Hernia.-Marie. Case of Obturator Hernia easily reduced. (L'Union Méd., No. 59.)-Wimmer. Strangulated Hernia in Children. (Ploss, Zeit. f. Med., No. 2. Analysis of forty-eight cases, chiefly German, already published.)-Doutrelpont. Operation for Hernia without opening the Sac. (Langenbeck's Arch., b. ix, h. 2. Has met with twelve cases, all but one recovering. Gives the history of the operation without mention of the name of the Luke.)

Hospital Gangrene. - Lewandowsky. On Hospital Gangrene. (Deutsche Klin., Nos. 14 and 15. Gives an account of an outbreak in one of the Prussian Military Hospitals. There occurred thirtyseven cases among 400 soldiers, and all recovered.)

Joints.-Volkmann. Treatment of Diseases of the Joints by the aid of Weights. (Berlin Klin. Woch., Nos. 6, 7, and 8. The author confirms, by additional experience, the accounts of the good results from this procedure which he formerly published. Its effects in the relief of pain, and contraction of muscles are very remarkable; and it also prevents the ulcerative process which results from prolonged contact of diseased surfaces.)-Charcot. Arthropathies dependent on Lesions of the Brain and Spinal Cord. (Journ. de Physiologie, Nos. 1 and 2.)

Laryngoscope.-Turck. Laryngoscopic Communications. (Allg. Wien. Med. Zeit., Nos. 1, 3, 4, and 5, with woodcuts. Published not long before his lamented death.)-Hohl. A new Laryngoscope. (Deutsche Klin., No. 1, with woodcuts.)-Tobold. Fixation of the Epiglottis. (Ibid., No. 3.)-Schrötter. Contributions to Laryngoscopic Surgery. (Med. Jahr. d. Wien. Ges., No. 1.)-Fournié. Case of Polypi of the Larynx and Trachea, and Tumour of Pharynx. (Gaz. des Hop., No. 56.)-Rossbach. Constriction of the Larynx from Adhesion relieved by Operation. (Langenbeck's Arch., b. ix, h. 2, with illustrations. States that there are only twelve other cases on record.)

Ovariotomy.-Dittel. Case of Successful Ovariotomy. (Allg. Wien. Méd. Zeit., Nos. 4 and 7.)-Gusserow. Two Cases. (Berlin Klin. Woch., Nos. 12 and 13. One fatal, with autopsy.)-Simon. Two Cases. (Deutsche Klin., Nos. 1 and 3. One recovered. In the other the operation not completed on account of adhesions, and at the autopsy the case was found to be one of enormous hydro-nephrosis.)-Stilling. Three Cases. (Ibid., Nos. 3, 4, 7, and 11. Two fatal.)-Koeberlé. Nine Cases. (Gaz. des Hôp., Nos. 29, 33, 38, 47, 58, 63, 66, and 67. Four fatal.)-Scharlau. Two Cases at Stettin. (Monats. f. Geburt, Feb. One fatal.)-Maslowsky. Case of Double Ovariotomy with Recovery. (Langenbeck's Arch., b. ix, h. 2. Illustrations of the new instruments employed. He gives an historical account of the operation in Russia.)

Penis.-Saurel.-Treatment of Phymosis by Dilatation. (Gaz. des Hộp., No. 31. Woodcut of the dilating forceps employed.)— Bourguet. New Mode of Amputation of the Penis, with prevention of Atresia. (Bull. de Thérap., No. 8, and Gaz. Hebd., No. 15.)

Prothesis.-Hermann. Mechanism of Progression with Artificial

Legs. (Prag. Viertel, B. 2. Description of a new artificial leg, with numerous woodcuts.)

Syphilis.-Sigmund. Report on the Syphilitic Wards of the Vienna Hospital. (Deutsche Klin., Nos. 1, 5, and 6. He insists that syphilis is much on the increase, and that it is very urgent that good syphilitic clinics should be established in all medical schools.) -Sigmund. Primary Syphilis of the Mouth and Lips. (Wien. Med. Woch., Nos. 9 and 19. Sigmund says that cases of this description are increasing in number. During seven years he has met with seventy-three examples among 5551 syphilitic patients.)-Desprès. Phagedænic Chancre of the Anus and Rectum. (Arch. Gen., April. An interesting essay founded on seven cases at the Lourcine.)

Tracheotomy. Hasse. Hasse. Twenty-six Cases of Tracheotomy in Diphtheria. (Berlin Klin. Woch., Nos. 1 and 5.)

Tumours.-Forget. On Odontoma, or Dental Tumours. (L'Union Med., Nos. 50 and 60.)-Richet. Diagnosis of Tumour of the Groin. (Ibid., No. 30.)

