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with the exception of a small residuum of undigested beef-tea. It measured 14 in. horizontally and 6in. in thevertical direction. Its mucous membrane was normal.The right kidney weighed 6oz. and the left 6 oz. Thekidneys were considerably congested ; the capsules strippedeasily. The pelvis was loaded with fat. The adrenals,ureters, and bladder were normal. The spleen was normal,but small. The liver weighed 50 oz.; it showed on sectionuniversal dilatation of the bile vessels of old standing. Thecommon duct was patent. There were twenty-sevenfacetted cholesterin calculi in the gall-bladder. Therewas a firm adhesion over the posterior aspect of the base ofthe right lower lobe. The heart weighed 16¼ oz. The peri-cardium contained a small quantity of blood-stained fluid.The anterior surface of the right ventricle was covered bya thick layer of fat. The right cavities were filled withsoft black clot. There was marked post-mortem stainingof the endocardium. Valves normal. A few raised patchesof early atheroma in the ascending aortic arch. The lungsshowed engorgement and œdema of their lower lobes;they were otherwise normal.

THE condition described below is one of very great rarity;indeed, it may be said to be a pathological curiosity of whichthere are few, if any, recorded instances. The remarkswhich are appended give the principal references to theliterature of the subject, and it will be noted that theseparated ovary has nearly always been found enlargedand diseased. Cases presenting similar features, towhich reference is made below, are defcribed by Mr.Knowsley Thornton1 and Professor Turner. 2 The formerfound a left dermoid cystic ovary completely twisted offfrom its pedicle and adherent to omentum on the rightside ; the latter found in a dissecting-room subject an ovarythe size of a fcetal head separated from its pedicle andadherent to the peritoneum. For the account of this caseand the remarks appended to it we are indebted to Dr.James Kerr and Mr. William Horrocks.

L. S-, a washerwoman aged fifty, was admitted onApril 26th, 1890, suffering from typical pernicious anaemiaof about four months’ duration. She was multiparous, butno menstrual history was elicited. Death occurred onMay 2nd.

Post-mortem notes.-The usual appearances after deathfrom pernicious anaemia ; fat of body very yellow; soft flesh;fatty degenerations ; " tabby cat striation of heart muscle.On examining the abdomen, an oval body was found lyingloose on the right side of Douglas’ pouch, with its long axisacross the pelvis. On removal it was seen to be lemoncoloured, in form ovoid, but flattened in front and behind,one end being truncated, the other bluntly pointed. It wascovered, except at one edge, by a membrane which wassmooth except where raised by hard underlying granules,which were especially numerous over the part devoid ofmembrane, and were there covered by a thin stratum offat. The loose body weighed 295 gr.; its greatest length was1 3/4 in., breadth 1ft in., and thickness 1 7/8 in. On section itwas seen to consist of fibrous tissue undergoing fatty de-generation, and having calcareous matter deposited eitherirregularly or in the walls of collapsed cavities in its in-terior. Small pieces of theloose body and of the left ovary weretaken, and sections cut. The section of the left ovary con-tained a large amount of fibrous tissue, showing extensivefatty degeneration and irregular deposits of calcareousmatter. Under a low power (Zeiss, oc. 2, obj. A) the structureof the loose body was almost exactly similar. Under a higherpower (Zeiss D) the separate cells of the loose body werehazy and indistinct, the whole field being dotted withunstained, highly refractive granules. These granuleswese irregularly distributed, but at parts lay along lineswhere vessels had apparently run, or along broad wavylines resembling the mark of a corpus luteum. In the leftovary the degeneration was less marked, and the structuresmore distinct. The uterus was lying in a normal position,the broad ligaments being similar on the two sides. The

1 Brit. Med. Jour., vol. ii. 1882. 2 Ed. Med. Jour., vol. vi. 1861.

Fallopian tube on the left side showed a normal fimbriatedmargin, with a small hydatid of Morgagni attached; onthe right side the tube was thicker near its outer end,which was without a fimbriated margin. The organ ofRosenmiiller was shown somewhat indistinctly on the right,but better on the left side ; fundus uteri symmetrical, itsjunction with the Fallopian tubes being similar on bothsides. The left ovary was lying in a normal position, its.mesentery being rather long, with a small attachment tothe ovary. On the right side there was no ovary, butbehind the Fallopian tube the oval body lay loose inDouglas’ pouch. The cervix uteri showed the anterior lipseparated by deep fissures from the posterior. There wasno scar or puckering on the uterine peritoneal surface; E6

