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Les cartes, planches, tableaux, etc.. peuvent dtre filmte d des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seul ciichA, il est film* i partir de I'angie sup*rieur gauche, de gauche * droite. et de haut en bas, en prenant le nombre d'Images n*cessaire. Les diagrammes suivants illustrent la m*thode. 1 2 3 6 FEOM CANADA MEDICAL AND SURGICAL JOURN liNAL. A RETROSPECT OF SURGERY. September, 1881-D^mber, 1885 PREPARED BT y FRANCIS J<- SHEPHERD, M D Surgeon to .he M.ntro.1 Gene,., Ho^piw , P„,e.,,„, of Anlton., .nd Leolnrer on Opemtive Surgery, MeGill Unive^ly! *^ MONTREAL : Gf^ZETTir, j.^^^^.^.^^^ COMl-AJSTY. 1886. 1 ] INDEX. Abrlninen, Bullet wound of '"'^^ Ahdomiiml Section in acute iieritoiiitis 23.5 ., ,„ in perforative " 972 Abscess, i reatuient of t'old .~r,j 1 " „ of Hill ....'■..'.'. 251 Acne Ilosiio('a qq Aloixecia Prematura ..'."" ic? Amputation ' "" ]2^ '"'"'VV'*'"®^" iietiiod ...'..'. 88 ,, at Hip-joint ]9o in soiiile giingrene if? Aniosthctics jr^i ". „f'l'ni"i'itered by rectuiu-- lil3 Aneurism, Treutmout of, by Esiuarch'^ bandage " nr Antiseptics . {o " fompuisory....' ."!:;:;;;;; 10 New 85. 118, 119, 131. 162 I'o-tab'.e ''32 28rt Anus, Fissure of ' "^ " Prolapseof '!!!','.'.'.' ." ai Coiunuiaory Antiseptics ifi Condylomata i=j tontraction of Fingers 57 torrosive Sul.li.aate, Toxic effects of '. 244 C, ,,, , , fi-" ill! antiseptic. 28(1 ^'oup, Iracheotouiy in , ais Deformities of bodv in girlhood m JJigi/;il divulsion of" Stomach 'M exploration of Hlnddor "7] Kcdsi 182 Bladder, Stone in 24 9() ;| Partial uxc ision of .' !.".!,"." ' 32 ^, Digital exploration of .' 71 Puncture of oqi Bone, Transplantation of ' " ' a Boncsetting ' 07 Boro^lyoeride '.'.'.'.'.'.'." 85 n.nLu „ . 'n Ringworm of the Scalp 227 Bronchoceles, Treatment of m ■ouboes, Abortive treatment of . " si Treatmontof ;.■; iS? T> 11 , by Pressure.... 1Q7 Bullet-wounds of Abdomen 238 CfBcum, Excision of 215 Capillary puncture of Urinary isiadder 'm Carbolic Acid. Injection of, for Car- ^ , bunclo ufi Carbolic Acid for Buboes " " «? Carbuncle, Treatment by injectionsof oarboho acid Kfi Calculi, Strange Urinary ....;.'.' 00 Cardiac Orihce of' Stomach, Forcible n iL dilatation of iqir Catheter-Fever 17? j>ophalocelo, Treatment of .' y&i Cerebral Tumors. Excision of lie Chancre, Varieties of ' ' ■ ' *^S chote"!?!"''.::"-.- -"^'M Chorsprobin in Kingworm ....'.'." m Uub-foot, Recent operations for cure of 35 . Treatment of iiq Cocaine in Surgery it? Colectomy.... ..: ^g coiotomy., : ..:..;;;:;::;•• 213 with delayed opening of the „ . bowel in diseaiie of Rnotuniii exploration of Hlnddor ocation of Shoulder ](,] ,, of KIbow 151 iJiipuytren's contraction of fingers. 57, 252 Elbow, Dislocation of 1-,, F^inr^ir '"^' *,'"'■ "9''te intiLssusception 278 J'-'rgot, Hypodermic injection of, in . I'rolapsus Ani c() iiry.sipelas of Face, treatment of '.'.'.'.'. 15,5 Iodoform in lyj^ .......ii ,1 Band — '• ■ er, administi ylate of Sodi fc/xcision of Kidney .' "^7 25 ijsmarch s Bandage for Aneurism. ... ^ ^ther. administration per rectum .... 193 Ethylate of Sodium in Nievus ... 985 '•■'-"■"n of Kidney [ 17 of Joints "21R i~/ in Children ...'.. 29 oi Bladder (partial) 39 of Gallbladder " ipT of Spleen 5 of Tongue ■". '. "j'c, of Pylorus " ' 00 of Sternum ." '." 122 .. Corebral Tumors 245 Ot Hi]) nan lixomphalos, Radical cure of . ! ! ! ." ." .' ', [ 179 Femur, Fracture of neck of iri Fingers, Contraction of ,S7 Fissure of Anus co Flat-foot .,2? Floating Kidney ".'■■■' 120 1 5.5 Foreign Bodies in Inte.stines . . ."" ' 238 Fractures of Patella 6.5" 161 Frostbite TrMtment by plaater-of-paris 159 of Femur iei 161 Gall-bladder, Extirpation of 121 Ganglion, Wrist ! 283 ^ Palmar ord Gastro-enterostoray 70 Gastrostomy Kt' 9RQ Genu Valgum, Osteotomy for . .'. .". . ' ^4 Germs and the Spray. m Glandular Inflammation, treatment of 116 Gonorrhoea, treatment of .... oa Gunshot Wounds i^ of Intestines.. '.'.'192, 228 Hernia, Radical cure of 103 279 i " w ''"P^i"m "^' ^y C'*'"'''di«ation 199 S;^lr,„^;-, ^<""«.tSd Truss in Infantilei.. 26' • -.IJ .Herniotomy aided by Laparotomy. . . 278 'O S IV INDEX. I'AQK I'AOK |.;„il.vlrrnliii(!nM,t(liseii8eot 280 ,,'"'"''' .... 53 lOiirlvilincnnMsiiniii'oiisesor U i'>iii,\ . . ■ • I Opium 111 MiiKiiy 195 :: ;l!!iir!r'.':!:::;:;:::::::: i I i:^ir;:r^!;Cr::^';;a^^^^ i^^ K.XCMioli 111' . 2HU lliiriloiiliiiiii'l'rcHliiii'iil of iJ;^ 1 yiliui:i'|i',Tr(iiiliininl (it. ..;.••.•.•••. • J •' " l).V lllClSlllll. -<)( << " l)y t'lii/tic preHsuro i:t'(8 liil'iiiilili' IiiKiiimil lloruia, Worsted _ 'I'ni-.- ill '-^]i liiKiiiiiiil llcniin Vy liiMuiiiiiiiili' Aiiciy, l.iKiituru ot, lor Milicliiviiiii iiiii'iirinn loiJ liituNtiiii;-, Siiiviry III'. ■■■•■■ '-<} llcudi'lioii (It 2, lOi, l>i " Oiicniliuiit oil ii*? \Viiiiii* 1)1' V ■ V!" " (iiiiiHlinl NVmiinl.H ot . .1!»'J, -ZS " liiiiiiiiviil lit' I'liii'iKii hiHYu'!' t'roiii -'*•* I 111 cHl i Mil I" III.'*! mot ion , ( iporutive treiit - , iiiniil 111 272, "2(0, Z7() Illlll.'<,-llHlTyililill,'ri'l^lltllieilt 111 iivs loijot'onii ill SiiiKi'i'.v o7 " in l''.ryKiiii:liif< l;!; " Kruiitioii ol' 2<« 26 2i) 28 157 261 JiiliilXi I'LvuIhIiiii of " ill ('liililri)ii " Si'iiifuloiis • " Kmm " Hip Piiiifri'ii.s «.'>'sts i.f, SurKiciil treat- muiii of ••-• Tf.', I'atelln, I'riirtiire of '«• If' IViil Dro.-.'iinK.s .... •••••. .•••,.••• f,^ I'dint'o'liliinl Spniiii, Din(?nosis ot. . ~^ I'lTituiiiti.^, .\i)i|iimiiiiil >L'cti(iii ill iniulii ^w IMiiisjiulu'iiif CiiiiMLTo 1»- I'ii.uyiiKtMl Tuljo •■■■•';■••• Pliisfcr-of-l'iiris, 'I'lCiiliiioiit ot triic- tiires Ijy ,•• • '<"''' I'oi.siiiiiii^ liy Ciiiriisive 8iil)liiim'<' used us II su^^'icl^l ilrt^ssiiit! 244 I'ulviiu-.Kxiisioii of ,Jg I'ri'limiiiMiy 'I'liichuotomy ■ IJ" " liiiriitmr ot liiiiKiiiil I'W I'riimiry Union, (;llu,^o» of fiiiluro m. . IV Proliip.-iis Alii tioati'il by hypuilcruiic _ injection of Kr^ot ',••■.;'■ ' Piostiite.npiMiitive'.trt'ntinentot hn- liirt?i'il '"2, iO* Massiigc of, for detention • 2fi5 I'rosliitic (Obstruction, Karly treiit- __ UUMlt of '^ I 1 UUMlt ot •••• :•• -'* I'soiis Abscess, New uietliodot treating WO I'nlmoiKiry Suit,'ery ^*- I'ylorus, Excision ot . 92 Kidney, K.\i!i«ioii ol ;,■■ \l " HiiiKcry of i4, 217 '• KJiMitiiiK 120, lo5 Knee, Mxciislli,is,Tre,umem,7.T ill V..,ricoeele ■ . Inicheotomy .'. . . V.lo ..-'i •• :>«! "•'•■I'tneMt of ;.. A lubeless ' "r ,, . Hiidnvil cine of ,. , (li'.ttm ll'ermo-nn.tery iV, .;.•.■■ .'. ^ '"'•^.■'Md V^nieoeele, Snl» nl'nne; h '"*• IVIiminarv... ]v, ,- • 'iK"t""-<- in. ''"mouH Tra..,,i,M.a,;;;n;;n^;nev;;'- ■•••■• 4 '"""•'""""^^"""- -•"""-'• ■'■■' 1.^ ot Mnsule lin I 11' . ^'''^^-"'i-fvoin;:L;.;er:.vjw;!^^^^^ f i A QUARTERLY mmmVT OP SIIRGKr, "ANUS J. suKPH^^^ji) ^^j j^ ,,,._ ^. DemonHfrator of Anatomy and J . , ' " ''"• «'' the Montreal Genera, hIX ''''''*^""^"' ^'-P'^intedfromty.-Canado Medical d: Sur mi. A QUARTERLY RETROSPECT Of SURGERY ---».... ...«!;, tTT'""' ""■■"»'■• »' "c^ K- " tl,e stomach, was 1„ ke.| „ " '" .. .""™'- '» '"■"ove canoe; Howe,..,, I>,„, c,,.,,, ,i, ™;; ^™"".'"l J.ca,„„f^„„„,„ 'kat a person ean cv.ntL '' i^' ''';r'^''^ «"^' ^--^ "«» «=so|J.n;..„s t„ the intesti,,.. ■ °'""'^'' "'"' ""''I'"! the "" "-O- -veil, an,, th^ : „, li 'rrH 'Tr''""-' "■^•'■^' ^-''d ;«^-'i°" «f the intest „e ha , 1 1 ■ "'"'• '""^ «"»- "f J" '-. a coU „f intestine .j St"" '™"'*'< V Ce.-n^. "fanguhated hornia, was r™„ e , ,"° »""'«'■"»»» as a 2-u.. or the oo,o,;was eixr /„:::'„ :;. r ''"'•"• ^ -"«na„t « '» !«t,ent recovered without leve " '"" ""^'anoes "■=.-„nd,t„o patient d " J ,, ',7""- "'^ -^ -« ^ in v»n..t.ng. In the thi,,! case . '""'"""" '" a Ht of ';"— • »' tk. transverse I', J.Tr"' """' ^' ' ''-' » 'ar«„ "" »i«moid Ue.oro. Pa.t o ' "f """"'''"'' '» a coil l( »«)«e-si,aped piece rf the n,",-^"""'"'" '"""«• a"d then a A d.™,a«o.t„be was inscl'd ;";;,"" ''"T' ""' "«'""-'• "'osM hy deep and superfi ai s, ° 'T"^ "' ""•' "'"'ou.en atrf -vas living ,,a|f a yea ^ , t ™" '"""" '■"™™'«J, '"Ss we,e nsed-CAvIt ^^ *^°f '■""""• ^""'''("ic Aess ! li! A still more remarkable case of resection of the intestme, which was f^eccc^sfnl, has been reported by Koeberh- of Stras- bur- (Gazette Hehdom.. 1881), and in this case the operation was^not done antiseptically. A yonn,^ lady, aged 22, had suffered frequently from colic, and in Ortober, 1880, symptoms ot m- testinal strangulation occurred twice in fifteen days. Smce then she had suffered from persister.t colic, which could hardly be subdued by hypodermic injections of morphia. Gastrotomy was performed on November 2Tth. Four strictures were found ui- volvin- si.K and u-half feet of small intestine, the slighest havmg a dianTeter of one-sixth of an inch, lie removed >^ix and a-half feet of intestine, and tied twelve vessels. Tne ligatures trom 'the two free ends of the intestine were tied together and attached to the fibrous tissue of the linea alba through a suture, which retained them in contact with the peritoneum at the mferior an-de of the abdominal incisioii. The ligatures of the mesentery were brought out at the inferior angle also, and were retanied, together Vith the sutures of the intestine, in a fixed position. The superior part of the wound was partially closed. Enter- otomy was performed on the third day ; the ligatures and sloughs separated on from the 12th to the 13th day ; the first alvine discharge took place on the 20th day. On the 2oth day, com- munication with the intestine was almost closed, and six weeks after the operation the external wound was also closed and healed. According to latest accounts the patient feels quite well, and suffers no gastric disturbance. The series of successful operations for Resection of the Stomach by Prof. Billroth and his assistant is perhaps the most remark- able advance which has of late been made in operative surgery, not even excepting the successful cases of excision of the kidney which are now not infrequently reported in the various medical journals. The fourth patient on whom Prof. Billroth performed the operation of resection of the stomach lived for several months, sufficiently long to establish the occasional advisability of under- taking this operation. An additional interest attaches itself to this pttient from the fact that an autopsy wa. obtained ( Wiener MedidimcheWochensr.hrlft, No. 22.) Dr. Zemann, who directed a d fi ir at no th( tio Th the post-mortera > ■ xd i-u *. i deposit, of canco, .JJZ^T^r ""'"'''' ''''''■" "»'-'■"- no one w„„W |,a,e ,„o,,,„| .^ ;,'''"''' "•■'!"'"' "> <»™, and removed from it. The ,vom., 1, ectimotro, l,a,I boon '™.l>lea, but ,,a„ takt ,: ' l: !"«7"/- a,„.,i,osti.o J'"«'-n of tbo ,„„,,„„,; ;"''■• '»»"■ At the point „f stomach there wa.s no stenor th « T'' "'""'"•" »'' "'e 'l"-o„,-h the orilice. 11,?™*'! T'' '"''" «-"^ ^"-e,I "-' h-dl, a sea,. co„h „ "r, Z ."if™' ''" •^" -»r«'3, so -eriy recommended for the e,,,! of 1 'T™,'?' ''^''^' "«■' f<»- to «me, been perfor,„ed S,J, ' i"""'"'-^' ''"'' «»" "'"o of Dofoit has i„e„,.red a : eat ?" f ' "7'""-" '-.eon organ for l,^pertropl,^. 0°f co ,,'0 1 ''"^ ''^ ''"""""'i '''<» ftl- It see,„s to be much m„ ■! "'"■"■'■'""" '"' ""■™0'=os*- "einss than in animalsT „I '"^7 ^'T"'' " '" '>™»n -'.thout bad ,-esults. The g!^, 11^ T" ^"''""""^ '■O'""™'! recent o,,eration as follows • " n,. p, • ,'""'""-'^'" -ioscribes a Ca^a di Salute, Milan, .>f:a,.eh 06.b ' r"' ^'"'^''"''"^' "' *" pat,ent suffering f,.„,„,,;,„da.ei;xi; i tr"'""^ °" " '™* """'«■■ of re|iared to deny — perhaps with a danger as great, or greater, than that it is intended to guard against,— and we nnist congratulate Dr. Zeller's dogs on having so well recovered trom it. But in ingenuity of suggestion and in boldness of performance, this operation of Dr. Zeller's cannot comjiare with that of Dr. Gluck (Berlin), for this gentleman hopes that, sooner or later, the complete removal of the bladder and ]>rostato — which he has can-ied out successfully in dogs — nay be introduced into -^lu-gory. [t may, says Dr. Gluck, be performed on men without opening the peritonemn, and the ureters should be fastened to th(> abdominal wall ; for in dogs, the sewing of them into the rectum has not well been borne, and the attachment of them to the cut urethra can scarcely be re- commended. We shall watch with interest for Dr. Gluck's account of the first operation of this kind performed u])on the human subject. We fear that not many even of our most brilliant surgeons will care much to perform it, and not many patients will care to submit to it when t!ie most favourable result Avhich can be hoped for has been explained *^^o them." — Beilagc Zum CentraV'httfar Chirw\git' ; (juoted in Pra.ftitio7U.'r,Jn]y,lSS'[. TranitpJantatlon of Boyie. — Dr. MacEwen, well known for the great success he lias had with his osteotomies, presented a paper to the Royal Society on a case in wliich he had successfully transplanted bone (Lancrt, May "28). The patient was a child 4 years of ago, who bad lost two-thirds of the shaft of the? humerus by necrosis fifteen months previously, and iu whom no osseous I'epair had occurred Tho j- u MacEwen proceeded first „ 1? ™ '"' ''''"'' ™<>l«3. Dr 'I- Po-'io.. of fte bone r;rM„:.f""™;" "'« ^^ '--3 i„ felse, and ti.en placed i; t ^C ^o 1 T """"'""'""I t"»w- of bone removed from otbe,' 1^0 .,7 ''■■'""'='"' "^ "'^'i*!- »' '-en „,„. „ ,,„„, „^^^ , ;" ,", Y;'-""'«l «iW^. The result h.^^ m...od firmly .0 tl,e uppe e " , 1 '"™r"' *^ ""'P«'™' "»1 3l.aft, and the bone ; o J ,X f, "', '"''" '">'■' »'' »"«!- The operations were perforj I ' ' ""''^^ '"- its fellot. J'l"3'3the first time this open! , """''■"= "■■^""""o-^- »e.e„„fie „»„„, The neces 1 fo ". I ! "•' P"*™"'" ''" => ■•»-, as nature generally is s^!m/l 7"'""°" '" '"'■"'"^"«'y he mterference of the s„r.eo„ is V "^"^ "'' ''»"" 'hat *a. before Dr. MacEwethVd:^? ■'!"'«'■ ^''•'»'™"«e M-Vamara. „f the West,„i„,t„ n^t, 'l ^"^ l''*"c, m; 1..S . mention of transplantin,, hone to , ' ,' "•'""'^ '° "^'^ «'"»' ■ « of a child. This he hal i'e do„T' ' '' '^""'""'^ " *» «e metatarsus in the transplantatbn ''""""' "f="' "™P- ^;-:.:rr!:rsr->'"ch.saidto,,a. "hen a man has had a compou^t " ^*'"""'' f'"' ^^■^'^. ™., °7'her long |,„„e, with cZ ,t :t' " "/ "^ '""»-™. tibia »»' a ,„ece of bone from a liv in 1 e °'™''-^'»™. *ejcut ■» 'he human subject. T™! ,t ? "-T" ""' "■■'-Piantit jelleus, and that the'patient ata 'invT ' u "'"'" "■•" ">»- any shortening. The transpIanM™ "T " '^^ ■"■"="'"' '"«'°"' hshed operatien in dentistry °* '"'"• '" "<"' an estab- Treatment of Hydnci, !U »»t and radical cu're of tTo^rrb'™'""* ^^ ^e treat- hefore the profession. AccorW ' """''""''"^ brought ."ery small percentage of the" '""" authorities, onlv a ;";- fi.il tohecure'd!:n'd!fte :r; r;"^'! '^ "'= -.i-'.W »n the whole gives the best esLk " 1 1! '"' ""^ ""' ">='hod 'he rislc of injection of iodine is " . '^T '''°'' "'^ ''''ere resorted to. Dr. Ogi,We W .| i t ,e T,' 'fV'"' ""'' <>» f J"lj, relates a case of hydr "t f t""'*^ ** *«™«' ' ^ ^^^ uiJ Willing to risk 8 the iodine treatment, cure was effected by the introduction of catf^ut drainaital, New York, of treating hydrocele in chil- dren is by scarifying the inside of the sac. In my hands this has not been at all successful. Mr. S. Osborn lately read before the Medical Society of London the notes of two cases of hydro- cele treated successfully by a single tapping, with tlie subsefjuent use of the galvano-suspension bandage. The first case was a hydrocele of the tunica vaginalis, which had been present for seven or eight years ; and the second was a case of double en- cysted hydrocele, present for six years — ages 70 and 63 respec- tively. The galvanism was believed not only to cause contraction of the naiscular fibres of the scrotum, but to impart a healthy action to the serous sac, aiding absorption. Mr. Osborn recom- mended a trial of this bandage in other diseases of the testicle, such as varicocele and neuralgia of the testis. Subcutaneom Ligature of Varix and Varicocele. — Mr. John Duncan of Edinburgh, in a lecture jjublished in the British Medical Journal^ July 9th, advocates the subcutaneous catgut ligature for the above affections. He holds that it is singularly .18 Ig 9 easy of application, free fmm .:.) -Thw ,3 certainly high ,„.ahc a„,l 11,, ^ """ '" "« ''Mulls, ^tautiated, surgeons ,vi l„ „' f'"'* T"'-"""-^ =«» bo sub- radical cure of- ™ri, or a^o ' ' 'T'"™ ""• "Pora.ion for heretofore. Most ..rgeor „,."";'' """' ''■"'^"'-'^'y than felt it unnecessary aniin ". ! ^ ' "' -'™-ole have and have contented themse v t h ? ir T '" "™"' »""«'«» Pens.o„, truss, cold douche ;;/"* 1»"'»"™ ones, such assus- eases i„ .hid, varicocele is',„„;e Z TT T '"''' " ">» few, and in these few it is „„, '1 '' " '"""' »«" ."o very ™a«ine," again, .< varicoc 1 ' t,„ n''^"'''" ''^''""''"""'•iaol -nse of weigh, and achin,, . ,; , "'"''^■'O"'" because „,■ the »"e„ds it, and in some ca^c h T "' "'""«'' ■""»'''a^« amed or very sensitive. But thi^'T ,"? '"' '° '•^■»"'» '"" I'""' of the harm that varicose l; '"' '' ""•■ "'^'^^t ^eeessfnl operation the d Zed f""" ^'"' ""0.- a tmues. To return to .Mr Z ! '"""'"' '=°"'^'''°" ""^'^ "on- fear I have rather strayed.' 111"™!' 7'™"""' '^"'" "I"'''' I " We veins are careMly so a.^ , "t ''T''"'^ '' "' f""""- : a"e.T and vas deferens and a „e » ^^ "'" ""»"=" fro" 'he ">7Sb at the point o^':; ^ ".';»™«' -■"' -tgut is thru^: onficc of emergence, male To ! ' , "''"'" '""oduced at the *in and fi^all/in-o,,;; ', . '7"'^''^'»-o„ *e veins ar,d the en* are then'firmlyT,-, „ ,' H h I?""', °'*'"'^-^- 'J''- 'wo gut will bear, and cut she ' CtrI7 ' "™ '' ^"™« ™'- "le scrotum, t„e knot is made en i '"" °? *' '""^'^ *'" of Pictures are covered with sljhetf fa : ' T'"-' ^■"' «>» J'te same manoeuvre is repeated .t I '' "'"' ™"«"on. '"'lo more. The effect iful f "' """"""^ "^ "n inch or a agulum between the lit^^ ture at fiTr, "' " '""'' '""P o'' co -on becomes perfect.; cZs ''^/f'^ '-"«■' ^uf which tc:::;i;!;:™'--.'e\tsrr advise an early operation, "l^ J^ ''"" 7^' but does not «en m advanced cases, but wll , r , '" "'"*"" ^"'■'«ng, 10 m^st. o , ,1 o„. Ho l,aa had cslit successful cases. ./„;;!:*,';"''''"■'■ r "'" ('"«'•"<" ^"'-"^ '"^^---.^ »f /f«<.. ......-..(» in a nic ,1' ■ f""';'l'.'"">«'>>J">7ii> .|..estion really uis 1 ,1. Ill, co,iclus,n„s aio as r„llo,vs : 1 . Mm,v .°i,f., , f -> ,,, „,,„„.,, „f .|.e ;„e,.,.„a, lateral ,i,a„,„,, , ■' , f ■:i;":, ;;:"!• ^^:::', t-^ -^ '- i-,„a, .uw,. •:; mccessfulcuseofc.tirin Z'nfV^ ^ "' ™" ''■"''"■■' ^"^ ^'' wluMT it ;. 7 ''-y""'^' '" "^'^^^ '"i^l^'le line, nnc ol tfio toti^^ue or perineum. He sajs the high oper-ition fj, *> 11 tinual pressure on the tube Ipi.lm,, ^i i ^ • . AT r^ ,^^ y^^"\'/<'>i' M'dwal JoKnUt Kelt IWWl k yir.Gohhv^Bml (Laneet, March t->th lHHl\ n ^ it i.s improper to introdueo H i '-* '"*'''' ''"'^ -rt«l i„to the t,.aoi,eal wound an., then c ".T,"'- miu-oved upon this amino,.,,. i- """""I'-"- l'<' liaH trachcotom/tuhos M r„l ■ , ■ " '""""'"'"" '"""■" ' ow method the greatest anxietv is felt lest the h,l, i i , , come blocked, and eonstant olJausin' ' „ i f ,, . ''' ^ '''', ' be earried out at fte<,„ent intervals ■ tl a t , f ' '" '" can scarcely he expelled „« .he "lot s J I r'",' """"■" their findin.r their wiv o„t , " , *"■' "'""'"'"' "' rr"f' ^^^^"-"::t:rie;;t:;;;:^ T', A ; m "^ ? ' ' '^"*^ ™'^''f' rational. gives his experience oftracheetomytithou t LIs r''"''' .he method ,„«,ested b. Dr. „. I Ma! i'' B ^ r'i ri: had two cases • n onr.), fi,,. .• ^ im^ _ i.ase.', , in cicli, the operation was i)erformprl oa „ liminary measure to f-ioih-Hh. fi .• I '^noimed as a pre- trachea was larger and moro V Tl' '""""^ """ «« not liable to b^e ,"d ! 1 ' " ""] '" "= "^•"" "l'°™«»". tation which is ofef c^ oZITh '"'""™'^" "^ "'" "■"- He is f„„ persuaded tirrt^^fthnrcrear tit ta If. 12 source of irritation, and that it h very desir-ihlp tn ^• it if f-ossil.le. ^ aeair.ible to dispense with uoMin- |„nl s, tho constant presence of in i,.«f..,. against the sides of the tr.cho-t Z.U "'^''^•' ""^'"t V^omn^ imtation, an,{ mi.^ht v M ' ''"'"""■•'' '^'^"'•^'^ ^'*' ■ , .111(1 nii;^r„t possibly ,i;ivc rise to erosion WUf n «n-d says with regard to the too early insert >n,!f- W sound, and worth makin. a note of I ' ?! '^^ tracheotomy may be useful is . 7. . ^'^"' ' ^"''''•^^'^ tionsai.o..t^heL:;:::r::::'^:-;;-^ ing i. needed, there would he «r a " im 1 i. 7""'"' • '^""" tVoin ovuiierant ...anulations .:^tey^^I Z T' I' '"^ l)v. Zellor of Berlin has it H.o "^ """^'"^ ^"" '^''^'•'y ^''^^"re. ■ate.,, .,.0,,,^ .,;:::;;,;:;;-:;;;' <™;p; -..o„,,, '!« I have ac,,„i,.e/!, rl,ip a r7':r "" ^ ''"-""^ fear of consecutive na,Towi„g of ti.e tracl.ea after'tl.J u,! „r! tl>e™,.ca«to,y, enters into the ,I„main „f l.vn e i, " r, .» rarely, h„ sayn, fear „f primary Lemorrha-o "d „ „„ " expenence.1 an, trouble frou, .eionJary Ik™! ,1 " T four cases there wa. complete al.seuce rf he™ h le « f iy legal «,»,.„«„, J^,„,. ^fZ f h„ ;','";: '°"''"'''">' ously advocating that a law si o^^ '"" """" "™""- 4 Ill Oi 18 «ct. lU -tatCH that to hi,, pemnal knowl.d,,, fatal case,, are .:nriHt»„tly „c,ii„.r„i,., which ciil.l l„. |„,.,v.,|,t,.il ,,y u,„ J'f .•v,.„ tiic simplest form, ol a,i.i,„,,tic,,. Now tlii,. i, »,,.;„„ l""K..aK0 .■.,,,1 Prol, N„,shai,„, „„„> look ,1„,,„,|, vorv ^-ree;; .poctaci,., ,„ a„ atmosphere icideicl ,|im hy carboli.cl ^.i-ay IH .experience ,iircly ha, lieen a very ,a,l one a„,l nur-o'v i^,' ■,"'■ "•",'"""' '"^ ■■" - ^-T i"W ol.I. i,i.lee.l. He oi,t-Li,ter' U..r 1111,1 io,i,t helieve we have at la,t reache, .footio,, i„ t e I t „e,„ ,. „,„,„„|,. s„,,|, ,„^i^|„,.„,^ ^^^^^^,^1 ^ *T .o aoy linrtier „„pi,,v,.,i,e,„., i„ t|,„ .,,.,„„„^.,„ „,, ;., 1.1 an eeetive l,ar wouiil i,e placed on all a,lva„,.e in ,.„.,; weiiM I„. .a ,.,,,,.„ ,„ „ie .le,.p„.i„„ and ,„a.i,.n,i„„ „? tl^ M..1.I .' A^e,,. Thi,s would be only the thin ed.-e of the wed-e -III til.; Stat., would make it co,„pi,l,o,-y to tn.t feve ,C ';•'' "'"• '■■ '■'" '"rii""'^ '-y .lie galvanic wire (under tte^^ly "' '■'""■■"''■' ilploy iuteiTOil urethrotomy in ..verv ease of .deet «.W"t .heni,elve, to my reader,. Prof Ni,„l,an " 1 1 ' ^ ^01. that the b ate ha, no right to enforce tho ,i,e of anv „,,■. . ' '• :":;"""'• '""• *-' ^ ><>„. a, the ,ur«eon ha,, to ar' te »"P".Hihil,,y, he mu,t be left free to choose which fol 7f 1": "7" " "''•■"' "-• I' i» a pity that the anti,,epti sZl w lel. h„, done so much for modem ,nr,.-ery ,1 1 be Lown "it.. .li»ropi,te by the over .eal of it, ad oclte,. Pro' Z, """" '^ '" " » '"-arto wonld commence hi,, l^.S^^Z V T m,l,l manner. There i, nothing very obiectionab I ,e '""'■wing more than the principle Involved. " ly „"„ 'n ;..-...... .0 treat an accidental ca,e or wo„n.., m,„t L 1™ iri will «""'•"', m'',"'"'"'^" I''"^'"' "»■• ---'"«- i,ti.i b It with a hngcr winch ha, not been disinfected : but after ; '"I ' '"• ('""■ "''»«'' P»'T"se a five per cent. .,olution of ear lie aei.l ,eem, to be the mo.,t convenient), the wound mu,t .0 ".oronghly protected, with an antiseptic drcsin^sTeh . o,,i„gmay con,i,t of carbolic jute or wadding, chloride of '...ic wiuMmg, or some other well known antisepti material " M 14 ai* i la^ he i. ,^mm,d, would «ave in his own city alone, fh>o« a tochous un.l dan;,..rous suppurative process. Prof Volk- «^«J.at t},r. recent International Me.Iieal Con;,M-ess i.. London, ^m^A a ,uost olo,uent a.l.l.vss on th. advar.ta.^es of antisep- noden. ,er.ua. N„...ry. Previous to its intro.luction the I t. c Mt, ,.13, ,„ „,.,i,,, ,,eces.lully a.^nnst the horrihle results ofd.rtand wound conta;^ion. which were so .omnv.n a lew years ho,. Nussbaum s v.,..ous advoeaey of n.upulso.^ antise,! t...sm. Iho Lnurt (An;;. J:i. I8MI) remarks, that '« our adnmat.onlorthe change eliected is only e,ualled by our horror at the previous condition." Eosi, of Hip Jowt /Jis.,..r.-Mv. .Jnl.n H. Mor-^an .n Vol. A. St. ( eorge's Hospital Reports, s:.ys that an.o.:^:' uy lar.^e lunnher ot patients that are brought to the llosprtal lor feick Children on account of huneness, the proportion in which •t IS due to morbus co.xte, is very considernhle. The lameness of morbus coxu. is , peculiar. The action of the joint itself is very limited, so that m progression there is a tendency for the pelvis 01 that side to move, and for the sacro-iliac articulation to take on the part of the more or less fixed hip-joint. Often in hip-joint disease the lameness is hardly perceptible after rest, and only becomes evment when the joint is over-worked and possibly ii^ flamed, and t Inis the lameness varies in the same patient under different conditions. In congenital dislocation of the hip it is otherwise ; the lameness is constant, and the head of the bone m Its new position freely movable. (In rheumatism, the lam- ness 18 more at first, and wears off after exercise.) The b..t method of examination is by laying the child naked on a couch and hrst grasping the sound limb a little below the knee, and flexing the leg .pou the thigh, bend the femur on the pelvis until he thigh touch. 1.0 .hdonien ; extension should then be made to the full ana n.e .a of .ne bone rotated in the acetabulum and made to perlonu .1. the movev. nts the joint is capable of I 16 This gives confidence to the patie.u and alTords a standard of co.n,,ar.son to tl,. su.-.n-on. Iftho s;u„e cour.e b. pursued with f.e atlrcted Inuh, .t ssU\ he found thai a point in reached ,t which turther .noveraent in son..- „i„„„t „„ti,e|, a o„„»k.,.a,„„, „f tl,o |,..„ce..,li„s. „,• t|,„ «,„,„;„, J;„ ;.'^ tl.Hatc i«..„,a„„,„„ ,^,,,,„, c.„„^„,,. ,,„,,, i„\„„.lj,! Aug, SUKUIiltV AT ME INTIiKNATIONAl. co.viMlliss. ^««„„ ,/^^atior.ol't},ekklnev; (/,) Stone with extensive ( ania"'e to vp...,i f; i J' v(; ocone, tic. of liorineplni i ' r ,.. ' "T T '"•" °'' '"' ""''"^■"■ niav be and ), ,« I. ',' , " """ '"""'^ «" "'a' «onc may be, and has been, ,!,aguosed in the !ain and of pus in ar incision ated from 3 inserted, J strength cd. Tiie ">he had a imount of •unctured ' tumour to consist calculus, iiid there ollapsed, ints eon- cated of alculous alciilous ) Stone, imj)Iica- it stone y ; also. in that it can be safely removed at this time by simple nephrotomy or by nephrectomy, with excellent results, compure.l with opera- tions undertaken at a later sta^^e. [The .litliculty of early dia-r. nos,s .s very ,reat, and Mr. John Duncan, surgeon to tl^ Edmburgh Infirmary, m the .Edlnhun^h Medi.ai Jnnn,al fov July, has ,,omted out that the r.eedle exploration is not always nifal ble as m a case of his, a necrosed transverse process exacts snnulated the feel of a calculus in ^he kidney. Mr Hark r daims to have been the first who successfully s.u.ded lor stone n the k.dney by passmg a needle through the loin to the kidney Itisabon a year since Mr. Menry Morris rea.l his paper .fn xVep ro-luhotomy before the Medical Society of Lond.'n I was the first who successfully extracted a stone fron, a kidney hy means o n.cjsion where there was no previous suppuration or •nustogu.de the operator, Peters, a German su geon, had P ev.ously, m a case of renal calculus, passed a tn.ca.' nd canula ,nto he k.dney, striking the stone. Being unwillin./ undertake the nsk of incising the kidney, he left the can. a .'