operating for varicose veins. Nevertheless, Dr. Bodine's idea that it was a bad technique, because, in a single instance, it had been followed by the curious pathologic changes recounted, seemed hardly a scientific deduction; the premises are far too inefficient; especially as a large experience on the part of the speaker, at the City Hospital, with the method of subcutaneous ligation of the internal saphenous vein at frequent intervals up the thigh, had not furnished any objectional results at all. Apparently, Dr. Bodine's case was the result of some uncommon form of microbe invasion. If the mere leaving in the limb of an impervious cord of an obliterated superficial vein is to be assumed as being the

cause for such a curious hypertrophy, one should obtain the same result in the "ring" method of operating on varicosities in the lower limb. Dr. John A. Wyeth, as well as the speaker, on the contrary, had had only good. results by this method, namely: tying twice, dividing, and leaving for obliteration every one of the superficial veins exposed in the circumference of the leg, and this ought to produce such hypertrophy easily, if Dr. Bodine's ideas were right.

As to the operation especially commended by Dr. Bodine, that of pulling out the external saphenous vein bodily, after making an extensive wound the entire length of the thigh, the fact that this wound is covered by skin for most of its extent does not prevent it from being a very dangerous wound in the event of a slight infection, and, as Dr. Bodine had pointed out, it is one difficult of asepsis. The originator of the method, Dr. Fowler, of Brooklyn, as his assistant, Dr. Packard, had said, has discontinued performing the operation. With further experience it seemed likely that Dr. Bodine also would not admire it so much as at present.

"FIRST MENSTRUATION OF A HEMOPHILIA.'

This report was presented by Dr. L. J. Ladinski, and was as follows: Girl, 14 years old; tailoress; born in Russia; nine months in United States.

Family History.-Grandfather on mother's side died of carcinoma; grandmother died suddenly at 71 years of age. Mother is one of 20 children, of whom seven females and two males are living. Mother is youngest child. She does not know of any relatives affected as patient is. History on father's side entirely negative. Parents strong and healthy; above average stature. Mother had six children, all living; eldest 17 years, youngest 3 years old. Two other members in the family exhibited same symptoms and same tendency as does the patient, that is, to bleed.

Previous History.-During the past three years there has been an oozing of blood from the mouth and gums at night, so that pillow and lips were covered with large stains. Never had any spontaneous bleeding otherwise, but the slightest bruise was rapidly followed by large areas of ecchymosis and the presence of hematomata, which would disappear very slowly. When vaccinated nine

months ago, there was very pronounced swelling of the arm and extensive ecchymosis. Arm regained normal condition in about four months.

During the past eight months she has had an attack of epistaxis every month, great in severity and duration. Under local treatment the bleeding gradually diminished. The last attack, two weeks ago, lasted seven hours. The bleeding is never attended by any constitutional symptoms. Nine days before admission to Beth Israel Hospital, the patient began to menstruate; was not confined to bed, but attended to her usual work. The bleeding steadily contined to increase in severity, so much so that she became very pale and weak, and was compelled to go to bed. Her symptoms became more grave a day or two before her admission, when she began to suffer from severe headache, was very restless, and had slight chills and fever.

On admission to the hospital, November 13, 1902, her condition was as follows: Well-nourished brunette; extremely anemic; mucous membrane blanched; dullness in the eye and lids; tongue dry and trembling; pulse very rapid and irregular; could hardly be felt at the wrist. Respiration shallow and very rapid. Loud heart murmur; maximum intensity over pulmonary area. Abdominal examination negative. Vagina filled with blood-clots and free bleeding present; uterus normal; patient was very restless; had to be tied in bed, and had moderate delirium. Retained nothing on the stomach. Treatment consisted of hypodermic stimulation, ice-bag to the abdomen and vaginal douches. Under this stimulation the patient's condition improved somewhat within six hours. The treatment was continued, and the improvement was slow, but gradual, and the bleeding diminished, until three days after admission it had entirely disappeared.

AN anticorset decree has been issued by the Minister of Education in Saxony, who holds that tight lacing is as fatal to intellectual development as the cigarette. By this decree no girl wearing a corset may attend the public schools or colleges-Am. Med.