Reviews and Notices of Books
277 was that the repeated tappings deprived the blood of some element, or elements, included in the infinite variety of albuminous substances found in ovarian cysts, the deficiency of which predisposed to coagulation of the blood. The author thought that no case of ovarian tumour should be tapped till previous abdominal section had shown that it could not be removed. He believed if this rule was followed the mortality might be reduced to less than 1 per cent. if cases were operated on early. As
... long as the clamp gave a mortality of 25 per cent. it was right to stave off by all possible means so fatal an operation as ovariotomy. Mr. LAWSON TAIT also read a paper on Two Cases of Hydatids of the Peritoneum successfully treated by abdominal section. In the first the operation was incomplete, because the hydatids had so matted the intestines together that the larger number could not be removed. All the -cysts were broken down, and a drainage-tube inserted into the pelvis from above. The patient's symptoms previous to the operation were very severe, but they rapidly disappeared. The patient completely recovered, and the hydatid masses had entirely gone when she left the hospital twenty-four days after operation. The second case was of a more simple kind, for the parasites were contained in a cyst in the lower . abdomen, which was completely emptied, and drained through the wound. The patient made an easy, rapid, and complete recovery.-A discussion followed in which Dr. MEDICINE has never wanted a " limbo" to which disorders that have been imperfectly studied could be conveniently consigned. During the first half of the eighteenth century scurvy occupied this border region. Physicians of that era, by collecting from each other and by individual additions, made up a very extraordinary number of scorbutic symptoms, so that at last they ascribed to this disease almost every distemper and frailty incident to the human body, and seemingly left no room for further invention. When, however, it became clearly understood that scurvy and scorbutic symptoms promptly yielded to the administration of small quantities of lemon-juice, the disease speedily lost its hold on the imagination of pathologists. Scrofula then assumed the dominant position it held till quite the middle of the present century. Not merely were all manifestations of hereditary syphilis classed as scrofulous, but rickets, favus, diabetes, gravel, gout, and even cancer, were referred to it. The advance of chemical science, and the discovery of uric acid in the blood of patients suffering from gout, opened a new field for speculation and hypothesis, so that at the present time gout may be considered as holding the debatable ground for vague generalisation and for all that is unknown and uncertain in pathology. To the lack of scientific limitation in the pathology of Scrofula, and to a cumbrous heritage of opposed opinions and diverse theories, Mr. Treves attributes the neglect that has of late years befallen the study of this disease ; indeed so great has been that neglect that the author may be considered as entering a new country, and describing for the first time its general aspect and territorial limits. The general Pathology of Scrofula is first discussed. The various views of the relationship of scrofula to tubercle are clearly enunciated, and the whole question elucidated with admirable conciseness. We doubt whether a more complete summary of the views of the different pathologists who have recently worked on the subject of tubercle can be found elsewhere. The conclusions arrived at by the author with regard to this part of his subject may be thus briefly summarised : 1. That the manifestations of scrofula are commonly associated with the appearance of tubercle. 2. That the form of tubercle met with in scrofula is elementary and immature. 3. That scrofula indicates merely a milder form or stage of tuberculosis, and that the processes are simply separated from one another by degree. The Nature of Tubercle is then treated of, and Mr. Treves strongly advocates the view that tubercle is merely a product of a peculiar form of inflammation, and not a neoplasm, and he brings forward some weighty evidence in favour of this theory. Presuming tubercle to be a neoplasm no other new growth is so intimately associated with inflammatory change; whilst its spontaneous curability is certainly more in favour of its inflammatory origin. In support of this view he quotes the experiments of Ziegler, in which tubercle was found in the inflammatory changes induced in animals, when two thin discs of glass, so cemented together that fine interstices were left between them, were inserted under the skin; on removal and examination of the discs perfect tubercle was found in the inflammatory exudations in these interstices. In the original and ingenious chapter on the Antagonism .