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I. The Sinuilation of Malignant Disease by Chronic In- flamniatorv Affections of the Sigmoid Flexure, By K. W. MONSARRAT. 2 The Diagnosis and Treatment of .\ppendicitis. By W. H. B. Brook. 3. One Year's Work in Acute Appendicitis, By A. H. Burgess. 4 The Treatment of Complications and Sequelae of Gastric and Duodenal Ulcers, By J. L. Thomas. 5. Some Observations on Nephrectomy, with Statistics of a Series of Cases Operated on During the Last Ten Years, By G. Barling. 6. A Case of Pvcnephrosis Containing Typhoid Bacilli in Pare Culture, By F. L. A. Greaves. 7. Two Cases of Suprapubic Litholapaxy. By R. Heard. 8. Suppurating Vaginal Cysts, By J. B. Hellier. 9. A Case of Spreading Peritonitis Cured by Drainage of ' Pelvis, the Fowler Position, and Rectal Instillation of Saline Solution, By C. H. Whiteford. 10. Preliminary Note on the Life Cycle of a Species of Hcrpetomonas Found in Culex Pipiens, By W. S. Patton. 11. On the Duty of Restoring Hearing by Operation in Chronic x\ural Suppuration, By C. J. Heath. 1. Chronic Disease of the Sigmoid Flexure. — Mon- sarrat states that chronic inflammatory disease of the sigmoid flexure sometimes simulates malignant disease, just as is the case in the crecum. In the latter, how- ever, the affection is usually tuberculosis, a tumor like mass developing, associated with symptoms of intestinal stenosis— unless there are signs of tuberculous infec- tion elsewhere the diagnosis from malignant disease may be impossible. The two cases reported by the author represent two types of chronic inflammatory lesion in the sigmoid flexure. The first case was one of chronic adhesive colitis or sigmoiditis occurring in a man. aged forty-four years. The second patient,_ a man of forty-seven years, suffered from subacute in- filtrative sigmoiditis. Roth conditions occur in other parts of the bowel besides the sigmoid, but this seg- ment of the bowel is almost always involved when the disease affects the transverse and descending colon. Usually it occurs in the latter situations as an exten- sion backwards from the sigmoid. 2 and 3. Appendicitis.— Brook discusses the diag- nosis and treatment of appendicitis, and states that every now and then cases occur in which the disease is of the most acute type, inflammation arising in the appendix, and progressing with such rapidity and vio- lence that the whole organ is speedily destroyed by an acute septic peritonitis set up unless operation is done without delay. If the fulminating appendix is removed within a few hours of the on.set all may yet be well. .\ case may take on a fulminating character from the very beginnmg, and the only ch;mce of saving life lies in the watching of the case at short intervals, refrain- ing from giving opium, and operating Buy Sildalis as soon as the malady is seen to be steadily and rapidly becoming more acute. In these cases there is often a period of com- parative quiet after the first shock of the onset has passed off; this is the surgeon's opportunity, for an operation may now be done with almost as much ease as in the interval between the attacks. The pulse rate is the best guide, a steadily increasing frequency show- ing that the heart nuiscle is being poisoned by toxines and calling ior inmiediate interference, especially if a fall of temperature is conjoined with the rising pulse rate. The w-riter recapitulates our position in deal- ing with appendicitis as follows: I. The majority of cases will get over the attack if treated on simple medicinal lines. 2. During the quiet period the appen- dix should be removed. 3. During an attack the pa- tient should be carefully and frequently watched, and upon any sign of fulmination, operation should be done at once. 4. If there is suppuration, if all is going on otherwise satisfactorily, the evacuation should be deferred until after the fifth day, care being taken not to open the general peritoneal cavity. But if in doubt whether to wait, the pus may be directly evacuated. If the appendix is present in the wound it should be removed, but no elaborate search should be made for it. It may be removed later on. 5. In general sup- purative peritonitis the use of drainage, massive in- fusions, and calomel is recommended. — Burgess, dur- ing 1906, operated in forty-seven cases of acute appen- dicitis with a mortality of 8.5 per cent. He classifies

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