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rheumatism. The significant symptoms are not appre-ciated. In most cases there is a friction rub ; sometimesthere is effusion. After abdominal operations, especiallyin cases of carcinoma, myoma, large ovarian tumours,and pelvic inflammation, there are conditions favourable tothrombosis in the peripheral veins. The principal of theseis feebleness of the circulation, often the result of cardiacdegeneration. Pinard has called attention to the value ofthoracic symptoms in predicting the occurrence of phleg-masia dolens. He wrote : ’’ When during convalesence afterlabour there is a stitch in the side think of pulmonary- embolism, which is followed in two to eight days by phleg-masia dolens."2 Dr. Miller gives details of eight cases ofpulmonary embolism after such operations as myomectomy,hystero-myomectomy, ovariotomy, vaginal hysterectomy forcancer of the cervix, and perineorrhaphy. It is unnecessaryto describe any of these cases, as in the annotation referred

to above two cases of post-operative crural thrombosis arerelated in which there was also pulmonary embolism with its.characteristic symptoms. Indeed, one of those cases (Case 2)is now described by Dr. Miller. The treatment of crural

’thrombosis—rest in bed with the leg elevated-is the pro-phylaxis of pulmonary embolism. If symptoms of pul-monary embolism occur after labour or an operation thenecessity for rest and care is all the greater, lest further,and possibly fatal, embolism may ensue.

PHYSIOLOGICAL REST IN CERTAIN DISEASES OFTHE ALIMENTARY CANAL.

DR. A. E. MAYLARD, President of the Glasgow Patho-logical and Clinical Society, delivered the opening addressof the present session on Oct. 13th. He took for his subject16 The Value of Rest as affected by Operation in the Treat-ment of certain Diseases of the Alimentary Canal." Every-one will agree with Dr. Maylard’s opening remark that restis probably the best recuperative agent in effecting repairof tissue, but we do not think that everyone will be ready tooarry the doctrine of rest to the ultimate conclusions of Dr.

Maylard. As regards the stomach he considers that a gastro-jejunostomy should be performed-

1. In all cases manifesting any unduly prolonged vagueness in the- symptoms and in which no permanent good is obtained by ordinaryremedial measures.

2. In intractable cases of hyperchlorhydria.3. Iri all cases of gastric ulcer.4. In almost all cases of chronic gastric catarrh.5. In all inexplicable cases of gastric dilatation.6. In cases of pyloric obstruction.7. In cases of recurrent gastric haemorrhage from whatever cause.

His conclusions as to the remainder of the alimentary tractare as follows :-

1. The oesophagus is given rest by the performance of a gastrostomy.The gastric fistula is one which will close at any time when deemedadvisable that it should be allowed to do so.

2. The stomach is given rest by the performance of gastro-jejuno-stomy. The gastro-jejunal fistula subsequently contracts or remainsfreely open according to the patency of the pyloric orifice.

3. The colon is given rest by the temporary formation of an artificialanus in the right iliac or lumbar region (a caecal or right lumbar anus) ;and

4. The rectum is given rest by the establishment of a temporaryartificial anus in the left iliac or lumbar region (a sigmoid or left lumbaranus). In both these last instances the artificial orifice can be closedwhen considered necessary.

Dr. Mayl1’.rd has but a poor opinion of the stomach and

quotes the case reported by Schlatter to show that the

possession of a stomach is not vital to the carrying on of thegeneral human economy. This is, of course, no reason for

needlessly depriving a person of the use of his stomach.It cannot be doubted that under the usual dietetic andmedicinal treatment at least some cases of gastric ulcer

readily recover ; it is therefore hardly advisable to perform agastro-jejunostomy in every case of ulceration of the stomach.When, however, the employment of the ordinary treatmentof a gastric ulcer for a reasonable time has not been followed

2 Le Bulletin Médical, May 10th, 1895.

by a complete disappearance of the gastric symptoms theperformance of a gastro-jejunostomy is fully justified, for

the most exact statistics of gastric ulcer go to prove that thepercentage of cases which have a fatal ending is very large.

THE INTERNATIONAL CONGRESS OF HYGIENEAND DEMOGRAPHY.

THE Eleventh International Congress of Hygiene and

Demography will be held at Brussels from Sept. 2nd to

8th, 1903, under the patronage of His Majesty the

King of the Belgians. The honorary president is H.R.H.Prince Albert. The president is M. Beco, secretary generalof the Ministry of Agriculture, and the general secretary isDr. Felix Putzeys, professor in the faculty of medicine at theUniversity of Liege. The subscription is 25 francs but theexecutive committee reserves the right of refusing anydemand for admission as a member which does not seem toit to be justified. Ladies who accompany members of the

Congress but who have no medical or scientific diplomacannot be admitted as members, but on paying a subscriptionof 10 francs they will receive certain privileges of the fullmembers. The Congress is to be held in two divisions-

namely, (1) hygiene and (2) demog raphy. Division 1 willbe subdivided into the following sections : (a) bacteriology,microbiology, and parasitology as applied to hygiene ; (b)alimentary hygiene, including chemical and veterinaryscience as applied to hygiene ; (c) sanitary technology,including engineering and architecture as applied to

hygiene ; (d) industrial and professional hygiene; (e)hygiene of "transports en commun"-e.g., trains, troopships,emigrant ships, and the like ; (f) administrative hygiene,prophylaxis of infectious diseases, workmen’s dwellings, andinfantile hygiene ; and (g) colonial hygiene. A long list ofsubjects for discussion has been prepared. Application foradmission as a member and for information concerning themuseum which will be formed in connexion with the

Congress must be made to the general secretary, Dr. F.

Putzeys, Rue Forgeur 1, Liege. All applications must besent in on or before May lst, 1903.

THE BIRMINGHAM CONSULTATIVE MEDICALAND SURGICAL INSTITUTION.

THERE lies before us a 60-page pamphlet entitled the

"History of the Consultative Medical and Surgical Institu-tion, Birmingham." The circumstances of the inceptionand failure of this institution will be fresh in our readers’

memory, nor need we do more than to refer them to what we

said in our issue of May 20th, 1899, p. 1374 ; June 2nd. 1900,pp. 1595, 1633 ; and May 18th, 1901, p. 1415, to make clearour opinion of the whole affair. The pamphlet appearsto be a manifesto issued with the double purpose of ventingthe spleen of the defeated promotors against the medical pro-fession and of keeping up the pretence that the Institutionis not dead. It ends thus : " How long the selfish attitudeof the medical profession in Birmingham will stand in theway of the needs of the people and of the reform of the

out-patient department of our hospitals cannot be foretold.Only this is certain, that as soon as properly qualifiedmedical men can be found to undertake the work of theinstitution it will be started again. The patients are readyand waiting. Those who cooperated before will support themovement again and the success of those who will sooneror later be found willing to serve the institution should beas gratifying to themselves as their services will be valuableto their patients." This is rubbish, and rude rubbish at

that. In a letter to the editor of the Birmingham DailyPost which was published on May 18th, 1901, and whichwas signed by eight well-known medical men, it was statedthat the consultants and specialists in Birmingham agreeto see any person whose circumstances justify it for the