searches I feel convinced will be scientifically proved.

LACERATION OF THE PELVIC FLOOR.

In the Jour. A. M. A., Dec. 3, 1904, Burtenshaw, while endorsing the practically unanimous opinion of the advisability of the immediate repair of pelvic floor laceration, at the same time appreciates the fact that the ultimate results of such operation are not entirely satisfactory and do not fully restore the normal functions and integrity of the torn structures. The unsatisfactory results often obtained he attributes to one of three causes, or a combination of the three:

I. Failure on the part of the operator to appreciate the extent and direction of the subcutaneous tear.

2. Failure to properly approximate the edges of the torn muscles and fascia.

3. An overstretching of the muscles of the pelvic floor, which can not be overcome or modified except by denudation and suturing of the vaginal wall, which he believes is not justifiable at this stage of the puerperium.

It is maintained that, if the pathological conditions are properly recognized at the time of their occurrence the primary operation should more nearly restore the normal pelvic floor than any subsequent operation possibly could. In closing the wound, however, the original lines of cleavage must be taken into account and the individual structures must be approximated and sutured separately.

The irremediable overdistention can be largely overcome by properly

placed sweeping sutures and thus a large percentage of the partial failures may be greatly reduced.

Dr. Burtenshaw's paper is a very instructive one. Its most important point being the consideration of the overdistention or overstretching of the perineal structures as a factor in the operation of perineal repair. This idea is one worth keeping in mind by the operator.

The necessity of a more thorough appreciation of the existing pathological conditions and a more careful and painstaking examination of them is apparent to all. And when the operation itself for the immediate repair of pelvic floor lacerations is conducted as a surgical operation should be conducted, with the patient on a table, properly anaesthetized, and in a good light, with plenty of assistance and the necessary instruments, then will the operation be more successful in its results and women will be spared the much too frequent secondary operation with with the usual long train of intermediate symptoms leading up to it.

INJURIES TO THE ANTERIOR VAGINAL WALL IN LABOR.

Hirst, in a paper before the Section on Obstetrics, A. M. A., as per Jour. A. M. A., Nov. 12, 1904, calls attention to the fact that these injuries are as common and often more serious than are those of the pelvic floor. Their nature, however, and causative influence (he believes) in the subsequent production of urethrocele, cystocele, partial incontinence of urine, cystitis, and causes contributing to pro

lapsus uteri-the recognition of these injuries and the methods of their repair are not yet understood even by the masters in maternities and the leading specialists in obstetrics, to say nothing of the general practitioner. And yet they are as easily recognized and are as easily and securely repaired during the puerperal convalescence as those of the pelvic floor. The difficulty has been that heretofore they have not been looked for understandingly.

In order to fully comprehend the subject it is necessary:

ments to the loose connective and elastic tissue between its upper third and the bladder. The immediate results of this injury are not apparent but in time one sees a bulging downward and outward of the lower half of the anterior vaginal wall, allowing cystocele. The constant pull of this drags the cervix forward, tilts the uterus backward, thus contributing a most important cause to prolapsus uteri.

2. To comprehend the nature of the injuries to the anterior wall in labor.

3. To be able to recognize these injuries when they occur.

4. To devise an operation that will repair them and restore their original integrity and function.

Hirst disbelieves the old idea that the anterior vaginal wall is supported by muscles, particularly the levator ani, but says.the pelvic outlet is closed anteriorly by the diaphragm of the urogenital trigonum, consisting of the aponeurosis, the muscle, and fascia of the urogenital trigonum, and that these lying as they do in the triangle under the symphysis are the structures that are injured.

These injuries occurring to the anterior wall in labor are two-fold:

I. The transverse rugae may be nipped between the head and the symphysis, or the fold of the vaginal wall may be pushed down in front of the head and separated from its attach

mon position of the head at the outlet the structures in the left anterior sulcus are most extensively torn.

These injuries can be easily recognized after labor by inserting the forefinger, palmar surface upward, and making pressure upward and outward toward the pubic bone. On the sound side the elastic and resistant cusion is easily felt, on the torn side the finger comes immediately in contact with the sharp edge of bone, nothing intervening but mucous membrane, and very frequently this is torn through, and one can see the raw surface as in tears of the floor.

The anatomy of the parts being known and the extent and character of the injury being fully appreciated, the remedy is easy to devise-approximate and suture the torn fibers of the anterior pelvic diaphragm. If the injury is sub-mucous, Hirst says, the sutures should be inserted so as not to crowd the mucosa too much. He avoids this by making one deep insertion of the

'duced to one-half, and in one the treatment was discontinued.

The treatment lasts ten days. The extract must be prepared each day according to

careful directions, and, when possible by a chemist, placed on ice, and taken in three portions after II a. m. Milk diet is advised, but vegetables may be allowed.

