IN THE period preceding the advent of modern surgery, the fundamental conceptions of disease were based on a study of the dead, of pathologic tissue rather than of pathologic function. Disease processes were encountered in their terminal stages after nature had exhausted every effort to rid itself of the invader. Those were the days of enormous neoplasms, enormous ovarian cysts, and bizarre lesions. Fistulous communications between the biliary passages and other viscera were regarded as pathologic curiosities because of their extreme variety and unusual nature. The unrestricted wanderings of a gall-stone often embraced a wide itinerary. A review of the older books of pathology revealed many remarkable cases. Gall-stones have been vomited from the stomach, coughed up from the larger bronchi, and obtained through a stomach tube. Faber records the case of a woman who voided thirteen gallstones with the urine. Gall-stones have been impacted in the male urethra, and have been removed from the bladder by lithotomy and by lithotrity. The gallbladder has formed a fistula with the pregnant uterus, and stones have been passed from the vagina during labor. An ovarian cyst was found to contain bile, the result of a communication with the gall-bladder. Instances have been recorded of biliary fistulas connected with the pericardial cavity, and gallstones have been found in a pleural effusion. The vascular system has been invaded. Realdus Columbus, at necropsy, found three gall-stones in the portal vein of Ignatius Loyola, which had penetrated from the gall-bladder. Jacob Camenicenus relates the case of a man in whom the branches of the portal vein were entirely filled by calculi.Fistulas between the gall-bladder and some portion of the gastro-intestinal tract are relatively common, so that the passage of a gall-stone from the bowel has been regarded as nature's cure. Many of the so-called cures obtained atCarlsbad were examples of this form of spontaneous anastomosis. Unfortunately the cure is worse than the disease, and the mere presence of stones does not constitute our present conception of the pathologic condition. In view of the high incidence of gall-stones and gall-bladder disease, the occurrence of fistula must be regarded as an unusual complication. In a series of io,866 necropsies made by Roth, Schroeder, and Schloth, biliary fistula was found forty-three times: nineteen of the fistulas were between the gall-bladder and duodenum, and sixteen were between the gall-bladder and colon. Undoubtedly, there are many instances of the condition which pass unrecognized because of the absence of symptoms.

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SUMMARY A community‐based investigation of the nature, characteristics and evolution of speech and language delay in a sample of 3‐year‐olds is being carried out in Cambridgeshire. 1936 parents completed a preschool language checklist (PLC) to identify children at risk of language difficulties. Two hundred and seventy‐seven children at risk together with 148 controls completed a scries of preliminary face‐to‐face standard language tests to determine expressive, receptive and phonological skills. Concordance between the Cambridge Language and Speech Project (CLASP) identification and speech therapy involvement suggests that the overall (CLASP) screening procedure identified a number of children that current surveillance had missed and support the conclusion that the PLC may be a useful adjunct for child health care services as an aid in prioritising children for referral to speech therapy services. Children with scores of 1 to 3 at 36 months should be reviewed at 39 months, and those with 4 or more should be a high priority for referral. Preliminary examination of the impairment profile suggests that children with language impairments rather than pure speech impairments at 36 and 39 months are more likely to have a broader range of overall language‐related deficit. RÉSUMÉ Le ‘Cambridge Language and Speech Project’ (CLASP). Détection des difficultés de langage à 36 et 39 mois. Une recherche sur une population globale, sur la nature, les caractéristiques et l'évolution du retard de parole et de langage sur un échantillon ďenfants de 3 ans est actuellement menée dans le Cambridgeshire. 1936 parents remplirent une checkliste sur le langage préscolairc (PLC) en vue ďidentifier les enfants à risque de difficultés de langage. Des tests de langage standards en face à face furent pratiqués chez 277 enfants à risques et 148 contrôles pour une approche préliminaire. en vue de déterminer les capacités ďexpression, de compréhension et de phonologique. La concordance entre ľidentification par le CLASP et la pratique ďune rééducation orthophonique suggère que ľévaluation CLASP identifia nombre ďenfants que la surveillance habituelle avait négligés et conduit à penser que le PLC peut constituer une adjonction utile pour les services de PMI de façon à orienter en priorité certains enfants vers les services de rééducation orthophonique. Un examen préliminaire des profiles de troubles suggère que les enfants avec troubles du langage plutôt que de troubles isolés de parole à 36 et 39 mois sont plus exposés a des déficits ultérieurs sur tous les aspects de langage. ZUSAMMENFASSUNG Das Cambridge Sprach‐ and Sprech‐Projekt (CLASP):Feststellung von Sprachschwierigkeiten im Alter von 36 bis 39 Monaten. In Cambridgeshire wurde eine Untersuchung über Art, Charakteristika und Entstehung von Sprech‐und Sprachverzögerungen bei einer Gruppe von Dreijährigen durchgeführt. 1936 Eltern füllten einen Vorschul‐Sprachbogen (PLC) aus, um Risikokindcr für Sprachschwierigkeiten zu identifizieren. 277 Risikokinder und 148 Kontrollen rriachten eine Serie ...

IN CERTAIN portions of the alimentary canal the onward passage of ingesta is habitually delayed. This delay, having its obvious physiological purposes, is caused by a localized tonic-contraction of the encircling musculature of the gut; and is so correlated with segmenting and propulsive peristaltic movements that wherr the purpose of the