ages, while in these improved buildings it is between 6 and 7, according to the agent's figures. In old style tenements, of about the same size in New York, the Board of Health figures show a corresponding rate of

II.4.

It appears from the death records in these Brooklyn buildings that there is no instance in which a contagious disease has been communicated to apartments adjoining, or above or below. These diseases, of course, enter there, as into the best-guarded private houses, but the outside staircase has so far provided all necessary isolation; while in ordinary houses used by several families, the stairway hall is as natural a vehicle for the communication of disease as for that of sound, smells or flames.

Cholera infantum, that product of summer heat, may be lessened in these buildings in so far as abundance of air, as fresh as it is to be had in the city, is furnished by through ventilation from front to rear in every apartment. But fresh air is not to be had in the city after days of high temperature, and the effects of the hot weather on infants is even greater than the statistics of deaths show. For these ratios are made upon the basis of winter population, while in our largest cities thousands of little children, whose parents are well-to-do, spend every summer out of town. Here in Brooklyn the Children's Aid Society has provided for poor children a Seaside Home at Coney Island, and near by it is a similar Home of the New York Society. In these Homes children are kept a week or longer, and it is the belief of those in charge of the Brooklyn Home that any cases of simple diarrhoea sent there can be cured in the sea air, even if life might not have been prolonged in the city more than a very few days. Here it would be interesting to follow these cases back to their homes in the city and see whether the primary good results are maintained permanently.

In every direction there is need of more accurate statistics concerning present conditions and the results of experiments in remedies. It seems to me that in every large city an account should be kept with each street, each block, each house. Its population needs to be accurately known, and it might be charged, as in a ledger account, with its deaths. Such figures may seem dry to thousands of people who ought to be interested, but they mark the distance advanced and point the forward road.

The death-rate of all our cities ought to be reduced five in the thousand from present figures, and at no distant day. In a city the size of Brooklyn that would mean four thousand lives saved annually. Among the directions in which this saving will be made those that pertain to the dwellings of the people and the care of little children seem to me likely to be among the most prominent.

A CASE OF OVARIAN CYSTOMA WITH TWISTED PEDICLE.

-OPERATION: RECOVERY.

BY GEORGE R. FOWLER, M. D.,

Surgeon to St. Mary's Hospital and the Methodist Episcopal Hospital.

Mrs. J., aged thirty-five, colored, was brought to the M. E. Hospital with the following history: She had always supposed herself to be in perfect health; menstruation normal; married eight years ago; no children. Seven years ago, while three months pregnant, she fell from a step-ladder, striking upon her abdomen; on the following day she aborted. Since that time she has noticed, at times, a peculiar sensation in the right iliac region. Three years ago she first noticed, after a hard day's work at the wash-tub, pain in the right iliac region, followed by some distension, which subsided after resting for some time in the recumbent position, These attacks recurred at intervals, but always

seemed to follow work at the wash-tub.

Three days before her admission she suffered an attack in the usual manner, but no relief followed a night's rest in bed. On the contrary, the swelling of the abdomen increased, as well as the pain. She was seen in consultation by Dr. H. B. Delatour with Dr. Wm. E. Stratton, when she presented the appearances of collapse, with quick, rapid, and feeble pulse; temperature 101°. She was taken to the hospital in the ambulance, and I saw her an hour later. She presented a tensely distended abdomen, with dulness everywhere except in the flanks; a distinct wave of fluctuation could be elicited upon percussion. She persistently denied having any enlargement of the abdomen except upon the occasions above referred to. It was evident, however, that a collection of fluid contained in a sac existed, and a diagnosis of ovarian cystoma with twisted pedicle, and sudden increase in the fluid contents thereof, was made. She was ordered to the operating-theatre, and the abdomen was opened in the median line. The tumor at once presented itself in the incision, and the diagnosis verified. The sac was almost black; it was cautiously punctured by the aspirator-needle and a sufficient amount of fluid withdrawn to relieve the tension; after which it was emptied by a large Emmet's trocar, over a gallon of fluid being obtained. Upon drawing upon the sac it was found to be absolutely free from adhesions, and when brought outside the abdominal cavity. it was demonstrated that the tumor had rotated upon the pedicle to the extent of one and a quarter revolutions. The twist had taken place from right to left. After untwisting the pedicle, the latter was ligated.

by the Staffordshire knot, the tumor removed, and the stump of the pedicle returned into the abdominal cavity. The patient made an entirely uneventful recovery, and at the end of the third week was allowed to sit up; in the fourth week she was discharged from the hospital cured.

The sac, upon examination, proved to be gangrenous, and ulceration had already commenced at a point upon the interior of the sac, at its posterior aspect.

A point of interest in the case is the probable cause of the rotation of the tumor upon the axis of the pedicle, and the direction of the twist. In all probability her occupation-that of a washerwoman-had something to do with this. While at work, with her abdominal wall resting against the edge of the tub, crowding the former in an upward. direction while making the up-and-down movements peculiar to rubbing the pieces to be washed against the wash-board, she probably, by this combined pressure and upward crowding, rotated a small cyst upon the axis of its pedicle.

