comes to a surgeon with a symmetricly enlarged uterus and the possibi ity of pregnancy he must consider it. I said that I could see no confirmatory signs of such a condition and consequently thought I was dealing with a tumor. I said this in such a way that they could not take offense. I spoke also of the seriousness of the case and of the possibility of the tumor being malignant. Sometimes we cannot depend upon a history of profuse menstruation, although it would seem that in a case like this we might. I intend to operate on Saturday and then we will be able to see what this tumor is.

Operation disclosed a submucous fibroid the size of two fists. The tumor was enucleated and the uterus and appendages preserved.

In regard to the operative treatment of these growths the statement has been made that we should preserve the cervix whenever possible for fear of prolapse of the vaginal vault if the cervix is removed. I think this is something which rarely occurs. The panhysterectomy method was elected for the first seventy-five of these tumors which I removed and this accident was not a complication. So far as I could observe the patients did just as well as those upon whom I performed supravaginal amputation. The latter, however, is a more desirable operation for the danger of sepsis is less.

ORIGINAL ABSTRACTS.

MEDICINE.

BY JAMES RAE ARNEILL, A. B., M. D., ANN ABBOR, Michigan.

INSTRUCTOR IN CLINICAL MEDICINE IN THE UNIVERSITY OF MICHIGAN.

AND

DAVID MURRAY COWIE, M. D., ANN ARBOR, MICHIGAN.

FIRST ASSISTANT IN MEDICINE IN THE UNIVERSITY OF MICHIGAN.

THE PARASITE OF SMALLPOX.

COUNCILMAN, Magrath and Brinckerhoff publish conjointly "A Preliminary Communication on The Etiology of Variola," in The Journal of Medical Research, Volume IX, Number III. The authors were enabled to carry on these investigations through the “liberal and enlightened policy of the health department of the city of Boston," which gave them "access to material for anatomic and histologic study."

As early as 1892, Guarnier reported the finding of peculiar living bodies enclosed in epithelial cells, both in variola and in vaccinia. Since this time these bodies have been studied by many observers, more particularly by Wasielewski, but no success attended their efforts to demonstrate the life history of the parasites, indeed it has been questioned whether they are really living bodies. The authors of the above mentioned paper endeavor to settle this point. They describe the

life history of the parasite as occupying two cycles, an intracellular and an intranuclear cycle.

THE INTRACELLULAR CYCLE.—"In the lower layers of the epithelial cells of the skin before there is any evidence of vesicle formation” “small structureless bodies from one to four microns in diameter" are seen lying in vacuoles. These bodies as well as the vacuoles steadily increase in size until they become as large or larger than the nucleus of an epithelial cell. As they increase in size evidence of structure, such as granules, appear. So far no definite nucleus has been distinguished. When the growth of the parasite is complete, which corresponds to the formation of the young vesicle, segmentation takes place, "leading to the formation of small round bodies about one micron in diameter. To this time the nuclei of the epithelial cells are not greatly altered.

THE INTRANUClear Cycle.-After segmentation of the intracellular body, one or more small round or oval ring-like bodies appear in the nucleus of the epithelial cell. These bodies increase in size until the nuclear ring becomes indistinct and finally disappears. The degenerated cell may break down and set free the parasite. The authors regard this intranuclear body as a further stage of development of the intracellular body and the spores which form "from its segmentation as the true. infecting material of variola."

RELATION OF THE Parasite to Variola and VacCINIA.—The authors have been able to demonstrate the intracellular body in the eruption of vaccinia and in rabbits inoculated with the contents of variola pustules. They have been unable, however, to demonstrate the intranuclear body in either case. The authors claim that when they inoculated monkeys lesions developed which must be regarded as variola and "in these the intracellular and the intranuclear cycles are found. It may be that herein lies the difference between variola and vaccinia. The authors do not. however, commit themselves on this point.

The so-called parasite has not yet been demonstrated in the detritus of cells and exudation. It is suggested that the "intranuclear cycle is sexual in character."

SURGERY.

BY HENRY O. WALKER, M. D., DETROIT, MICHIGAN.