^ ., elated the wou...l afterwards with tents, passed in a litho- had p enously also operated in a ease of .-cual calc,d..s, but the J one be.ng branched, and difficult of removal, the patient died He, previous to ope.-ating, sou.ided the stone thn.u-d, the loin by .neans of a needle, and so settled the diagnosis, w^ c e ^^v.m .-en^ calculus and t-ibc-cular disease. Mai^het^ in he 17th ce..ury,successfuhy removed a real calculus f.-om U eT^^.sh Consul, Ifobson. but the ope.-ation never found favo.^ ought. .ot to have so magisterially exploded the opc-ation," n^o k.dney has been frequently exposed for susr.ected sto, e and nearly eve.y time without fatal result. The L t^on s' ^t undertaken to relieve seve.. neui-algia, s. ^ d' ^ caused by .to..e. '1 he ..euralgia in every case was re ie ved and . son. r.r.na..ently._ One bc^ in Un/s Hospital wa:! '::^ cut fo stone .n the k.d,.ey, but forsto..e i.. the bladder also r.o stone be.ng found in either situatio,. H.. ,eeovere Z'Z "euralg.c pa.ns were temporarily relieved J l>i'l«7 »"^ •■M-iil [.,, „,,.,i,: , ''■ '''"""■•'" I"'<=a» ^™<-, 11,0 "-"«'- .!:i ; . a l:.:,::,:"r'^ - -^^"-""^ "■'* "™ '■■■-"■n,.s i,, all ";;"■"" '""""'■■■I «l.c K-i,l,a.v, -v.-a-,„.n. .a,: I., ' ':''r'':";;™''. "'"' ""■ ■■"'•'••'" », v,„v ,-._.Ti,i.. „, :„ f ■' "■""'""■'" '-' -fc»A„,,^ ,„ "- '■■'■■n.-ai..,,ar ] , : ''"'' "'"'••• '"•"■«!<•■■" -cti„n „f "1.■"■,^'ill.s a,v ,,lac„I ,,„1 "I'"""""" "lioi, thiM-sudaccsai,,! -' -••■-..ir ;::':!;i"'"r-'"-^^ I'Mui.l witl.in a„.l ,„.„■ tiK. w, "«-"m„lati„„ „r "■'";;"-« •". .>.-s„i,ic.ct. well i;;::;;' '""" '"^ ""-■■"- ■-•- -i::;;!::t::'F'-^ -lit Lucas each Ml'. IJurwcirs le stone liiiviijo' L' liad Ihilod to ucas' uuso, the '• The luiubar iltli, free fVom 'Ji' the papers, \<^''I a paiiiliil f the Kidney, i'<^'iiioval were I' alMloiiiiiial iiioval of the alls togeth' I- The precise iHes removal ' ^in rallon- "/'■idad'd to il important I section of CJaingee of « Jit'al, as a Lirfaces and '■ately and puliation of lese ends, , draina^L^e, [•est. Ifi.s orous eon- attril.nte;! ''■^s of the 1 h'ahle to ) the de- processes 21 in tl.o atonic a,„l ti.o .a,c,l, ovincM „,„,t o.pocially i„ «,, !„„„ ■ I"".,,,. sul«.a„eos i,. tl... „. I, ,.,,o,.i,U,, ,,, „' ""■'I, «l„cl, soparatea the sm-fac,. a,„l I,,,, I i-tl,,.,. , ' to .icoo,„,,„siti„,, Ti.o „„. ,, ,„,,t ,,,,,,,;'• " "•":''■'"•■>' ::::u;.::^:;:'!;::::;::r^'r-'"'^'-"''*' of any l,loo,Iy.flu!,l ,,1 id, i„ ,„i, r , 'T ''™"">P'«"ion ™i..aMo w„on eavites a-o opon:,:";;;!- .I^ZZ:!^, ^ ,. a«„ p., ,«te,, ,„oo„i„. f..„„ e„t ..Waco, soo,:!^ "i ^ „ M V T "'" "" ™' '•f-'«'l-nt otr„.,ion. iniM. Verneuil's paper on " Priniarv [I,.;, , " i .y mms( ir tii.it the patient is not (lie siili;,.,.f ^r '""'■'■"1 ■'>J8 fe'i-cat operations intent!,,,, wit , „„„. 1 e, . , t "^'" ""■™'; '"«'l-' ''^ «-' '»•,■«,.,,.,. Tl,e,.e wo,-,. ,.,'""■«"' •""• ""0 from ■« ™'- <"-,™,.o;::L:;tc:z:"rc^r;rrr^ , aiiu .111 tenam^ to support the v ews which M.- Po.. has so aby advocated vi-/ /i ^^^^^^viiicM i\ii. Uanigee having ia.la., r jl^^^^^^^ ti,„ soet.on by stating ti.at after •i it maintained so lie believed to los were rest, Hess variation not l)een sur- ged by many itistics of his *at operations oaled by first dressinf : I by directing the attention of surgeons to the importance . only of antisepticism. but of rest and support, and he possi i ity of preventing suppuration and the septic conditions it 'leads tf iMv^r^^t"^''^^^^'^'^^^"' "-'^•'-terism,notpr cpally to the u.se of antiseptics, which answer only .me of' the requirements of wound treacment, but to the accuri adaptat ^the wounded surfaces, the thorough drainage, the ml s^ft gauze used m dressings (gua.e makes a l^autiful splint b ^ elasticity and adaptability to surfaces and parts ,t is applied to , also to the careful bandaging over this gaLe splint a uniform and safe compression thus obtained The sprxv ^ somewliat truublesome, are imposing. H li'iffHt a (Iran OP Son fJ,„ n/r ^i -, ''■--•^ii.stinota.ivano ,::::; ''"V";' "'"^ ""■"'<' "- " "■'"'^ ' ''••'■^ tol>-ou place i„ «.,','■ """°'" "'" '""''^'"■ '':'"■ "W"'"» Mi c,-o,lit I "7"' "'"• -""«. n,„I ,avo ""^J«,t ,„„!„ „f ,„.,,„.„. ; "''^' ""•"■ "nmdiato remc-al was «;^ .-.•ovc.io, u„, howeJ 1 ;;?,?"■"« ^ "1 «-., ;iti, ""'"". ■• ov<.,. la ,.':'■"" "' ""^ ''^«»'"l l'""I..c«.,f t "™ ;" -".Oct variance w4 JV M i 'T' """' ''^ ™-" " «■"■*!"« "i.c,-ati„„ i,: c : .r"'"" ■" "^ '•"■""""" --■«■ ^;;';;;;v..s c,„„p,„e„,„,,„„^.„ „,. ^ « ;to« „,- Tcova,, ,aid ''■""■'"/ '-y n,oa„,, „r tl,o tl It r''"™'^'"=« °l'».p.'a-puWc '" """■'■ •"«»- tl.c no,i„e!i , y "'- 'S"'" ""0 tl'e true pelvis • '■""■« 11.0 cautery, t c : "'""' ■*™" I"-' I-'on. . I' -« '■•■•Mc l„ ,„.i„a,.^ i„„,, ™„ •''X"'' '-"Jo- tl,o patient "« "Aponence wa, cl,ie% ,i„,itl ,! i;f'f"™'"^'^'""'""-.sl>saieration." pm-pubic was an l)elvis ; fed. In 'thodical ' patient rgJi said Iren the 21- think le used 25 r^i". TJuohanan's roctati<'nIni. afnfl- ;"•"• -'-^=- -.a^-t :'^^, s I'Vi*:: ■""" '"■"'" -••" In cases of enlar-od prostrate ul. ' "*' '^••^''"' '^ ''"rved Hhifl; ;'"^-™;-vi.M,,:„,,;;::::;:;r;;;;'":;;^^^ '- to "SO the hiifc e„ „ct ,,„,,,, |„, „' r ' ■""' " "■IS WKi'mav "- «.o„o ti„. .1..,.,; : ;':. ''"''"■■•rj"' -' - »i,i„, ■„,, "'« "I'.Tat.o,,, a,„l „lt „.,, „„ " ' ^'''"'■'",""" »-l<»af„.,. '"o usole.,,, i„ the troalmonf . """"''"'" "'" ''"'"'awi Weat„,„„ster Hospital ahn ,.„„ *'f- A- -Pearco Go„h|, „,• «-' -l.ilo otho,. mot ,, ':■ ,:^',;';,7- '" 'vWohhep„i„to,,:,„ »'v of hloo, ,h,.„„,h pa,, ; ' ;r" ""m'"'^ "'"" "'" --.o».o„the,.ha::irc--:--"f III H Pmra the wl.olo ,li„cu,,,!o„, it ap,,,,,,,-. tl.at tl,o l,an.la.-o h „„t l'«o y t„ ,,„|,..r,„.,lc the oWcr ,„otl,o.l. „C t,-oatm,.„t Imf tl I ce,- t„, ca,c. wl,orc c„,„,oli,|atio„ l.an alroa,!, 'J, J^rchlon of Joint << M nii;«„ • i- ■>er-n,l on the f. b,,;:! t, ' ■-;'-'— "..->f.ioin.,s ati.i.'- •' On M "'o""«iiti"n9. 1. On tlio motlrod of oror. result, A„fi. . '''"""'■ ^i'^ I™ ajircat influonct.on tlie too lot -l-a,lvanta.cs of |„«t,,oni„« the operation -7oft,.e paper: ,. A,„„„tati,:'„f the i! ' r^fu:::,': Tr '''r f"' ""•'"'"" °-'- "' P»'i-°» .ffe in VoL tu.ero„,.,, of the internal orgaas, or those wl™ tW S.ea™ s not caiiso a ;lio Mood fH icaMo to all preparatory i(la<^o is not . I'lit that it enced. it is resorted to iho " Com. ^rmtforinn 3ns of joints od of oper- iy motlmd ed. As a I)cttor tho nco on the lore advis- e different nalysis of n. After , he said extensive of second- operation It^ofthe idiny an is a sum- icated in ng from disease igh tem- ;. In all ti of the •ed. 3. ■'-. «„,... ,i,c. ,„,ti„„. i,,„, cj,, ' r ' '" '''"''"'"'"'• ■■.«;- i'.^i.-o::,::^: ;:t'^r':,::r'r';'--*-' '•"•'••-•ivr.ur is so t., im„n vr. fl 11 ' , ''^'•tlior's present ■•■■« ' -s;:: , :i i,,''-r::::;',' -^■'■^ -f^-'^'"- ol..r-,i.l tliat c«i,i„ • ? "^"™'''''■ ™»« : lie also ,le. 1«" i'- '«. M viaX ; , r «"? ''P"'- ■'-■•■oun.linss of the to ,■ V. t..,™„ 1 ■ r' ^ '""'"''' ■■"'"' ""'"«'" it »i,o ''"■"> aic::: ,;:;:;; ■;,r:''''-"i "-" -.., ."'•'t with cotto,, wool a,,,! Z , , ""*'' ""^•'^''"8 *e «"• !">"- I..UI hec°„ .^.r. '"» P-'nortc,™. I„ ,he one case ■"-"■" no I? el ^a'lt :„ ""'''"';'-'^''"'™'P-')'»f'»-i «o»u,,K.rfeetly f e ,' „ ' " "n"™'"' '° '"-' '"" '^-'Planted (from «.e J ■ ^^':Z:™'' l;'"^™ ""«- a"'' PorLteum >"" '•» 'o«, in rrrr rir "1:7^ ™"^ » ""^ I't^ia. At the present time kH M.O., ,l„. ,„..,,,,,„ „,„,„;, ' '--■""' .1.0 lu,,i,.ln. "-on ..ut .,f.l,i,,.v..,|„., ,,.. ' r ^^ """ ''•■■"■ ■■ ''"'■""■'■■ oxoisio,,, iwsont.,! ;;) i,„,|„, ■""""'■"« ''"V"'. omv,l ,vi,|,„„t ■"■''■' -il^ occ.,,,,,, .;j !;■''■'";'"•?'"'■'■ "•■'» - ".".1. .s ■■'" ' - l-r,„.„, ,.,a,.|y ,.;i , , "'■; ""'™''' "-■»!' .0,1 '"W out ll„. „|i;,;t,.,l ,„,,, ,,. , : *" ' '", 'I'O ,™^ ,„,,||„„| „|.,.„i. i.'"--'-.- 'lo -.L, :J:{ I :.' "■'"■■^ ' ''"•■'" ■ooors,.t,.,„i„ """« "■ere ,:,„aMc a,„l .vcisi,,,, ' i' ? ,'"■'"■'''■" -i"'"' ='"oo- "■o.-«..»»,„ i,„,„,,„„| „,^".; ' ;'"';"..i< >„. si,. ,viina,„ '■0'"OV,I,.' H,.. i„i„t. ,.,„ '"• •'""^''.•■" "■■>V..,^- tl,.. |i,„|, I 'I; lno„j,,i,,uw,.i„ei,,io, ,:,:;:: r-' - -«." n' 'ion, M,„.t al„4., nnl ' ; ■. '''''"'«""• "^o a,„,,„la. J" tl'« «CCti,M, of 7)/.,,,^,,.^. . .„ H-tor. of G..i.f^.,„ ^ !;;^;'- ^---./•^././. P.,: . ^^^-^^ou of Jo;,,t,^ Arte d'J '" ''" '^WW./.. 7.//..,. .^'"'-« i'.«ananntiou of tL^ 2 ''" Vll''^ ^^^ ^^'««- •' ^^^ •> !*•• cent, solution of ciH.oL ' "^ " '"J"'^^'^^" ^^ '"^ •^"tl,.hIogistic foutmont (f vTt ""' ^''" •^■"'"^' '^^-l ''"'^t «!on, Moo.1 'ottingj.,,,14 •;™^-«;;'-^-Fossion, -^->- cisions, (Irainacro, scranin.r . '"'*" ^'' "" value. In- *,-"od, an,,M,:r:^:,r:fif """':"°"',' *"•• '^•^- "■"» .^IKcally after suppuration has set <\^o of hone ' ''""Ml MCllfo '»Ut JKldcd ■joint (liiiiiii- 11- ; furflicr, '■ed witlioiit •'IS much ns I'sh |M)iiih'(l Ik' .'iffcrnpf. 'hmI ofoiit- 1 was it not >r,sj,stoniic •iiit ;i(rec- ir \V^illia,n ii|Mihiti<)ii. linih hy ov^au as II Hio dial anijMita- lio uiaiii- ■^'i lay ill I'eatniont io a (lis- . Prof J'/Jf'im- a scro- uch an ous iii- un of a ' 1(1 that -S exten- M '. In- M to be 'i d, ex- 1 as set w '2if -'":::;:;]:7::;- , I'™„„™ visil.i,. „„lv altcM- •, tim,. ■ ■ '""l""'">- "' l"Wli '''■"'■ ^"yn, "I- N,'yy V„,|<, l„.ii,.ve.,l ,|, ,1 ir ,1 . . "■'"•' -"i.i i«'.ii.,„„.„.,i ..,,,; ,.„„,,:,' "'"";'""" ^"•-- iHcras,,,'^. ||„ ,„|v„,..„,.,, ,1, " • . '""" """''• "I'vcr l.o ^■•«-i»i..n „.„,, ,i,, ,,„„ „,,,,,„•'"'; ?' ;' "" '" ■■'"I.|.u,ati ,|,c.„ »i 1 ^'-'''^<-*' iii'»V('inciit of fl,,. 1-. 11 ■'"»" el..'»o a,ll,o»i„„» will, '„; ""■ '"V"'^ '"■" '" '"'-k '" "- -i'l'ii.'; ti,c ci, ,: ,, ' "'■'':'^- "■'";■'• ^"m'^.■'l ti„.,„ •-•'"■"I ly »o ™„|,|„ a ,;,... "' r^'' "" •■"""-i"'-'-'>-'ti"i., oan 1,0 "l'»"l«loa,„d]„,cl,„,avi„i,,. n "^"""'Si't it .atlio,- i„„ '■■'■' --i- tl,„J„i„, ■ \ ""' -:'"-• aci,l, an,l iC ,,at •"l>icoa.sfi„„|, „,„„„,, ,;'"•" '«■! ""--Imcd t«acco|,t .l,i. «'^i"t.. „l„aiu IK.sl,nl,. ""'-"'": ™l, more importaut even I'rum the .li.icissioii in l,„ti, s(.,.Hn„= ;, "■' "^t- 1-I»«l0 Joint, as „ cttin, of .,,„ G,:,'; '' ..'''V::;;^;;'';;-" ;'■ month after month in tl,,.;,. ». i -'"'"^ '^'''^*-<^se -t 1 ti,at until 1 ;::':;;; ;;;f"«"'« "t'-- <"■ Vcial troatuK.„t <,f j„i„t, ,; ' f " ''■>' '"«l"tab lb,- ti.e operation is to .nntilatc. in , ''' '" "'''' " '" '^''"'"' ■■"' im|.e.-fcction of our art." -'cknowlorlguiont of tl,o weroreadon the above .sul.ieet .'' ,5" .'""''''"<>'— f'-l-rs Childrc, ,y Dr. Bellon,, , M , '" 7" l™,' ..""f*-'™ of lloMry 1.'. liaker, M... (VaUcr j' e ,' M '" '"'° ""''• "'■■ of London. Dr. Bollen, vo,f , ■'^'■*"'- Harler, all viow. but did not a„ zrr',. tZ^'^TI^V' c- iiuie^eifit:' ,;;;! .;;x ::; ";' '""' -i ••""---^ piaster jacket gave the requirel" ™i • ,' "'"""' '^"'" "'" flamed srino, and mhd.t 1 '')^T -''''' '"' '" "'o !"■ '■»'■'».-, e.'en.ion.""li: ll ■ . i , '^'^Vtf- ^^'f »' or apparat,,., yet devised. Mr Baker ,ni 1 . °' "I"""' tare the use of the plaster ,1 • '" ^"■'"'"' •'"rva- to the spine, tha t „ .it; ."■" ^ ""-■ ' 'l""*' --t of.row^,g chiidro: ' a ,:;rr "'i""'' "'^' ^-''-'^ lately neces,sary to prevent tedef • ™""*o"cy "as al,s„. -..thedi4j ,::::;t;::?;za-:- 'e in Germanj n';;Jit be cured was cured by Oct. 1.1 881.) I' that English nd all thought it in the early "f excision of Hiht the anti- this reckless liat liosf)itaIs i"iiit disease treatment of itals for the I will be to 1 perforin an ble to cure ; nent of the ''/— PajMTS l>iseases of ; Bird, I\fr. Barker, all f'nll 8ayre's '"• ('oldin"- ■e might bo • I advanced ' caries the ' to the in- I'ortical or ' of spinal iii" curva- uired rest ;iie chests vas abso- I the first les wJiere 31 the disease had been ari-esited ind nM.n f ^ul.l,tmn(o„tl,c,.„K.tl,o,l.„ft,.c,h„. 1 ,T ""' •'' "'*'''■"' many «™ tl.o iao-kct was i til X" "'""«'" "'•■" i" "" use i„ rich.tj, i .^ . "'.y '"""'"i , tliat ,t was of --» "f tn,« s„L,l' oa H S, ;::^'"'™''"- f" --rtain I'l"" »f .•.■«( i., .1,0 l,„ri,„„e ""• "'"''•>■ ■^'»««'< "'0 oldor •■■•« from ri»I.. I,„t T "" "T""''"-'' '"■""'•• -> ™ '■■■""■ tl'o ,i,.t. It ,„ ,, I '''''■";' ''«■'-•''«' >"i«l.t i.c used ^'"-■'ion, a,„I cases i, ll; "ariot s '"•"''"'"" '" "'" '^'■"'•■'' f'i«l' 'leareo of ..araly.'s ,27 '""" '^^"'"•'•i'"'-"! with a„y ^•I'ild by the anas, „itl, . .et;^^;^'''' ''"•'''^''''''' ''»''"''=' '!■« -l™cato,l theaso of t o tcl ,, , "'° "" "'" """'•• ""^ -'»» ."- ... »e yot'deviso.,, a,;:/;;: ' , ,r":r.i;;;'f'»' ""™^ '- "^ "■ -•'>..« o.,t ti,e di,.eotio„s of ,i,e,ie:i :,:r """ •" '■■"■° 1-1 dealt almost o.cK, ""'I'""'- "• ""' ''---ion -Y^Io,vs|,eako,.swl.o,^:„, : ,,:, '''™ ?"-«^'"-' limited it. 'o be aaiood tl,at tl,o oa,li " " f"^"' "■'■•'"mo"t iicen,ed «.-o uoablo still to saltlH "',"•>'"•'"'" '^''""' >"" we 'iocido,! s,,i„al i,,.i atiof „ ' ,"' ""'. ''"" '■"'• »ympt„,as of co„t,.a-i„dica.i„,it. T V : "';r"™' ^''""''' ^" '^''"'-s ^^ ma,„,.,ty , ,.^, „„ ^^^„^^ offet-ed ;;;.; ;^ar r X ta»..s r,. N„r„n„„r„u.„.s (i.y s„s|„„,i„„ „, „t,,„,,;^ ;;,„^7»<'' ;■" '■v«i:::^:.:a™:;,: ;;:::;;;:;;; 1.W ol ll,„ ,,|„„.. \,„, „vo,- l.,.o„ |,r,„lu„.,|. 7. Tl,.m..|, l),- s „! 111 the (lisoussioii. " lis iv(.MT,.,I f,v ., >'r,"i "uc Ovh.v, .(■ I • , '"•"'•'' f'» a si.-Tsti-.n ,„:..l(> l,y Mr -.io..in.»„in.nK,i..,..::rt ;;f^|;;;;;;«"■7- doa„ o,.c wa. ,l,,nv„ „„.] ,, ,,,,., ,,„,,, „,„,,. „,„;;.;« K.wi,osi,ios 1),.. ,s,.,^,, ,,i,,„,„„| „,^. ,;,„.,,., I, .,„.|^. atoral cu,.vat,„-o „f „„ ,,,;„„, ,„„, „,.. „„ . „. ,„^,, • j^ lus ,„otI,„,l ,„ e.vt>.„,i„„. ,j„ .„.. .I,„k, l,owov.,. IS. coiiM not l.ut fool Ihtt,.!-,-,! .,nl,. I . " "'->'-i. I'l. .>.ijre . I,. okota.,an,oa,,»,,U,oatu,o,,tf„,.»|,i,,alc,,rvatu,.o. Af.o,. ■.o'l""S more „eo,l l,„ ,»!,, „i,l,''. ,,,, J,, T "' ''""'^»'™ I)u^;"t'i.1f';'" '"■""■ ^'-'''''--'''-.A.lol,- Ki.d,o,., of bo , od a ,urg,oal „„,„ul of (l.o l.la.l.lo,- ,v„ul,l (onuina.o fa^ II l)ut tliat m more i-oooiii (i„„,. i„„„ . lat.iiiy, rortio,,., of ,1,0 Waddl,a .;.,:'■' ,™''''""'''«'^' '^"'S" Iai«u, without fatal rosal ' ,■ V "" '?"'"" "' '"■"" loMiit. Ho iias uimio a mmiUcr of suooesa- 1 or otlierwise) kct could 1)0 iip- t, or horizontal, 'tiial istrai^liteii- lOii'^h Dr. .Sayi'o i plaster, IIkmh; ill might not do liirt without ro iiit hrou<:;ht out 1 made hy Mr l c'ondenniod N ih\ kSayre acceptance iitui'o. After I discussion Fischer, of lit suri;'eons iiate fatally, lively Iar_i;e unt of pro- of success- es results dc,,e„.l principally L;;3 ''""S"™". .•>•-! tl.at good Wad e.. ,„ay l,e l,,.,,,,, „^ .ro.JZ^Cm""'"^ '■"™" 1- iraumatic i„j„,ies of the hi,, ,'"""•« ''<'"'l'--- |- «vo,,ieula oi- „„ Mad :,":,„;: ' -"-<> od.es. 3; Gcnoral dilatation of tl,o bladdo, T ' ^"^'""^ >=»'«""• *»«--'»e l,as boon removed ^'''T,' '""> ™»» of tho abdominal, vesico-vaginal -.nd o^ f '*■"'''"• «■ Vesico- «ve ulcerations tl.-'at.g C;;:":," "»'»>- «■ Destruc- "■O'les of treatment. I faney tl t, • '"*''^"*-"« other I'toly to come into fashio, , ichllv f' Tf"" '" "»' ™'7 .n the list. The diagnosis'oT ," ^,.3'^ ' "'" ""«»-» "-"oned ::"r:tr--^^-^=c;d-^ the presence of a bougie for an infi '""'<• '»'opl'agus tolerates «>»^ ^^ougie should b? int led"; 1 T'' "'"■°°' "> «>"« ""O (ii) that the presence of a bo'i > '. T "^ "■" "°'WI,, -oof the esophagus and re„de"f t ""'""''™ "^ "™- bougies possible, as in the urehn le ,'""■'"'"««»'' °f larger »«amst starvation is ensured and „"''"''' ^""^<' *at a secutty 7"loA It is of great „ e in i T"" °' '"'"'^ •''"'"go "bout the mouth, nose, &o '" f°*™»'>oe of operations %*S:i~-::-^;,^/w,byc.K. opmon existed on the ,,„es i„„ f' " f ""'"'^ '''f'^«"oe „f In France, and on the C n nt t ,1:7, "T °' '^'l"'"- ^»ed vi., that the cha„c,-e ? Irf ill """''^ ™ "»«- the softso,-e. The former was ll "^ ,™ ''""« *'*'"'o' from by *e seeonda,.y sympt™ ^^' "^ '""o.- neve, followed O'^.sted on the same patient H?„ ' , '''' *" '"» «oo,-es co- '-.ive features of ,'he ^^ so.^rM,":" "fo '''''"'' "^ "- ' " ^^ fo appearance and ri;,!!;" "■""'■ '"J'' ''" "■"* "'""^ ""^'"^ °f Ae truth of *h i ' „:T\-, ,f."' ."■"■^ ™' '" England a stron-, school whci, , „1 not holil this v,ew, and its leader, Mr. Hutchinson ha sa,d some years ago that >■ .Inalisn, ,vas dea.l." t i™' CO iecte,, at the H,l,.,ital d„ Midi in Paris were oppose,! Mr Huteh,ns„„s pos,t,„„, which was this, that soft si e was due to an moculatron w,,h pus modified hj the presence of syphilis in tThelfT ™ " ""'''"■''■"•• '^"' «>° 'Poakr'wie: d rela ,on to sjphdis as measles did to scarlet fever. chmc hfTerence between the hard and the soft sore, and could, dou ^d whether ,t was always possible to recognize with certainty he oft sore from t e hard sore, though with characteristic sores the e was no difficulty. He believed that the soft sore was a sort appendage to syphd,s-an epiphenomenon. The soft sore was *.e to the moculafon of inflammatory secretions only, but modi- fied, ,n so,r,e way wh.ch he could not explain, by the coincident presence «1 syphilis in the individual who yielded the pus J was a sort of abortive innoculation. Soft chancre bore the same relation to syphilis that imperfect vaccination, which often caused mu .rntatton and even ulceration, bore to perfect vaccina ion rt b IT, r' "T r" "" "™ °"'^ » '™-"«'-^ »f^«i«". h.m and Dr. Drysdale was, so far as pr.acticc went, not great. behoved that excs.on under certain circumstances surpresses all subsequent ,nan,fes;ati„„s, and where it failed to do th the subsciucnt .hscase was milder and more slowly deve ope'd- Bnt. Med. Journal Heport, Sept. 17, 1881. 3.^ I of the truth of u strong school r. Hutchinson, d." Statistics )pposed to Mr. iore was due to e of syphilis in >eaker believed t bore the same believed in the ore, and could, e sore, but he with certainty icteristic sores Jore was a sort e soft sore was nly, but modi- :he coincident the pus. It bore the same I often caused t vaccination, orj affection, ence between not great. 'I of Chancre lurpresses all do this, the leveloped. — QUARTERLV RETROSPECT OP SURGKRY. Pl>L'r» .1.1, _ n «. . - - •" «ho M„,„.,, 00-.,., „',',.J';;;;;. '""""-■■" Xecmt Oi,„atmm for the Cure of Ch.l, f , , oases of t,,i„ „,recti„„ i„ ehildren, Z^^^ '^^T' treatment hy apparatus „, „|„,ter of „,!.!{ '""'""' •■"""'- found ,0 be successfnl if snffi^!^ ' ' ' " ""''"•'>' "'™j8 '0 H.e after ™ni,a,,l; " w ', mI' ""™ "^ "'" ^"■■*-> eause, afto,- ti,e tenotomy ind U "'"""■" " " "^^l'^" b"- p"sitio„, ehopatientisiv it: r':f° *"'■"''' ■" "■■»'- tervals. There iro «nmn .? ' ' '^ '*^^»' ''it long in- but ntt.0 bcu.:;: :;rirrt: 1'"?°'' '"'"■"'"■• ""^^^^a,; foot in position. In tLos^ t^a ,, „ t,™ ,""". '""'-'"a «« surgeons, espociaily Mr Davv!w t ''''''■'""« ""'"^ ^"">« aJvoeate excision of part^' J,',, ,,'"''."'''' ""'''""' '''""^™' i» ".at this is rather o e ^ I "''^ """""' "'™''™ cliil.Iron. Mr. Davy thinks 1 I " "'"""',' '" ''" '■'-»'■'«■' 'oin oessfully in those ci. In *T' ""'' ''"' "'""•'■""'l «"<=■ patients he has lost one oaso fl? .'•' "'""''•■"""•^ "" fourteen »o.-o treated without a tt:iern,T[;TT'", '" '"^ ™- a-'.v Icind. Tl,e majority r' ' ;," ,f ° "'"'""' '''^'-i' »f stales fibrous union vonid a, I! ,"''"">' ""'o". b"t he -lapse, Mr. Davy co:lrd J^' oi.",! '7 '■■^" ".?- »'■ out now removes a, vod-e-sh-nnln i . = '" ""''o"' bone, at first insisted strongly thir; 7 i .'.''" '"'''"' '''''■ "° a vice to render it sufiici " ' ^ *"''" ''" """I-" "-od in ;'0"0Jari„, theopor rfDr::tg»'-.«'^ «l"se,,ing to bo he uses a fine saw. instead of U,e ehis!?' ™ '"'""■"-■^ ^"^' tlie chrsel, to remove tlje wedge- X »hnH piece „f bone. aW(. J/,.,;..7„„,„ o,., 3] jgsn ti P<.s.t,o„ ,.l ,1,0 wc.,l;;,..sl,a|.c.,I pioce of tl,e tar. al a,',, t, ' ot tho skin IS hrst ivmovod tlicM flin «AfV . . ;M"J'tion from the .lo„,„„ l,v a 1 u 1 , 7 , ' ,■ '"" ,"""''' ""^ 'liivotor pa..o,l l,ot,voo , t ' t ' ■'""" " «™''""' surface of tho director -mhI ... " ^'''' ""•^^''' back splint. „iti, a f„„t': i . x,r: '■'"'""" "'■ ' and swung, so that it is rtop,nKlo„t. ' "P"" Mr. Bcnnott cxi,ibit«l a um„, a^a i 47 ,| iho y teno tomv ,ri L ' . SUC..SS. The operatio,. of o.eisionlrs S 1 ' " i"^; it' Sopt, 8th the wound ha,l a-aiu healed .,,'1 » tr"' ''^ allowed to walk with hoot S" i ^ ,'.: ."^ ^^ '"''!! .™ «~. the hones was „,. hut ::i:;; -:;--;; « "f ^«" '-ofited'hy oth: 'ri, : 't r^B: ';• cases the average duration of treatment was abont two ^oX t -t.ol,1881.) The sal arch to fx; re- oficnittMl oil. For its base uj.wiinls, base of the wed^^^e '•"I'ty. A portion :s are raiserl away f'e and a grooved and the hone, a t'f on the under s,f of hone slieed )f the astragalus, ' is then approxi- I ''y means of a up in gum and )nnd is left open •It tlic Clinieal cen the subject had performed [)ec. 17, LS81.) nth onlj partial don June .'50th, septic dressings healed e.\ce[.t a be discontinued 5kin, and a i'cw ich had to be 'ke down. By rov. Sth he was Hien exhibited .'he patient had ioii, and should e cases which » Mr. Davj's it two months. •37 The short time taken in effp r «'>loration in patients of the poor 'r"i' """' '"' '" '"^f"''*'^"* con- -e unable to purchase siabr ?"?''' """"^'^'"^ ^^^>-' ^^-y -« ease out of seventee t X '. r'' '^"^^ ''^ '"^ ^'-- .«^'t'- patients died T:r;;"'' '^['■'^ .'"o'-e scientific and conservative "^ 'T '' ^' ■^^'^""« ^o be u >« -metinies resorte!>---. ^"---'-", the patients b / , '" '^ '"'^ ->-Ieribl!y ^"''ofsi.vweekstotwo,„onti? f '^ "■"^' •"''"'"^ "t ^I.e ^-^;venintheNoven. ^,,:;::''7*^^ ;hoJp.s' method of o,,eratin. Is H '" '^""•^'■■'' '•'' '>''- -n - porfbnned bv makin:;' "'"^ ^'^^^ ^''^'^ ^^'^^^ opera- ^oUnd dividing all the r^l^^Z;:^ "T "'^ ^'^^^ ^^ ^'- Jf'e foot IS then brou.dit into '^l'''^'''"' ^''>wn to the bones -'.;'- wound leit o^;'"^;::;:;-^-- a spe^ «^ -'ver through the botton^, j?"^' '\^"';'^-' ■^t''^''^- ofi.itrate prevented /rom.sprin.in,.-u,Io,r""^ '^'' A'ranulations are ^^ ^^J ^i-n the LdeJ ' M ^^ "l"'^'^'' ^^^ ^'- wound is indu "d -•^^ into the wound.'' "^.rU;:::-^^ '■^n^' nerves should if nossiblo » '^ '" ^"^''■'^''^" ^''e arteries ^hould be used. l^'wZ^^ ;;^h.b,ted to the Medieo-ClC;ic^ s"-"'^' ' ^'"^''^ ^■'- '^<> ^ operated on in this ^^^^ ^^'^^ V''"'^''^ ^^'"^ '-' ^^-'aetory, the patient havi'r;,,,'; --"t-eined to be w-alk on the sole. ° ^ "'''^"^ ^-^^t and being able to ^.rtlrpatmi of the Lnna —T.. i . ; omain of surgery, at any ^to as r 'f^ T""'"' '' ''^'^'-'^ ^''^ "'^^ ^moval of the lung. oi'V "' ' ''" ^''''' •^»'">'^'«^ >'« ^•^^^d the idea that .s,? trernen, o ''^''" *' ^'''' ^^^ ^on- ^^'"Jured. and after soiru. '"'?"''""« «» operation nii^dit K ^-'-^^ 'hat the aniin^I ; :t/:::: ^^-^ '^ -s Wy ^ell ueath occnrrod U t "",-,tii; recover ne"fo,.f),- iir, X rernai.un. side. He believes tl.ut in ...a,, diseases of the lun^s ro not so fa. removed f^ou. s.u-,ical intede.ence as is con ml l-eved, and that the excision of a diseased h„., o. pa.-t of I '"'^S would, un.ler certain circumstances, he a justiliaMe opera- t'on. Analo^.nis experiments have been mudehy Schmi.l. On <-';,'l.t do^^s operated on, five dien to the cases for which it is suggested by Schmid, tuber- cu ar disease of the apex, is manifestly .iurd.-i /l Lancet, Dec. 24, 1881. ^^"twn whidi tr '^ ^'^^^-^'/--'^^he- 5« perhaps no affection for winch there is such a vrnety of treatment and such a number of specihc cures Its treatment is not confined to medical men • -T druggist thinks he has a heaven-born genius for managing Uu8 disease, and the number of powerful caustic and astrin:^ent remedies patented for the cure of gonorrhoea and gleet exceed oh mternal and local remedies are in great variety, and U.hion rules m this as in many other things. Every new remedy 8, of course highly recommended, and is better than any tha't has preceded it. ^ Zeissl, in Wie.er Bled. Woch., advises for acute gonorrhc«a three or four injections daily, feebly astringent, viz., 1 to 3 grs of hypermanganate of potash in eight ounces of water If the patient is no better in eight days the strength is increased .ses of the lungs i as Is coninioiily iig or part of a ustiliahlo ojiora- >y Schinid. On irco (lays after Sclnnid con- witlioiit sjiecial uorrlia;j;os. Ho 1 (dead) body, IS there was no n unsuccessful as the animals Tliese experi- iur^'ery to the !isi(jn of a [lart iuali;^nant dis- nd sufficiently of the opera- ^chmid, tuber- ird. — London aHection for 3h a number medical men ; for nianaiiincr id astringent L^lect exceeds I'ine diseases, variety, and new remedy ban any that &- ^'onorrhoca ., 1 to 3grs, ter. If the is increased. 39 to ci,5l,t „„nee, „f „t„ " " \? ^ "j" "/ '-''L oacl, l„Uf,.,|,,,,„„ i"tr.«l,„.c, ,,„„Kie, into «,„ nil :.'■', ^r'""" "'"•""''^' '"■ to ten minutes. Ho i, opposed ,'',"• '" ""■'■'"••''" «-" '>"'y '.0 o,np„,., J;:,r ;r , r„ r" r ""^" i""^ "< of p.-o.tatic l,y,K.,.t, ,r , 1 "■" ""V'' """■•"•"«i"'""-" ».l .*«l,tl, aJtrin^ent ,o „!„ '" b^ tr"" "'," ""'■' '■■"'"■'- 'li«cl,argo whici, oJcct, in ho bnlU ""'V"""'"";? «,v tho Dr. Wilson {London Lanat ISXn i, . cases of .„no,.rhcrnitJ! of ion the [lelvnc •athor ivntr(t nhint to un- nt. It has a or diaersed. stretching is Oi" curing or as locomotor gonhuch, of le late Inter- the motluH n the dark, s of cases to lan surgeons i\ by others, in (liferent pool Medlco- va^ foi- loco- lere was ira- ; pains had could walk ident. The le breaking ataxia was The disease 41 in this case was much more advanced than in the f.rst case- Ititnc.i't, Mr. V. A. S.utham, in an article on " Nerve Stretchin-' " w.th part.c.lars of thr.-c cases (/,.,,./„;, Unret, Au-. Ti 1S«T) U p"'";"v""';' "" '"'•^'-^■^ "'' t''^' '"•Hchial pl.ms were st'retched y -(Nussl.auMMn 1872, for spasn. of the arn., nun.erous •' " "'7'"";;t.ons m which this motho.l of tn-atment has been .."''';'• '""• '•' 1'"^" 't W'*^^ ^«'^tricted to neuralgia and other l"'"'"l or spasmodic affections of a simplo localiz,.,! natu.v but """■•• '••'•■••Htly it has b..cMi adopted in d.seasos of a more general •^'"•'.••'•"•^';^ ■';.^ I".; example, tetanus and locomotor ataxy ; and •"•M.g tlH. I;.st few months, casos of anaesthetic leprosy iLe, in ""lia, been successfully treated by this phm " Mr Southam's three cases were all cases of clonic spasm Ir. (.ase I„ of clonic torticollis, he first stretched the spinal cces...y ..,.,., Hhoughteniporardy. ' •"•■fit lolIowH g, he afterwards excise.l a portion of the nerve a >^Mv.thout g.,d result, owing to the fact, he thinks, of his no! .,< tting.,bovc the pon.t where the spinal accessory gives of^'some "".H...lar branches to the sterno-mastoid muscle tched the spmal accessory. The muscular spasms came on in ShH'T"'^' '^ '•■'^'' ^■''^••^^'^ '•»• --P'^te rest. w li; m'^:!' T^'' '' ''' ■-^' ^-^' -^'1 also both arms, --both legs-but more especially the left, .Ira^.i... S ';a:T7 "^t'.r---^ '-^ --tional disturl^c^ •^ . ;^ Has performed with the greatest difficulty, and it was W . he greatest effort he could bring his hand [o his mout i operation was followed by great relief for about six weeks w ^;trl r '"''"'''' P^^^^*^ '•"^ At the time wilt, g a < ec.led improvement had taken place in the patient's ;;; ;.:n, t e ,,asm only coming on at loni intervals, e^^ WMMi ins attention IS ibrected to it. 