slight prominence on the posterior surface of the uterus was.seen on section to be a small intramural fibroid, The uterusfrom peritoneal surface over fundus to cervix uteri measured2* in., the cavity measuring 2¼ in. vertically. On section itwas found symmetrical, and the orifices of both Fallopiantubes pervious. Near its outer end the right Fallopiantube was dilated, the cavity containing a little clear fluid ;its outer end was not pervious. The left Fallopian tubewas normal. The left ovary measured in greatest length19/16 in., breadth 1 1/8 in., and thickness in. ; its surface wascovered by a smooth membrane, through which hardgranules could be felt ; on section it was gritty to theknife, and numerous small cysts, with cretaceous matterthickly deposited in their walls, were cut across. Most ofthese were collapsed, but the largest, which measuredabout ¼ in. by §in., contained a thin serous fluid. There-were no signs of peritonitis, of either recent date or oldstanding.Rcmarks by Dr. KERR and Mr. HORROCKS.—The extreme

rarity of loose bodies in the abdomen merits a careful con-sideration of the nature of this body and the cause of its.detachment. There was no doubt that it was quite free,and the superficial appearance and microscopical examina.tion of the tissue suggested that it had undergone prolongedmaceration in the peritoneal fluid. Loose bodies in theabdominal cavity are usually detached appendices epiploicæor uterine fibroids. Sir Spencer Wells mentions a loose bodyfound by him during an operation on the abdomen; it con--sisted entirely of fat with cholesterin crystals. The loosebody here described showed definite, although fatty, fibrous.structures, and certainly was not a detached appendixepiploicæ. A detached myoma would show more distinctlyits muscular and fibrous nature ; it would be unusual for itto contain cysts. The presence of a small intramuralmyoma would favour the idea that the body was a detached,myoma, but against this is the fact that myomata are fre-quently single, and that on careful examination of theuterine peritoneum no scar was found. The conclusion thatthe body is ovarian rests on the following facts. The sym-metry of the uterus and Fallopian tubes shows that duringthe growth of the uterus there were two ovaries, so that theright ovary must have been formerly present, and, as thereis no trace of an atrophied organ, the loose body probablyrepresents this lost right ovary. The shape of the loosebody and the ovary is similar; the surface covering, probablyperitoneum, which is wantmg along one margin, has astrong resemblance to the marginal attachment of the normalovary. The fact that the left ovarian mesentery is slendermakes it possible that the delicate nature of theright ovarian mesentery predisposed to its detachment.The size of the loose body, although it bears a marked re-semblance in its relative proportions, is greater in all itsmeasurements than the left ovary, which may, however,have undergone further involution. The fact that the mem-brane covering the loose body is not thrown into folds, andthat there are no vascular connexions, shows that the bodymust have been larger than the left ovary when it wasattached, and this perhaps predisposed to its detachment.The macroscopic appearance of sections of the loose bodyand the left ovary are very similar, each showing collapsedcysts, with calcareous deposit in the walls. The absence ofany definite cells in the Graafian follicles is accounted forby the advanced fatty change which has taken place. Thecollapsed cysts seem to be degenerated Graafian follicles withcalcareous deposit in the surrounding stroma. Rokitansky3describes a similar appearance, The loose body resemblesthe left ovary in shape, proportions, position of attachment,and macroscopic and microscopic appearances; and it seems

3 Opera, New Syd. Soc., vol. ii., p. 337.

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"quite certain, therefore, that the loose body is the missingright ovary detached. A curious fact is that the body lay,perfectly loose, and excited no inflammation. Cases arerecorded where an ovary has become adherent to theomentum, ultimately losing all attachment to the broadligament and becoming greatly displaced.4 In a case men-tioned by Doran of operation for dermoid cyst of the leftovary, the right ovary was found attached only by a pedicle"as thin as a large nervp," and had formed no new adhe-,sions.5 In Sir Spencer Wells’ case the appendix was lyingquite free in the abdomen, so that a loose body of inert.nature may lie loose in the abdomen and be tolerated.Cases are known where the filling and emptying of therectum have caused twisting of the pedicle of left ovariantumours, but in this case it was the right ovary ; still itseems likely that the greater size of the right ovary madeit more liable to be caught, and that a slender mesenterysimilar to the left ovarian mesentery made a slight amount.of twisting sufficient to cut it off.

[NOTE -The case of calculous pyelitis treated in theCharing-cross Hospital, and a report of which was publishedin THE LANCET of Aug. 16th, was by an error stated ascured. We are asked to state that the patient had. whenlast seen, a lumbar sinus, discharging pus and urine.]

Notices of Books.Proceedings of the Neiv Yorlv Pathological Society for the

Year 1889. Printed for the Society. 1890.--The most note-

worthy feature of this volume, which comprises the

,description of many interesting pathological specimens, isthe Middleton-Goldsmith Lecture by Dr. Reginald Fitz.Its topic is Acute Pancreatitis, and it evinces a wide

.acquaintance with the literature of an obscure subject. Thepublication cannot fail to arouse much interest, since it isclearly shown that the affection may arise secondarily to acomparatively common disease - viz., gastro-duodenitis.The further results of such inflammation are very serious.

