The operation is very quickly done by a single curvilinear incision around the ischium.

SOME RECENT METHODS OF INTESTINAL ANASTOMOSIS.-George Gray Ward, Jr., gives in a recent number of the Medical Record a brief resumé of the subject of intestinal anastomosis from the historical point of view, and divides the many methods into three classes:

1. Where a foreign body is placed in the lumen of the bowel to facilitate accurate approximation, with or without suturing. This class includes the many devices suggested from the time of the Four Masters down to the present day, such as goose trachea, rings potato, chromatized gelatin, tallow, raw hide, rubber, cardboard and cork, and lastly, most ingenious and popular of all yet described, the Murphy Button, and Harrington's Segmented Ring.

2. In this class belong all the stitch methods without mechanical aids, including the interrupted and the continuous sutures with their many modifications; here belong the Maunsell method and the more recently described Connell suture, which latter especially must ultimately come into more general favor.

3. The methods wherein mechanical devices are used to facilitate the placing of the sutures and are then withdrawn. In this class are to be noticed the inflatable and collapsible bulb of Halsted and the great variety of forceps suggested by Mudd, Grant, Morrison, Lee, Laplace and O'Hara.

Of the three classes he selects one from each as worthy of special commendation, namely, the Harrington segmented ring, the Connell suture and the O'Hara forceps. These all have special points of excellence and each is to be preferred in its class. Thus, the Harrington ring is to be preferred to the Murphy button, the best hitherto devised in its class, because it is readily broken up into four segments, which naturally pass out with greater facility and certainty than the button, takes up no more room when shape and yet has a much larger lumen and is very much lighter; the Connell suture is superior to the Maunsell because no longitudinal slit is required and the knots are all buried within the lumen of the bowel; and, finally, the O'Hara forceps have decided ad

vantages over all other apparatus in their class and perhaps over any of the other classes, because only one size is needed for all cases, they are very easy of application, they serve at the same time as clamps and avoid contamination from the interior of the gut by never necessitating the exposure of the lumen during the whole operation. These are important advantages of the last named instrument, but they all have some characteristics which commend them to the surgeon who may wish to be slave to no singular apparatus. One should make himself master particularly of the Connell suture because this requires no special apparatus, only a needle and thread being needed for the most complicated procedure in intestinal procedure.

Department of Obstetrics and Gynecology.

In charge of DR.P. MICHINARD, assisted by DR. C. J. MILLER, New Orleans.

ACCIDENTAL PERFORATION OF THE UTERUS.-Abram Brothers (American Gynecology, April, 1903), mentions the frequent occurrence of this condition, and reports several cases occurring in the hands of midwives, professional abortionists and ignorant persons generally, in the effort to interrupt pregnancy, are frequently seen by physicians connected with public hospitals, consultants in gynecology and the medical assistants in the coroner's office. But the majority of cases which occur in the course of legitimate work and in the hands of honest practitioners of medicine never see the light of day because of the fear of criminal prosecution, or, at least, of public ridicule, even cases which do not go on to fatal termination.

As a matter of course and fact, the author is convinced that it is the rare exception that uterine perforation ends fatally. In the treatment of these most unfortunate cases we must consider them in groups or sets. The first set of these cases are those in which, during the passage of the sound or curette, the uterus is perforated.

These cases will usually get well if manipulations are immediately stopped and no irrigation employed. If the uterus has been injured and the operator has irrigated the uterine cavity three sets of conditions may arise. In the first set a mild peritonitis (local) may call for nothing more than the same line of treatment. In the second set an acute septic peritonitis may call for an immediate hysterectomy (usually vaginal) with drainage per vaginam. The third set may be less virulent and more chronic. They are apt to terminate in localized abscesses, which may be located in the pelvic tissues or in the pelvic peritoneum. The operation in the majority of these cases will be in the nature of an exploratory laparotomy. In those cases in which the uterus has been injured and the intestine has been dragged through the wound, laparotomy must be done as early as possible. If the strangulation has been fatal to the viability of the gut, it must be exsected at once. The uterus may then, according to the judgment of the operator, be repaired or removed. Miqual reports five such cases, which were not fatal; hysterectomy, and curettage should be less resorted to in the large proportion of these cases and recovery will be increased in percentage ratio.