'nx, operation is simple. An incision two inches long is made lung t e posterior bonder of the sterno-mastoid, its centre be h^ on a level w.th the uppe. border of the thyroid cartilage. After X oittin^' through tho ration is from tlie level iv ; the sterno- ^ite directions, to which the stoid foramen, nerve stretch- , October 8tli, rosis in a man, B Manchester Mr. Southam ftoi- the oper- of a fortni;^ht to reapjjcar. lain. In the he left sciatic :or ataxy in a 'he operation ['ter about ten lually to dis- i this respect, the operation, (luacles of the r weeks after and paralysis 43 At a meetin;,' of the 8nr;,ncal Society of Ireland, in December last, Mr. Wheeler detailed the treatment of a case of acute tetanus, by nerve stretchin-, which was successf.d. The patient a «n-l a^^ed eij;ht, last October received a laceratnl woun.l of thj ha.nl, and when tetanic spasms came on the usual remedies were a.l.n.M,stered without ertect. The median nerve of the forearm havm;.^ been exposed, was stretched, and the patient progressed ^'radua lly t.nvards recovery.-(/.o..W, Decen.ber 10th, IHHI ) U. h. (lark in July. IS?!) {0 /,,.;,.„, M.U.al Journal reports a successful case of nerve stretehin;; in a case of acutJ tetanus. li. M. Simon, in the Jirtl. Mnl .h„r.. Fob. 2-,tli, m-> ro r.mt'i a cas., .,f inlantilo |,a,%»is afl'.ctin;- tl,o vvM h" in a duH /,vc. year, of aj-o, groatly l,„nontt..l hy 8t,etol,iM« ti.e sciatio VUidoH Mnllrah; of Novcmlior 8tl,, 1881, stales that at a moot,„j; of tho Socioto ,1,. Chi„„.«i,., N„,.e,„l,o,- -,„], M U Jcntu ,„.oso„te.l a patient i„ who,,, l,e l,a,l saccessfi.lly nme- e.«l »tretch,„. the lingual „erve f„,. ..euralgia of the face , ttl, ep.lo,,t,(„,™ convulsion. The „ai„ was local-,, i„ the e , p re«,o„ a,„.,ele, iowe,- jaw, . ,,c let si.k of the tongue ; itZ lasted fo,- o yea,s, but in rt,„ last few months it 1,„J Z inc^ea ed m seventy ,>s to be insuppa-tablc. M. Le De„tu ,.eacl,e,I he nerve t .-ough tho month. l,old the tongue aside an,l gentiv ra,« the nerve above the ,uuco„s mcmln-anc with a maH hook for a few m„„,c,„s. o„ the second .lay the pa„e„ w" ab e to sleep. Thi,.tee„ days after the operiion tl . I l" nt,n,lyeeasea a„,l the patient was able to eat and sloe,, w,. M Le Dent,, sa,d that he had p,-eviously in anothe,. ease p,.actised' w,th succes., ■■esection of the auriculo-tempcal 'ZTt ne„,.ag„,. ,,. Polaillon said, that tl„.ee month, bcfere, he had »li-etc ed the „,ferior ,Ie„tal nerve for violent neurabna and the pat,e„t had been H-ee f,.o,a pain ever sinee.-^^ "1 * Med. &,m<-e, January, 1882.) 'Journal '^^ D,ake of this city was the first, as far as I know who acute tcanus m a swede aged 28, produced by running a rusty ^ nail into the foot— (Canada Med. and Surg. Journal, Vol. V.) The left sciatic nerve was cut down on the posterior border of the j^hiteus niaxiinus muscle and stretched. There was ameli- oration of the spasms for a few hours, but they soon returned more violently than ever, and the man died 12 days after the operation from oxlianstion. This operation was performed August 2Gth, 1870. Dr. Norman Mcintosh of Gunnison, Colorado, reports in the April number of Auwriean Journal of Medical Science, a case of sciatic neuralgia of sixteen years standing which had resisted all ordinary treatment. The paroxysms lasted from five to six weeks, during which time the patient could neither eat nor sleep. The sciatic nerve was stretched and complete relief followed, and four months after the operation there had been no return of the pain. Billroth, of Vienna, recommends a subcutaneous nerve stretching in sciatic neuralgia, by extending the leg and flexing the thigh forcibly on the pelvis. Dr. J. Cavafy of St. George's Hospital, London, in the British Medical Journal for December 10th and 17th, 1881, in an article on nerve stretching in locomotor ataxy, gives an account of 18 cases besides his own, where this method of treatment was employed for locomotor ataxy. The cases are derived chiefly from German and French sources. In four cases the ataxy was cured (three of Langenbuch's and one of Esmarcirs). In eight cases the ataxy was diminished ; in four there was no improvement. In one case, patient died 15 days after from pulmonary embolism. In the greater number of the cases the pains were removed or at least greatly alleviated by one oper- ation ; but in three cases they subsided only in the territory of the operated nerve, while in one they disappeared from the part operated on, but increased elsewhere. The improvement seems to have been permanent in the majority. Dr. Cavafy comes to the conclusion that the operation is applicable, especially to early cpses where pain is a prominent symptom ; but he would not hesitate to employ it in later ones, especially as the operation has not been followed by injurious results beyond temporary irnaI,Yo\. V.) terior border of lere was ameli- sooii returned days after the vas performed reports in the Scienoe, a case eh had resisted Vom five to six r eat nor sleep, [•elief followed, 3n no return of taneous nerve leg and flexing , in the British , 1881, in an v^es an account I of treatment i are derived four cases the of Esraarch's). there was no ys after from the cases the I by one oper- :ie territory of from the part )vement seems .vafy comes to jcially to early he would not the operation md temporary 45 pamly,™, ,a„a thi. very rarely. The woun.l i, often slow to i.e,^ a. „, i„s own ea,,o ,vl,cro it was ..nhealcd after .six weeks. Dr. Jul.us Althaus (Ji-it. AM. J«r., January 7tl,, 1882) referr,,,. ,„ Dr. Cavafy's paper, .says that it may not bo out of ..ace to raenfon that at least five fatal eases have l,ecn recorded due to norvo stretching in locomotor ata.y-ono by Soein me„t,oued by Dr. Cavaly). another by Lngenbueh, v " or.g.naled the operation ; a third by Billroth and Weiss ; a out" cause ol death app-ars to undue violence in stretchin.. hock. Dr. Althaus goes on to remark that the operation eau- '"■t be cons,dere,l a slight ono, and we must be careful not to oo^eai the r,sks attenJin,. it from the ,,atient a„,l trie I It a undue v.oleuce and stretching should be avoido.l, and whe c there ,s the least suspicion of an affection of the me lulla , h a. astnna an, certain cardiac and respiratory di.se. c>; he operation slioidd not be resorted to. ' Bri![of ';"?"''■""*■''■"*■• ^- •^'•«'« Smith, Surgeon to the 24tl an,l .!lst, 1881, on Medullo-ArthriHs, propo.ses to .nme' 1.0 two forms of so-called white swelling ol>i Xw eHro ™..nonly called strumous, as follows .A'I.e' 0^;,; 1 le .! ,'-"™"'"« ""Is ol long bones, vuduUo-a, thrill. He p oc I to remark that the pink marrow in the cancellated end a d Iblir IT '" "'" '^»l>''-»'la..dular cl.ass of .^s d-Ud piobably disc Uiriros mnat r.f H c ,• "'oaus, glands. In diase of U,e s'e. ,, ^t" IT'^'' this pink marrow which is afte ted wH, T " "'"/■"V'"'"' " '' disease, similar to fj„t r, , ™ "' niflannnatory glands in c v 1 ' Th ■T""" """■'"^ °'' '^"P'-"" tl.e sa,„e histologica Z thev s , w ..""'"'"^ '"^"'^ "''^ "^ have a like teudenc. l^^ ',^ *"" ""= '»"'« sluggishness, and is this d rtt,l 7 "'*''" ''"^'"" '"otamorphosis. iLre ■s ''.; diHereuee, however, a strumous -land ha- room h n -a d .t suppurates, its .ntonta perf„.;to thrskirid srat' itj rlischarged. Rut it is not so with bone glands. They are bound down by a bony shell, and the swelling results in compression and strangulation ; an outlet is forced where there is least resist- ance, and it is for this reason the inflammatory products in the ends of long bones take a most dangerous course — through the articular cartilage into the joint cavity. Suppurative synovitis is set up, which generally leads to complete destruction of the articulation and even to the loss of the patient's life. A-fter describing synovio-arthritis, he gives the symptoms of medullo-arthritis, and states that it may be distintinguished from the synovial form by the intense starting pains, by percussion round the joint causing pain, and by the great tenderness during any sharp movement. In the synovial variety the pain is not a prominent symptom ; the joint has a pale, smooth, sometimes glassy and lustrous skin, and large, blue veins course over it. In medullo-arthritis the skin is not pale, but a dingy red ; in- stead of being smooth, it is rough and mottled, and frequently covered with long hairs, &c. He believes if the pathological condition of medullo-arthritis is recognized sufficiently early the progress of the disease may be nipped in t)ie bud ; and that if we can reach the inflammed marrow and remove it, we ousht to cure the patient. Even after supjmration has taken place, the treatment he advises is better than excision. lie relates two cases of advanced medullo-arthritis, both at the lower end of the femur, in young girls, where, after making an opening in the condyles and gouging out with a Yolkmann's spoon the cancel- lated tissue of both condyles and inserting a drainage tube, the best results followed. In the first case, after several months, the cavity filled up, and the girl now walks about without the sHghtest lameness. In the second case, after first trying simple drainage of the joint, it was determined to remove the whole contents of the condyles. At the time of writing the child was progressing most favorably, but had not commenced to walk. In this case it is probable a permanent stiffness of the joint will remain. Both cases were treated antiseptically. Mr. Smith says that this operation will be most frequently performed in morbus coxae, because the hip joint is most frequently affected with me- 'hey are bound in compression I is least resist- iroducts in the — through the -ative synovitis truction of the ife. symptoms of inguished from by percussion derness during e pain is not a oth, sometimes ourse over it. lingy red ; in- nd freciuently e pathological intly early the ; and that if t, we ought to ken place, the [e relates two )wer end of the ipening in the )n the cancel- tiage tube, the jveral months, t without the t trying simple ve the whole ; the child was 3d to walk. In the joint will Ir. Smith says oed in morbus icted with me- 47 dullo-arthritis. In med.illo-arthritis of the hip, he taps the great trochanter a little above and posterior to its anterior inferior angle. The opening is made witli a gouge, keeping carefully in the centre of the neck of the fenmr. He drills throu^'h this through the epiphysal cartilage, and taps the marrow in.^de the' head of the bone ; if the bone is soft here, it may be scooped out ; ,t not, ,t ought to be left ; the incision in the skin is closed antiseptic dressings applied and left on for ten days, at which time complete union will probably have taken place. As the gouge approaches the epiphysal cartilages care must be taken to handle the gouge gently, as any roughness might break off the diaphysjs and set it loose in the joint. In Lancet of Dec. 10th, 1881, Mr. G.' A. Wright, V R C S reports a can of pulp,, duease of the knee, treated bv erasion' on the l.nes alren^lv laid down by Prof. Lister. On Jan. 22nd' 881, an m. , was made as for excision of the joint, but not div.du.gtL. i,:.u.entum patella. The synovial membrane, which was thick, pu i>y and very vascular, was cut and scraped away and some of the cartilage removed at the margins ; a soften/d cavity m the outer tuberosity of the tibia was gouged out, and the articular surface of the patella was scraj-ed. The whole of the diseased material was removed as far as possible The wound was closed with silk ligatures and an India rubber drain- age tube inserted. The limb was packed in a Gooch's splint. On l^ebruary 6th the wound was healing without suppuration, and on February 16th the wound had ^uite healed ; except on the second day, the temperature had never reached 100° The knee was dressed seven times in all. On the 21st the'snlint was remove,!, and passive movement began. On the 28th the joint was fully flexed under chloroform, and one adhesion ^ave way; passive movement was kept up, and on March Otirthe child was sent out with full range of movement of joint and free from pain. W en last seen, May 27th, she could walk, run kneel down on the bad leg, and flex it to its full extent w thou pam or difficulty. The patella was freely movable. The opera- ion was performed antiseptically. This certainly seems too good to be true, and is a great improvement on the operation of excision • k New (?) Treatment of Varicocele. — Dr. R. J. Lewis, in the PhUa. 3Ii:d. Tunes, Nov. 5th, 18S1, recommends the excision of the reduruhtnt scrotum as a radical cure for varicocele. The e.xcision she !>1 embrace a portion of the anterior and inferior part of ihe scrotum ; a clamp is used to fix the skin hel'ore cut- thv^, and is also kept on whilst the metallic sutures arc ap[)lied. Dr. Lewis has not seen hemorrhaj^e follow the o|)eration. The wound is then dressed with carholized oil, and a perineal handa^^e is somewhat tii^htly ai)plied. (Anier. Jour. Miil. «Vt'.,Jari.,l8S'2.) Tills is merely a revival of Sir A. Cooper's ofteration, which is fully described in Guy's Hospital I{e[iorts (Vol. Ill) for 1888. Scissors were used ^o cut off the redtnidant scrotum, and the parts united by ordinary silk li;^aiures. Every case reported did Avell, and healed without a bad symptom. But this is hy no means a radical cure, and is only advised where there is jjjreat pain. It relieves the pain, bui does not cure the varicocele ; iti fact, it acts in much the same way as a well-fitting sus|)ensory bandage. Spon(je-lraftinlo texture, and can be easily adjusted to any surface. If, therefore, the bI„od-clot or fibrinous exudation merely acts mechanically in the process of organization, there is no reason why sponge or other porous texture should not similarly become vascuhir and organized Ihe first experiment was performed on a female patient sufler- mg from several ulcerated wounds in different parts of the body Ihe largest of these was situated on the outside of the left le- It was circular in a shape, and five inches in diameter by from a half to three-quarters of an inch in depth; the edges were indurated, slightly raised, and in some places undermined There was a cellular tissue slough at the deepest part of the wound which gave to the whole ulcer a putrefactive odour. The rest of the floor was in a granulating co-idition. Tiio usual antiseptic dressings were first applied, but very httle progress was made in its contraction, and on the 3rd of August, 1880, Mr. Hamilton filled the wound with one lar.e piece and several small pieces of very fine sponge prepared by dissolving out the siliceous and calcareous salts by means of i ii i« dilute nitro-liydrochloric aciil, subse(iuenily washing in liquor potassic and finally steeping it for some time in a 1 to 20 solu- tion of car])olic acid and water. The sponge in the central part of tiie wound rose a little higher than the edges, so that at its greatest thicknearf it nuist have measured from half to thrce- (juarters of an inch by five inches in width. The sponge was made to fit the wound very accurately and was inserted beneath the undermined edges. A piece of green protective was placed on the surface and above this, lint soaked in a 1 to 20 solution of carbolic acid and glycerine, with a little tincture of lavender in it. The whole was covered by a pad of boracic lint. An ordinary bandage was ai)plied. The patient was kept in bed, with the limb at absolute rest. Next day it was redressed. There was not any marked putrefaction odour. On the 5th of August there was a distinct putrefaction odour. It was dressed as formerly, but the wound was irrigated with 1 to 40 carl)olic solution. This was continued throughout the i)rogress of the experiment, and at one time when the putrefactive odour became great a 1 to 20 solution was emi)loyed. Oakiun was now used as a top dressing over the glycerine and carbolic acid. The sponge at its shallowest part appeared to be slightly red in one or two points, and the undermined edge had extended for a short distance further over it. On the (ith of August the sponge was irrigated as before, and was gently S(iueezed so as to remove any waste materials which were contained in it. The edges of the s[)onge were now adhering to the granulating surface. Five days after the commencement of the experiment the wound seemed to have shrunk a little, there was very little putrefa-^tive odour. The thin parts of the sponge felt firm and their inter- stices were evidently filling with organizing tissue. If the surface was pricked it bled freely. Healing seemed to be going on from the edges to the centre and upwards. The edges of the sponge seemed to be dissolving as it became infil- trated with the new tissue. Its surface Avas covered by a grayish colored pellicle, very much like that seen on the surface of wounds healing under antiseptics. From this time c ward the sponge rapidly became filled with organizing tissue, until on the hing in liquor I 1 to 20 solu- le central part i, so that at its hair to three- ho sponge was iserted beneath ;ivc was placed to 20 solution ire of lavender •acic lint. An as kept in bed, was redressed. On the 5th of It was dressed to 40 carbolic f)rogress of the 3 odour became was now used )lic acid. The htly red in one idod for a short :he sponge was 3 as to remove The edges of surface. Five Mit the wound :1c putrefa':;tive md their inter- :issue. If the led to be going s. The edges became infil- jd by a grayish ;he surface of TIC c ^ward the ue, until on the 51 20th of November there was only a small piece of it seen on 1.0 surface. As soo. as it became vascular Ind filled with new tissue the epithulnun spread ovor it st.ad of the edges and surrounding skin being .Irawn downwa.ds and towards the centre, the reparat,ve material had i v ...vnup^Klso^^ Plough. I ho fu-st expcTunont showe,! that if spon<^e be nlaced cm- a granulahng surface its interstices will, i^ .^^rs^ot' be tilled with blood vessels and cicatricial tissue \n-t . • ease of a blood-clot, and that ultimately thr:^^^^^^ ;l.sappear n. the wound, leaving an organizing mass of L^^^^ m ^ts place. It further showed that even%vhere Z^^Z costumes , n a putrescent condition organization will go on n to mr :;;:h;M.;r ^ '^^'''^ ^ Four other experiments were made of healing wounds bv soon,.. .m tu^on tl.e huu..n subject, allof which we^ .::^^ZZ i- last, wluch was a case of old necrosis of the lower en of ibil ommun,cat.ng w.th a wound of considerable size. ^1 '^ no granulat.ng surface at any part, and no attachme t of t" ^nge occun.d after several weeks, for the simple r In t ^ the part could not furnish sufficient embryonic tissue t the sponge and organize it. ^ '''' ^" ^'''''' Other experimerits on animals were carried out in Vienn-i for ^•' t T^:r ;' ^y^VJ^odhead, m rrot: Strieker's IZ^^ ton s ait.cle. A mmute account, accompanied by beautiful t :;:.,r^T" ^^ ^'^™--opi-ppearaL :; t tlic hit r t : OH ^^'^I-™-»ts made, is the infiltration of .^.entangled leucocytes is f.und .^:Z:oZ^^^: o^.an.n.g layers was m all cases .,uite distinct, and in n I y H instance was organization found to commence within the interior ol' th(! H[>ongt' among the primarily eft'used lym|ih. Without exception tlie cicatricial elemonts grew into the sponge in the rnrm (tf a distinct layer springing from the tissue to which it had l)('(,'()me attache(l,and from this attachmenthlood-vessels also arose. The hlood- vessels first become much distended and unduly tortuous. When the loops of hlood-vessels reached the sponge framework, they were pushed into it, and always ma'ntained the character of complete capillary loops. lie was unal)le to detect anything like free, newly-formed and [lointed oH'shoots. No evi- iece of s[)ongc :he connective nizing process. L^ is excellently licient to cover lay not have a [)erience to de- ihat long time oal or calcined nstance, where ; contraction of a solid frame- S3 When speaking of the displacing action of the heart upon tl... hlood-vossols Mr Hamilton asks, " Why is it that ir. Lr.ut md.v,duals there .s such a difference in stature v" ami auHw.TH ''ay .t not he that the cause of it, in reality, is tilt ' ^ F u.g acfon of the heart is specially vigorous in .hone of g at s ature and t e resistance of the tissues slight, while in th'se of small stature the reverse conditions arc present." " Why is it .at growth goes on to a certain age ? ' " May it not he that the heart ,s relatively more powerful than the delieat,. HtrKch- .thle tissues of youth, hut as a.h>l..scencc is reached, the tissueH eoome sufhnently rigid to counteract the heart's ;"• in Z '' He says much the same thing is seen in plants. When growth - most acfve, the plant is in a cellular, pliahle eondi ' u - I becomes older, and n.ore woody Hhre is formed wit i V stable condition is reached. ' For a further account of this most interesting subject I must n^r the reader to Mr. Hamilton's original aHicle,' whie .T^ well repay a tiiorough perusal. J7..6-..^.>.;, and (U.opl>a,o,fon.,.-'rho operation of ga«- t ostomy was f^^rst performed by S^dillot in 184!). Sine tt!n th.s operation has been practised a large number of i .. England America, and Germany. The first successf a tZ\lT' 1 -^'" "^*''''^'^" ^^^ performed for Htrie- tuie of the oesophagus, in a boy 17 years of a.e, cJSL swallowing a solution of potash TI.p r... ■ ^ all been un.Wta.., f„,. ,„d ^Lr™"" "'"'"'" '" last M,. 1 ecye, read a paper „„ "Two case» of Mali.,,,,, Str,ct,„.„ 01 the a3.„pl,ag„,,, in „,,ieh Gastrostomy ,™ hm tube He said, m these two eases, he had perform,.,! gastrostomy ,„ ,,rereuee ,„ the wishes of 'his collea „ str,ctu,e of the oesophagus. He said that malignant ol,«tr,„. he considered oesophagostomy the preferable operation. ' VI X Even when the stricturo waa low down, oesophaj»09tomy is indicated as a preliminary and exploratory operation ; and, if a tube cannot bo pa93ed through the stricture, f;astrostoiny should be perlormod. (Esophagostoniy is a much safer operation than gastrostomy ; never, in fact, having been fatal. Mr. Reeves said it should be performed on the loft side of the neck by making an incision from half an inch above the epistcrnal notch to the level of the upper border of the thyroid cartilage. The Surgeon should stand on the left side of the patient. If possible, a sound should be passed previous to the operation ; and after the oesophagus is opened, a tube with a funnel-shaped end should be passed and tied in plac", an 1 nourishment adn in- istered through it as soon as the effects of the anaesthetic have passed off. The operation should be undertaken early, before the obstruction is complete, and before the patient's strength is exhausted. — (^Lancet lleport.) At the adjourned discussion on November 11th, Mr. Golding Bird presented brief abstracts of five cases of cancer of the oesophagus, in four of which gastrostomy was performed. In the fifth, the operation had to be aband-^ned owing to the occur- ence of oesophageal hemorrhage. lie pointed out that gnotros- tomy was only a palliative operation and could not bo judged of by bare statistics. One of his cases, a man aged GG, had lived five months, but symptoms had only existed two months before operation. In the others the histories were much longer. He said gastrostomy of itself was not a fatal operation, but that it was resorted to too late, and that the earlier operation was resorted to, the better the result. lie believed in those cases which pre- sented themselves for operation late in the disease, the stomach should be opened at the time of operation and nourishment given at once. He was distinctly opposed to cesophagostomy as a substitute. In four out of his five cases cesophagostomy would have been useless. Dilatation of a cancerous stricture high up might be fairly tried, but when in the chest it was his opinion that dilatation was more dangerous than gastrostomy itself. Mr. Durham advocated, where possible, feeding the patient through an clastic catheter, passed into the stomach through the mouth. ^ha<:;ostomy is ion ; and, if a , ^gastrostomy afcr operation I fatal. Ivlr. of tlie neck the opisternal roid cartilage. 3 patient. If lie operation ; funnel-shaped ihment adiiiin- itesthetic have ; early, before t'a strength is , Mr. Golding cancer of the ;rfornied. In ; to the occur- ; that gno-tros- t ho judged of 00, had lived months before 1 longer. He hut that it was as resorted to, es which pre- , the stomach •ishment given igostomy as a ;ostomy would icture high up 'as his opinion my itself. Mr, atient through [gh the mouth. ss ■no .■atl.ctor ,I,.„M only 1,„ loft in throe or four ,lay,, an.I an- ;; I-- I"';; -"■-lu-.l. He .U,| n„t tl,i„l< that Or. KrUahor^ ""■ll,.„l ot ,,a.»n,s 1 1,0 catl,otor tl,r„„,.|, tho „„,o ,„ .o„,l, l,ocau»o .n';l;;a«rooal,le. I.r. K,i.l,„l,or, at tl.o Intornati^al Oon.ro,,,, IM M,at ,„ ,c«,,l,a.oal strictnre tho calhotor couW romain in n., n„lofin,te porioa. Dr. Dousla,. Po>,o|, warno.l tho u,o f u,tholor., a.an„t tho ,lan,^.o,■, of ,ho passage of instruments "7" "l«";"-.. Ur. Andrew Clarke, an,l The surgeon, X »..l«e,,.u.ntly spoke. aln,ost all a.kooate.l the use of ,1 71c « I ';;«/."; '"™'''»-(^"'"™'' -;'■ «•/-' '•" Jinm *&,„ The prevailing- opinion .,oen,e,l to he that eathetersshouM he „.,e,l l.ero possihlo. „, stricture, t late it, an.l to feci tho patient • l«Ml.e passa.-enf a oalhoter in a caneorousstrioture prevented ;«;;;"■' "■.■.'»'■„„ „f the stricture by food, and so teLpZ i^ 'l''-^'- '"■ K'-vth. In cases where the stricture „a, low down » p.ol,al,le cathotorisu, would not l,o sueecssful. Wh«.o the . t.".. . hut where the cancer wa.s low down and a catheter 'I '■■ |..;.»», gastroston,y is indicated. It wa, the gen I .■"■- n„at .1,0 operation should bo performed early, btt t| a . n,lo the p.a.,„,.t woul.1 not consent till too late. D . A Jrw Clarke brought out the fact that the passu-e of a caH.ot ™,Hn,.d a groat deal of patience, an.I th f if ,,; p. 2 VVith regard to the operation of gastrostomy, several of the lii ::;; d'T;!; "-' ■""':■« "' "'» ^'»--" - ''-'•°. : ^ a '.""""«' ''^ '"" "'-"I™ "f ^''ta'-e.^ an inch rl;':'as':::S.'' "-' '- '- - «™ '^^^^ before t J^^'::1JZ^Z'J'''T *"•«• "-»••''•) -S-ds the im. 1- wo..,ld u! ^,t the Ic rr "•"""'" ""•"" "° "8»-^ „„est the use of an asp.rator syringe and injection of ,.'! 