D. M. C.

PROFESSOr of surgery and CLINICAL SURGERY IN THE Detroit college oF MEDICINE

AND

CYRENUS GAVITT DARLING, M. D., ANN ARBOR, MICHIGAN.

LECTURER ON SURGERY AND DEMONSTRATOR of surgERY IN THE UNIVERSITY OF MICHIGAN.

PRIMARY CARCINOMA OF THE VERMIFORM APPENDIX.

ARTHUR W. ELTING, M. D., of Albany, New York (Annals of Surgery), reports three cases of this disease. The extensive literature on diseases of the appendix contains very little on this subject. Of the few cases reported, some are doubtful. The literature has been carefully

searched and forty cases found. Only twenty of these, however, carry sufficient proof. The author adds to these, three cases examined by himself and draws his deductions from the twenty-three cases. The ages of seventeen were reported. Nine of these were under thirty

years. Twenty-four per cent were under twenty years of age, the youngest being a child of twelve years. The history of the development and decline of the appendix should make it a favorable location for primary carcinoma. The diagnosis of primary carcinoma of the appendix is rarely possible except in well-developed cases, which will present the same symptoms as chronic relapsing appendicitis. In order to determine the frequency of this disease, every appendix removed should be carefully examined.

LIST OF SURGICAL OPERATIONS.

C. G. D.

F. D. SHEPARD, of Aintab, Turkey (American Medicine), shows what can be accomplished by strict adherence to the essentials of modern surgery. This list of operations covers a wide range of surgery, in all, seven hundred fifteen cases. Three hundred fifty-six are operations on the eye. The others of importance are as follows: Fifteen urinary calculi, fourteen genitourinary, fifty rectal, nineteen laparotomies, twenty-six plastic operations, and twenty-one tumors. The remainder cover the field of surgery from simple tenotomy to amputation. A glance at the list will suffice to show that cases do not average the same as in general clinics in this country. For example, only one case of appendicitis is reported, two hydatids of the liver, nine suprapubic cystotomies, and seventy-one operations for hernia. The nose must be a surgical landmark in that country as eight restorations of that organ are given. The death rate for the entire list is but six. The author relies on boiling for sterilization, omitting nothing but the patient and the operator. The hands are cleansed with soap, water and alcohol. He is working alone, without skilled assistants and nurses, and most of modern hospital facilities are beyond his reach.

GYNECOLOGY.

C. G. D.

BY REUBEN PETERSON, A. B., M. D., ANN ARBOR, MICHIGAN.

PROFESSOR OF GYNECOLOGY AND OBSTETRICS IN THE UNIVERSITY OF MICHIGAN.

PROLAPSE AND INVERSION OF THE UTERUS.

E. FUNKE (Centralblatt für Gynäkologie, 1903, Number VI) reports an interesting case of acute inversion of the uterus with prolapse. The patient was twenty-seven years old and had had one child, the birth being accompanied by considerable postpartum hemorrhage due to atony of the uterus. During this pregnancy she suffered from sore throat and hoarseness, which did not entirely disappear after the delivery. During her second pregnancy the throat symptoms increased. Examination showed edematous swelling of the larynx and epiglottis and

the appearances of laryngeal tuberculosis. The symptoms improved under treatment by menthol and tannin.

Funke was sent for hastily and upon his arrival found the patient breathing her last. Between her legs lay a sausage-shaped mass which further investigation showed to be the prolapsed inverted uterus, to which was attached the placenta. It was learned afterward from the midwife in attendance that the patient at the beginning of labor was short of breath and coughed badly. The child was born rapidly while the mother was having a severe attack of coughing. Finding a hard mass in the vagina the midwife sent for help but before the physician arrived the inverted uterus was forced out of the vagina, during another coughing fit. This accident was accompanied by a sharp hemorrhage and the woman died just as Funke entered the room.

The causes of inversion uteri accompanied by prolapse, according to Kaltenbach, are traction on the cord or placenta and straining or manual expression of the placenta. In this case the accident was clearly the result of straining, together with an adherent placenta, the uterus acting as does the intestine when intussusception occurs.

OBSTETRICS.