HYDATIFORM MOLE.-In the Am. Jour. Med. Sci. for March, Palmer Findley presents an instructive article on this subject. He states that nothing definite is known of the cause of moles. They are most frequent between the ages of twenty and thirty years, and are two and one-half times as frequent in multipara as in primipara. The weight of evidence points to its maternal origin, the vascular degeneration of the chorionic villi resulting from a disturbed maternal circulation. Failure of circulation causes degeneration of the connective tissue stroma of the villi and serous infiltration. The syncytium and Langhan's cells penetrate deeper into the decidua, which explains the unusual proliferation of these epithelial elements in hydatiform mole. No proof exists that cystic degeneration of the ovaries has any influence upon cystic degeneration of the ovum. Malignant degeneration of moles occur in about 16 per cent of all cases. No sharp line can be drawn between benign and malignant hydatiform moles, syncytial invasion of the connective tissue stroma of the villi and of the uterine musculature occurs under normal conditions, and can not be regarded in hydatiform

mole as evidence of malignancy unless found to a marked degree. It follows that macroscopic and microscopic examination of discharged vesicles will not determine the benign or malignant nature of a mole. The length of time a mole remains in utero does not influence its disposition to take on malignancy. The diagnosis can not be made without seeing the vesicles; these are seldom expelled until abortion is in progress. The most constant clinical evidence is the rapid development of the uterus, irregular in shape and consistency. To avoid malignancy our only safeguard lies in early recognition and immediate removal. Ergot and vaginal tamponade will control the hemorrhage and often excite the uterus to expel the mole.

The curette should not be employed. After the expulsion of the mole always explore the uterus with the finger, irrigate and pack with antiseptic gauze. Two weeks after the birth of a mole, curette the uterus and examine the scrapings for syncytial invasion, and if found in the act of proliferating, hysterectomy should be done. Watch the patient for three years after the expulsion of the mole. If uterine hemorrhage occurs curette and examine the scrapings microscopically. All new growth in the vagina and lungs are to be regarded with suspicion. The maternal mortality in hydatiform mole is twenty-five per cent. It is the exception for more than one mole to develop.

Department of General Medicine.

In charge of DR. E. M. DUPAQUIER, New Orleans.

ACTION OF VACCINATION ON WHOOPING-COUGH.-Facts have been published recently going to show that vaccination could in certain cases cause an arrest and even a complete cure of whooping cough. Up to the present time, the use of sera against whooping cough, repeatedly experimented with, has failed namely Dr. Leuriaux's special serum and the antidiphtheritic serum.

Dr. Pochon recalls in the Revue des Maladies de l'enfance that Violi, in Constantinople, following the example set by other Italians gathered on cows at the time of vaccinal eruption. On the other hand, in 1901, Dr. Hervieux presented before the Academie de Médicine, in the name of Dr. Dietrich, the medical attendant of the colony at Michelot (Algeria) a very interesting report on the curative influence of vaccination on whooping cough.

Dr. Dietrich had, in spite of the parents' objections, succeeded in vaccinating in a village, a dozen of children suffering from whooping cough, in the period of spasmodic cough or paroxytic. At the same time 29 children of the same locality who had not yet had whooping cough, were also vaccinated.

After eleven days, of 12 children vaccinated during the course of whooping cough, three were completely cured, seven markedly improved, two only showed no betterment. Regarding those who were vaccinated when not yet having whooping cough, 24 out of 29 had not contracted whooping cough, three caught it, two had left the village eight days before Dr. Dietrich's departure, but they showed no sign of infection at the time.

The author concludes from these facts:

1st. That vaccination seemed to have exercised a curative action on whooping cough.

2d. That it seemed to have had an immunizing action.

The occasion for employing the method is rare since children usually contract whooping cough at an age when they have already been vaccinated, a long time previous. Yet, Dr. Pochon has observed a demonstrative case in a child aged 5 months, having paroxysms every 15 minutes, a very serious state of affairs, indeed. Under the influence of vaccine, the paroxysms decreased most obviously, while the pulmonary congestion retroceded rapidly.

But the most interesting part of this observation, notes being taken down, day after day, it might be said hourly, was the fact that the number of paroxysms decreased as the evolution of the vaccine proceeded. It must be added that the fever and the "malaise" produced by the vaccine caused no ill effects, and at no time, even momentarily, seemed to aggravate the condition of the little patient.

The conclusion to reach perforce, is that in case of whooping