They involve suppuration and often gangrene of the organ.’One remarkable case is given where the gangrenous pan-creas was passed by the bowel, and the patient survived,(he was in good health seventeen years after that event).But, as a rule, of course such cases end in death. Haemorrhagealso may occur into the organ, and this may itself be a

precursor to the inflammation. The signs of the conditionmay simulate those of perforative peritonitis, irritant

,poisoning, or acute intestinal obstruction. Of especialinterest is the association with acute fat-necrosis in the’omentum and elsewhere. In fine, Dr. Fitz has writtena memoir which ’must serve as the basis of all subsequentstudy of pancreatitis.

Practical Chegnistry for Medical Students. By SAMUELRIDEAL, D.Sc. Lond. London : H. K. Lewis. 1890.-’There is one thing which serves to distinguish this littlework from the rest of its class-it is for the exclusive use ofthe student of medicine who intends to pass the exactordeal as at present required by the Conjoint Board. It is,in fact, built with a somewhat dangerous closeness uponthe hard-and-fast lines of the Synopsis, which exhibits inmore than one respect several peculiarities. So long as theSynopsis remains as it is, so long may the book with advan-tage be referred to. Nothing more can be claimed for thismethod of teaching the subject than that it is admirablyadapted for pass purposes. We notice the absence of ana-

lytical tables, which commonly find a more or less useful,place in most practical chemistry treatises.

The Electric Illuntination of the Bladder and Urethra as

4 THE LANCET, April 7th, 1883.5 Doran, Diseases of Ovaries, p.122.

a means of Diagnosis of Obscure Vesico-urethral Diseases.By E. HURRY FENWICK, F.R.C.S., Assistant Surgeon tothe London Hospital, and Surgeon to Out-patients to St.Peter’sHospital, &c. With 54 Illustrations. Second Edition.London: J. & A. Churchill. 1889.-In calling attentionto the second edition of this brochure, it is only necessaryto point out that the clinical portion of the work is practi-cally new, being both more extended and more personal tothe author than in the former edition. There are severalexcellent photogravures of clay models of bladders withvarious forms of polypus and tumour.Faith Cures; their History and Mystery. By AURELIUS

B. GLEDDON. London : Christian Commonwealth Publish-

ing Company, Limited. 1890.-We have here a veryfair discussion of what constitutes the curative powerexercised by faith. The author does not deny that sucha power exists or that it emanates from a divine source.His whole argument is directed to show that the meansrequired for its operation are present, as will and

emotion, in the mind of every sufferer, and only require tobe stimulated in order to place him in the most favour-able position for spontaneous recovery. The miracu-lous force at work is in fact the galvanising influenceof awakened hope and will, acting through nervous channelspreviously unemployed, and restoring normal activity totheir associated organs. A sketch is given of the influenceexerted by these wholesome energies from the earliest agestill the present day, and it is shown how the same process,under whatever authority applied, has ever been fruitful inrecoveries, wonderful, indeed, but not really supernatural.Fallacies, as is truly said, easily arise when subjectiveevidence is alone relied upon. The significance of previousor concurrent medical treatment as affecting the result isjustly insisted on. A chapter on scriptural references tothe use of means may be commended to faith healers in

general. The author’s advocacy of the combined use ofprayer, faith, and means proves him to be one whose beliefin a God is compatible with a true sense of personalresponsibility.

Orient Line Guide. Edited by W. J. LOFTIE, B A.,F.S.A. London: Sampson Low and Co.-The fourthedition of this useful book has reached us. It purportsto contain chapters for travellers by sea and by land, andno one who reads the interesting chapters will fail to be

inspired with a longing desire to enjoy in reality the variousdelights with which the volume charms the imagination ofthe reader. Home scenes are depicted with a master’shand, and eastern lands are brought so vividly beforethe mind by text and picture and chart as to make one

; fancy himself already a traveller on board one of the Orientline of steamships. The book is intended to bring information

, of the route and arrangements before intending passengers,. and this it does in the form of a connected narrative. It con-

tains accounts of countries and cities, descriptions of coastsand naval engagements, chapters on natural history and

i astronomy, and, what will interest most invalid readers, a, well-written article by Mr. James Struthers, M.B., oni Health at Sea, in which the author details the method ofi obtaining the full benefit of the voyage. The presentB edition has been somewhat amplified, and contains notes of. interest in regard to the Red Sea, and further particulars of

the Suez Canal. It will be found most useful as a meansof reference on board, and will afford a ready stimulus

- to flagging conversation during the protracted voyage.1 Beyond its practical utility, as a literary work it is of

high merit, and the engravings and various maps and

s charts are executed with great care and skill. The

- pages illustrating the flags of various nations and the

systems of signalling at sea will afford much interestingreading.