1. ™' '." "".:' '"•'"""'■■• Langenbueh thinks that al soon a, d.fl,cult,es o, swallowing are at .all pronounced the flrsi r \ of tho operation slioiild 1)0 undertaken, and that tlio surf^con should not wait till the stricture in iinpermoahle. With rej^ard to the second {lart, he recommends a very small oi)enin;; into the stomach, so small indeed that a certain amount of force is rt^iuired to ;^et in the tube. The tiihe shdiild he provided with a stop cock, and so all escape is prevented. Jk'fore openinj^ the stomach it shoiild he fixed with a sharp hook to prevent punctur- iii;j; the posterior wall. — i^Med. Times and Gazette.) D'-. P. Kraske, in the CmtraUihitt fur tVnrur(/ie, warns the profession against the datjger of stitching the stomach to the wall of the abdomen some days before opening it, as the stomach contents are very liable to escape through the stitch ])unctures in the gastric walls. This occurs especially if then is any de- gree of tension. He reports a case where the csca|)ed matter through the stitch punctures caused a fatal peritonitis. He therefore advocates immediate opening. Dr. Kraske thinks that this danger will have to bo taken into account in consider- ing the advisability of the first part of the operation being per- formed early in the case, as suggested by Langenbuch. Dr. T. F. Prewitt, in a paper on gastrostomy, publis^hed in the /SV. Louis Covrier of Medicine, gives a table of fifty-nine cases: forty were malignant, twelve cicatricial, three syi)hilitic, and in four nature of stricture not given. In the cases operated on for malignant stricture the patients lived fourteen days to six months, and one patient is still living. In the cicatricial variety six recovered, as also one where the stricture was of syphili ic origin. Peritonitis existed in only seven of the cases. Exhaustion alone is assigned as the cause of death in the large projjortion of cases. Mr. A. F. McGill, of the Leeds School of Medicine, reports in the Lancet for Dec. ord, 1881, two cases of gastrostomy. In both cases the operation was performed for malignant stricture of the oesophagus, about the back of the cricoid cartilage. In the first case the wall of the abdomen was incised and the stomach sewn to the edge of tho wound by thirteen silver wire sutures ; then the opening was made into the stomach four days after, the patient in the meantime having been fed with % •St it tho surj^con Witli rej^anl 1 openinj^ into mt of force is D pi-ov'kUmI with fore opeiiinj; tlie revcnt punctur- tte.') ri/ie, warns the nach to the wall as the stomach ititch punctures then H any de- escaped matter )eritonitis. He Kraske thinks mt in consider- ation bcin<; per- onbuch. y, published in )lc of fifty-nine three syphilitic, ! cases operated •teen days to six the cicatricial tricturc was of /en of the cases, ath in the large [edicine, reports gastrostomy. In lignant stricture I cartilage. In incised and the •teen silver wire tomach four days ucen led With S7 Slinger's nutrient suppositories. Four months after tho opera- tion tho pat.ent was still alive. I„ the second case t..e patient died on the seventh day from exhaustion. /Ja/»,>jfr,'n\^ Oontradlon ,>/ (he Fin,ji'r>,,~\)r. Myrtle in the Brim M.Mml J,nmu,l of Dec. \\v\ 1881 . contributes' an arc.cio on the above alVection, in which he .lenies its connection with gout fur the following reasons :_1. [t is never met with in women, and they are quite as much afllictc-d with gout as men 1. Many ot the worst cases ho has seen (his own amon^' them) have not been gouty themselves, nor have they evei-' had a gouty progenitor. ;;. (iouty rer.dies V-u'e no influence over tins afloct;on. I. That the very m de of dealing successfully With contracted linger, by divisl. n, .;ith s..'.se4uent mechanical extension, is a plan which surgeons ...;,; n.,t readily adopt in c-ases ot enlargement, stilloning and contraction from gouty deposi Ihe g<.noral ignorance of the profession with regard to he pathological changes which cause this cu.traction appears to i)r. Myrtle mcomprehensible, especially since the various writers on this disease have so clearly demonstrated that the con raction is due entirely to changes which have taken place •n he bands oi fascia of the fingers and palm ; that the tendons with their sheaths, the joints with their covering and li-viments are not implicated. Ho .lescribes two forms of (contracted tingers:--.lhe one, traumatic, traceable to some local in- jury. Ihe other, idiopathic, generally met with after middle btt' ; one or more fingers may bo affected, the third most coiumunly and the forefinger and thumb being rarely impli- cated. Dr. Myrtle says there is only one method of treatment VIZ. subcutaneous division of constricted bands with subsequent mechamcal extension, as recommended by Mr. Wm. Adams. M^ H Vt. " '''';*r^ '""^^ '""^^ ^' divided separately. Ml. H. A. Reeves {Brit. Med. Jour., Dec. 31, 1881) can- not agree with Dr. Myrtle that gout and rheumatism ^, not rejiuent causes and he differs altogether from the statement Di Myrtle that it is never met with in women. He can clearly recall five cases, and is sure he has seen at least seven or eigiu m women. Mr. Reeves gives the causes as follows • ^ 1, rheumatic and gouty diathesis; 2, injury; 8, occujjation; 4, heredity ; 5, neurosis. Occui»ation may claim a large per- centage of cases, as it is not uncomuion in boatmen, coachmen, sailors, bootmakers, wri'-ers, and even those who have ibr years carried a walking stick and borne their weight on it. Dr. Myrtle believes the contraction due to a hyperjdasia of the fascia, while Mr. Reeves considers it to be intlammatory. Mr. Southam, of Manchester, has also observed it frequently in women, and considers it commonly connected with a gouty diathesis. Mr. Wm. Adams states {Brit. Mul Jour., Jan. 21, 1882), that when he published his work on " Dupuytren's Contraction of the Fingers "' in 187'.', he had never seen a case in women, and since that time only one case has come under his observa- tion, that of a lady aged ()<>, in wliom both hands were aft'ected. He says that the affection may be of more fre((nent occurrence in females than has been su[)posed. Many cases liave been sent to him as cases of Dupuytren's contraction which he excluded from that class, there being no puckering of the skin of palm or prominent fascial bands, but as a rule the fingers were con- tracted, because they were bent at the phalangeal articulations and could not be straightened. 1 have seen one case of genuine Dupuytren's contraction of the fingers in a woman aged 52, who had a decidedly gouty diathesis. The little finger and ring finger of the left hand were affected, and there was considerable puckering of the skin. I have seen but few cases at the Mon- treal General Ilosfiital Out-patient department, and these all in gouty patients. I am inclined to believe that it is not a common affection in this country. Treatment of Fissure of the Anus. — Dr. Mascarel proposes the following treatment, which he has used with much '^uccess in the case of those j^atients who fear the radical cure of fissure by forcible dilatation ; — 1. An enema of warm water, to which a largo spoonfui of glycerine has been added, is ordered to be given daily. 2, After eacli motion, a small pledget of hnt, satu- rated with the allowing ointment, is to be introduced into the anus : |i Glycerine, 30 grains ; oil of sweet almonds, oO grains ; ^4i , occupation ; a large per- il, coaclimen, lavc lor years ; on it. Dr. r[)lasia of the natory. it frequently ivith a gouty 11. 21, 1882), s Contraction ise in women, his observa- werc affected, it occurrence ave been sent 1 he excluded vin of palm or )rs were con- ' articulations ise of genuine aged 52, who ger and ring I considerable at the Mon- d these all in not a common arcl proposes much success 3ure of fissure ater, to which ordered to be t of lint, satu- uced into the ds, oO grains ; 59 brown ointment (onguent de la mere), 60 grains. 3. After in- tvoducuig the lint, care must be taken to smear the ointment well aroumi the outside of the anus. 4. If there is great con- stipation, five cenfgrammes of powdered belladonna root should be given every night. In eight cases out of ten, fissure of the anus W.11 be cured a ter three weeks or a month of this treat- Dec ; Ib8l5"''"" '"''' ''''' '''''''' " Practitioner, I have found, where the patient will not consent to - perative measures or the pain of touching the fissure with a point of nurate ol silver, the application of an ointment of calomefgr iv opmm and ext. of belladonna each two grains, to a drachm of cuiat.ve. The bowels, of course, should be kept open ±.r..P.aW2l ' n Isov. Fraot,.n.r.) Judging from the immediate effe^of he operation, I think it would be hard, in this countrv at Is de?:roff" 'T""'' "''"•"■"^^ '^ ^ --"^ injekon be- "'™'™ ™""' ™^ -''-f;~^^ TOUIINAL,' i QUABTKRLY RETK08PECT OF SURGERY of the Montreal Gc.oral Hospital. Acute Traumatic Malumanru i\T.. p- i it. cas,« 0,'^alisnant disease rapidly f ,ti„! 'Vr "''","7',"' whicli, under favournhln ^i,.„ . '""»"»". Uic lissue-eifmenta coma, or encephaloid cancer, which onsl ts o r T heaped up cells and their progeny/' '"'' '^'' '^'''' The first case is that of a bov 1r pus was well establislird, he has not failed to arrest the jji-ocess imoicdiutt'ly, ana allay the jiain in a few minutes. Ten to forty m'-v«iu!S of a. .''olution of 8 to 10 grains of acid carbolic to the ounce vi' water is injected. Some care is re(juircd to insuio cei-tiiiiity in reaching the central portion of the gland, and Dr. Taylor has found it better to wait until the gland has attained some size, and its stroma has become suffi- ciently distended to admit of free permeation of the injection to all parts of its structure. He also advises munbing the skin of the gland with ether spray before injecting, so that Hie gland may he firmly held to determine its size and to ascertain the depth to which the needle must penetrate to reach its central parts. The average time jiatients treated l)y this method have had to forego their usual avocations has not exceeded three or four days. Some twenty cases (successful) are given in detail. When pus has already formed, Dr. Taylor aspirates and then injects carbolic acid solution, and apjjlies compression by means of a bag filled with shot or sand, with an intervening layer of oakum or absorbent cotton. Under this treatment the bubo rapidly disa[)pears, and there is no need of the knife or poultices. For the axillary and cervical regions, he finds that compression can be most easily kept up by means of a potato trimmed to fi'. the location and enveloped in a strip of thin muslin. I have several times arres.'o'. suppuration in buboes I. .'rr,; rately applied strips of bel'a ■ .i la plaster. This relieN . (;.o pain, and often, by the i»ressure which is used, arrests suppi; - GS *" ' ' "'* ™"'=<:^^''"l »« l«. i' ^M» lair to become a ,oco..„i,cd ami favourite lorui of treatment. "-'-OoHUtil TreatMHt of Fm...l„nd P„IM,.~Mv .]„„„,]„.„ |i„, , ■ son m. that i„ f,.aetu,.e,l patella ti.e .,. of' ^Z ment. ..not caused Uy the nu.eles : fepeiteJ ol„erv ton ll ™v,„eed lam tl.at u i. al„a,s eause.l ly, an,l in ,„.„,„„.,, ..r sepa,at,on. JI . II„tehmso„ says that when the musele is at rest . a ways relaxed, and when relaxed there i, no reason X """ '" ""= "*«>■' ""'1. '" lact, thatit ahvaysdoesso when there tion a. the ,„„,„ent of the aceident, but as soon as the li,ab is in bed at rest Us agency ends. If the effusion is the cause o ft e »eparat,on of the fragments, get rid of it as „uiekl, a os h the effusion may be blood or synovia or a mi.J.ure of th t If this, eases, JI . Ilutehtnson says, are ,„ost difficult to treat for o T : i r"" ': "". """=• "^ ■■ " ''«"■•"- "i-^i-tion of cold. Ihe ec-bag and sp„-,t lotion are the best measures ac- cordn,g M,.. Hutchinson, who says that if by these mem s yl can get nd of the swelling in 8 to 10 days you will hav , id ance of bony umon. When the effusion has been subdued he bones should be brought together with obli.ue strips of plas fixed m the notches of the splint. The limb hould be extended from first to last on a well-padded back splint, and ,1 e ,e Itt levated ; after being bandaged the limb 'should not be totche'd fvcnn s,x weeks to two months, when the patient should be allowed up, using a patellar apparatus, however Mr. Christopher Heath while agreeing with Mr. Hutchinson as to the cause ol the separation of the fragments (BrMsk fther tlian Mv. H., and does not J joint, hoth in cases of fractured patella and without fracture. If tlie joint be lesitate to aspirate the knee- injurj of the joint joint be aspirated a few hours after tilt) ac(;iaiida;.5e over an envelope of eotton- waddin;;, and h(! allows tlie patient to go al)ont with crutches as soon as th(! pliister is dry. If he sees the case before there is etl'iision, he at once a])plies a plaster of Paris bandaj^e, and allows the jiatient to move about. This method of treatment which Mr. Heath adopts is certaitdy a ;.;r('at im[)rovement on the old one of clumsy apparatus, and pr<)lotiji^(!d rest in bed, when atrophy of the (piadricc|)S is certain to ensue, and it is some months before use of it is regained. The most successful result of fractured patella I have ever seen was in a case where before effusion took place the leg was put up in a plaster of Paris bandage, and after a couple of days the man allowed to go about with crutches. The bones were sejiarated by a very short interval, and of course the union was fibrous, but the man had [)erfect use of his joint. Dr. Hamilton of New York uses a biick-splint of leather or gutta-percha, or gum shel- lac cloth (the latter |)referred). It should reach from the middle of the thigh to two or three inches above the heel; a roller of C(»tton is then turned round the leg and splint to witliin three inch(!S of the knee, and another from the uj)[)er end of the splint to within three inches of the knee. While an assistant apjiroxi- mates the fragments, the surgeon should make two or three turns with a third roller around the limb and splint, clo>!e above the knee, after which the roller descends below the knee, and a numlter of circular turns are made close below the lower frag- ments, which tiu'ns should a[)proaeh each other in front till the whole patella is covered. The heel is left elevated or suspended. l)r, Hamilton does not believe in evaporating lotions, but says the swelling usually goes down in a day or two, and then the {)atella bandages should be tightened daily as required by over- stitching the obli(jue turns. At the end of four weeks the ap- paratus should be removed and the limb bent gently daily, after which the splint shonld be re-applied and the patient allowed to go about with crutches. With regard to the union of the fragments, some surgeons 67 deem it necessary to always get l,a„y u„i„„, and Mr, Li,.,.r fro- quenty „n,.s the fragments t„,eti,er. Now the l,oliof i, ^„ ,, a roa that l.o„y union after all i, „„, ,he „„.t cleniraM S .at pa lonts wl.o l.ave good flbrou. union liave Letter u,u of 1,2 hmbs than those with bony union, an.l besides the tL Z refracturc ,s less. Mr, Hutchinson says he is by no "n™ f an enthusiast as to bony union. Dr. Ila.nilton .Icile.li; , Hi gamen lous, Mr. Heath remarks that the reason hon^ u s less advantageous than ligamentous is that the |,a.elh. rac s adhes,o,,s to the external condyle. No doubt !e are ,„„ apt o have ankylosis with bony union than with ligamentous nil or Ins reason the great Pott abandoned apparatus ; he c' dlu that pos,t,„n alone approximated the fragments sufficiently i»*f„m » ^"V^'-y.-rodoformhas now taken a ree,.-„i„,I place as one of the most valuable antiseptics. It may 1„? 1 , m the form of powder or iodoform wool. As a powd^i ," useful m the treatment of local sores, sinuses, L. It , Z of lessening suppuration are remarkable, and under its in u ,^e wool IS d.ffieu t of preparation. It is made by heatin» oi.d.t ,„l a pound of absorbent cotton is soaked for a short time, and tho wool ;s afterwards placed in a drug press ; when dry t w„„ contains about 10 p.e. of iodoform, and is ready fbr us Tho ohjecfon to the wool is that an irritating powdeHs spread ove fte .-oom.and „s odour is very disagreeable to many peel The former tendency ,s overcome by adding a little glycerin to he ether, and the latter, modified by the alditien of'cLai; t « 0.1. The wool should be stored in air-tight boxes. It is very useful as a dry antiseptic dressing and is much used at present m Germany. After an amputation the stump may bo dressed after sewmg the wound with catgut or silver w'ire, and i s S ' a dratnage tube, b- ...„p„rly applied pads of this wool kept i^ position by gauze .andages, the dressing may often be le t on or ten days without change, and the drai°nage'ube and stitb!" 01 o. silver wire; removed in the Hrst dressing. The wound i"/ tl • X ^i in a large percentage of cases .und to hf* ve united hy first intention. This mode of dressing ;j;ivoK u3 all the rotjuisites for the rajud healing of wounds, viz., rest, elastic pressure, antisei.ticism, and drainage. Before apiilyiii;^; the wool pads, iodoform may be dusted on the wound. In Germany, where it has ^or . l most freely and in larcrc quantities, some cases of jioisoning have occurred, characterized by elevation of tcmperr.ture and an erythematous emotion, and albumen in the urine. The Germans use it in wounds \'' the uioutii, and pack it in cavities in tlio form of a paste made wiJ; rosin Some fatal cases have been described by II. Henry. According to Mikulicz wf Vienna, the use of iodoform gives brilliant results in strumous diseases, and also in lupus after the epidermis has been removed with caustic potash. I have found it of the greatest benefit in gangrenous and slough- ing wounds seen after crushing injuries ; also in foul ulcers of the leg. The best way to treat foul ulcers is to dust on iodoform powder thickly, cover thi' over with oiled silk, over this jjlacea pad of absorbent cotton, and bandage carefully and urmly. Here, again, we have the benefit of elastic pressure, with asepticity. In the treatment of soft chancres, its supei-iority to every other application is generally admitted, and its application is quite pain- less. Its odour is objected to by many, but it ma> be controlled by keeping a tonga bean in - box .ontainin., the powdered iodoform. Mr. W. Wiiitehead {^BritMed. .7oh>-., March 11, '82,) first dries the sore and then applio- with a camel's hair pencil a solution of iodoform in ether. The ether rapidly ,'\^aporates and leaves the iodoform uniformly spread over the surface of me sore. This process may be repeated several times, snd wi.cn the appli- cation is dry, it may be painted over with co dion, and a pinch of absorbent cotton is applied over this. Mr . hit' !ad has had great success by this method. The solution oi iodoform he some- times use.: IS one part to two of ether and collodion ten parts. The dressing is renewed in 24 hours. Mr. Lennox Browne says a solution of iodoform in collodion may be made without the addition of ether, by shaking up one part of iodoform with ten of collodion. The iodoform should be of Hio neck. " '" i'li'ii'liil.ir oiihir-nooiits '-'"''■«'"«.'/— Mr. John Ma«l,.,li i? i> a ■ *"■" «. :i.to,.™(i„„C;" f J" " "" '^''"1 -'"'. 1882, "" i-<-..,™c.,i i„ ,, 0°. ";;:'„: I '■ "'""" •■'■«™""' « "••«' ..,,,1 cause oCvl.i.l, c„„|,| , h ""' "'""■'""!"". the "•""«"-^ "f ..n a,„o»,l,„ i . 'r "'""f"'"'- '■-" "...ler the «-.th,«i,,,„,Mi„thedc.,comHn'e„l„:'''w;"'"''''"'"-'""'™''' ''«'■! '"•,■,, ,h, „ „.,„„,„,, ,„ „ ;7,, „, ' '^' '"o, .free o,„Is of the «■■'"«, >„,„.„ or le,s after the „!„ ','"' '" "'" ^''"'"'""'al «■■ •"".linn ab,h™i„ai *°i ::::r'''f,"'™'°'°'"^.-vt.iist •"""■ H." The patient „nf h !, ' '^^ "'" "^"■•'1 deep ™.ne li„d h«, ly, a„d , oaM '"™" ""'"''"'■ ™« °f 'he Mr. Ilry„„t ,."„' .t"'™' ,*'"ee,« of success. 5" Stricture of the Desce, di!'. rZ'T"' !' •■' "■■»'= «f exci.ion * ^(1 '"' " l.f. r.„,„,,„, ColotZ " =' jn°''" ""■""«'' -'i"e!^io.. ..,.„.o ", My aged .-,0, „h„ had surtered ft' "'"''''""",' '''■" ''"''"'"«' °« '■'«!" «'«.|„. Tl„ strict, r," "'"'''^'"' "'-""etiou for .""•""«!' "- -v<,M,d and stiZ i, ','" " '^«'"™' «'™'"ecl ^«"l. .....1 it was ,0 „a„ rj " r ? " r ""•■' °f *e f : « ™th,..er. A diseussio 1 , .'^ *" "^ ."»«*=- of a ' «» the <;,.t operation of .„,.". ■?■•'""' ^""^<' -% Of the speakers .v..da;dr;;^^Sir;=X that i X left ol' tilt' left rectus inuscle, as being more likely to lead to a correct diagnosis in oli-cnrc cases. Qaxtro-Kntcro^toniji. — Dr. Anton Wiiifler, in the Cnitnilhlatt fOr Chirur ""' "'«' "f "'^« ;»'« '-^ » M.,a, t„ p,.v:,,i'r . r't::; '" "'" '"■"^■ w-i'i" f™„ life po"r.eu ; T'l; ""'"'"'"^ '""''"" »'• *« '^»v, au.I when the hi-,,!,!..,, i. .. ,,^" '""''• ^^e trociir is hal- '■-i-).o,,„i,,d,!::::rr:;rtn:,"'r'^ puncta,. ,.1^1,;;; ale „ , ' ' "'" "'"' "'""''""" -"" '5^^' p.-oseat„ eea.«l o ; fa '] T '"•'"'"•' "^"f""'"' "'' '"'^'^'^ a<- „..i,„ ,eo„ p:<::.,:d tirt:;,:;;::; « ■"''■'"^ --i'^ie^ I%al Medical and C\J ^^ meeting of the London J-emoved a tuiiiour of full i Jyll liii i bladder ( m a man ) through a i' ' 'i perinaeal section of the urethra. The patient has been operated on some time previously for stone (,by litliotrity) but without com pleto rc'lii'f to his symptoms ; subsecjucntly some phosphatic deposit was removed by the lithotrite,at this time he seized what at first felt hke a calcubis, and practically crnshod it under pressure, but it was evidently fixed, givin^L; the impression of par- tially imparted stone. As little benefit followed this operation it was decided to open the bladder. This was done by perineal section, and on introducing his finger into the bladder and pres- sure being made from above the pubes Sir Henry recognized a tumour about the size of a chestnut growing from the opposite wall, coated with phosphatic matter. The mass was easily twisted off with a'[)air of forceps and very little bleeding followed. The patient speedily recovered and had no return of the bladder symptoms subsequent to the operation. Regarding this and other cases Sir Henry advised that in certain cases of hematuria which was clearly vesical and was not ex|)licable except by ttie hypothesis of itni)acted calculus or vesical tumour, an incision of the membranous portion of the urethra fi'ora the perineum, fur the purpose of exploring the bladder, should be made. In a paper in the Lancet, of 7th May, 1882, Sir Henry remarks that it is only during the last few years that he has gradually realized the fact, that it is possible, in not a few cases, to explore through a small perineal incision the whole or nearly the whole, of the internal surfiice of the bladder with the index finger — a necessary condition, of course, is that the bladder should be em})ty, and that firm pressure should be made with the right hand above the pubes. The method of operating the author describes as follows : The central incision should always be adopted, and a medium grooved staff, and a long, straight nar- row-bladed knife, with the back blunt to the point, should be used. Having placed the left index finger in the rectum, the knife may be introduced edge upwards, about three quarters of an incli above the anus, with or without a small preliminary incision in the skin, until the point reaches the staff about the apex of the pros- tate gland, where it divides the urethra for half an inch or so and ia then drawn out. cutting nnwards a little in the act, but so as 73 to avoid any material ia -•;e..'hand,.,^e.;i;:r:rx^^^^^^^ '■e,nove the snleen M r , ,'""= '"="" '''■'onnined to An ineisio,, wa's , d, , ' I .C' ^T' "';"°'-'^" -«'»"■ the ensif„,-m ea,-til-„.e t , 1 t " '"" ""^''"^ '"'I"" eoh.,-,ed spleen It r ;.:;:":,:; t: ;: '";/"■"?• ■"■" hesion. The enla,-«ed vessels a Z T ^""' '''"'" »''■ lisatn,-ed in sepa,-at: p„,Z ', ,;:::, ^^ '^^T' ^'"'' was re,noved withou diffienltv W ' ,T ' " ''" °'=""' closed the patient beea,„e fo ^ed s " ll ", 'T'"" '"-' ''™« -tificial ,-espi,.a.ion and the .,, eel ' ,'. '"'l;:?^"™'" '"^ the ope,-ation vornitin., came '„, °, ".''': *'™ hours alte,- fueney, ,-apidly ex,,„ LTI ,: , ^'"'"f if" 8™- f- *o operation The spleen p,-e:;,t: 't I'l "^-'^ "f pearance o, annp.e hypertrophy. The fata, r.u, w s t tsTd Jl. ' 1 ■ !' I^ii li W MMI'inimii . ummmiatiSmSi ' -1 f X by lieraorrha;j;e, but seemed to l)e due to disturl)aiice of thegreat- synipatlietic plexuses, and the consejueiit shock of vomitin;^. In the discussion which followed, Dr. Stephen MacKeii/,i(! raised the (piestion wiiether removal of the spleen in leucocythe- mia was justifiable, (pitting Mr. Collier's tables, which show, that thou/h the spleen has been exciseil successfully in several cases, in no case has the operation succeeded when performed for Icucocythemia. Dr. MacKcnzie thought possibly the operation was jutifiable when the blood disease was not advanced, and the s\ibject was a young one, as there were grounds for believing that the spleen was [)rimarily at fault. Mr. Lucas thought a less serious operation, as ligature of the splenic artery, might be ado[)ted if the aftVction were a simple hy|)ertrophy. It would seem that for the present surgical interference in leucocythemia is narrowed down to splenectomy in selected early cases in young subjects, or perhaps to the substitution of some less formidable operation as ligature of the splenic artery. — (Report in Britixk Medical Journal.) Surgeri/ of the Kidney. — The operations of nephro lithotomy, nephrotomy and nephrectomy are now considereil l)y the surgical world to be justifiable operations. It has been established beyond doubt that nephro-lUliotouui is a most successful operation in projicrly selected cases, viz., where the stone is of moderate size and single, and the kidney has not become disorganized. It is a most scientific procedure to perform this operation where stone has been certainly diagnosed by needle exploration, or where the pain and other symptoms lead one to believe there is a stone present. If left, the stone is certain to disorganize the kidney, cause nuich suffering, and probably death. The operation of incising the kidney {nephrotomy) has not proved a dangerous one, and it has been frequently demonstrated that the kidney can be easily explored through a lumbar incision, and even cut mto with great safety. In cases of strumous or calculous jiyelitis, the sacculated kidney can be drained through a wound in the loin and the patient freed from the danger and \a\\\ of retained matter. Nephrotomy, as an operation, is merely palliative, and, 75 as Mr Lister suggests, should only be nerform..] u .u patient ,s too weak for nephrectomy ''^''' ^^' li'mhar colotomu fi ^ tmns verse one. as in .•>«e t„be wa., i„hv„luc,.,l XT , P""™c.,aK.,l ; ,, ,l,ai„. i.-J«.M,f ,„.,,,„ .™ ' L '° T''""™ "«■■ «"■' ''»•' -I- "ft- .Lis l>a,, , . 7:Tr "''•';" ""'■' •^'«'"''"™- '"■' the earholie ac , , ,. J^ "■•''' T """' '""'^' '"''"'""-••■1 f"-- some eighteen hvaf/^ I '"■"■"' '"f""^' »■>'" v»3 sent l,„„,e l.as sinee e, f, n™- "'"'"'f ""' -'-•» 1 Lave heard .C opemtionmavlift,!,;'" "T '''"'"'"'• ""'' ^ 'l""l< «"» "i-nhie operatt thanT e, L n1"'"|;,r,r"" """^" ^-- Kreater, ™any oases having hefn M|„„e, '^'^ "^ "'""^ urine, which bv som„ l..„ i '™" "'"''"'ed by suppression of »cid, eithe, a I r„ °7 """'"""' '" «'<= '■•'» "f carbolic '.om;,.,.hageI , Z, ,":r '""; , '" "'" "™'^" '•»'»' f™™ shouhl bo performed o.n, ""^.''^""•"""«'> '" what oases it l--lormedV I r:;' : '"' '7'"''' Nephroetomy has been Py.--litis. LatelyD B,a,T„ : :; *TV''™'"""' "'" ''^'^■'■'-'- Olinieal Society, note "To "' f "' ""''' "' "'« I"""'™ «lenlo„s pyohfi tI I T f f'"''^""""? Performed for viously di.:;!::; ,;:,,:■; :;;-f ;-'»..o l.ad boon pre. by abdonnnal section, under Z ,11 ^^ ^^"^ """ '■^""'«''' operation, a mornhil ZTLT^ l«-ecaut,ous. After the patientp^ssed* 1 s;:;: x*""''^'-"' -" ">^ "- was high, nrino su,, e J ^dte n^":"" ""■ "^■"'*™- eomatoso condition from „1 i ' ™' ™'' '" ''' «™i- «o'.Iing iiird and D ""„;':: .