BY THOMAS STONE BURR, A. B., M. D., ANN ARBOR, MICHIGAN.

DEMONSTRator of OBSTETRICS AND GYNECOLOGY IN THE UNIVERSITY OF MICHIGAN.

FORMALIN INJECTION IN PUERPERAL SEPTICEMIA. BARROWS (American Journal of Obstetrics, Volume XLVII, Number III), in a paper read before the New York Obstetrical Society, cites a case of puerperal septicemia treated by intravenous injection of a one to five thousand formalin solution. At the time of confinement the patient's temperature was 104.3°, pulse 124, respiration 30. The fetus. was dead, and fetus, membranes and placenta were badly decomposed. The uterus was irrigated, and later curetted. On the ninth day the patient was in a semicomatose condition, with rectal temperature 108°, pulse 160, and respirations very shallow and rapid. Blood cultures showed a pure growth of streptococcus. At 5 P. M., five hundred cubic centimeters of a one to five thousand formalin solution were injected into the median basilic vein. The temperature and pulse showed immediate improvement. The following morning the temperature was 101°, pulse 104. At 9 P. M., twenty-eight hours after injection, the temperature was 102.5°. The next morning the rectal temperaature was subnormal, pulse 86. The temperature rose to 103° and a second injection, seven hundred fifty cubic centimeters, was given in the opposite vein. The temperature fell to normal and the patient recovered.

On the day following the first formalin injection and subsequently cultures from the blood were negative. No disturbance of any kind followed the injection.

PEDIATRICS.

BY ARTHUR DAVID HOLMES, M. D., C. M., DETROIT, MICHIGAN.

PROFESSOR OF PEDIATRICS IN THE MICHIGAN COLLEGE of MediCINE AND surgery.

THE TREATMENT OF INFANTILE CONVULSIONS.

ADA MCMAHON, M. D. (New York Medical Journal, March 14, 1903), says the treatment of infantile convulsions resolves itself into (1) the treatment of the convulsion, (2) the removal of the exciting cause or causes in the given case, (3) the prevention of any known cause again acting as an irritant, and (4) the strengthening of the infant's unstable nervous system.

Should the diagnosis point to a direct irritation of the cells as in certain cerebral and spinal diseases, that condition will demand the bromides, effective elimination, and a room kept darkened, well ventilated and quiet, together with proper nouishment. Surgical interference may be needed. But should one of the reflex irritations be at fault such as from improper food, foreign bodies in the nose and ears, adherent prepuce or clitoris, or dentition, these should be corrected as soon as possible. The pyrexia in itself may serve as an irritation in prolonging or causing the spasm. The cold or ice pack with ice to the head and at times heat to the feet will be required. The pack warm or cold, will (1) reduce the pyrexia, (2) increase peripheral circulation, (3) lessen the rigidity, and (4) assist in elimination, and will also permit, without much disturbance to the child, of the giving of stomach or intestinal lavage. If stimulation is required, stimulate freely. Whisky, nitroglycerin, strychnin, adrenalin chlorid or ether given hypodermicly, will often tide over some of the most dangerous cases. Oxygen is of much value in oncoming asphyxia. Saline infusions, when there has been a large drain from the system, as in cholera infantum, will be beneficial.

Should an acute toxemia exist, the above mentioned methods are no bar to the treatment of the acute exanthemata, pneumonia, scarlatina, secondary meningitis, and the acute infectious intestinal diseases.

While the infant is still in the pack, should an ileocolitis exist, copious enemata can be given; if there is much tympany add to them a carminative, especially milk of asafetida, or keep in place the rectal tube. While the child is in the pack, watch the temperature closely. Remove the pack when it falls to 101° Fahrenheit (rectal), again applying it when indicated.

At times the toxemia is one of low degree, as in malnutrition and rickets. Here the disturance shows itself in certain groups of the muscles as infantile vertigo, carpopedal spasms, and laryngismus stridulus. By proper feeding and good hygienic surroundings, with or without some of the motor depressants, we have some means of relief.

Infantile epilepsy must be distinguished by the history of previous attacks, no known exciting cause, and a predisposing heredity. Inas