186

by the same mechanism as she hers in the skin. During thisact of copulation his position in relation to her so closelyresembles her own to her victim, and the male so differs in

appearance from the female that the first observer of the

act, de Geer, in the middle of the eighteenth century,described the male as a blood-sucking parasite of the

female. ____

TEARING OF THE VENA CAVA DURING REMOVALOF PYELONEPHROTIC KIDNEYS.

IN the Boston VTedical and Surgical Journal of Oct. 24th,1912, Dr. A. T. Cabot has reported two cases in which thevena cava was torn during operation. The means by whichthe accident was successfully treated are instructive. A

woman, aged 35 years, the mother of six children, hadsuffered for ten years from dull pain near the right costalborder. Six years ago she noticed a lump there, and it hadlately been increasing. Micturition was frequent and theurine has been cloudy for some years. Examination showed

a large elastic tumour extending from the right costal borderto the pelvic brim and across the middle line. With thecystoscope jets of cloudy urine were seen issuing fromthe right ureter. A large pyelonephrotic kidney was

removed. At its upper, inner, and posterior parts it

was very adherent. There were large veins in its

posterior part. These were clamped and separated fromthe capsule. It was found that one of these veins

was the collapsed vena cava, which had a rent in its wallwhere the renal vein had been separated. This was closed

by two silk stitches. The adhesion of the sac was so firm

that a considerable portion of peritoneum came away withit, leaving a gap beneath the liver which could not be

closed. Wicks were so placed as to prevent the escape ofbowel, and after the wound was closed a tight binder

was applied. Recovery was uneventful. In the secondcase a woman had an enlarged and tender right kidneyextending down to the level of the umbilicus and over to

the middle line. By a long incision from the last rib tothe outer border of the erector spinæ the tumour was

reached, a trocar was introduced, and about three

pints of thin pus escaped. This left a large, flabby,collapsed sac, having but little appearance of kidneysubstance. It seemed that its removal onght to be easy,and it shelled out without much difficulty until the innerposterior aspect was reached, where it was found firmlyadherent to the psoas muscle and the great vessels, makingseparation with the fingers difficult. This was done as

carefully as possible. Considerable oozing followed and wasstopped by packing. When the tumour was finally freedwith difficulty and lifted into the wound what appeared tobe the pedicle was found to contain only fatty tissue, andwas tied and separated, and the kidney was lifted out. On

removing the packing extensive venous haemorrhage camefrom the depth of the wound. This was found to come from

a couple of small openings in the side of the vena cava,

apparently where the renal veins had been torn across

in removing the tumour. These were clamped, and anattempt was made to suture the opening in the depthof the wound, but the patient’s condition made this

impossible. Clamps were therefore placed on the vena

cava. When they were in position so as to control the

hæmorrhage they included’ about half of the vessel. Thewound was closed and a large drainage-wick was passeddown to the clamps. A large dressing was applied so as toprotect the handles of the clamps from pressure. After the

operation the patient was very exsanguine and was givensaline injections. She slowly recovered. After a week the

clamps were removed. Examination of the specimen showed igreat dilatation of the pelvis and calyces, with no evidence ofa ureteral opening. But little kidney substance was left.

The sac was lined with granulation tissue which yielded apure culture of the colon bacillus. In the first case the

condition of the kidney seemed to be the result of a,

calculus ; in the second, of mobility associated with

infection by the colon bacillus. The difficulty of shellingout pyelonephrotic kidneys is illustrated by what happenedin both cases. The occurrences point to the advan-

tage of operating in two stages-opening and drainingbefore proceeding to removal. The subsidence of the

inflammation after drainage causes great shrinking of thetumour and some loosening of adhesions. In operating onthe right kidney there is greater danger of injuring the venacava than in operating on the left. The ease with whichthe vena cava was sutured in the first case is noteworthy.The patient’s abdominal wall was thin and the parts couldreadily be brought into view. The opposite condition existedin the second case and prevented suture. However, withthe clamps including a large part of the vessel, naturesucceeded in forming a cicatrix which held when they were.removed.

THE SECOND INTERNATIONAL CONGRESS OFLIFE-SAVING AND PREVENTION OF

ACCIDENTS.

! IN 1908 the First International Congress for Life SavingWork was held at Frankfort, and after the Congress it wasdecided to continue the work as a permanent institution.Accordingly it has been arranged to hold the second Congressthis year during the second week of September in Vienna.The organising committee, which began its work last June,decided to extend the scope of the Congress by adding the-Prevention of Accidents to Life Saving Work as an object ofstudy. In connexion with this Congress a permanent inter-national committee office is to be established as a centraldepot or inquiry office for all matters connected with

these subjects. The Congress will be under the patronageof His Imperial Highness the Archduke Leopold Salvator.

All speakers will be permitted to address the meeting in theirnative language, but motions and papers must be translatedinto German or French before being handed in. The

I following sections will be held : (1) Medical and SurgicalFirst Aid in Accidents ; (2) Training of Non-professionals inFirst Aid ; (3) Life-saving and Ambulance Work in Townand in the Open Country ; (4) In Land Traffic ; (5) At Seaand on Inland and Coast Waters ; (6) In Mines and SimilarWorks; (7) Among Firemen; (8) On Mountains; (9) Ambu-lance Work and Sport; and (10) the Prevention of Accidentsin General, among Workmen, and in Regard to Public Traffic.Notice of intention to read papers must be given before.March 1st to the General Secretary, Congress Office,.1 Radetzkystrasse, Vienna III. Further particulars can behad on application to Mr. S. Osborn, F.R.C.S., Permanent,Secretary to the British Section of the Congress, ConstitutionalClub, London, W. C.

LONDON (ROYAL FREE HOSPITAL) SCHOOL OF’MEDICINE FOR WOMEN (UNIVERSITY OF LONDON).-A-bequest has been received from the late Miss Mabel Sharman-Crawford to found a scholarship to bear her name.The scholarship, offered annually, of the value of iS.20 a yearfor four years, will be .awarded for the first time in July"1913, on the result of an examination in biology, chemistry"and physics. Other scholarships to be awarded in July,1913, are the Isabel Thorne Scholarship, value £30, and the’St. Dunstan’s Exhibition, value f’.60 a year for three or five’years. The Agnes Guthrie Bursary for Dental Students,.value £60, and the Mabel Webb Research Scholarship, value.E30 a year for one, two, or three ears, will be awarded in

September, 1913. The Dr. Edith Pec’iey-Phipson Post-Graduate Scholarship, of the value of .640, will be awarded inJune, 1913. Full particulars c:m be obtained from thesecretary of the Medical School, 8, Hunter-street, W.C.