^ 1 -,7 ''"""''•'• *^^- - -H.nau, aor.fe the same .Society, re- PI ■ 't I : ,f ' ml I '5 X ported a case of nei)hrectomy for scrofulous pyelitis of the right side only. The incision was made in the right loin and the kidney removed. The patient died of collapse shortly after the opera- tion. The 0[)eration was difficult, and part of the 12th rib had to be removed. Mr. Ilowaid Marsh also reported a case of ex- ploration of the kidney and partial excision, where the patient died in thirty hours of sufipression of urine. These coses are instructive : in one apparently the morphia suppository had something to do with the fatal result. It also seems that partial excision of the kidney is (piite as, if not more, dangerous than coin])lete excision. Suppression of urine seems to be a very common complication. It is a question whether before nephrectomy is jierformed, a preliminary nephrotomy should not be tried. Now the loin is the most favourable position for nephrotomy and perhaps the most difficult incision for nephrec- tomy, so th's would be an objection. Some hold that if a pre- liminary nephrotomy is performed, it much increases the difficulty of a subsequent nephrectomy. Again, it is important, in con- sidering the advisability of performing nephrectomy, to find out whether the pyelitis is confined to one kidney, or, rather, whether the other kidney is healthy. Strumous pyelitis is rarely confined to one kidney, and therefore excision of the kidney must be a defective operation, as the pyelitis is only a small part of a general disease. These ai'e some of the difficulties in the way which make one hesitate to jierform nephrectomy. Having, however, decided on the operation, which is the best incision, through the loin or abdomen ? Certainly the abdominal incision gives the operator more room, and the surgeon sees what he is doing. I have fre- quently excised the kidney on the dead subject, and have been often araai;ed to find how much more easy it was to remove a kidney through an abdominal incision than through the lumbar one. Removal through an incision in the loin is very difficult, especially the ligaturing of the vessels entering the pelvis of the kidney, besides, in some people, the which I have previously ca !, I'^ionH " '' r'''''' ^'^"«^'- 'nore easily avoided hy the abdolin r •' '"^' ^^''^''^''^ '"^^ ^« «nd also where it is double oJl ^'^"'^ '" ''»" V^'^^^ the other the extreme low ;rdonh1-!^^^ -treme upper end "^g the pelvis at all. MaL Jr. ".'^'"^"^>'' "« ^'"tery ente... -can decide when an&;Xr:X^:^^^^^ * Brooklyn Annals of Anatom V and Surffer" 'f-' nr - 881. i i m QUAKTKKLr KETRO^PECT OF SOKaKRy to the Wontreal Disp..nHHry. ' " -Excmon of the Tmxn,^ it nr . F R m? ;^ ^'^"/yw^.—IVIr. Walter Whifeehoarl P i? na "i"' ""Ij w Ztl^l 7 '''"" ''' "" ''"f^"" ■■Pislottis will ,,,,J"' ""^ ^' f" '""=k as the safety of ,he twit J!: jis. ";? ^/aiiTr'^d """'""« '-■- - - oen.rallj fcund that a moment's pres- ■I hi- Sll : III ' ■ 'WirMHiBM Biiro with a small piece of spon-i^e held in a sponge forceps suffices tenipnrai'ily, if not pcnnancntly, to arrest any })lee(ling ; it is, however, regarded as desirable to twist immediately, or after the tongue is removed, every bleeding vessel. it. A single loop of silk is passed by a long needle through the remains of tlie glosso-epiglottidean folds of mucous membrane, as a means of drawing forwards the floor of the mouth should aecundary hemorrhage occur. This ligature may safely bo re- moved the day after the operation. Mr. Whitehead recommends that the after treatment should conaist in feeding the [)atient for the first three days absohitely and solely by nutritive encmata, satisfying thirst by occasionally washing out the mouth with a weak iced solution of permanganate of potash. Speaking should be forbidden. This operation of Mr. Whitehead's is now ^lite an established one in surgery, and, (or the removal of the whole tongue, is pre- ferable to any other. It is easily performed, requires few instru- ments, and more certainly removes tiie whole tongue than where the (icrasetu' is employed. Mr. Henry Norris, F.R.C.S. (Mn^'d, May ;'.0, 1882), in a paper on EintheUoma and Idhyosh of the Tonyue baHedon the reoordn of xeventy-five eases, gives some observations on the relative value of different methods of excising the tongue. These observations are confined to cases, twenty in number, operated on by himself. Six operations were done with the galvano- eautery (icraseur, and in one of these the cheek was divided ohliquely downwards from the angle of the mouth, after Gant'a method. Seven were done with the twisted wire dcraseur, and in one of these also the cheek was divided ; in two, the twisted wire rope was passed into the mouth through a supra-hyoid in- cision, and in two the wire was looped round the tongue without any preliminary incision ; in the remaining two cases of this series only tiie anterior portion of the tongue was removed. Three cascs^were operated on by the twisted wire ecraseur after median division of the tongue. In four cases the knife or scissors were used to remove the organ. The average period of convalescence in five of the galvano- 1 i c u 1 b( b( nc to SI cautery cases was .32.-1 ^, ,. Th„ i. . longest, SO ilavs TJ, ■ .l ' *"*«'. 2(1 rlav, . (l,„ c.„valesee„eeafte,.,„c,lia„,livi,i,rrtl .' ^''^ ■"""■"«" V'M „t ilie average |,eri.,,l „c e.,„v,iosc,., ■ 5 ' '""-""' -^ '''V". -"■ "'«/>™te„ .ire .c™ ::; o7 ^■""^'V'-""'''" «.'c well i„ 12 ,1 , l„„„c" , ,t •'"^"- 1'*' I».tie..t, a y""'- : a,„l i„ tl,e seventi, ,Z J ''"■ "•""'""■'^ '''■■ «- -vouucl >vas :,eale,l. I I ree '" ?" "'"' '*""■'"•'-' ;::: »■»» r-f-nae,,, ti.e aver^;^ .L;r:;V'"' T"' """"^ "■/. "lays. I„ ,!,„ f„„,t|, ,'.''"' "f ^■""™l«e,„.„ w,„ "-;™-i"' -t lo:;;';;,':;,:''"'^'"''''-'"'' """'-■''■". not a^ect'";,::,:;™;:':; ';;: ;'::;:,":;": " ";■«- - > .1.™ not reoo,„,„e,„l th°o ««pra.|,y li ,:."r '■"• "" ''""" '■■"■■y for drainage, and tl,„t a til ' "'■^'' " '" '"" <""">»■ J'.-. Morris prefers tl,o ,1 „flc ,"'1'"'!'° "' "'« "■-'«"", -rtaddsn„,,dngt„tl,erisU, VA;: U " ""*''""""• 'liv.s,on of the symphysis is the „,o,fT ^ u, "'"""''•■■•" ""'l able method „f ^^.l^,,,, J '" '"™rfable and leas, favour- -."'..■ane on the inuer's, .feee ^ 1 ■>"" '''/''"' ""•■ '""-"« bo other,vise removed. I„ T, ' , ' " •'""' '" »»'"="='' »"'' oa.uiot employed the «alvano.ea„te ^C lur -'r'^'r', "^' '""™ carded; the slou.d, which fnV ' '"' '"" "»«*«- t«.io.lofeo„vaies:e„ : ,™tr' H '""' ""'""'"• -' "■« ""•e ecraseur, hut ean.an r mme„/ ° "°" ^"''"' """ '"^'l .".'■ as the operation must ^^1":^'':' ''' ■''•--^ case. Hisrecoveriesafterthe, eofM ^ /'°'" ""''•''"''"'' ■'-■0 rapid, and hemorrh ! "setl "' ""''" '''"""">" "0 considers the most impo",; ttZZ „7 1 '™"'""''""' bo the passing of a stout liarate the tongue from the floor of ^h-. mouth, and the ^-crascur was then introduced through a ''.'hyoid iiicision. Convalescence took place on the 27th L ; ■ A. tube was placed in the suj.ra- hyoid incision for drainag<^ • -ifter removal of the tube, the supra- hyoid opening soon compleieiy healed. Mr. Henry Gray <'roly, F.R.C.S., records two cases (Dublin Journal Med. Science, July, 1882,) of removal of the tongue, in which, before removal, ho ligatured the lingual arteries by an incision extending from the symphysis to the hyoid and back to the angle of the lower jaw. The tongue was then drawn out through the incision below the jaw, as in Regnoli's operation, and removed without hemorrhage by means of a benzoline cautery. The period of convalescence is not given, but the patients re- covered. I forgot to mention that the gustatory nerves were also divided for the purpose of relieving the ptyalism. Mr. Bennett May, B.S., F.R.C.S., in a paper on Excision of the Tongue, ^c, (Lancet, June 10th, 1882), believes that, notwithstanding Mr. Jonathan Hutchinson's impressive appeal for early operation in cancer of the tongue, surgeons will not generally urge, nor will patients accept, any operation for the removal of a considerable portion of the tongue, until the other- <»iiowou» ,lisca,« was of r,„i,i „ „ , ""^ '''"'""•'«'' "" 'I- -utl, a,„. I„„,. j w I: r: ';,"" '"'•"'«" "- """■■"/■ '"■•i'W -.■CM„..,1 l,y a li;«„" f "'" "'""'""• ■'''■» '"'.«.»■ """li.u, line nl-tlie 1,1,- II, "'^.'■'"';""' "" "'^■'»i"i. tlirougl, ,l,e V"i.l Lone. The 11 'i '",' r' "" •'•■'"• '" " -»'« ^' 'I'o "" f ■ »i.U'. w:;":: ii .::^: "t r *-"'"; "^'■'-'-- «i". a ..-Lain ^cra,o„r lltiJ T^" "' "'"" '•"""""I -»;"^ KH,.. of eo,:a,e,:r::oV:;:"" "^ "•» -'- f- »i.^ '"""lliH a«o. Tl„. „,,i,.,„ /"'^ ™'"''^"- «•"' »"rae six '■•■'■' - -""". of Ihe Xtr'""'"'' "■""'"""^' •■'"" '- ™- '/■'' ""»e records two caqp,y '.^""■nm,, Jour, oj mjiml ,&>„„,_ «-i-l^ hcia April 27? 88~1 m"";""""' "''*" """""n «l.o,t account of 'the Tr tafn f'f . ' °''° ""'•''■' «''™ " h "carifieafon. II„ "'!,"' °! ^'7 "'"'' °' """' '™'"'™ ™™ : the one eon isW of " " "'"" "^" '™ «'-»^» »' I«'^<-., the nose hei' con LeraM '''?' ^r'" ™''"' "-^ ^^^ «7"-»a, a varicose oondLVr;"" '"*'■"« °' ""^ "-' "itl'ONt aene. It „a8 in tl e ll T""' '■'"'' ''J'Portrophy "l-ated searificaZ T tnd? iT AT """' ''^'■- *'"' l-M'^ of feeble circulation who etl *' "°^^ °'^'"'™<' - a..a .ho were ea,i, a^ecteJ ^^^-^'JZ^::!:^, T^ ;iiH IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 11.25 If iM m '- lis 12.2 " lis ill 2:0 JA III 1.6 y^:%' A=. 0/%^ V Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 # V o ^^^ t/j X l;n II J ^ H I ^1 hot room the nose itched, and caused great discomfort ; when exposed to cold there was great pain. The operation of scari- fication Mr. Morris performs as follows : First of all, the nostrils are filled with cotton wool to make the skin tense , next all the blood-vessels are slit up thronghout their length by a knife double edged at the poiiJ, then with an instrument having a number of fine blades close together, the vesr^ls are thoroughly divided transversely ; free hemorrhage follows, which must be encouraged, and is beneficial. The clots and serum are absorbed by blotting paper, and the patient is enjoined not to touch the nose for several days. The scarifications heal in a few daA-s, and leave no scars. This operation is to be repeated a number of times until the nose is reduced to normal. Mr. Morris had scarified 28 cases successfully ; one which was done in 1879 has remained well ever since. — {Brit. Med. Jour., May, 1882.) The above mode of treatment is a modification of that em- ployed by Hebra and Volkmann. Hebra employed a double-edged lancet-sha[)ed needle, with a shoulder 2mm. from the point, to prevent it going too far into the skin. With this instrument the vessels wore punctured deeply and rapidly. The punctures were made in horizonttl rows. In mild rases the repetition of the punctures usually was not necessary. In the severer forms Hebra employed Volkmann's method, viz., shaving or scraping off the inflammatory ^./oducts and hypertrophied masses with a Volkmann's spoon. The operation is not a painful one. He employed this method also to remove nsevi, port wine stains and superficial taleangiectasis. The epidermis only should be re- moved. In the mild cases without hypertrophy, and with the formation of pustules, I have found that the evacuation of the pustules as soon as formed and the nightly application of sulphur ointment prove very beneficial. The ointment should be washed off in the morning, and the nose rubbed with a soft flannel, covered with the lather of Pear's transparent soap before being reapplied in the evening. I have also occasionally seen benefit derived from the application of chrysophanic ointment, 20 grs. to the ounce. Dr. J. H. Staines, in a paper read before the Cambridge t t e ti S( " f'H 'Iwelton the nece,,];.- of ,i,„l ,'• .T'"'^ '" ''""' ^•"-'■■">, 'Hn,u!anta,a,.l rt,e ui of ' i f' " ""'''"""° "^ '"'"•'■oli» com,.,„,led the appi o«l? ""i '°°""^- «^ "'» ■■''■ a lotio,, eontaininf 2 "ta er^r"! T '' " '' ""^^ "^"^ °f and lime water. 5e poke of . T"'' "'""'"""■• ^'J'™""" and deacribed an insZ t L, e ,tTofr °' '°r' ''^'"="™- multiple puncturea f „ „„ i 1 -^ .^"'I'niann for produchig precipitated .ulph^r in tlT ?,"""' " '"'™™'«'' *= ™» of of lime water, wils drrchZ i " °'' ''""''"'^ '" "^ »""oes camphor. '""' «'^''"'"» and a httle spirits of ducX^Cflt Bafrif 'r'*-^'''' "■" '»'^'^ i"'™- gljcerine. Mr Ba ;!|TV r T?'""'"' "' '"'™'<' acW with -d it moat ancc^M n^la" ^ "f"" h '?" ""'"'' ^"^ "" 'hat it ia leaa irritating / "f ^^ohc acid. He holds free from the '""'"'^' ""^ n^ed it of the atre^-gth of 1 20 Z f^'T"'"* ^'- ^"'-"l' used it at the Gene™l H . ', *^ '"" ''■" "eeka I have Wounda aeem a^parentlt to T , ^T''"''^ ™P''''»^'='' "'th it. »»n with earhoind • n e" oTth 'T"': ""^^ ™P""^ In several caaea of aeve.e or , „ „ '.''^"■•'="«"> °f l-3» or 40. .™ used, h^aling too^pL TXiZ' ' i'" ,T"' '"'^-^ '' 'n TOter, and I am noiv ab„„f ,„ ^ !' ™"'*'' 'naoluble diluted with water ° "* " *''"'°" °f i' "' Sijcerine, ".e above ne:an;C^St':V:■*^^™'^"'^ "'^ «-»-' 1882.) Both have thf adt^.e Tb'''" ^^"""'' ^"="- ^*' tute of odoar, and free from ,11 f ° '"'•^ '"'"''''• ''o'ti- *e a,r the, both de L ^e 12 Tl ^''°" ^^P"-" 'o equivalent weight of mature Sh "^T .'°* ''""' ""^ "'■• "» t«ce their own' weighT t lae a^t^ T '"' "''" "■'"'"' 'ep.icagenta,eveni^diMea:LS:-.tfr-7Xrtt U'l I ,r''! ri -rji K* il i!Pf It '■, ' 1- V il ^ . ^i'i' peutically appeai i to be the glycero-borate of calcium. It is absolutely innocuous, and can be applied in stronj^ solution to so delicate an organ as the eye without bad result. They are both good disinfectants and preservers of meat, M. Le Bon has transmitted meat simply coated with a varnish of the glycero- borate to La Plata, and it has arrived in a perfectly fresh con- dition. He thinks both salts will prove very useful as antiseptics in Lister's mode of dressing wounds. These salts, from ^heir solubility, will no doubt be an improve- ment on the boro-glyceride of Prof Barff. Dr. Geo. Thin (^Lancet, May, 1882,) reports several cases of chancre treated by a solution of glycerum boracis, in which the sores healed with marvellous rapidity. The theory, says Dr. Thin, on which the method was conceived was that of keeping the surface of the sore saturated with a solution that would effectually prevent the development of organisms. lie thinks this would prove a very suitable application for phagedaena and hospital gangrene. Treatment of Carbuncle by Injection of Carbolic Acid. — Dr. Lopez Rubio records (^El Siglio Medico, 1882,) a case of anthrax, in which treatment by subcutaneous ii»jection of carbolic acid — a plan first suggested by Dr. Olavide — gave very remark- able results. The anthrax occurred in a man aged 30 - -s, and was situated in the interscapular region. It measurec^ m first seen, approximately, 7 inches vertically by 5 horizontally, the centre being occupied by a cone of dark-coloured sloughing skin. The constitutional disturbance was considerable, the pulse being 110, accompanied by pyrexia and severe headache. A five per cent solution of carbolic acid in water and alcohol was injected, with a Pravaz's syringe, into each of the four quadrants of the tumour. Next day the anthrax had decreased about one- half in its superficial dimensions, its angry complexion had de- parted, while nearly all constitutional disturbance had ceased. The same treatment was continued for two days longer, when the patient had so far improved as to be able to return to his work. — {London Medical Record, June, 1882.) Dr. Chas. Taylor (^Austrulian Med. Gazette, Dec, 1881,) 1 I a ir P' sii te s'ronglj, recommends f!,e injection .c „ t ,• ment of ca.buncle. Ho haTtlT ''°'"' '"'' ''" *« '--eat- «al* a„,i condition. Pit; , e,-e Tf '"-T" "^ S""'' ''"'"^ 'ay8 0fel,ei,.e.vi,,tencc,by .i „« ' ■ ' T*'" "■' «-' ""-"o 'he sixth .,«, w,„ submUt ,0 " ' '"™ '!"""•''" ■"='" '•"'» "'era ; -"; Tl,e five ca,es tre li tl'T ■"■'" '"'■"■•■' ""^ -" ~s *e 8,xll, lingered on throu d, !r„ '""" ™°'""-"' ™r 7^ f>ou,hi„,.and ,,rof„se sZtZ. ':°rT"" '^''"'^^ "J'podemic sj-rioM five or ,iv ,1,. ' I ^^ '' '"J"'"' '"«■ a *m around sboui,, ,,, ,^J^' 'J "J P"« carbolic acid ; the acd that „,,y ,, Lit" 0, l! ' ": r""" '•' fr™ any enters the tun our "the pa nt "" ''"'" ," ''" "'"" »>o acid and ex,,eriences a idow of , 1" |, T"' '"""""' ™-f"rtable, Tte carbuncle rai.i'diyabtt' X 'If ''^'" >™™= "'rou.hou. it and ceases to trouble^„r ru" ' 1 ?"? ™" '"""'^ "fpn^, pu.-atio„, speedily toZmZ- ,? " '? '''•^' "^ »"«- sup. sufficient, aided by then," a rLe?" Y'""''"" "^ ""= "'^''i i» hoi.sV«.tint'*uc[it::;:rSf r,; '''-> '™" ^""-^'^ he considers that boiis Ire ,ol ',,""'""«'' "'»'■• "Penings ; earbolic acid destroys thp^al'??' '",'""' "'""^S--'. and should, in their early stai be dt, , f •'"'™*' ">'•" hoils -.of.ercury/ni.ri::;irs:r:7--S,:-:^^^^ 'n passing, as being generaliv welf l'' ""^^ '' . "™'' ""'•>' "ention -ann, Simon's cathe.^Cbl'^o; '/"":''• ""^ ""^"'od of Tuck- of the ureter fr„,„ the vt "a B '" ? ""'^ '^"-"''^ ««ature against unpleasant surprise duriiT' "^ ""'' ="•" »■" S"arded or rather during the autops; I „t ITr °' "'» °''"^«»°. m eases where nephrotomy fs tCZl ' "■ ^ "'^">»<' I pi 1 X I would suggest the following mode of procedure : The morbid kidney is exposed by means of a small incision made in the usual position at the e(igo of the sacro-himbalis muscle. The ureter is then isolated and its buuen temporarily obliterated either with a ligature or a small clamp. V solution of some salt, which is rapidly excreted by the kidneys (potassium iodide), is then in- jected subcutaneously, and its presence in the urine is, after a short time, ascertained by the ordinary tests. If the result of the chemical examination be negative, the temporary ligature is removed from the ureter and the wound closed as after an ordi- nary exploratory incision. IJut should traces of the salt be found in the urine, we are assiu-ed that, functionally, active renal sub- stance must still exist in the sup])0sed normal kidney, and extir- pation of the organ affected may be proceeded with. Two conditions may diminish the value of this test. (1) For reasons easy to understand, a lecotropal kidney would not be diagnosed with certainty ; and (2) under peculiarly complicated anatomical conditions, the isolation of the ureter might be attended with great difficulties. 1 believe, however, that the ureter will in general be easily securt J, so that the method is worthy of trial in the class of cases referred to. — {Edin. 3Ied. Jour., Aug. '82.) The Coat Sleeve Method of Performing the Circular Ampa- tation. — Mr. Richard Davy, of Westminster Hospital, describes the above novel operation in a clinical lecture (Brit. Med. Jour., June 17th, 1882), and gives three cases to illustrate its advan- tages. He dissects back, as in the circular amputation, a sleeve of integument 8 to (I inches in length. Then the soft parts are divided to the bone, and the periosteum carefully [leeled otf upto the point the bone is to be divided. After trimming off any pro- jecting tendon or nerve from the stump, and tying the vessels, the skin sleeve is tied up with a piece of ta])e (very much like a bag of flour is closed up), the tape is passed through a cylinder, and the ligatures are allowed to hang through the crucial slit on the face of the stump. The wound may be treated with or with- out dressings. Mr. Davy prefers none. The surgeon must carefully watch that the tape does not strangulate the skin sleeve. Should the stump become oedematous or any necessity -89 ■>>«"18. are utilizc.,1 30 thai ,).l ■ ^^ "'*"'"'"'■«'>■ "nan^e- a'«i the c.hi„„., r:': i. :"^ ;:;■*«•;' V "-in.™. sutures, which, however ..ecew, v „;■ ,^""' "'"'""»" "^ ■»oval ; and the sm„res 7Z7' T '"""'""''^ l"''"'"' "' f"" li»ear cicatrix „„ tl,efre' ^l"' '""i'ity granted -apin,, sec„nda,;1;:™„ r" ';:«• ;;" ,'" "'« ""'""' '- elusion olair, and adaptabilit;°fo, , „4,': X ""' '■°"' T'' ''• amputoting of the hmb higher un th... ^^' '"""^"^ *" "'« a suiBcient amount of 3ki„ to J I 7' "''™'''"'^ '" f"""'^" Richard Davy is well t , ' "'" " "»*' »!''««>■" Mr "surgicaitiL es . ;:'■;' e '■""'' '"^ p^""'-' -"-;• tions for elul,.r„ot, his ha 11 '" ^ " "''"'''''^•' ''y '-opera 1-er for controlh' g heloX , i 1*""°"' ""' "'"^^ "" '"^ this connection I may rel fL , "? •"";" ^'^P'^'tions. I„ of amputation of the ri..h, ll ,1 "''"' ''f' '»" *«<> ™ses i" England with the at. of M uT''- T°"""' '''''''''""y Mr. McLaren, of Carlisle, ,te.ult "'■ ^ ^"'^ ''''-^ second, under Mr. Cowel I's Zt!t T w'""''' "'''''""': " lost three ounces ; and a third c '^^^tmmster Hospital, Plymouth, performed It,!! IoT-m"" *'''- '"'"" «™". » AS^raw^g ^//vVia/'y CaJmU n. i^ of the Dublin Patholola S~ ' 7'"' '^ ^ ''''''' '"^'^ting lfH2j, showed l>,t^^ ^^^^-^ ^ournl Museurn of the School oplsrbvs'.r"'"'^'^ ^^ ^'^^ of the Bengal army The fir ^ ^"''Seon-Major T. Robinson, :^ -ar^le shaje, nll'lnt^erilTr Tr^^'^ ^^'-'- oxalate of lime, mixed with crvstallZ ^ u '""^''^^"^ «^ --dofaM,e.ofmore*:.tstmt:-;:; il N:' X shape ; the whole calculus weij^hed nearly an ounce. The hiillet had entered throu;;h the ri;:ht gluteal region and ilium to the hladder two years hefore removal. Dr. Bennett remarked that several similar examples of rare interest are in tln^ Museum of the College of Surgeons, Duhlin, and were presented hy Mr. Cojles and Mr. Cusack. In Mr. Cusack's case the hullct has very little stone ahout it, and was removed two years after the receipt of the injury. In the session of 1878-9 a suhject was dissected in the anato- mical rooms of McGill University,* in whose hladder was found an ounce hullet. It was partially encysted, and in parts coated with a thin covering of phosj)hates. Unfortunately, the track of the hullet could not he made out, as the dissection had gone too far hefore its discovery. The hullet was not at all altered in shape, and was one of the old " Brown Bess" variety, 10 to the pound. As the man had died in hospital of some lung affec- tion, I was able to find out that he had been a soldier, and went all through the Crimean war, so that pi-obahly the hullet had remained in his bladder for 22 or 2;} years. It is a remarkable fact that bullet wounds of tlie bladder are much less dangerous than bayonet or knife stabs, or injury from fracture of the pelvis. A Neiv Method of Detecthu/ Stone in the Bladder. — Mr. J. McK. Davidson {Lancet, July 1st, 1882), has devised an in- strument for detecting stone in the bladder, which he terms a lithophone. An ordinary sound and about two feet of Indiarubbor tubing is all that is required. One end of the tubing is slip])ed over the sound after it has been introduced into the bladder, and the other end held closely to the ear, and the bladder explored. Mr. Davidson .says that the advantages are as follows : — (1) A small calculus can be detected, which would otherwise be over- looked. (2) Practice will enable the operator to distinguish the size and character of the calculus readily. (3) It is probable that a somewhat similar ear connection with a lithotrite will enable the operator to find and secure small fragments more readily and so crush them. I should suggest that instead of •This specimen is now in the Medical Museum of the University. a c a ti fc Sf Of tu <)1 ^?^^::^.zzz'=j:;'" « puMishe.l in thii Edi„ U,,i f '-^ '-•"'", .some ^ycars a-o fra«...e„.,„r.„„„ i„';-,:'tu:;; "■■ ;:::;' ■■'■ "^•'-•"■..' -ri: I I'ad tl,„ ,,1„,„„,, „,■ !'■„!";'" ''''"■'"■■'"^^■' '■'"! -I' (1- »u,„l. (tf"2. -WW. A,,/. /.,„,, ,..,;. " ■ ■^"""■■1" No^relt,, rcconls >hc I«l,™t was ai-oil :iN ■ ,l„. ,,.„.; •*, ' . " ""-' ''"' rase -'lo, t"r,i,l „,„! ;,i„r„| ' i^;;^""" "."•'» """"'-l i" the loft -vc, «,.ai„. to tl,„ ?•,;:'"""" ;;'>''''-aM,y.l..U, „f f* i" ti.o h„„e„ „, ti,o vd,, ;,;■;.'"'' ''■'■'' ^"•" ""'''• ^'» --lies. Ti,o'i,,icct:;„: ' ,^;: ::' '" '^ '» -'■■j™.y "itli tl,o same .■cJt„f , ,'""'"•'"'''"■»'"''" ■-"•Is, both „r,ho opcrati „ ami thoVulo W f •''' ' ""'''" '™'^^. ■mclei could h„ folt wl,i<,4, .,!..! '^ ''■"'l,»'m,ll, a,„i i,„l„|e„e taros. The author : aX'"" ":' '" "'« -»' "f 'I- punc a few branches of the Irma ! v f ?° "" °'''''"'-''"°" »f eiout to oftect a cure. Th sTc uVZ. "" "'"^ ''^™ ^'"S- a«ea 2a, iu „,o. varioceM:: rsi:;;tr "T"'"^ 3po™aticira^:e:i;:;;,:f,:::;,f '--^^if "« '•■■™ '"" operation the cure was oom2,t a , ""'' """'' "«^ 'ast turned, the author "St T "' "'' ''^''"'" ™'"^ - o-«e'e,l that I'yl"nc, ll,„,v worn „„ a.il,«i,„K "■ "'■"""' »■'•■'■" l«r(. tl.„t its ,v,„.,va| „.,. C "7 ■ ''"'"'^ '" "'■«! m,. ;."■""- ,..iL;i: ' r:::^^^^^^^^^^ »'•".-> ™.-of that ,„.»,„, .■e,.,I,.,, ' '"'"' ""■■ "'■'"""■''• '" '-"n. ni tl,o „ay „r „|„,,,,ti„„ . ' ""■•■""<■ "liiccti,,,, sta„,l., tlio Co„;.m...s c„„l,U.„„fi,,. , ,1 , ■'" •'"'^ ' "'<■ '"'"ll„.,s of free .,,,h,,c. i, ;',:;':"'■: -'■ ^'- ■'- v. m..,, „,at of ti.e ....u,aci,. N ;", : V" ': '^""■'^' •'■"'"• ■■" •■-»,■ 'Hose p,.o..„t ,v,,„ i,a,,r .:;:;" ;r"'^'' i---". '-^ l>r. l!i<-l,t..r„t\Sa„ \',~,J" ■'"'■•'<""•■.•'"«■ •>tl,,TH«,) ;-e-ii,™ a c.a.,0 „r :,.';,:::; ;;:' l!^:;:-' ^-",":r "'■■"■'^. lomit.,1 ,c«.,.ti„„. Tli. i.-,ti,.„t , i .r • '" "■'""''''« I'"''- "- '>- ".0 „„.,,.:. ':: r T:; ::: "'■"■■ '"^^ °"'- aiiiBstlii'tic. " ""'"e I'leasiiro to tlio (Lmmt, J„\y illtl,, 18N-> i ",•'"■'/"■'"«— Mr. Jl™,.^ Jlonia ™lii te,.o« ,„„'^.„,„ J t ";„'"','. "'^ r "':'"'" "f "'" I""-"- eonditio., is sligi,t° lit" ;;:, "■•^•""« P--'»n- Tho ".to actio.., but, as a .^1^ , ., '" '""'«'"« "'" '""»elo veloped in an elastic bandage or f ^r . " / ^''V"'''"" '' ^^"- n(- i-oof *i «'i^^«a^t 01 nim elastic webbmr ^uA i. l at lest, the symj.toms soon disannear r,. fi *' ^""P* also describes the '' Rider's S, • ' '''^' ""''''^^ ^« iongus. It occurs v.r. r '"T' ^ ''''^'" °^ -^^e adductor very frequently, and the surgical instrument 'f M maker is often applied to for Home rem'M'ial sii[)port. It is caused by the horseman suddenly iiiakin;^ a btroni; jirip owing to his horse rearing, shying, slipi)ing, or unexpectedly taking a jump. According to Mr. Morris, the pain at the time is often very trivial, but subseiiuently more pain is felt on walking. Pain is confined to inner and upper part of thigh. In mild cases a lung web or leather 8tra[», 2 to M inches broad, and fiadded, is apjtlied. This stra[) is passed round the thigh anil {)elvis like a spica bandage, outside the breeches, and firmly fastened in front. In In severei" cases, where blood is effused, the surgeon is generally consulted. This, by the a|)|)lication of bandages and absorbents, generally disa|)pears after a time. Dr. Edward Henderson {Lano't, July 'JOth, 188'2,) gives an account of an accident which happened to himself when taking a small water-jump in the neighbourhood of Shanghai, The nuiscle on the inner side of his thigh seemed suddenly to give way, and this sensation was attended with such acute [)ain that for some moments he had difiicidty in retaining his seat in the saddle. On dismounting he was comparatively comfortable, and acute pain was felt only on movements of adiluction. When he wrote, a week after, he was still unable to ride, lie says the accident is of common occurrence and well known to horsemen. When a man has once sustained this injury, he is liable to a re- currence, and sometimes {permanent weakness is left boliind. He thinks the accident is (juitc common at Shanghai, owing to the riding of China [)onies being very common. These being of small size, a stronger grip is necessary to retain one's seat. Use of Salicylic Silk as a Dressinf/ for Wounds. — Dr. J. L. Gibson, Mr. Chienc's House Surgeon in the Edinburgh Infir- mary, gives (^Lancet, July, 1882,) a table of a number of cases treated by salicylic silk in the antiseptic dressing. This method is an approach to dry dressing, which " Mr. Chicne has long been aiming at." Next the wound is placed a piece of protec- tive of as small a size as possible, merely to prevent the dressing sticking to the wound, then two or three layers of carbolic gauze wrung out of 1-40 carbolic lotion, above that a variable (juantity of salicylic silk, ana over all 8-plies of carbolic gauze. By thus «cttin.