Lawson Tait asserts that the ovarian cystomata to which this accident most frequently occurs, spring from the right side, that the twist always occurs from left to right, and that this is a result of the passage of large masses of fecal matter from the rectum. But the rotation of this tumor in the opposite direction, together with the history, the attacks having only occurred in conjunction with or following the movements above referred to, have suggested to me that the rotation, in this instance at least, was due to the peculiar manual labor which the woman performed.

DANGERS FROM NECROSED TEETH.

BY WILLARD P. BEACH, M. D.

Mr. A. has been under my immediate observation for the past ten years, and his case illustrates very forcibly, at least one of the dangers of retaining necrosed teeth in their sockets.

About nine years ago the second bicuspid of the right upper jaw contained a cavity, which was filled with amalgam, and shortly afterwards commenced to ache severely. He insisted on having the filling removed and the nerve killed, which was done. A few months later the tooth died and blackened, and a sinus opened through the gingival mucous membrane in the region of the tooth's root. This state of affairs lasted about two years, when a series of small abscesses occurred

on the right pinna which lasted for about one month, and numbered ten or twelve in all. He recovered from the attack and was tolerably comfortable for a few months when the same experience was gone through with, but this seizure was more prolonged and severe. There were marked constitutional symptoms, and a large abscess made its appearance in the right temporal region. These attacks returned at intervals of a few weeks or months, for several years, each one being slightly more severe than the last, and finally involved the scalp of the right side. About this time a large abscess made its appearance on the knuckle of the little finger of the left hand, and the man commenced to show signs of marked reduction of health and strength.

I have inquired of several dentists as to whether they had ever known of a similar case, and they invariably answered in the negative.

I further noticed, that the vent in the mucous membrane closed, and it was shortly after such closure that the abscesses made their appearance. At last I decided to have the tooth extracted, which was done nearly a year ago, and since that time the patient has been in perfect health, which was an experience he had not known nearly all the time the dead tooth was in his head. The root of the tooth was very much softened and roughened, while the tooth socket and tissues surrounding it were quite sensitive to pressure.

To my mind, this was a case of septicemia, which I can readily conceive to be the result of pent-up pus in the neighborhood of the dead root. I would earnestly recommend the removal of all dead teeth, for while we all know that necrosed teeth may be retained indefi. nitely without causing trouble in many instances, on the other hand, one such case as the above is sufficient to demonstrate that there is always impending danger of either septicemia, pus in the Antrum of Highmore, necrosis of the alveolus, or numerous kindred affections, while a dead tooth is left in the jaw.

OBSTETRICS AND GYNECOLOGY.

BY E. S. MCKEE, M. D.
CINCINNATI.

The following is a brief report of what occurred in this department at the meeting of the American Medical Association, at Nashville :

Dr. Ely Van de Warker, Syracuse, N. Y., read a paper on "Stricture of the Urethra in Woman," in which he thought the frequency and seriousness of this condition of the female was not sufficiently appreciated. The most of the strictures he thought to be of the annular

variety, and situated near the meatus. He had no experience with electrolysis, but was of the opinion that it would only prove irritating to a sensitive urethra. The sound he considered utterly misleading, and was not an exploration of the parts. We should use those instruments which might be called those of precision, viz., the exploring bulbs.

Dr. Andrew F. Currier, of New York, spoke of the toxic form, and described a case occurring in his practice due to cantharides. Stricture in the male has been overestimated. Many cases are treated where

treatment is unnecessary.

Dr. George J. Engleman, of St. Louis, said that this frequency of stricture in woman was something new to him. He would ask the essayist was it not an inflammatory condition rather than a narrowing. Has not used electrolysis, but a mild, sedative current; the positive pole of the galvanic battery, will act as a sedative to the irritated nerve and will often accomplish what Dr. Vanderveer seeks by dilatation.

Dr. C. B. Reed, of Middleport, Ohio, had found a self-retaining catheter worn part of the time to be very valuable. He once had a violent case of peritonitis follow a dilatation of the urethra.

Dr. A. F. Currier, of New York, read from the title, "A New Operation for the Relief of Prolapsus of the Anterior Vaginal Wall." The Doctor thought that lesions of the anterior vaginal wall had not been given the importance they deserved. And this importance is an argument in favor of its treatment. Prolapse may occur outside of parturition. The operation described was an oval cross-shaped denudation, the edges of which being approximated dispelled the prolapse. He had made the operation three times, but the time elapsing, five months, was hardly sufficient to decide as to the permanency of the relief, but everything pointed that way. As for cicatrix, no one would know that an operation had been performed.

Dr. Ely Van de Warker, of Syracuse, N. Y., thought the operation one well devised to cure the trouble, but if he would offer any criticism, it would be that more denudation should be made in the lower part of the vagina. He had made a number of successful operations after Dr. Reamy's method which has for its essential feature the going deeply into the connective tissue and giving a strong support to the

sutures.

Dr. T. A. Reamy, of Cincinnati, remarked that it was very impor tant to go deeply. He uses silk sutures. Suppuration does not occur after using catgut. He uses this suture also, but it may give out too He leaves his sutures in two, and even three weeks.

soon.

Dr. A. W. Johnston, of Danville, Ky., thought ectropion of the bladder much like ectropion of the eyelids. Ophthalmologists used