Urinary Organs.-Liégois. Case of Urethral Calculus. (Gaz. des Hop., No. 37.)-Leudesdorf. On a new Lithotome. (Langenbeck's Arch., b. ix, h. 2.)

REPORT ON MIDWIFERY

By ROBERT BARNES, M.D. LOND., F.R.C.P.,

Lecturer on Midwifery &c., St. Thomas's Hospital; Examiner in Midwifery to the Royal College of

Surgeons.

I. PREGNANCY.

1. A Fallopian Gestation cured by Puncture. By Dr. EDOUARD MARTIN.

2. A Case of Tubo-uterine Gestation. By Dr. POPPEL.

3. A Case of Abdominal Gestation. By Dr. Dreessen.

4. On the Recognition of the Seat of the Placenta before Labour. By

Dr. PFEIFFER.

5. On the Etiology of the Normal Position of the Fœtus. By Dr. COHNSTEIN.

6. A Case of Diphtheria of the Mucous Membrane of the Bladder and consequent Discharge of a Portion of the Mucous Membrane; Retroversion of Gravid Womb. By Dr. HAUSSMANN.

1. A woman, æt. 29, pregnant for the first time in January, 1867. On the 25th of February, after exerting herself in moving furniture she felt a sudden acute pain in the abdomen; a choking sensation and vomiting set in, with straining at stool and urine. The vagina was narrowed, the uterus anteflexed, the body enlarged, the os hard to reach in the hollow of the sacrum. Some days later along with considerable hæmorrhage a piece of decidua came away, and there was felt a small circumscribed swelling behind the abdominal wall projecting over the left horizontal branch of the pubes. The bleeding

returned profusely on the 16th of March, a fresh attack of pain having preceded. On examining now there was decided latero-version of the uterus, the fundus being pushed to the right, the os to the left. In the left side of the pelvis a spindle-shaped swelling was felt through the vaginal wall, and the same swelling was distinguished through the abdominal wall externally. Moving it caused acute pain. These. symptoms and the decided growth of the swelling, led to the conclusions that it was an extra-uterine gestation, and that the further development ought to be arrested. Dr. Martin punctured the swelling with a fine trocar. A few drops of watery blood followed. Eight days later it was ascertained that the swelling had not increased; but a sharp rigor set in. Some days later the tumour was smaller, and the uterus had recovered its normal direction. On the 4th of May the patient was considered well.-Monats. f. Geb., February, 1868.

The

2. Baart de la Faille has collected twenty-three cases of this kind. Dr. Poppel's is as follows; a woman, aged twenty-nine, had borne two living children. She menstruated on the 1st of May, 1867. On the 20th of June, she fell ill with severe abdominal pains. The uterus was found enlarged, and there was a small show of blood, suggesting abortion. Next morning the abdomen was greatly distended, fluctuation was plain. There was acute anæmia and deep collapse, although the hemorrhage per vaginam had not increased. Fifteen hours after the onset of her illness, death ensued. diagnosis was acute perforative peritonitis with internal hæmorrhage. Autopsy. Much free fluid blood was found in the abdomen. The uterus was enlarged, of irregular shape; its right side was strongly arched at the fundus, and exhibited on its upper and hinder surface two irregular rents, through which portions of a placenta and of a fœtus protruded. The right tube was inserted a little higher on the body of the uterus than the left. On opening the uterus lengthwise two cavities were exposed. The lower one, which was the uterine cavity proper, was clothed by a thick decidua. The upper cavity was divided from the lower by a partition of muscular nature, but communicating with it by a hole admitting the finger; it contained a fresh dead fœtus corresponding to a development of five months. The cavity was clothed by ovum-membranes and placenta. A corpus luteum was found in the left ovary. It followed that there had been a transmigration of the ovum, but whether extra or intra-uterine could not be determined.-lbid., February, 1868.

Pregnant

3. A woman, æt. 35, had had three living children. again, abdominal gestation was diagnosed by Professor Litzmann. She dated conception from the middle of June, 1860. Pains and hæmorrhage occurred about the middle period of the presumed pregnancy. The abdomen and breasts enlarged, vomiting often attended the pains. Foetal movements were felt. She then got better; but in March, 1861, pains lasting a whole week, different from labour pains, and foetal movements recurred. These movements grew more feeble, and ceased on the 30th of March. A sensation of