- ri.l of the Macintosh, with Li 9S 't8 poulticing action is dot a 'T'" f ^^' ^'"^''^ ^'/ R'^etnf E. away rch, 1882,) refe Jii'mnadon. D,., n 'lia«...Hin« the ex,,rt ,o,« of ,1, . r '''■'''' '" """ '^'"^"'"y " ;r«»" !'- ^' '".:::;:';: r.r'^r '; "^""' - the ,,at,e„t tli,„,;,|, (|,„ ,.„.,„„ ,1 ,' • ""* '' "" aiso examine can approach i. „„„t Lily hi . , «'"""-"""• '>« the linger of el.e pelvi,,, i„,„,e,lia.c.|y al a;^ 'llrT","' , '," """ "^'''^ forame,,, i, a ,,„a,h-ih„eral J^. r *"'""'' ""^ '''"'"■'"»'• ".» i«,.„,„ of .'he a™ ;: r : :';"::• ^'T'"""''"^ -"" of"- ,.elvi,, i,, p,«|, ,„,:,;•;„„ » ;'''■;'- 14, ,hi, part »o placed that the area of the ha eof > ."'" ""''^''^'' '" by a transverse Ih.e of cut h,/, »'-'<"al.ulum i, ,livi,led ;o«r half i. a«ai„ ^il!:: XZZj?"' r^ "" *" In exauiiimiga patient ih, 1, 'onzontal hne of the cartilage. be considered, lJt;ZZ:^ZTT "»"''»^-'-'» Ae sake of comparison. Inyo, "2 f' "" "'''^"'""^ f'"' "» bad, at the same time,' ^^ t^"' '■"'""-."-« vagma™. The symptom, elucidate. Z "a rectaTe" °" !""" have been-pain localised to the postcotlPd Tf '^""'>'">'''' by pressure; enlargement of the i!, "" ''""^"'""^ of bone ; depressio,r Hhili ' '"'™-f"''™ »"lands, thickening «on of the p'ost cot^ d '^C "' ""'™^"""' " '»*- and pelvic abscess.i^X ^rf ' T'Tl' °' *^ '"" P='^'^ \^(^«aon Med. Record, June, 1882.) f 'I I til 11 M 1 1j ii ir S( ot '■g an to th( wit skc is 1 Q 7 REPRrXTET) FROM Trrr .',..x. Q.aAKTKKM-K.Tnos,KCTo..«aK«EKY. Demon.,,. .„,.,,„„„„„, „„,,"'' ""■ '""■ ""<■"■ >=»". MlOill UnivCTsity ; ' S,,,™,,,. I, ,, , „ - iiiin the «Io„(rc,,l G,.„„,„l J|„„,, ,'■ *'"•''"'"■ Dc.|»rtra,.„t „f tension „,. MovoJo. s 'jJZ" ' 'If " ""'■^'""^ '^- papers at the last ,nocli„. u l-Tl/'''; ^"'*«' "f "vo Thefi,.stpape,.™s ,„ M^i/' a ^ t, 'k ^C S^^'r'T' second by Mr. William A,l„n,s,F R CS ' '"'' ""^ _hasona,„ year. ..e:::;;,' ,.■„,; ™;;-;' "'■-iffJoi«ts lias been ti.e fashion for manv „f , n "'"'" '"'"'«''' " i" the hands 0, bonc-s te"^, ;.:.' 'r '," '''"™ "■°™^°'^- setters are a very mkco]Uu. ^^J»- -^Jarsli says bone- other ^inl, in till „"e' '' I.'Sf';''" ■•^-""' "-h ignorant of Anatomy, pltholo./v ,^ % '' :"" """''^"My ™iths, others are sh r ,c *%'., T7 *^'""" ■■"■" '""<='<- t» Surgery as herbSr M„ 'Z^' '",? """ ^''"'•°" ftc remote districts of En -la, f™ '•""'' '""" ""''«<• i" we have bone-settc-s resilinT tl "vir™"™;, ^''''' mth the names of the ,„-i„crnd ho,? '""'' "'"'"'elves al^eleton in the co,,su,ti,,^:: , r™ Ltr'"' '"? "" " ■» -ong, Se. This class employs anLsC ™""'' ~'''^' freely, making p>' X . s * '1 ! ■Nil use of daily passive movements, rubbing and shampooing, and in spinal cases they often put on a Sayre's plaster jacket. In every case the bone-setter asserts that a bone is ont and that he can put it in. A patient who consults a bone-setter is merely playing a game of hazard. His fate depends on what is the matter with him. If he has a stiff ankle after a sprain, he Avill very likely be cured ; if he has a strumous joint, he will be more or less injured, while if he has a bunion or node on his tibia, he will find himself neither better nor worse. Mr. Marsh then goes on to relate a number of cases which were injured by going to bone-setters, especially patients suffering from tumours of bone. " But," he asks, " how is it that bone-setters sometimes succeed, where surgeons have failed " ? and answers, " There is a considerable number of minor ailments of and around joints, <-,hat interfere with free movement or produce pain, such as adhesions, slipped tendons, hysterical affections, rigidity of muscles, &c. These conditions .... have one point in com- mon, that they may be cured by free movement." Bone-setting consists in the process of carrying the affected joint through its full natural range of movement in all directions, and especially in that direction where there is most resistance. If the knee is flexed it has to go straight, &c. In the majority of cases really little force is used, for an antBsthetic is often employed. Then, again, bone-setters acquire ' y practice much facility in handling and moving joints, they know how to seize a limb at an advantage, and where no annesthetic is given, they take care to divert the patient's attention, so as to take the muscles off their guard. In most cases, very moderate force is needed to break down adhesions, and the less the force required to remove the impediment to motion the more sure the case. This fact might be clearly set before medical men, so that in future they will have less fear of doing injury by manipulation Manipulation is chiefly useful when healthy joints have their movements restricted by external adhesions or by rigidity of muscles, slipped tendons, &c. Joints after sprains, dislocations or fractures should not be too long fixed by splints and bandages. When joints are seriously diseased, manipulation will generally 99 however be improved. ^' ^'"^"^" ^^ ^^e limb may Joints that aro fi*- f« injury, are cool a,„,l IrZ: f " "7 '""" "''■'"■• »"- pain, if there k no heat in t^i.^Yr""' ""'''''«' ^^ M«™ Pulation, on the eontrary it u'lT' '^ """"" '''"•'•"« ">a"i- certain cases where tl e ll ; : / ""I" '™"" '"' "™« ''■ I" ■io evidence of .tr„ct„r 7^1 's r,"; r','''"' "'''" "'"« - !"'«• «"" « arc apt ,„ commir e rC tt "^ '°"°"-^"""« regret. '«''„« is that we cannot fail to Movement '^-n Stiff Joints JIpT "'" «^ " Forcible „ (1) Cases of traumatllori": "S ^'^-^'^'"^^ ^ ^«"-vs : ally occurring in the adult. *^ constitutions, gener- (2) Cases after rheumatin ;«« (8) Case, after stl: "d er^nr "' "" '"'"*• (4~) C-KJP^ ..F . 'Jii'ease ot the jomt. and extending l„, the ™ j"'""™""' '" the neighbourhood of, The fe7clar„T'"''' °" ™'™''"- -"traction,, and fractures into join ,' ";«,!• -T" """ <"«l«atio„s, f-^rt:::::e:r:het:i ir -"'"«.f--abioo„c, ciironic org„„orri;«al "'"""' """'="'''" ""^ acute. *-,,, and Mir, Adam, considers, are centially !Ji \ 'S't t : ' U unfit for this method of treatment. In the last class, where stiffness is due to muscular contraction, forcible extension is injurious. They should be treated by tenotomy and gradual mechanical extension. Mr. Adams deprecates violent extension, and says he has seen many accidents, such as fracture of bones, rupture of arteries, kc, follow its use. Ilis method of procedure is as follows. In severe cases at the first operation, he uses only sufiicient force to attain the least jiossible movement, then at successive operations, repeated at intervals of two or three weeks, he tears through the other adhesions and gradually increases the range of movement till the full extent is obtained ; after each operation he applies hot water dressing, generally using spongiopilinc and in the leg always makes use of weight exten- sion. Absolute rest is essential, and in some cases he uses the local vapour bath two or three times a day. In simpler cases, a single operation will often suffice, but it is frequently necessary to repeat it three ur four times. Sir James Paget, in a Clinical lecture delivered in 18G7, was the first to treat of the cases that bone-setters (mre. This he did in his usual masterly manner ; the lecture is published among his " Clinical Lectures and Essays." Among the affections of joints cured by bone-setters he enumerates, slipped tendons, locking of joints, especially the knee, injured joints held stiff' by involuntary muscular action, stiff' joints following sprains, and hysterical joints. He says, in the treatment of these affections we can learn to imitate much that is good in practice of the bone-setters. Dr. Wharton Hood in 1871 published a valuable little book on bone-setting. That bone-setters fail frequently to do any good and very often do great harm, is no doubt true, but with charlatans one success covers a multitude of failures. The victims of the bone-setter's skill rarely say much about their injuries. In many cases, indeed, the operator before com- mencing treatment demands written guarantees from the patient. Thus w? only hear of the successful cases, the disasters being carefully concealed. There is an Italian woman in New York who has an immense bone-setting practice, and I know of several JOI cases that liave trono f,> i ^ ^ein« cases of w" I si /C T "" "''^- ''"'' "' "- certainly beuc-fite,!. Tl,„se o,'! I ■^■''"■■'■'™' "I"'"" ''"> successfully treated i,y J", ,„ ''• """'•' '■" 'I'-ite »' a.y n,etl,oa™, yet in «»„; Itw' , :7 """^ "-^ ''"" o-eat deal It public, marvellous. So the „M 'T""" ™'-*' '*'''''• »'"! '» «l'c foois rush in where ^J:Zl:i:,:;'"''' '""-" '-•• '"■" »"'• M. Kocher, at the tr . f"""''"' •■"'' '"""S'" i"»cet, Nov. .<, I8«i ,t ''"T"" '"'"" '-'""^''^ss ^London In sub.coraeoid dislocation? " ''''''""■ "" ""' '"''''"t- geon should be to IT'ti ' "T'' T "" ^™ "'■ "-'""- ttepartsofthecapsuCL ■;:;;,:" ' \"''™'^ ""■' -'-^ .I'y «he altered position of I, " ""I '^;" '"" "" "- s'^'ch .'" the capsule is on the iun ■ , d th" "'"""■'"• '^''"' '™' is Sickened by the coraeoh , u "™' '""^ I'"'' "I'cre it 'he capsule is'alsoterT """• '"" '»""■ "-' »f a™ outwards, the ten "nhe t 7 ""''"'"' """ ''^ '■"'■''""g "'e rent rendered patent fo„t " f'" '■"'*'' ""' »"^ "'e oal median plaL, the Pp ^b "'T'" '"' *" "■■"" 'lie head of the bone heh,r„,T / ""'""'' " relaxed and, 1 """< "emg prevented passing foriviir '- ■ ■ lower fibres of the lUir capsule, enters the -J- method Of procedure. The patient should hy the 'enrnd fo.<=sa. The follow- be seated, ■.n 'ill Ml with the surgeon on his left hand. The elbow joint is first to be flexed at a right angle, and the elbow firmly pressed against the side of the chest ; then, while holding the elbow in contact with the body, the arm is to be slowly, gently and steadily ro- tated out until firm resistance is encountered ; then maintaining this rotation the arm is to be raised forwards and a little in, and lastly to be rotated in and the hand brought to the opposite shoulder. It is stated that there is no need for anaesthetics when this manipulation is employed. M. Ceppi says this method is most valuable in old dislocations, they can be reduced without force and without annesthetics. M, Kocher has succeeded in twelve cases of dislocations, varying from three weeks to four months old. In one case where the bone had been displaced for eight weeks, he fractured the shaft of the humerus in attempting reduction, and six weeks 'ater, when the bone was united, failed again. This patient was seventy years of age. This is certainly a very simple method of reducing dislocations of the shoulder, and is well worthy of a trial by surgeons. The fact that anaesthetics may be dispensed with is much in its favour, as in no operation have they, especially chloroform, been so fatal (why it is not known), as when used to cause muscular relaxation for the reduction of dislocations of the shoulder. The method much resembles that employed now almost universally for dislocated hips and is based on the same principles. Lately, I have used Sir Astley Cooper's method of operating with knee in axilla, with success, when I did not wish to give an anaes- thetic. Mr. James E. Kelly, FR.C.S, Ireland, has lately advocated a method of reducing dislocations of the humerus (Dublin Jour. Med. Science, Sept. 1882), which in his hands has proved most successful. It is as follows : First the patient should be placed on a firmly fixed hard couch, which ought to be about three inches lower than the great trochanter of the operator. The patient should be placed as close as possible to the edge of the couch, on his back with his head low. The operator then places the injured arm at right angles to the body and standing against it, with his side to the patient and his hip placed firmly, but not 1% a^anist the crest ol hi, i|i„„. ' „ " *'™'^ ''^ f'"''™*? i' turn, hi„„elf rapidly ,' Z if ,'"\'".l' ''■•'•^'"l '"«> *« axilla) operation (whiol, ^ Tro , tcl t «'7"^' »''"'"'"«"' "'' ""» ««en) is the ease with w ,i 1 nf "''"' "'" '""^^'i"'- are lisioeation .i.hout ilt„t '"",""" -J"™ »l"»,t any fixed by being between r„ T^f '"'"': '"'" -"f""'" i' nelhod appear, very ,in,l ! "'"' "'" P""™''' '"-b- Thi, diffioulty „? havin/thrf ,:;■ '7 1 P-fo-anee. The 3-i,„e ;,,,,,;„,, :re:;,„;r„,""--- -" "-" -"- «oe„tt"^f'r :^7!:X> -^r'" -"■»"f„rred„ei„, in the Dublin Jc,,rJl\f m^J'TT''''' "' ''''"^ "V be !„„„,! theC«.&„^„„™^ •;**»*-»« for October, 1882. I„ d-cribe, a ca,e of Itl ';'";''"; f'' ^"'™'-- " »■ "« "ethod signally failed luKe "' f"'"'' '" "'-I' K-'^Ler', operation for the radical l~fH''™'.''™ "''""' ""»' ''"table of the operation, are To e , cce".?'?" '?''," ""■"'""'• »'«' ators than of any other, % '° "'" '"""'^ "'the ori»i„- wbicb accon,pa„Ltlt„r„;r^^^^^^^^^ method which accordin.- to re„r,t , Pfo'ess.on. One 'bat practiced secretly b? the hnr,r !'""^'' "''™''''"- - his death he gave hi, ,„ftl„7 ,„,, "^f ?" »f B°»ton. Before l-bed in 1877, and efe b Dr '" " '"* '°°'' P^k- for years treated bernij by\t; "T""' ^•'- «•""<•" '■"'I the hernial ring ^ arL, I ,° ':'"""" "' "•'''^ '«"■'' "to close the rings\„d then a, l! '"""""'"ory exudation to days rest in bed was al th ,'w ° " """f"' """^^^S"' .'i'^" d-ihie hernia, „ade:he:"arcj:rt:, "^ ^'-- '» i™. umour and thus breaking down e a^b "''' "™P""ati„g the his book he olt-n made fL adhesion,. According to days and then i^^ed h I-d^'or"""'^'^ ■" '»'' « ''-e -<»-outdowi„pona„d":i:r:~»~^^^^^^ i i vli. .fi' t B aflhesions between the sac and omentum, and returned the mass into abdomen. Mr. Ilcaton never had a fatal case during the whole period of his practice which was over »'>0 years. Surgeons, however, who have adopted his method have had but lair success with it. In the Neto York Mt'dioal lienord for Nov. 11th, is an article by Dr. Wm. T. Btill of New York on Ileaton's opera- tion. He has performcid the operation 49 times on 40 patients without any serio\is disturbance, but only in twenty-one can he report the ultimate res\ilt, the remaining nineteen have not been seen since leaving the hospital ; of the twenty-one cases traced, five have been cured, seven impi'oved, four temporarily improved, and five have not been improved at all. With one exception, all the operations were for inguinal hernia. Dr. Geo. W. (j!ay of Boston has operated twenty-three times, with the result of fo>ir cured, eight relieved, and three uin-elievcd. At the end of his paper, Dr. Bull (juotes and endorses Dr. Gay's general conclusions as to this operation, " I know nothing of the merits of the operation in other kind:^ of jiernia, but in the one under consideration (inguinal), I can hut conclude that it is safe. It is not very painful, it is not very difficult to per- form, it does little harm even if it does no good. It will cure a certain number of cases and relievo others." Dr. Bull from his experience feels justified in recommending the o]ieration, and he is siu'c that in another series of twenty cases he could greatly improve his record — and he hopes that his report of the opera- tion will incite the profession at large to study its advantages. Dr. Bull, who is a very able and skillful surgeon, deserves great credit for the way he has recorded his cases, although his success has not been so great as others, as, for instance. Dr. Joseph H. Warren, who no^v asserts he never has a failure, in his first series of cases he had some failures which he con- sidered due to " imperfect instrument and crude injecting fluid," or Dr. IT. S. Gi-eene, of Kansas City, Mo., who had 91 cures out of 97 operations. It is certain that Dr. Bull's statistics a; > perfectly to be relied upon. Enthusiasts in any operation or mode of cure are very apt to look through rose- colored glasses and s* 3ures where an impartial observer, such 105 ™ti,lic,l will, 1,0th ulTmk IT "^ °""' '" """ l'° "» i"vonta new ins.ru t t:''''^ ""'"""'.-"> ''i'" no. 'i'l'i^, ...«.:.., ,.f t,.cati;"„:;..r ;,■:;;;,? ;>""■« "-' ■ ' »"C' l.avn,g l,ec.„ li,,t i„„,a„„„, ,f' ^ « "-; -0 .. au M recent operations for the ,.a,Ii,.,l / }, •^'"■'l"-''' "f the William Dnnnett Sp„ L^ ^ T ''""'»' ''^ """ "'' M''. operation at the meet n.! 'the BntH^'u",. "?' ■'''"'•'''' '"» 187St; ,i„e„ then he ha cl, , "''"'' '^«^°=i'"i<.n of Modieal J„,„.„a,.. „a rat - Te'^jl "t™ ^"1-. to the Tl.e ope,.ation i., pe,f„„„ ? , " , "a, ""' ''" "I'"™"""- cork ,e,.e,v, l,nt with «' t '■"' """■""'°"' *'™"l'i"S like a Wfenearthepi C t I'T t'/'*"™ '° "'™ ■ '* - oowa,,,, into the'bo„:ja, 3 , e ^ arr ""' "' •''"™™'' to each other Tlio ^.n,.,. ^ -M^proximates them '•»■■ Woo,,. ope^rVXr ^^^^ Iff"' ' "* - separatmg it from the snhe„t„,„„° . ' "°'""° ''• "'"l ™ay 1.0 necessary J rm " " '° '""'' "' *■^"""- The rupture having hee, r« nc 7JTr '"' ""^ '»"«•■ into the scrotal wo,r„,l ",,,,' /''";" '^"'■'"'"Sor i. pa.sed make out tlie condition of the. I.. ■,• """" "'"' «as>ly i'.« strneturos. ThT , . ! ,1 ?''' '"^ ""'' ">" "'"'■'"'^- «;.er, the "permatie coTS!;! ::- ™« ^ '>eh, h, the of Hie screw is, with the ri-hf h, 1 .7 ^ ^"S"'' "'^ point "'OKroin,s„ as .0 pa,V t uT' I '' '"''='' "'"*'" "' i"'or„aI ring in such a vav haf h ■'"'"""■"^ '™''™ "' "'« of the left finger. 'nZllo^t T T"" "'™"^ "^ "P an.1 fascia hel.I in the i ..radar " f '" *'"""'' "'= »»' o«ernal pillar subcutaneCy ata', s I'" ■?"' "™^' '» "« »o as to push it throu,-h the h.'t! -n ="""' '° ""^ '"ew and again across t," Po„ ! ' ^ , "" "' "'^ '••^'"™l «« "•rough the scrota fascT/L"""'"'''''" P°"" ^'"orging -iaieana, are appi^^'ertZt 1 "\„t tt^^ f *' -''«-'->"... «n,p„sLrw,re!::o£i:: inva i ■yi #1 jii l.'5'iip m \ is taking place. The handle of the screw then lies flat on the abdoinon, the point is protected by a ball of india-rubber, and the Hcrotal \V(nin(i clused by a suture of cat;^ut, there is no lu!morrha;;e. The screw is removed in the the 9th day, dress- nigs reliiKiuishod in about two weeks, and at the end of a month the patient is allowed to ;^et up, the parts bein^ firmly consoli- dated. In sixty cases in which Mr. Spanton has operated (^Annah of Anatomy and Surgery, Oct. 1882) all are now living, and in a large projiortion of them a jjermanent and satislactory ctjre has been affected, while in others the patients are so much improved that some who could not wear an efl'ectual truss are now able to do so quite comfortably. In a small proportion the result has been almost nugatory. If a contiimous ligature is [)referrcd, the screw with a large eye at the point is passed in the manner described above, then threaded with a liirature when the point appears through the scrotal opening, and the screw gradually withdrawn upwards, the ligature following its track and occupying its place. In order to keep the ligature tight each end is fastoned to a glass rod which lies in the groin until the parts are consolida.ed (in ten to fourteen days usually) the ends are cut off and the ligatui-e remains. When this method of ligature is used operating under carbolic spray is desirable ; but with the screw Mr. Spanton does not use the Rjiray, The most satisfactory cases are those of congenital herniic in the young, and the operation, says Mr. Spanton, is especially adapted for those cases in which the hernial aperture is large and the sac bulky, or when the congenital rupture is of old standing. This operation, which is a modification of Wood's and Wutzer's, is, according to the author, much less dangerous. All the cases operated on were of the inguinal kind. Mr. Sl)anton thinks that the wide-spread prejudice which prevails both amongst the profession and the public against operative interference in all cases of hernia, except when strangulated, is being rapidly overcome under the new era of antiseptic surgery. Manjp surgeons now cut down on the hernial tumor, reduce it and pass catgut ligatures through the pillars of the ring, so as to bring them together. By this method, Dr. II. 0. Marcy 107 1'"'" cue off 11 r ™' ^1 r, '";'• ,"'""■'"'' ^^ '»'«» "' >vi.icir ho completely curcl J.T lii. 1 T' ''"'""'' '^''''■'" «^'»' ""e Voikma,,,, „p„,,e.„ f„,.t ,',;"' ';7'™"" »'"«1. Prof scraping their el": ' / ' "? ''•''"■'•™' "'"'"■""'^'l ■!"«. »"..a.e., i„ the „eo 'o ' '' J'"';" '" "''"; "-'^'n.e.io,, i, " «.■•>■ l>o Ii,,.at,„x.,I, hot a'tl^e,,; '""'"'" ''" '*''"'-"l fo™» the t,„,iea va:.i„ali. It eom, '," °"°*'°"''" ''"''"''' "'»" 'l'>ostion. Vollcnn.,,:!' '''''■'° ''"'"'™l '■« out of the 1 Tf >i """"' practice n these niqea i. m 1. If the neck of the ,ac can he 1,117 V . ''""'■ place,! around it, the nilhrs of H , '""""■" '""J' 1"= SNture,,a,Kl the inter o of „ ''"' •"'""'«'" '"«»"'cr hy Simple ,ran,ver!e ,1 '"■ '■'" ""'''»'' »'" ""'1 ''raine.h Practi,e,l. 2 If he , ! r° '"■ '"'"'"' "'"''''"» ''-"I'l l-c -ith Wahr,;;, re :;;:::;' ';;, '■'°'»'«"' •' »'-" I'C treated «-" the ,ac should b 5:^0,7 : f ™''. "' °'»™"""' »"" one should consider r is ii-r' •''•"'"''■ '" "''I I'»«™'3 .«-'c is incomplete desren;" "t ' ttlr '77 ' '■'' ""'"' isolated, it sh„u|,| 1,^ c testicle, ,f the sac can be castration should be perform^' rAl,"""'"! '" ''"''""'' "«"' RemoMl of Portion of /„te„;„«._Dr W„ p ,n „ , Montreal, and now of Gran.l Fill, \x I- ?' " <^''"'' "^ *^ rorkM,:,^,,, yw of'^o t' uthls o"^""/" "-^ of the above. The first r,„ 7 ' "' ''"'™™l cases in a woman, where on cuUinTT*"'"'^" '™»ral hernia was found to'hegan,,:::"'™;™; ; '""""^ "f ""«'■- beyond each cvtitiFty „ L ,1 "1'"' "■"' '""'''■'^ " 'i'"" temi-y ot the slough, and a double linen ligature 131 I"! ii'hjil I b ^ ■mi 7, I placed arounti the mesentery. The la^aeiituiy was divided bejopd the li<;aturc, and with it five and a liaif inches of the Mwel removed. The t\v>. <.'ut endaof tl»e inte.stini' were hroimht U^thfr by a cuntiniiourt h^ature "f carltolized sho('inakc'i''.s thread, fh* enl"-.u«l. an al,,i in ot "" I' "I"'" -^i ^""'-" ^""'-cl iyn„iuie «.*' ::;;;, "i;t:'M ':;;:-::" ■•'' "« '•■"'■• ln;,lm,',,l „/ T;,mmt,\—'),. |,-,|„„,.| „ , '-™lli,i.. ,,, „„. salievlal i; Z'L ^!u "'" "■";"""•■" "'' simnlil I,... T1.L. v,ln,; „r ,] . ^ ^ lvmj.,nz.,l as it by Mr. 1.0,., ,1 , , : """,'";■'" "•- '"■" P"i-od o„. ai.-». i,n,nc..n ' „ ,.1 :f ' ""■''"r'™'' ''y "'« r'»'-" Dr. E. iStover (/./„y. jy^,, ^, ■»c>..l.< the. application of pow.l.ro,! hicaZ, /, r f ■"'"" ".fia,nc ">ond the operation in the acute ;„ ! ,f ".""' f™"- moans uncommon to see even mild o , '" " " ''^ "» tonsillitis in which a Consider I n ' "^ '*"''»""-= «■■ eh,-onic ">v«.utio,,i,,thoe„urs::r:*tr:ti''"''"«r-''''"'''™"''' v-y apt to mislead the practition r ,t: he Wef T';"" "" has been ivrou-ht hv the n!,l of =„ ,, """ " ""re ™'i»n. " It is also •• '■'""•^ ""1"''^"' l'"^al "Ppli- a -rics of :i';j:'Xr '';;"'■";'"« '»°'-™"'"i al"ys less and les compi tc „ '"'*''""" '"™'"""" - chronic tonsillar hyper rl?'' V:- ''°"""' '"" ""&'" »f Aat the removal of t,e Zi, , "° *'''™'^ f™'" *e theory generative system '"' '°""' '"^'"'"^ "«tet on the «.e solid nitrate of silver or !T, r" ™'"=°'' '"">'"'' ''3' stiehsof these should e rose :;fth,°- ^'■"' ""'"'^^ '"e follicles, which arc ea ii; set and re'ofT' "' "'-'""^ "^ hj-pertrophied gland I„ this ! ' ""^ '■"«'' ^"^c i" a ";e«.andin a most effitilTan^r^'-'C'l '''V'™'' °^ "vliich are soon dischar-ed ,„d tl, "'""S'"* '»'™. ■■none direction wl.il £, tc nt ^t ^V°"'h "" ''"""™-' »"' 'ion in another. Two or three 1 ^ '''>''se,,„e„t cicatri.a- cauteH.ed daily or :::;,*:, t;:t,d'"th:;': '""" "^" ^^ |^~eeeanheactedonwith^';:;tt:u2rrS ■h f nm 'i I-:; llfl'l i II '1 tl ai al m th ^ C *'^i QUAKTKKLVH,0TKOSi.ECTo.suHc,.KY. Mr. Charles Roberts FUC ^ • Surgerj. as a srwcialilv is a .-,■„,» . ,, ™ """ Orthoposdic ^e public. T e speciirs. i' " ' " ""^ P"''"^™" »"d a «a,.r„w field of STaJd,™"'' ''"'""" '^''^ •«'^''"™ "" it^ importance, a„d 1 ana ^ ' "dVi: ""'T'l '" "™"='"™'« loses sight of ,l,ci,. relation tl f """"''"■•"= !"« facts till l,o wMIc, o„ tl,. other hind h 1 """'"f""''""™ »" »"ch other ; an.l .opellod hv I e a I '.'r^v ''""'""•'"' '' -l-l-^oned i"duced ,0 ha;,d ovo, to ,h T" f'"" "' "" ""''>='• »"'' « •luite competent to ea " ^ a, f'^ T' '''"' "''''='' '- - tl.c importance or de v Lee'IV r "'° '"'"' '" ""''«'->'al"« author says no defitXtf? ""r,''';"""-' "°"'™'"-- 1''- alarm to parents, or i, CX^l'Z^^ ™° '" '" ™^^ »ent arnon, medical men, as laC Llf it?"^"'' '-"'" this IS due he belie ves to an curvature ofth imperfect acquaintance with <^ spine, and, Its ml X origin. Specialists are accustomed to treat lateral curvature, knock knee, and flat-tloot as distinct detbrinities, while in truth tney are all links in the chain of one deformity. Mr. Roberts thinks in all cases lateral curvature is due to the loss of lateral balance of the body in the upright position, and is an effort of nature to maintain the centre of gravity of the body and sup- port the head and sluulders in the |)osition which re((uires the least expenditure of muscular ellort. The paralysis, wasting, or loss of a limb, or shortening of one of the legs by disease of a jomt, rickets, knock-knee, or flat-foot in growing children will produce lateral curvature, and these are its chief if not its only causes. He does not think it a deformity owing to general debility or to awkward sitting position. The curvature thus produced is antero- posterior or round-shoulder. It is almost peculiar to girls verging on puberty, is found in the strong iiid healthy as well as in the weak and delicate. It is less common among the labouring classes than among the rich and well to do. He is satisfied, after a careful examination of the subject, that acquired lateral curvature in girls is due to the change of position of the lower limbs resulting from the development of the j)elvis from the infantile to the female type a year or two before the accession of puberty. At puberty the knees in women are brought closer together, and the peculiarity in her gait in running is due to the fact that she has to move her knees round each other and to throw the feet in a successiorj of small semi-circies. A little additional strain will convert this condi- tion into knock-knee, and by throwing the weight on the inner ankle the arch of the foot is quickly broken down and fiat-foot is produced. This deformity is exceedingly common amonti- women, and a French mvant has lately (piotcd it as a proof of the physical inferiority of woman to man. To a slight extent flat-foot may exist in all women, and Mr. Roberts suggests that it may be Nature's plan to promote what anthropologists call marriage by capture. To a large extent, however, flat-foot is the result of civilization, and he says that the highly arched in-step and the everted foot arc peculiar to civilized jjcoples. Both conditions owe their existence to the wasting of the muscLs I 115 calve., of whiei, „, „^ J' ^ ''-' , ■"■•" n..klo« and la,-.,, must be directed,!,, ti,o fi^t in , '"'"■■''''•""" a""'''!",, formed knees and feet 0,,,ll«'' """""'"'^ »"^ 'l-^" the foot .ivi„„ „,a' the ^ ",7 *"''' ''""" »''«"= -'-I' "f boot. .,i,f, i,„i;7„L s Lit;: i:;i f-'-^*" -"-'"-'^ and speeial e..e,cises favon,.al i . to M. ' , '"'''""' "'" "'"''• ".useles ,l,oul■■ *''"^1' Symnastie exe.