A GENEROUS OFFER.

We hail with much joy a charity at last that aims to benefit physicians. Recently a cremation company, operating in the neighborhood of this city, "in recognition of the support which our cause has received from physicians generally"-we quote from the certificate— has generously issued a large number of certificates to physicians, entitling them or any member of their immediate families to free cremation at any time within ten years. The certificate itself is a thing of considerable beauty, printed in sable and gules and bearing upon its field a funeral urn, couchant, vert, and is suitable to frame and hang up alongside one's diploma and marriage certificate. No doubt there will be some to cavil at the phrase about support received from physicians, but we think that no more than moral support is implied; we question very much whether any physician for the sake of ingratiating himself with a cremation company would deliberately increase his deathrate in order to furnish them with material. Other critical ones might view the offer in the light of an advertisement but we feel sure that between the lines we can read charity writ large; we are certain that this kind company has recognized the increasing poverty of the profession; has observed the imminent dissolution of many of its members from starvation or from the nervous wear and tear incident to trying to make ten dollars' worth of bad accounts buy one dollar's worth of groceries and has noted that the chief obstacle to a general euthanasia is the question of how to meet the funeral expenses. The company does not express the hope that the recipients of their certificates will hasten to avail themselves of the generous offer but this is doubtless only modesty. There is no reason why any doctor should hesitate to take advantage of this-the first charity open to his kind, what we might indeed call a cremation dispensary; moreover, if he have any disinclination to personal incineration the certificate entitles him to the privilege of trying it on the dog, as our theatrical friends say, i.e., upon whatever member of his family he can most conveniently spare. Doubtless it will be a novel sensation to the members of a profession that has been accustomed heretofore to give so much for nothing to actually get something for nothing; and we shall look for a large and encouraging death-rate in the near future among physicians and their immediate families.

A. D. C.

REVIEW.

Progressive Medicine: A Quarterly Digest of Advances, Discoveries, and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M.D., assisted by Charles Adams Holder, M.D., Volume II., June, 1900. Lea Brothers & Co., Philadelphia and New York.

The second volume of the current year of Progressive Medicine has for the subject of its first section Surgery of the Abdomen, including Hernia. Several interesting cases of gastric implication and gastrorrhaphy for gastric dilatation and gastroptosis are reported, in which very excellent results were secured. Several pages are devoted to operations for gastric ulcer, particularly after perforation; the importance of avoiding obscuration of the symptoms by the use of opiates and the necessity for immediate operation are emphasized; the results of early operation show, of course, much better results as to mortality, but also give a much more favorable convalescence. All the vexed questions regarding appendicitis are discussed, but they appear still to remain vexed; we believe, however, that in an individual case an experienced surgeon would be more likely to make the necessary decisions. wisely than would appear probable from a surgical symposium upon the subject. There is an account of the Bassini operation in detail as done by Bassini himself with a number of cuts illustrative of the various steps of the operation as done by Bull and Coley; also, a long résumé of Bloodgood's very extensive contribution to the subject. Plastic operations upon the colon are extensively reviewed and well illustrated; also, the diagnosis of abdominal tumors. There are a number of interesting radiographs showing calculi in the various abdominal organs. The surgery of the liver, operations for repair of the ureters, and the surgical treatment of aneurism of the abdominal aorta are also discussed.

In the section upon Gynæcology, Stratz's treatment of pelvic peritonitis is reviewed, and though some excellent results have been attained, there is no likelihood that his methods will in many cases displace other modes of treatment. Other subjects are the treatment of inflammatory pelvic exudates by compression and posture, the ultimate results in the operative treatment of retroversio-flexio-uteri and Kelly's operation for the repair of lacerated perinæum, amply illustrated;

especially there are long discussions upon the cause and significance of hæmorrhage in cases of uterine myoma, upon the occurrence of streptococcus pyogenes in gynæcological diseases and upon moveable kidney in women.

The next section takes up first various methods of blood examination though no very marked advances have been made in this direction during the past year. The different blood diseases and disorders of metabolism, diabetes, diabetes insipidus, glycosuria, gout, myxedema, exophthalmic goitre, etc., are treated of at length.

The fourth section upon Ophthalmology is largely made up of short articles. There appears still to be a good deal to say about conjunctivitis and several interesting pages are devoted to corneal ulcer. Among diseases of the retina, the attempts to cure detachment of that organ make interesting reading, though no very certain results have as yet been attained, it being hard to differentiate in the small percentage of recoveries cured cases from those that spontaneously got well. There are good pages upon optic neuritis and atrophy and upon the toxic amblyopias. In the treatment of glaucoma, "resection of the sympathetic," introduced by Jonnesco is spoken of as a promising experiment; its immediate results seem to be very good though it is hard to say whether they will be permanent. The volume as a whole is a worthy member of this excellent series.

TRANSACTIONS OF THE PHILADELPHIA OBSTETRICAL

SOCIETY.

Stated Meeting, October 4, 1900.

The President, J. C. DACOSTA, M.D., in the Chair.

Varicose Veins of the Vulva complicating Pregnancy; Dermoid

Cysts.

BY WILMER KRUSEN, M.D.

(See page 304.)

DISCUSSION.

Dr. B. F. BAER: Varicosity of the veins of the vulva and vagina during pregnancy should always be a matter of solicitude on the part of the attending physician. I have never met with a case in which rupture of these veins during labor occurred, but I have been made anxious in some cases because of their great distention. I do just now recall a case of large tumor of the labium about which I was once consulted, in which the history indicated rupture of a vein during labor. The time at which I saw the patient was some weeks after the labor, and suppuration was present. Incision showed pus and blood-clot contents.

As to treatment in the presence of rupture during labor unless there were evidence of great hæmorrhage, I would favor the old plan of compression, etc., rather than incision and ligation of the bleeding veins. Ligation would probably control the bleeding, but it seems to me that the old teaching, of compression, rest and waiting, within reasonable limits, of course, is the better. If suppuration occurs, open and treat as a labial abscess. There is then less danger from sepsis and possibly, also, from hæmorrhage.

The question which Dr. Krusen has brought up in presentation of the dermoid cyst is an important one. Some years ago this form of tumor was considered rare, but after abdominal and pelvic operations were performed more frequently it was found that dermoid elements were not uncommon. That three consecutive cases of this character

were met with in the practice of one physician shows that it is not an uncommon disease.

The removal of the dermoid tumor without spilling the contents into the abdominal and pelvic cavities is of practical interest. It used to be considered a very dangerous thing to rupture a dermoid cyst during operation, because it was thought the contents were more irritating than were the contents of ordinary ovarian tumors. My early experience led me to doubt this. While it is advisable to avoid soiling

the tissues involved it is often impossible to do so, and I have on some occasions ruptured a dermoid as well as an ordinary ovarian tumor during operation, spilling the fluid into the peritoneal cavity without harm. This has convinced me that rupture of the cyst is of little moment if proper care is taken to cleanse the parts by irrigation or sponging before closing the incision.

My first case of dermoid tumor, operated upon probably twenty years ago, was a girl twenty-two years of age. She was suffering from peritonitis from some injury. Operation did not prevent her death,