Among the cases reported were some very grave ones, including arteriosclerotic kidney, but the results were uniformly good, a speedy and apparently permanent cure resulting.

An explanation of this remarkable action of the macerated kidney extract is not given, but the authors believe that it is the most valuable known remedy for nephritis.

ALCOHOLIC CIRRHOSIS OF THE LIVER

IN CHILDREN.

Hoffman (Deutsche med. Wochenschr., No. 30, 1904) reports cases of

alcoholic cirrhosis of the liver in children aged respectively 21 months, 30 months, 42 months, and II years. They had taken alcoholics with their meals (given by parents) ad libitum. One received one-half pint of wine a day; the older, one-half pint, not to mention beer, daily for five years.

The

The anatomic picture was strikingly similar to that seen in adults. liver of the youngest was coarsely

iodin catgut (first recommended by Claudius) as really sterile, strong, and slowly absorbed. The catgut is soaked in a solution of potassium iodid and pure iodin, of each one gram (15% grains) in 100 cc. (3 1-3 oz.) of water. Then it is ready for use.

GOUT IN CHILDREN.

in his

Lentz (Deutsche med. Wochenschr., No. 33, 1904) calls attention to eight cases of gout in children collected from the literature by Minkowski monograph, and adds the following case from his own practice. A male, seven years old, had his first attack of gout at six months of age, the earliest. development yet reported. Two to three times each month the child was awakened from sleep at night by violent pain in all the extremities, most severe in the hands and feet. Toward morning there was gradual amelioration, with complete disappearance within two or three days. The child was weak, poorly nourished, and anemic. In the intervals, it felt well and examination showed nothing abnormal, but the next morning after an attack the distal phalanges of the fingers of both hands, especially the third and fourth fingers of the left hand, showed typical pea-sized deposits, so characistic of gout (chronic). The skin was normal. There was no tenderness, but

STERILE CATGUT.

Fuchs (Muench med. Wochenschr., No. 29, 1904) warmly recommends.

painful. The toes showed nothing abnormal, but active motion was painful. There was no fever, and the urine was clouded, highly acid, of sp. gr. 1023, with a heavy sediment. There

was no albumen, no sugar. Microscopically there were abundant crystals of amorphous sodium urate and crystals of calcium oxalate.

Under treatment by alkalies the attacks grew milder and less frequent and the deposits in the fingers disappeared, but after several weeks the child was lost sight of.

PARAGLOBULIN IN THE URINE AS A`

SIGN OF AMYLOID KIDNEY.

Real (Wiener med. Wochenschr., No. 30, 1904) gives the following: In a patient sick of pulmonary tuberculosis (cavities), the uranalysis showed abundant albumen. Dilution with water clouded the urine. Treated with a saturated solution of ammonium sulphate, a precipitate soluble in water (paraglobulin) was obtained and the diagnosis of amyloid kidney estab

lished.

ACUTE NEPHRITIS CAUSED BY PERU

VIAN BALSAM.

Gassmann (Muench. med Wochenschr., No. 30, 1904) reports the following. In the case of a patient suffering from eczema, 6 drachms of balsam of Peru were ordered to be rubbed into

the eczematous patches each night for two successive nights. On the second day there was severe acute nephritis with general edema. Even after 14 days there was 6 to 8 per cent. albu

men.

THIOSINAMIN.

Since the introduction of thiosinamin into therapeutics by Hebra, in

1892, it has been used widely in the hope of prompting the absorption of scar tissue. Hebra saw lupous ulcers favorably influenced and large glands (particularly tubercular) reduced to normal size, opacities of the cornea cleared, absorption of exudates prompted, contractures due to skin scars and contracted muscles and tendons relieved, and ectropions cured regardless of the cause of the scars, wounds, burns, etc.

Hebra cautions against use of the remedy before the inflammation has fully subsided.

In 1903 Sengemann of Breslau reported two cases of Dupuytren's contracture cured by thiosinamin and in March, 1904, Sengemann of Bremen (Deutche med. Wochenschr, No. 13) reported the following case: A private officer, 35 years old, had contracture of 10 years standing. The fourth finger was flexed to an angle of 70°. After 45 injections of thiosinamin, combined with massage, passive motion, and local application of paste of thiosinamin the fingers were straight. The duration of the treatment was 60 days.

Other cases treated successfully by Sengemann are: Two additional cases of Dupuytren's contraction, ankylosis of all points of the thumb following extensive wounds of the soft parts, cured by 25 injections.

Hart (Deutsche med Wochenschr., No. 8, 1904) reports the cure of a case of pyloric stenosis. A male, aged 56, anemic and emaciated, with gastric troubles of twenty-eight years' standing, has gradually grown worse, until he was limited to liquid diet, and com