-ciso :,,,!'; ::7'« ""'' »''»" "^' vi.o,.o„s bent position ass,nned S ^ , ' , I, '"■" ''°^r ''"' ""■" "■'"""- '1.0 e,.„s3-,e,,ed Oriental' it: J't^';::' "7'- -'» « ove,-t the knees and in.e,, 1,7 -,1 /'"'"' "'" P^'"'^' formities, while sitting c la , „" T ""'""""' "" ''»• favours them. "'° '-°' crossed, di,-ectly This ve,'y interesting article of \r.. u , . . „ »«efnl ideas, and should "e,d ,';,n' ' ? '"' "'""''' «ve,.,p,.aetitio„or intc-este i,?! i^ t ' ^i,:/"" ,•"'«"'"' "^ like all men with a hobbv Mr n I . , '""''' ""''- ''"'■ oases of lateral eurva „ et ' „ft ^ ! "":'! " •7'«>'"- '"-t all assertion, and as far ,, °' " ''■'"'""' " '^"copins correct „.. ml: ;:i^:::z:: rT' -- ^^^'"^ C'lrvature is more fre„„eo l! curvature, and iate,-al in the labouri^Hl e' w r ^"" """ '" "' "'•^^'™ "'-' frequently seen in the L™, ''''"" "«"'»'-'«o' ''-^ so , 1 >y sten in tlie labouring c assos ''' Fn m„ •s more common in fhe«.. nn,^ ...;! r . , , ' . ^" "•>' «'^P«'''ence it and tins I hold is duo to their often bcin' compelled to nrrj- u..; i *. i ligaments are refaxe 1 ! ^^^ ''' ^^'^ "^'^"^^^^^ ^^^- ^''e reJaxed, the system taxed by the momentous , 'if 'If. WJ (I 4 m \ changes going on at that time, and the feet having to carry increased weight. IIow is it, again, we do not see lateral curvature in boys, jet flat-foot is not unconiinon among them ? Anatomists have always held that the large calf in European races is duo to the less prominent os calcis re(iuiring more leverage power and so more powerfid nmscles, and the slender call in dark races is due to prolonged heel re(piiring the less leverage and not so powerful muscles— thus theie is always a constant relation between the size of the calf of the leg and the length of the heel. The highly arched instoj) is not peculiar to civilized people. Tlio North American Indian, as is well known, has a very high arched instep: although, as a rule, he does not go bare foot, still the jilay of the muscles is not interfered with by the mocassin he wears to protect his feet. On the Treatiiu-nt of Glanthilav Injimninatlon. — It is now four years since Kapesser (an army surgeon in Darmstadt) described his method of ti-eating glandular inflammation by the inunction of soft soap. One of the lirst observations he made was in the case of a badly nourished scrofulous little girl, whose neck was immensely swollen and discharged copiously foetid pus from oes.,es in easil^: i,f *:;;■■• ;;"---■', "hitlows, •" spirits of ,...,„ ,: ,,,.;, 1°;" •^- '-" '■■U- are ,teepe,I gutta ,,ereha li,,„e, these Zl ' "'"' "'"■''™'> "i* -rgeon, an,, not lef the Ment^t:""?'^'^ "'■''''"' ''^ "'« bo no te,li„,„ suppuration v M "^ ^ '"'""''"■' """« '"" ">ayfor,n in a'b,l„ ,C '77'; "^"■y '-"H »'«oss i° walking. Housm r , t l' T ''"'" "'" ''o "» '•'ouble *on«,, Sa„ «: r Ko :,nt ™"": ■"•^"^ """ ™»'-o caries of the sternum a„,I Z^Z^^ZT """' "^ "»-•' «f mhbed in twice a week in the e „ „ ' ^-""."ct.on of .,„ap 3k.n hy heing .split „p into acid an7l»Tic st ts 1 'J T *" «ter. The c.ces,, of alkali in f-ese ,a , " /'^ ""''"''"'' "^ of the skin, formin.. soans wl.iel, f "'"""' "'"'' *= fat The caustic pot„,h°soZ t „ !". ° "T"'"' ""■ ''^ "»'-•• form of a fomentation, „ '„'; ' "°'^ ''"'^ -'>en in the rela.vec H " s ' ' '^ ' """'' ^""•'■^"^• Ti.o first or s.aiier h,^ .^^ . Uh" 'TP'"^ '•^•"''^^-• -ith 2A percent, of iodof,,nn ' ,1 "'' >",pre.naterl filled with peat-dust Zl ''"""" ^"' ^'"^^'•- '''•'^' i« I" oni, five ea,e., ,! ::::;:"; '" ''" '""1 '■■"■'^-'"^ mere was „„e deati, i„ a else of! f . ."'" "'° ''"'''■'«"■ ation of nerve »tretcl,i,", wT, f„ , 'l n''''""''''.''''''''^ "'« »l»'- ab3orl,e„t of .-ases a,„l li„„r l , ? """'''"'I'sive, a powerful Naphthalin. — Ou-incr fn fl.„ whicM,avef„ilo,ve, :„° r'""'™" ""'™ "'' l'"'-""'« hospitals, a les 1, ,; „ "" ™ '" "^■'■"""' »"'' """ian requires a ^'Tz;^::rzty'T"■ '""' ^'^y ■' other suhstancos u,ed : L ' "d " "'""''"'''"°" ""»" ,^^p^' ■■■' .a h,dro.ear.„,,;:r";,; : ,7j :';fi;'«r- large (juant ties in tljo dktlll,,; r , '" "' ' '"'"'oil m oils au'icoal tar, I is to',' ,""'' '" "'""'' '" '-="'3' nor in the secretioj VrL f "u'^r f "'?: '°""'™'> ether, in war,„ alcohol, and strt t., , , ^^ '»'?!"V" -'" used these Naphthalin dressin.^s in StV ,, '^ '''^''«'- ""' conclusion tha it was /"''", *''"''°'' "••""" '» 'he disinfectant for 1^";:: ^ ir^'D-"- ,'' ^^ -^'■"' it extensively ,,„d found ;, ^„J, ,' 7 ^J''"''«"ow ha. u,ed wounds and u cer 1 >" '^ '" ""'"-"""'y S'™ulating solution of chl ride of .""f " ""' '"""•»""' ^^i* » 3 p,c° i. laid 0, he To d, 7. r .""" "™'' '•'"''''' '" %''"hahn, layer of wool oTered t l , ,f "'',"""' °''^'- "' "«"' -"°'he b' Djan.o::;7:S ,;'t:* - ,^-'3- another handage. for surgeons, who like hi Jelr r.^l^l'^^.^P'"'!"''" <'''<'=™«' rjf I > iniself, have to treat patients in hospi- is tills (leliclcnt in funds and with an insufficient supply of nurses. — (*nt. Mnl.Joiirnaf, Nov. 'Jfjth, 1882. (hiilc of ILnh'oijen. — This has of late hoen nauch used in Krancc. M. I'ean o|)eratos in an atuiospliere of oxygenated \vat(M', instead of carbolic acid. M. lialdy employs gauze and wool soaked in the peroxide. It has been successfully used by opbtlialniolugists, and many French surgeon, use it for washing and dressing ulcers .-md al)Cessos. It was first (New York Mi'diml llrcrd, January (Jth, 188;{) introduced by Mr. C. G. Kingsett of London, in 187tu. Dtna antiaeptic precautions employed. The I;, t' m it'' V case in which this procedure was practised, was that of a man a;;e(l 4;J, who for fifteeji years suftcred from calculous forniations in the gall-ldaddor, liealin;^ was completed in two weeks, since then his general health has ;,'reatly improved and he has gained If) Ihs. in six weeks. He has no pain and has entirely ;;iven up theuse of morpiiia, which hefore the operation, had heen con- stantly employed in large (piantities. — Anuriaan .Journal of Mi'iUml S'rleturs^.lan.,, 1HS;5. Total Ki-amon of thf Sfenunn. — At the recent Congress of German Naturalists, at Eisenach, Prof. Kojiiig reported a case in which a woman had heen treated hy several jihysioians, for more than two years, for a sternal tumour which, without hein<^ excessively painful, <^ave great uneasiness from its steady increase in size. The tumour was as large as a child's fist, was moder- ately hard and clearly arose from the sternum, and passed later- ally into the ribs. It was sarcomatous in nature. It was de- cided to remove the sterrnim after experimenting on rabbits The operation consisted first in the division of each rib near the sternum. A .slight opening was made in the right pleura, and on further dissecting it was found that the pericardium was ad- herent to the tumo\ir, and it was accidentally torn, as was also the left })leura. In spite of these openings the patient was only dyspnceic for a few moments. The wound was then closed after the removal of the sternum and dressed with iodoform. The dressing was not disturbed for 12 days, when it was found that part of the .skin had sloughed, and that the heart was bathed in pus. Improvement was steady, and the patient was shown to the Congress with the wound (juite healed. (^^7. Wienej- Med. Zeit., Sept. 1882 ; (pioted in American Jour. Med. Sciences, January 188o.) This is a remarkable operation, and the successful result makes it justifiable ; but another Euro- pean surgeon, who lately extirpated a portion of lung for phthisis and lost his patient, has been much criticised, and the oper^,tion is now being made the subject of a judicial investigation. Amputation at the Hip Joint. — Notwithstanding tiie very great advances n^ade of late years in operative surgery, this operation is still a very fatal one, and one which the surgeon V2S fa.,,l ca,o, have ,.e„ .,,„.<„,. ,,.,.,, t^. „ ,'; , ^^ ;^ H» - »:;;:::? :rrr:;~,;;,s E "'f'""" """'I'" '"^ "»•"!' ««'aler tl,a„ ir tho l,.|t arlnv L 1 , 1 conipi-oHscl. Those ca«a have ,lcstr„v,. , ■ V " the ri«h. iliac a,.,e,,. rt ™ay ,«„ „:;,;:,;,"' , x:;:;;= to comiacsa Ihe ielt iliac artery. >• ' »itli aalety a »uceoHrf„l case „f a,„p„.a,i„„ „f th,! I 'fo'r n er! ilTt;: femur ,„ a child six years a,„l ei,ht ,„o„ths'„l,,. I ,^., Jordan s method was e,„,.l„y.,d ; that is dissecli,,. „„t the hroush t„e .soft parts .some distance down. Davy'., lever ,vm "iZne death!"'^' "" '"'" " "-• ^'----^ '-"■ Mr. Lewis Marshall (^/vV. Jfcv? ./o^/r Op^ l«8'i. -onea.edtw„,ea:,,:r;^^^^^^^^^^^^^^^ u .0 co,npre.„ the femoral. No more than two vesl! we ^«at„red m any n.stanco. Two draehms would repre nt l" maximum blood loss. Cat.nt ligatures were used, and h w „ d dressed w„h carbolic oil and lint. One ease di;d three Z h a tes with M T'h °'", ™""' '^''°"'- '''■ ^'"■*»" <^ y Hemorrhage and less opportunity for septic in- 1 m ft li 14 fection. The vessels cut are more easily dealt with. It should only be employed where the soft parts are intact. Mr. Jordan holds the danger is much loss when the femur is enucleated and the soft parts cut across at .some distance from the hip joint and where they are smaller. The stump, though at first flaccid and limp, soon retracts. Mr. Marshall says his chief object in bringing these cases forward is to call attention to the somewhat tardy manner this metliod has been adopted by the profession, while all the London surgeons are endeavouring to find means of arresting hemorrhage from the posterior flap, they never even give this method, in which wounding of the gluteal vessels is altogether avoided, a trial. [Mr. Jordan's method is fully described in his book on " Surgical Inquiries," and in the Lancet of March 28, 1879.J Mr. Shuter, at a late meeting of the Clinical Society in Lon- don (Z?n<. Med. Jour., Feb. 17, 1883), reports a case of sub- periosteal amputation at the hip, performed after Jordan's method. The patient recovered, with new bone in the stump. When shown to the Society, he could walk easily by means of an artificial limb which was attached to the stump. Dr. R. Varick {Am.Jouv. of Med. Sei., Oct. 1882) reports a case of amputation of the hip joint, with recovery, Trendelen- burg's method of controlling hemorrhage being resorted to. The method is as follows : A steel rod is passed obliquely through the soft parts between the femur and the femoral artery, com- ing out at the fold of the scrotum. An elastic band or tube is now wound in figure of eight foshion round the ends of the rod passing in front of the thigh, the knife is then introduced and the anterior flap formed. Having ligated the vessels and removed the compressing Land and rod, the femur is next dis- articulated, and the posterior flap formed in like ma'^ner. Dr. Varick says this is the first operation performed m ci".s way in America. It was done for a case of compound fr..oture of the right leg and thigh, with considerable laceration of the soft parts. Queation as to Amputation. — Mr. Wm. S. Savory, F.R.S., in a short paper (Lancet, Jan. 6, 1883) remarks that perhaps in no case is the judgment of the surgeon more severely taxed 125 1 a.,, tk. ,„j,„-y,ss,.a,„r ,i,a„ tl.o „,,„„,i™ „, ,, ,,„'„' of recovory f,.„,„ the „po.-aU„„ s„ ,„„cl, ..oate,. a .11 ^nly cusc .' It was formerly l,d.l tl.at lc« risk to iilo is in curro,! by operating i„m,o,lia.cly after tl,„ injur t„, .■o-to „orio.l ; „„t Mr. Savory tliks t,,at „,,i „ , l" on l,as .ra,l.ally ci.angcl, „„in« to ti.e ,U(,orent o. r "t I surgeons l.avc l,a,l fro.n military, wl.o always aJvocatd oons,der"wl,etl,or it is worti, wl.ilc, for tl,o pros, eot of 1^ r;::,:; ;^■ '"■" *" ■"'^"" -■'"•^■' <- "^" f'-" ■■■- i. ";, ; :^"^^';^r^ "*"; »' -* -f >- H.e, .,., lie savs «' '■ '■■=*■"■'' '" "'^'••"■"•"■■y amputations '"■ says . teecondary amputations are more favorable than F-ary ones wl.en there is a choieo of ti,„„-„,at i , on u,^ at brd to wa,. t,ll the te.nperature and other si,„s f ,.c e a dstnr anee have subsided ; but secondary an,putations ,«" av„rablethanprm,aryif the operation fs foreed u,,on 4 a penod ,„ the case when a high degree of (ever sti I p," vl am;:;:;,!:' r ■ ■ '"''•'"? '" •"^' '■™^'«' '"^'»-" --i y amp„tat,on after rnjury a,„l ampntatio,, in disease, for in the latter case there ,s almost always a ehoieo of time." In the Lancet of Vfh RrA 18«^> sr. o of S;,,,,.,' 4 . . ' ' ^'""''y' "''<"' spealiing ot .Sy,„.. A„,j,utaUon. says the tcdeney of surgeons of the backwards at the expense of the flap, and thus lose a consider able porttou of the thick iutcgumcnt of this region, which makes wi;ht^';!!;r:!r"■'i=-=''°■■'"'»'-'«fflcultyho 1 „,;„ , • V . '^ »'«.i.^iuu, cue less aitticu vill have m dissecting off' the integument from the heel But this difficulty may be overcome, after znaking the incisions by opening the joant and working from above do;n. The d se'ti ^ I- ' : Mil ft ^ IS thus rendered rendered comparatively easy, and there is no danger of scoring the Ha[). I have seen this method of dissecting off the heel-flap performed many times in Germany, and have taught it in my operative surgery class for the last six years. In addition to the method of dissecting the flap, the incision for the heel flap in Vieinia is always commenced by making a transverse incision on the plantar surface of the heel, as far forwards as the line of the tij) of the external malleolus, and then extending the incision to the re(|uired point on each side. In this way there is no temptation to sacrifice the heel flap. In the same article, Mr. Savory, in speaking on Ligature of Arteries in tlieir mntinuitij^ condemns the i)reaent practice of, after making the preliminary incisions, laying aside the knife and then endeavoring to expose the artery by tearing through the intervening tissues with a director. He points out that it is almost impossible to avoid bruis- ing the artery or vein, or to make a clean and satisfactory isola- tion of the artery by this {ilan, and prefers the old-fashioned method of using the knife to expose the artery. He has never seen the artery cut by the knife, even when it has been used f.ieely in awkward hands, but has seen the artery injured on the living and dead by the abuse of the director. Mr. Savory also prefers carrying the needle round the artery without the ligature, and passing the thread through it afterwards. Treat inent of Frost-bite. — Dr. Lapatin of Tiflis makes known a remedy which, he says, never fails, if mortification has not set in {Phila. Med. Rep , Oct., 1882). This is Balsam of Copaiba. It should be spread thickly on a piece of muslin or linen, and the affected parts covered with it during the night, a stocking being put over the whole. In daytime some balsam is merely spread over the parts. After one or two applications, the redness and pain cease, and a few more not only remove every scquelne, but seem to impart to the surface a remarkably increased resistance against frost-bite, if common precautions are used. I have em- ployed this in one case, but as the patient never returned to hospital, I cannot give the result. Treatment of Soft Chancres and Buboes. — Antier states that salicylic acid is highly efficacious as an application to soft I I 127 upon liner, ( P>-n .tif ',,'='>^'^'"'^"^"^J 'eaves no stain niight he of use in those c.s es of 5)' , ' application ■'egn,,.,,,. to lose conliJccc i„ „,o uk.1„ :;-■,=;;" •■"■" mammary «la,„i» „l,id, l,a,s lately 1,0.,, i„ v„ . , T , out of the gland neatly, and .e,i, I..":: ; ^l^T' akes , aee by H,..t intention, and The ,a,i,.nt ^ .t. ':.:';:3 ::fr/::r;i:::;iz::;ii::::-:;--:-f «-^«.:::c:;„:::r::;:x.;2i:r;:::r all, un,„„ „s by fit-st intention, and tl^t the a e -e . , I' «t,e„, was under treatment was o,dy, say, two wel, but, present Jy is to re It I., „' ^ ri're^r "^ "' r"'" operation, and the final result is ly ,„«,," T ''■- casdy see wbat Callaeies we may fall il,tr . """ -.l,ods, and bow little ^''^^^^Z^tj^ ^^;X^ L-, "-y, asserts that SUnronna -la r, . 1 1 cancers of the breast- Z .' '' '^' ""* ''^'^^^^ *..... ...;.;:;r'.:r;a:r;; s.;x pttp ;;::-— :z;:.5't f-aiu i(» naps or covenniirs of anv kinri 'VUr. v> «ou„d bein, settled, the incision sh™,d be irried 'into tCe a* 'pit it ft ■, tt- i'l V-f m about an iiicli below the margin of the great jjectoral muscle, and all tli-j glands removed, whether enlarged or not. He has come to the conclusion tliat, in evert/ cane where the breast h removed, the axilla should be cleaned out as a necessary accom- paniment. The one operation is useless without the other. As you cannot tell whether the glands are diseased or not, remove them and dissipate the doubt. Dr. Banks has records of 46 cases, with (! deaths ; he admits this is a serious mortality (1-3 per cent), but adds that if the o[)eration is to be of any service at all, it cannot be otherwise than a serious one. Five cases died of septiciiemia and erysipelas, and one of bronchitis. All the fatal cases were from 44 to <)7 years of age, and they died from three to six weeks after the operation. In 11 cases the patients died from recurrence of the disease in from 3 to 12 months. Three cases died from one year and two months to two years after the operation from other diseases. Ten cases arc still alive witliout return, in whom the operation has been performed 2 to 10 years, and three are alive on whom the operation has been I)erformcd one to two years. Nine cases on whom the operation was performed within the year are not tabulated, and one case has been lost sight of. Dr. Banks thinks if going to reappear, it will generally do so under 18 months. Gross says if the patient lives three years, the probability is that it will not recur, and the author agrees with him, and adds that it is a perfect de- lusion that the operation prolongs life even if the disease reap- pears. Although Dr. Baidvs usually practises Listerism, he does not do so in these cases, because he says the spray seriously lowers the temperature and vitality of the patient on account of the exposed condition of the upper part of the body for the 80 or 40 miiuites which this operation should take. He contents himself with simply washing the wound well with carbolic lotion. Prof. MLane Tiffinay (iMari/land Bled. Journal, Jan., '88) reports 80 cases of mammary tumors operated on by him during the last eight and a-half years, only about half being malignant. Twenty-seven cases were in whites and only three in mulattoes. He remarks that mammary tumor in the full-blooded iiugro is extremely rare. In all the cases the tumor was excised, and all ( c t 1 f; 120 appca,. diseased to ll,e „ako,l e.c " ,'1 '^, ""' -e. e„ ,e eo„*.d /. .„ Jr^trrt::: '" ^° "ever b„,.„o dd, ,; ,u,8 '.::'■!,;":', ' 1°' '"■"'" '""• mnrr. H,o. /• ^^' ^"^ "^^ mustitis oiice four p. e^nancy and laetat.on ran a peculiarly malignant course The skm was always involved earlier H„„ H,„ , "'" """'S". ilie rule th^t n.„ .■ ■■" /^arjiei tlian Hje muscular tissue. The luie tnat trie entire idnnd aliituLi i. . , parted from. Tl.o re^ rflJnr/witlToo^ ''™:.''^- (mcluding secondary operations), r^^'dear-r Z Shock, two from embolism of the lun.r« nn« f.. u . one ,an,renc, one erysipelas, ^^Z}^^^^'^: rence took place most olten within six months' the ^era ion 15 cases are reported cured, 13 remain free three year, after the operation, and of the other two, one died of cancer „f the op^sie breast and one of a tumor entirely distinct bm gina disease three years after operation. In 29 cases whl hea,,,,,, g|,„^ „,„ „^^ involved, six were cured; but f 102 ea OS where the glands were afteeted, only nine had a Ifte fav^able ves^h.~Central6laUf. Vhir., July, 1882. These results are not very encouraging to the operating sur- a 1 r 1 , 1 :j| p 1 geon ; still, if even 10 per cent, recover, the operation is quite justifiable, though no doubt, while some lives are saved by the operation, others are considerably shortened. Mr. Banks had 10 out of 46 cases operated on by the method of removal of the whole breast and axilla living from two to ten years after, which is a considerably better result. However, in Volkmann's cases, the ones living since being operated on in 1878 are not included in his list. \ 131 RKPRINTKD FROM TitK "PiM.rw QUARTERLY RETROSPECT OF SURGERY P..K...,. ..V PRANCIS ,;. SHKPHKUO, M.O., CM., M.R.C.S,, E.. Surgeon to the Montreal Go„efil Ho.ni* ^ , -Leet„rero„0.e.e.er^^;:::,-rr--^^^ ^n^/^.;,^/. ^,,>Y/,^y._Dr. Robt. F Weir in iho ir 7- 7 iVW. (Philadelphia), May 5th iss"' V ^ ^'^''"'^ article on '' m- Li Jl fr' "" "'teresting tHytrieJe.a.en.onti::i;r-;^.X:f^ trolling the progress of nutrefaotion Th;. • / moie (liltitult to alTcot tl,a„ t|,c bacilli tlicmselvos an.l fl,» anthrax spore is the. most resistant to disinfect Lof a such ac d n e to five per cent, watery solution is a good disinfect- a or those organ.sms which have not passed"i„to the co - r "P"''" «'■»""'' •■"■'' '!'=" »"« P"-' in 400 of water mu t ^n«,s,e,,t in r,,hher Cloth ti^.t't^U^":; ahont „„.ha,f per cent, of earboh: acid/ tie" yrrnt: m ;(jH m therefore should be freshly prepared. Another source of failure is encountered in the cat-gut ligature. Kocher, of Berne, gives a case where septicemia was apparently caused by cat-gut ; and Volkmann rc[)orts two cases of malignant [lustido from inoculatioti by anthracizod cat-gut. Koch has found that solutions of carbolic acid in oil or alcohol are absolutely inert in respect to their action on bacteric lile, either on the spores or bacilli. He however remarks that " when it (carbolic oil) comes in contact with substances containing water, as for instance the tissues of the body, wounds, etc., then it undoubtedly gives off part of the acid to these, and in this way an antiseptic effect may be obtained." Dr. Weir first used corrosive siihliinate as an antiseptic in 1882, after reading an excerpt Irom an article of Delacroix. He used it in the strength of 1 to 2,000 for three compound fractures of the thigh and six of the leg with very satishictory results ; but the solution used was found too weak and a stronger one was employed, as KUnnnel and Schede of Hamburg showed that it was free from risk of toxic effects. In 212 extensive wounds in which it was used by Esmarch and Neuber, there was no poisoning and oidy 3 deaths. In this number were 30 major operations, 32 re-sections, 5 herniotomies, 14 nerve stretchings, and in only 11 cases was the dressing changed more than once. Dr. Weir has himself used this dressing in fourteen major opera- tions, and three compound fractures with the best results. One case of extensive laceration of the thigh died in twelve days of septicaemia. The following is the mode of employment of this dressing. [Neuber, Kiimmel and Bergmann use carbolic acid for the spray and instruments, and sometimes for Avashing out the wound]. The 'sponges and compresses are wet with a solution of sublimate, 8 grs. to the Oj (Solution No. 1). Silk, if used for sutures, etc., is dipped for two hours in an 80 gr. to Oj solution, and then permanently kept in an 80 gr. solution. Cat-gut as used by Kiimmel is made by immersing it in an 80 gr. to Oj solution for twelve hours, and then it is wound on bobbins and kept in an alcoholic solution of twenty ^'rains to 133 the pint, with one and a ha]'' -.unpo. .f i • instead of koepin- ' it i T , T '.'•""'^■'•^ '" "'^ ^^^""'l' ''^•"1 -^1 tl.en dries it and keeps it t,n Z ^'""" ^^•^^' of alcohol with .5.S.S of -dycenne ..I.I. . n " ^'''^ ^'"^ P^ished h^ n.bbe.. tube;or " , ':■ ^.'""«« ''^ — As absorbents, sand saw dnsf ^ -^ '^'"'"'^ '^'^ F^''^'^^^^- -^enn, the. anti^r;^:, ::tt ^^^^ "^^'^ ^^^^ dissolved in .lissof sulphuric ether 1 """ ''' '^ '^^^'^-^-^- sublimate is the m..st 00!^ V- ^^'!'^"''''"g ^ Koch, corrosive destroyed the Z"'"''''^ ^'"^-' ^ Part in 1,000 Qf 1 -. itsistant nuco-oriran sm a„ j- not poi,„„i„,„ J i,, ti "; f " "' »^ " 'l''^™* It is form or carl,.,lic aci 1 1' " T"' '" '"'""<•'''' »^ i"'"- '0 d..ai„, a,.„ the l7,r:f '''?"•''' :'''''"'----y ™i'«s by fi„t i„,,„« " ,,, ^^„ °f "P """-liately and with a mixture of l,ia,„„th ,n,I wl , "P^atio,,, washed The bleeding havin,! „" com !»' '«"■''" 'O"' «" *«ken. stuffed with 1 10 pe^ oe, " Z T^ '"''■°""''' "'" ™'»<1 i' close the wound. Tins 1 '"? '"''"'•= *« '"^hes and the wound closed y" i „ ', '''T" """ 12-36 h„„rs. wound is then dressed with a ,0 '"?"*'" " """"• ^he covered with gun, pap , „^ '1''" "^f '--* gau.e and place by a gum banda" 2 s, " T^ ' ""'" "''" " ^^P' » to ensure even pressurf' The f "^ '^''"'" "'' »*<• during the opeLr ate Z^Z:T' Tl' ^"^ ^P»»«- already suppurating wound, I 15 ™ "'"^ '''"^' •"' '" der Medicin, Feb 1883 V U H ^'"c.-(ftrt,,;,„-,,, German Surgical Socielv held' n T"' '^'™«™'-' »f «'« Riedel of Aix la Chanll 5 ^"''" '" ^P"-" hst, Dr. .utitl' ,r^\ '■'="' » P^P"' ™ the use of bi™„,. "• "" ^"'™"''^'' *« »»c of priory suture it as 1.''^ X • ;i< ijiMtoiid of secondary ones as recommended l>y Kochcr, and Haid als(» that hismiith was useful not only in fresh wounds hut also in those that were sujipuratin-^. Ilis conchi,.ion from an (ixteiisivo use of hismuth was that it was a good antiseptic, l)ut that hko all others was not an unfailing one. Ho had com- ItitKMl liisiuuth with corrosive suhlimaie with good results. In tli(f discussion which followed Prof. Kocher remarked that his increased cvporience had incrcised his confidence in hismuth. I'rof. von Langenheck also spok. in high praise of hismuth aa a remedy most useful in promoting the union of wounds hy first intention. J lis method was to wash the wound with bis- muth suH|)ended in water, and after closing the ^>'ound carefully and inserting a drainage tube, to ap[)ly pads of bismuth, and th(!n carefully to bandage. Dr. Isiael related a case of excision of the breast treated with bismuth, in which a severe stomatitis HiHultcd, but no other surgeon present had had a similar (!X[)erience. i.)r. John Duncan {Ed. Med. Jour. March 1883) in . i article on '■'■(Ifrim and the Spray;' states that a few years ago he made an attempt to discover the percentage which remained ase|)tic of cases in which major operations had been performed when the skin was previously sound, and was nstonished to find that in more than half the cases, most of which he had hitherto regarded as aseptic, organisms could at one time or ether be discovered. He is confident this result was not due to any error ;>f manipulation. He asks whence do these organisms come, from within or without. That organisms of various kinds easily find their way into the blood by other channels than by palpable wounds may be held as certain, and that when present in the blood they are liable to attack tissues devitalized by injury. Dr. Duncan has found that in most acute abcesses organisms exist, and he ha- found them in strumous and chronic abscesses. Dr. Ogston found also that in a long series of acute absces.ses examined by him, chains or groups of micrococci were invariably present. The author then says that it is impossible to avoid the conclusion that if the abscess be the effect of the presence of organisms, their entrance into the blood is com- V08 136 >vannll,, ,av, I) " , „ ' . ''"■"'""^'""'o^- M«i.,e„ro and three weeks, in whiel, tl,„„ r,? ["'"'"'""' "'""h ''"aie.! i„ |n«^ of the most absolute puritv in at, , ;«*" V' ">« ^''^inment contact with them, wl.