burning in the stomach remained, with severe vomiting of grassgreen matter. Shortly before the death of the foetus a discharge of blood took place from the genitals, and lasted ten weeks, during two of which it was accompanied with dark coagula, but no membranous shreds. After four weeks, the burning sensation was lost. She was now unable to exert herself. The circumference of the abdomen diminished after the death of the child. Menstruation did not return. The position of the foetus was made out by external manipulation. At a later period menstruation returned. In October, 1866, the patient had been obliged to keep her bed on account of severe abdominal pain, and menstruation ceased again. In January, 1867, she suffered from frequent mucous diarrhoea, through which she became much emaciated. The encysted foetus was felt as a hard knobby mass, the size of a four-year old child's-head in the left side of the abdomen quite immoveable. On internal examination the entire brim of the pelvis was found filled with a fixed, hard mass. The os uteri was pushed over towards the right pubic bone-much pain was caused on examination per rectum. She sank on the 1st of February, 1867. Autopsy. The cyst was found adherent by numerous points to the omentum. The bladder bounded it and was adherent to it in front. The uterus was not generally enlarged. The mucous membrane looked normal. The left Fallopian tube ran across the wall of the sac. The left ovary could not be discovered. The right tube was found free. The right ovary was also distinct. In the sac was found the remains of the foetus macerated. placenta could not be made out. The inner wall of the sac was covered with a smooth serous membrane. At the point of connection with the rectum there was a fistulous opening.-1bid., February, 1868.

The

4. Dr. Pfeiffer adverts to the fact that the seat of the uterine or placental souffle may sometimes be felt by the hand, a peculiar vibration or thrill being perceived. He then observes that under favourable circumstances, as thin abdominal and uterine walls, by applying the hands flat to the uterus one may find a smaller segment of a ball, as if seated on a large spheroid, and that this smaller mass has a peculiar stretched elastic consistence differing from that of the parts of the uterus which contain the child. This is the seat of the placenta.

Professor E. Martin, commenting on this, said he had subjected the proposition to repeated trial, and thought it required further observation. Ibid., Feb., March, 1868.

5. Dr. Cohnstein begins his memoir with a full historical summary of the theories hitherto advanced as to the causes which determine the position of the foetus in uterô. His own conclusion is that the position is to be sought in the foetus itself, not in the active or passive movements. It is the circulation-relations in the fœtus which until the end of the sixth month determine the breech-presentation, and after this period causing the substitution of gravity of the upper half of the trunk, cause the head presentation. This proposition

Cohnstein illustrates by the developmental history of the foetus.Ibid., Feb., March, 1868.

6. Dr. Haussmann refers to other known cases of casting off of portions of the vesical mucous membrane, and relates the following:-A woman, aged 39, who had borne a child, was seized when three to four months pregnant with retention of urine requiring frequent use of catheter. The uterus was found retroflexed. This was relieved. The temperature and pulse had risen. The urine was at times alkaline, and showed cells of epithelium falling into decomposition, and vibriones. There was at times extreme pressure to void the bladder, which the patient could not satisfy. She several times passed the catheter herself. She recovered. A substance which at one time seemed to have choked the eyes of the catheter was passed, some blood following. This substance corresponded in size to about the fourth part of the area of the bladder. It had several small holes, most probably artificially produced, but one of which possibly answered to the opening of a ureter. One surface was tolerably smooth, the other surface showed numerous beam-like processes, which penetrated the entire membrane. It consisted of fibre and elastic fibres, many epithelial cells exactly like those of the bladder.-Ibid., Feb., March, 1868.

The following contributions are referred to by the title only, on account of want of space:

A Case of Retroflexion of the Gravid Uterus.-Spontaneous Rectification. By Dr. BEHM.-Monats. f. Geb., April, 1868.

On the Mechanism of the Obstetric Forceps. By Dr. DIETERICH. -Ibid.

II. LABOUR.

1. Spondylolisthesis in consequence of Lumbo-sacral Caries. By Dr. BLASIUS.

2. On Osteomalacia. By Dr. CASATI.

3. Pelvic Deformities affecting Labour. By Dr. CASATI.

4. Obstetric Operations. By Dr. CASATI. Forceps, Craniotomy Cephalotripsy, Cæsarian Section, Induction of Labour.

5. On the Symptomatology of Incomplete Rupture of the Uterus. By Dr. C. HECKER.

1. Dr. Blasius describes the pelvis and lumbar vertebræ taken from the body of an insane patient. It was not known whether she had ever borne a child. She died at forty-nine, of phthisis. The pelvis was well formed, but the bones were porous and very fragile. The union of the basis of the sacrum with the last lumbar vertebra had undergone considerable destruction through caries; the upper anterior angle of the first false vertebra was completely destroyed, and in its place was a rough sloping surface. The last lumbar vertebra was in great part destroyed, and had slipped forward on the altered base of the sacrum so as to hang as a projection in the pelvic cavity. A year before death the patient had suffered from sacro-coxalgia, which was followed by psoas abcess; abscesses also appeared