^ „! I ^""'='.' ''™"«'" "'o actual through the air is gn ded Li " 7'"''"." "'"'='' '"'' "™« solutions, or by givin. he ' ™ ! ^ ""*'"« """" """^^P"" . fair „' - ^ . ° ' * "" Se™icide powers of i:vi„„ *„...„' fa.r opp„rtun,.y of coming into play." Dr. Dunca^T's e;;;!! ( , i' ' -I u :il V i1 f Is « incritH uro most viiluaMc in iiHsistiti;; to cleiir away the clouds of uncertainty which still cnvelof) the sj»ray. Ijawson Tait and Keith have heen most successful without it in ahdominal ojierations, and if in these why not in others. PreHminitni Trncln'otomif. — In a paiter on the above auhject read hefMi(> the New York Surgical Society {AtuinU of Atialoiiii/ and S'lin/fn/, April \HH:\) Dr. Ohas. McUurnoy aa>9 tlie ohjccts are aevei'al, Firstly, to prevent the jiassa^'e of hloofl down the trnchea. Secondly, to facilitate the continuous and safe administration of the auit'sthetic. Thirdly, to avoid the jiossihility of hein;^ called upon in the course of tlic opera- tion to open the wind-pijK^ under forced adverse circumstances. Fourthly, to permit of a continuous, rajad and complete opera- tive procedure, and thus avoid much unnecessary loss of hlood. Fiftlily, to aecin-e to the patient after the operatior' an abundant supj)ly of air, which is not contaminated hy the dischari^e from the seat of operation. It does not appear from the article that Dr. Mciiurney had ever himself performed a preliminary tracheotomy ; lie evidently comes to the above conclusions on theoretical ^^n.uiids and from the experience of others. In the dis- cussion which followed njost of tiie speakers were opposed to the operation as bcini.; uruiecessary and often dangerous, thou;.'h some advocated it not very strongly. Dr. \Vm. T. Bull had [terformed preliminary tracheotomy four times with the ordinary tracheotomy tube, Tredenleuburg's tube he saw no advantage in. Fh,in/ni/eal Tubes.— l>v. L. A. Stimson, at the meetin"; of the New York Surgical Society, held Jan. 2;]rd 1888, (J}^ew York Med. Jo;//-., April 7th, 188?)) said that since the last meeting of the Society at wliich Dr, McBurney read a paper on tracheotomy as a preliminary operation, he had liad a patient under his care with a tumour of the superior maxilla, and it had occurred to him that possibly a substitute could be devised for the tracheotomy tube, consisting of a tube to be introduced through the mouth into the pharnyx, the space around it to be blocked with sponges in a manner that would prevent the passage of blood into the pharynx, air passages, or ocsopha-us. Ho, with Dr. U ipl"'i''atin which consisted ail L'll.'tl HI ^'th, and of th(« .liiunotcr of ^^"•'•dian-lahalfuf itHoxtromityciimMl is;- ney'H assistances ha,l (.or.atnictod <»f a tuhc» six or Mcvt'ii inches in >• -{H urethral suiuid. Ai)out a en I'l'l provided with a II to ahnost a <|iiartor i^ii^t' one-ei.'hth of '>''^'H.lfh, perfurited wiff, " <'"«.-e,;,rhth ..f an inch in -Id hj asl r V X^ -"' ' '' ''"'^^ Htitehin.. t fast to thl f "' '""""" ^'' '''"^ ''^ «I«>n;,'o, • n n last to the flan-o and niacin- hehind if ... * impervKiMs ti^^^n,. i.. ] . n '^ otniiKi it a jueco of - L^a ..r: ;; :, :,, r xr'"-] -'' -"'" '■'"'■" '- ■•■ iuc.,i T„ : ?;,,':';;;:■'■''•'" ""-"-- lni,-l;,..| ,„-,„„i(l it .,i„l .,« . , ''l'"n«ns were •rial. ,„i„,t ,,r„t r; f ,f ,^""> ;■; "- l-'l- tl.at -...her 'I'a. any .u-H ",'""'5"«v""l "■".. t<, the eo,„,,.i„„ J '"Oo^on wno nav ni: rnado usa r^r ,.n i , it a decK od nreforonr^n . „ i • ' "^'^-; will mye ;;'.i.'e.-ana::^";::,;r::;xf--y;Hii^ operation he t„ A;;'""?' ''/ "'-' " ^"">™ -^ Billro.h'a in ti,e no r ;;i „" rr f™« '•^'•"' ^''"""^y "^-'"^ed . "'"*' '" "'030 conclusions- d i 'ni.„. It « coraparatirely simple and roiuires no ehh^L * ("•^1 P ^-' ranlc as true causei ■ H,o ?... "' "'««<= only the two first can importance, is on! ■ tlilT ?"■ '"""'"""^ "' «■■-' other two have o i^inatTd S '!">"'":'"'"' "' "«" 'vl"cl. the -■on excites, Jf^^.^Xt^Z^I:''- '"'"' ^"'- ;^ci^.t^:::::&--=r;i- ™ shall see that a I nflaml r """'' "' '"™"=""=' ""•■ "■"■'o oould find, he Is on toZ ™' "'" """^ '"''»'='''- 'f « istration „ wl.Fc should f ' '"'"" T"^^ "'^ '"'^™»' »''«>i- malignant grow h t „1 ! ' """'«™' '""" '» ''»'' °^ » cease to notice anv .l« T '""V^^ "^ formations, we should oaneer and Sa ^ aT^ .hefo" f'T'" "''^^^ wish has been that our mindt,! ,w, ^' '"""■' *'' W' view in which we m^ see to™ '1^ ""' f°™' "^ what we call cancer i'","^ " "• »"<»■ all, just possible that process: or "1^ rl^^'T™ "^ *.« -«™™atory restricted form thati if^T f P™pos.tion in a more by changes wi:;h t' Ht: ^ ^'^'1 "' '"'""'^^ rare and exceptional form of ^l,' ""''"' "P™ ™'-"'i" rodent nicer) ^hLh Z loll 'i^rntat" ? '" '" ^™'"' which run a chronie-ll,, r ""' "^ "^n^or, but action, whiel, s ", ^a f J^ ,T ""~' °' f°""' »' ""■'bid true e;nee, M I , h ^ "T™ ™"'°">" ""iammation and argument in supper :T t '"""'''" "'"' "" ■"'5™'°- of'cancer 'r^^Zt^^Z ^::Z'''T^ "^'«^" recurs after removal BnuZl \ ^''"^'^ constantly this contention ^v. '"^ ''''^''^^ '^" ^' a"«wed to contention, w. must enquire where it recurs. If the • y t uha I iiif^ 'i ::i recurrence be in the lymphatic (glands, or in other parts in close proximity to the growth, it proves only tliat excision was de- layed too long, and that infection lias already been accom- plished, and the speaker quaintly proceeds to say that a farmer who allowed a thistle to seed before it was cut down would have no right to infer from next year's crop that his fioM had a con- stitutional tendency to the production of thistles. Mr. Hutch- inson concludes his admirable and practical address with the remark that " When the doctrine of the pre-cancerous stage shall be widely adopted, and when surgeons generally shall recognize the pro])riety — let me say the duty — of operation for purposes of prevention, then, and I believe not till then, sliall we witness a considerable reduction in the mortality of cancer." In the discussion which followed the reading of the address, Sir James Paget, while admitting the existence of a pre-cancerous stage, the importance of which Mr. Hutchinson had urged, said it was impossible to exclude the general or constitutional in- fluence, without which local influence would not operate to promote the disease. Dr. Thin remarked on the absence of all positive knowledge regarding the changes by which a ))hy- siologicaiiy healthy epithetial cell acquired the properties of stimulating an abnormal increase in the number of cells present in a part. Cancer cells differed in their vital properties, and in their chemical constitution, from healthy epithelial cells. Their contact was not tolerated by the adjacent vascular tissues, on which they acted like an irritating foreign body, and the action of staining re-agents showed that they diffeved chemically from normal. He was unable to follow Mr. Hutchinson in regarding rodent ulcer as representing a transition between inflammatory conditions and cancerous changes, the specific cancerous changes were as highly developed in rodent ulcer as in any other form of cancer. Mr. Butlin said we were now aware of preceding conditions to tumors of two different kinds, those which were merely inter- esting and those which were valuable. To the first belonged traumatism, deep seated inflammations and inheritance ; to the second class belonged certain typical morbid conditions, some i 141 of which were hypertrophic, as moles matory as certain chronic inflammatory cond and of the vessels and areola of the warts, etc., some inflam- breast. tions of the ton- "'■ ^'"'f^^'"i sugj-estcd tl,at the fact of l„,„- d„l,„ ;„ , .encc of ca„„er u,ight be ex|,l,u„o^ ' <^^"""'» above subject, ,.ivos a nt if l;-^ "" "'■'"'''' "» "■« t.oat,„e„t SuCin" T 1 T"" ''"'=™' """'■»* »f 'j'i.at .be »oo„e:°:,;3'»:rf ;'""»' i'^-f-"M.o »^- optically occluded L 1," ""™ "'"' "''" "'■•= »■'«■ i-vwo.;„,.,e.„ ;l: m m:,':?'"' ^r f- ^"^ '"»■>■ "f two wavs Tl,„ '"* """ '« J""" '" oitlior »«p-.zw::;z:er::ftt:r«-^ p>o-i.n of a.., .,rst;„u :r s'if !"'■ r^ t r w"n.l »ce„« iu,,,e,.atively to demltd it b r'""' "•" otber operative measure. .1 1 1 ' *° ""'"'"'' ^■'<" "Jl Jone under t 0™";! i 1" i'" ""''""'••' ""«' '""^ - '« damage done b, the buNe l,ed b?;: "f" -''''"' the harm that i. added comes ToX ^„:' " " ^™-/ finger." *"^^oiiy irom the exammer's I'll if' .;i',; |!'': \m .? t I liil Pnlmonarjf Svrgery. — Koch remarks that nine years have passed since he brought forward a method of procedure by means of which certain portions of lung tissue, even whole lobes, could oe converted into fibrous tissue. He used then a concentrated solution of potassium iodide, but observed that the same end was attainable by means of the galvano-cautery. He pointed out finally that since November, 1873, he had found a considerable number of cases in which the first or milder treat- ment had been put in actual operation. By means of paren- chymatous injections, pure iodine tincture had been introduced into portions of lung where tubercular degeneration had been demonstrated either by physical diagnosis or aspiration. His second plan -'as to destroy with the galvano-cautery those truly circumscribed tuberculoses of the apex, and especially to treat by these means those processes in the lungs which develop in- dependently of specific infection. After relating two cases in which he had used the galvano-cautery in Prof. Leyden's clinic, in x^erlin, he gives the indications for, and the method of employing, the galvano-cautery in the destruction of portions of lung tissue. (1.) In acute gangrene developing from sac- cular bronchiectases. If a cavity is found during the operation it must be laid open by a more or less capacious passage through the lung tissue, drained and irrigated. When a number of small brenchiectases inter-communicate, they must be converted into one large cavity, and created in the same manner. (2.) If acute pulmonary gangrene be present, with (as after bullet -vounds of the lung) dead and putrid tissue, surrounded by cfcdematous, hepatized parenchyma, cauterization of the necrotic area, must be freely performed, whilst at the same time a fistula is set up. (o.) A funnel-shaped opening through lung tissue is indicated when a foreign body in a bronchus is not expelled by the natural means, and is giving rise to extensive secondary changes. Koch regards excision of poi-tions of lung unfavorably. In pulmonary prolapse resection is an operation de luxe, for we know that such prolapses soon shrivel of themselves ; whilst, on the other hand, it is our duty by immediate reposition of the prolapsed portion to prevent any curtailment of the !v-!l 143 3;;t:LT.:\.^\~ r: :ri -^^^ "■»- ^-^ inspection. Ifcm„„.ha „ "J- , '°°' ° ""^ '""« '''"■"ar.l for replaced and ,ho .leurultac t ! ' *" '""« '' '" be '('"rf.. No. 32 1883. , * ""' *'■ ^'"'"■'' iM 188S.] ' ^^"- *^"°""' '" «". ^ai • , Dr. Cade,, («„ .S. 1 i^ t^L'^f: f'^"" ^«''- ■nent instead of .he usual one'oi Si!, ^ "'™''^ ">'' "■»'"■ »™l- It was recon,n,e„d d bv trT, "f-"' ''''™ ago as 1857. One hundred ,-,^ns of f ,"'"'''" =" '»"« water is a sufficiently stron- sdn ■ !""' '° "°" ™"ee of warts s,,„„,d be earelu W dr, "d "ft >: ' ''"'■ ''''' afterwards ^ry cotton .„V „,'"„''= f' '» "*"' ""^ ac.d efflcientlj takes t,,„ ZTl[. ,m •,^"''f ^''^x '■•l»™ic sc.ssors,andh,astheadva„ta e,?h ',"" ^^ "'= '"'"'» <»■ ""■ch less painful. 117 „„ f„ •"""= ? '''""<"°''» '"ethod, and part, of ,1,: „„d, as .!«;;, ?; ?J *" f "■'* a-l other «'->^e so.ea,iod s.p.,iiitie^.::tsh:.:'re:- ::;""'' "-«-- --:rT88tS:frtt\^T*^^'-"^ potassie bromide to .ntTollrde'' 7'"™' "' " '"'"«»" »? "■"ly «ays, that the pSl , I r ^'"'^ ""' "'" »''»'», he ^imeuiti re,ie.e:an:r t H x.;:!':!,::;-"- "■■" '-^ e"lj c<,ualled by their ineffleiencv I el , '' '"''''"'"■''' '" good rc.ultsfro.„rethra,i„jerns„/: e :i:tr';"'I°™'^ P-ve„t the n^oetural atta ^ C^'Z^^^'fT- ''""" '^o pracfced just before retiring' for h ni it '"■'°""°" '" almost no pain, and are very effeetive f , '"•'""'™' "'*"■» (.»««« Jour. Me4. &,w4 Ap J 8 S"' ,1- f '''''™'- ■njecfon be of service to pr v2 ,' ! ^l- '^^'«'" '"" «>i» after th , „.„„_P;-'^;;o-ct.o„s .hie,, occur (ia„a.<, Apn, ii, ls83) considers that h »'. |!i !'l l-'jc ilBi V most, if not all, the cases of congenital talipes ef|iiino-varug, the tendo Achillis is the head and front of the offending;. That when this tendon is shortened to the utmost in the elevation of the OS calci.s, it can contract still further hy effecting a rotation of the bone upon its antero-posterior axis, the astragalus also participating in the inversiun. In the many cases of slight eciuino-varus, section of the tendo Achillis will remove the talij)es varus, and a [irolongod and intimate ac((uaintance with the employment of plaster-of-Paris has shown Mr, Owen that in many instances of the two-fold deformity of iulauts division of the tendo Achillis is the only cutting operation required. Ilis method is as follows: About three or four days after section of the tendon, the foot is to be put in a thickish sock which fits evenly and smoothly. Then from about the line of the clefts of the toes to a few inches above the ankle, the foot is to be quickly and firmly encased in the wet plaster bandage, and immediately that the last turn is fmislied, the foot is to l>e forcibly mani- pulated, so that as the plaster is setting, it may be steadily held in position towards llexion and e version. In three minutes or less when the plaster lias hardened, the tip of the sock should be cut oif in order that the toes may be exposed to view, to allow the surgeon to see that the bandage is not applied too tightly. The plaster should be left on for two or three weeks, and at the end of that time the bandage should be removed, and the foot rubbed with oil and again enclosed as before, only as the plaster is hardening the position of the foot should be absolutely rectified, and again loft for two or three weeks and then re-applied. After this the child should wear a stitf leather boot. This method of treatmenc is not altogether novel. Dr. T. G. Roddick read a paper in 1880 before the jVIedico-Chirurgical Society of Montreal, which was published in the Can. Med. and Siirij. Jour., 1880, on the treatment of club foot by plaster-of- Paris. Ilis method differs from that of Mr. Owen's in that ho applies the plaster-of-Paris directly to the skin, and after divid- ing the tendo Achillis he maintains the foot in position by strips of rubber adhesive plaster. »"'«»" to .„„ .,„„,,„,'«:.l'.;'' ■="■>. ""., CM., M,ac.,S., K,„ ■L-octiircr on Om.,.,*- ^'^""^"' Hosp tal • i>,v.f ' ^x'. on Opc.,at,vo an.l Mi„o.. .4, Irv M p -m V''*" ^""*"niy aoU after the o,.|,i„.„ ,,„„,„, ,„ / / '"" "' ''-.led „o„e, l„„g ;»- atel^ ,,„o„ ,,„„,,„, ,.; « - M .suture of divided nerves ho mu.,culo.,pira| nerve five Zii °''r'' '' ^'^ <>f '"'•■re of ar of t,,„ ,„„„, ^^^.^^^ ,„;™ *» after it, division. The .»' he baet of tl,e ri.-l,. el W i "™ ™ ™ *o outer side "> "Sl.t hand ami ««;„ f!' "f "°" ™' »™Pletely J P-«y returned after Zl^^ ^ ir"" , •■'"" *^ accident „ Pat.e„t eould ,„.„„,,„ ,.,„^ ;„„,";;,*■-»" '» hospital the floxed, but could not e.xtend flet '""™' '"* "'e elbow ^fe«ree and supination ^^^^^^^ » *o slightest of the forearm. The limb wCm, \ ''■'"'"'^<«' PO'i«on "fered, hut there was a ^end r sno t T'""' ^" ^^^ "■« soar just external to the bi "ens f? '''"■™'= ^-^ "f the »-d upon, and on cuttingdir h""' t """^"o" "' -i^'- ''oro found without mueh^dSv Tr '""' "^ *e nerve "erve seemed to have retraetld ^j' '"' "PP<"- ond of the ,7 of a eommon pea t h tt d ''""""'^'' ™ " ^"'h he Jie two ends were mo^ to a„ ?„ ™ "™''''^' "'-Ph'ed. lower end of nerve was taken offl f\ '""' ' " '""^ "f the bu h on .h, ^__^ removed ?rlr; "' '"'' P»^' "^ "-e -ated and kept i„ po3i.i„„ /~,,„ff ™* ""ere easily appro.;, operation was performed anHsef.f ""'*'"' ^ta"-"'- The by first intention': The o': Itltr' '^ """" """^^ 1 881 ; by March 15th ther„ , Po*rmed on March 10th -'"™»g, andafew * ; ™"".= ^'^^'''Power of e.tensi „' .-a.erse„sat™onthebaekofthehand" fc 'fl \ was more perfect. The patient then left the hospital, and was not heanl of for two years, when he returned to show how com- pletely he had recovered, — sensation was perfect, and there was no difference in the size of the two arms. The j)atient said that it was about a year before improvement was very obvious to him, then ho be;j;an to mend rapidly. Mr. Holmes remarks that to Mr. Wheclhonse Ave are indcbtcMl for having brought this operation prominently before the profession ; his great sue oess in uniting a sciatic iiorve nine mouths after its division encour- aged surgeons to adopt the operation. The uniting of divided nerves in recent wounds has been largely practised, and with much success, but as in these cases the wound very frequently recovers its function without this procedure, it is impossible to say whether the same result would not have followed had no suture been used ; but Mr. Holmes asks : " Is the case of old injury and persistent loss of function really different V Will the nerves in these cases recover their functions if left to them- selves ?" That they do in some cases Mr. Holmes thhiks is certain, and gives cases to prove it, but, he remarks, such a favorable issue is highly dubious, especially, as in his own case, where the interval between the divided ends is large and the nervous filaments are included in a large bulb. In such a case, any restoration of its anatomical continuity appears hopeless. Statistics as to the results of secondary suture are not of much value, because many cases are reported too soon after the opera- tion, many cases not being greatly benefited till some time has elapsed after the operation, as in Mr. Holmes' case. Tillmanns records 13 cases of secondary suture ; of th( r., Mr. Holmes classes 8 as successful, 3 as dubious, and 2 as failures. Mr. Bowlby, in his Jacksonian prize essay on the Injuries of Nerves, records 20 cases, 6 only of which were perfectly successful. With regard to the time after the injury at which the operation should be undertaken, Mr. Holmes says we are not yet in a position to lay down certain rules. If the parts are quiet, and the wound completely healed, there can be no motive in defer- ring the operation. However, Mr. Jessop operated on the ulnar nerve with partial success nine years after its division. Mr. 147 Holmes lately unitofl Mm „, i- , after tho aci,;: : , ' , !;V"''' ;;'■- "«"- oi,.ht ,1a,. Mr. Herbert W. Parrc (Bnf M. j t record, a case of aecoXry s ;.f^^r .i ""^-'""^ '°^''' 1«8») after its division. The nZe , ,"''""' ""™ "« ">»"»" tl.0 wound l,.alcd tl c cic ,t7 '"'"' '"''"■ "'" "■™' >■ »«« ™« fingers bee™ e td^JJ """^f"'. »"" «.o little and 1- hand in a slin,. Hi^ "„„ ","1 1 ''tM "' '"'™' ""' '° ''"^ hy the constant pain in [ill f °™'' *e™usly affected nation was very Sc i v H T ""'' '" "°'«'''""-l.ood. Sen- patienf, reque^st one ; I? ™,' ,™''''°'^ "^'°"'- ^t the ondsor.heicrv;s?::;„:i:i;r„rdtar^1.r^"^-"'i of the lower portion was imhcddod 1„ T^,T ."^'"^ "PPer ond -as not enlarged; the I r ', "0 f « ™'"' '"™^' ^''' swollen to ahout three time t, ,1 f """■''■ f"''""" ™ bulbous nodule, which was hi ."'"'°' "'"^ ''"''^'' '" •'' «™ necessary to diLcc; h™ .per tt":f"'t!:'™'^' ''f"^' '' »» two inches before the two nd 111 "T™ '"° '''"■ "•""" were joined by three fine e.7, , \ ■°''«'" '"tether. They Aeath and nerve. The ™„ f T",'? """»•' *""='' b"* when he left the hosni a, 7o " i'° 'f ""' '"'™"™' ""d -nsation had docideTy'i're, «,??:"" ""^ "''^'■''"»' pain, and he had some returnr. !: r •" ™' '^''''' ^om phalanges of little and rLgTn"' f T f, T^'' "' *' '^' had made little progress so h p J , ^" f''"''"'S''t after patient De Watteville L ClZ^Z^^XTr "^^^• hnued for a year by Mr nfwlTT^' ^'''°'"«"3' was con- fair use of his hand! hL^ed to tL'^l"^' '""s ^^^^'-^ 'he faradic current hlmseSl^'Zr'Stf lil fH nir y had hoc 3cn at work for several months, and his hand was as use- ful as ever. Mr. Vago attributes his patient's recovery to the Btoady and lon^^-contitnied use of electricity to restore the nutri- tion of the wasted muscles ; hut rai;,'ht not the name result have boon accomplished without it, as in Mr. Holmes' case. In another similar case, however, of Mr. Pa-e's, operated on at the same time, the result was not so fortunate, because the patient, being a nervous, hysterical woman, persisted in keeping her hand in a sling, and refused to have electricity applied. Treatmmt of Na'vi—Ur. Martin ( oates, at the recent meet- ing in Liverpool of the Uritish Medical Association, read a paper on the Treatment ofNcavl {Brit. Med. Jour.. Aug. 18th, 1888) He began by stating that for superficial venous ni^vi he adopted the late Dr. Marshall Hall's method with complete success. His object was to excite just so much increased action in the growth as to cause deposition of lymph and occlusion of its vessels. A cataract needle was introduced about a line from the circurafcr- caco of the noevus, and passed from the point of its entrance to the opposite extreme edge of the growth, keeping it, in all its course, as near as possible to the surface. The needle was then withdrawn almost to its point of entrance, and pushed again through the naevus at about one-sixteenth of an inch from tne lino of the first puncture, and so on until the lines of the punc- ture took a fan shape. It is desirable to keep the needle as close as possiHe to the surface, though, should it penetrate the thm covering of the growth, a jiiece of adhesive plaster arrests the bleeding immediately. A small white spot soon makes its appearance in the centre of the growth ; this gradually spreads a-u(l there is left in a few months a spot perfectly smooth, and whiter than the surrounding skin. One operation has invariably succeeded with Mr. Coates in superficial venous mevi. The briyht scarlet or arterial imvus, whether it appears as a small bright spot, or as a patch measuring two inches in diameter, or, again, as one or two minute arterial branches, re(iuires, re- marks Mr. Coates, a more pronounced treatment, based, how- over, on the same principle— stimulation, not destruction of tissue. In his first case, the author punctured the nsevus with 149 a blcedinn; lancet nnd ,*,.*^ ti ™ ouro,l, a„,I „„ ,„„"„,„, I ;■" " f'»'""'""c„t,. Tl,c „„v„a --"0 witi, a l,l„„t n„. :„",,)'";:; '7' ';« '- '«•! a l-«o '"'1 at ry,t nnsic, to ,),„ si;,, ' ' f "'>'f<«">^ with the flat is creJ. ' • "■'"''' " ■*'»>' aljsorhcl, a„.l the „,„vu8 In those ca»03, Mr Col 1 ' "''""''"" '^ "»' applical.lc. Tho operation' tv,^;:!" ;''"",''"'"" """'"™ " -I-- '-all nocllo, i, a„ „,,( ,, „^^,^^ / ""''! ».vringe, with a very '0 fill the „,evus havi,,. ho™ '""' """""•'^ "f i<>'li"e feronce of .ho „, =,, „,' "as,,! r't" '"" '''"'" "'" '""""- Propeliecl ,lo>vly iK.me ,„ ,, t„ u "'"""■'' ' ""^ f''">" '» of the growth. Tir i & i t :T ° •"'"'"^" '■"'" -'"■■^ !«' ncedie into every part:f « ' ! l'^;:'"" ''r.!-"' "f '"" drawn, an,l pressure made on tho ,; . f '"" " "'™ "'*- and then the operation h, o:,, I ^"'i:"™ ^^ \'"'' '"""'''• th.s treatment many time, wi it' ,7 " •"" P™"'»°d One injeetion general,™ :;;:! "■"''" "^''"'' ™« ^^''l- not of that variety, says H n i ."*'"" ""^"""^ '" »■•» o«eet„ally obliter,^ ^ «i n^e rflM f 7^ ''" ^^"^"^ " acid ; they are vasenhar't ;o:s vl yt^ • " "-'"f™ " '"'™ raisin to a ripe fiV onri u- " '^'/'^^^'"o m size from a dried plied and tho^ohie t on av!i mI"" V" "" ''™''"''^ "^ «np- V that useful inTr m . fi''^ "'° '-"tment of largo n.vi larger the „a,vi, the! !'er tt' rT?"'"^ "' ^^^"^"°- ^'he '.eatcd the poi^ of Z^lJ^Tlr r'^'C """"« thrust through the skin in nVl , ^'"'^' *" >'lade is n-sary,a^dthe:r„tii::e:7tot,:::r;?,-^^^^^^^^ IpL > £f mass, central, (Iccj) and poriithoral ; each district must ho searched out and invaded. The skin punctures should l)e made well within the limits of the tumor, as the elFects of the cautery necessarily extend hoyond the limits of the tissues actiially traversed. By slow and cautious withdrawal of the hlade, the small eschars ni ■ permitted to remain, s<)alin;:; Jie wounded vessels and pre- ventin;:; the loss of any l>loo(l. A. few hiack sinuso.-i, surrounded by a ring of skin which has been rcddeneil hy the scorching, remain after the o])eration, and the tumor is found smaller and firm from coagulation having taken jilace throughout the entire mass. Oiled lint is used as a dressing. For the next few days the part looks angry and swollen, and is very painful ; then a slight amount of sloughing takf'-i place, and in a few dnvs more some small, clean ulcers are seen. Tlie ulcers heal, and cica- tricial Contraction taking place throughout the entire mass, de- termines the process of shrivelling. The integument only peri.shes where wounded. Mr. Owen has been most successful by this mode of treatment with those tumors occupying the entire sub- stance of the li[». In the discussion which followed the reading of these pa|)ers, Mr, Tiiomas Darby said he had seen " raspberry marks " suc- cessfully treated, without leaving a scar, by hypoderunc injec- tions of absolute alcohol. Mr. Silcock often ])ractisod an old and now almost obsolete method of treatment in the case of capillary ni\jvi, viz, painting them with collodion ; a natural cure was thus often brou"ht about. ,^Ir. F. J. Bailey said that smaller n;evi had been very successfu ly treated by vaccination. Since the introduction of ethylate of sodium, he had used it rather extensively in the smaller no3vi with great success ; in some of the larger ntcvi, he had seen good results follow the use of the perchloride of iron. Transplantation of Mmcle in Man. — Hclferich {Arcliiv f. Klin. Chirurijie, B. XXVIII, ]>. 5lJ2) reports a case in which, as a result of the removal of a fibro-sarcoma from the arm of a woman aged 80, the whole upper half of the biceps, with the exception of a thin strand at its outer part, was extirpated. Into 151 the cavity wliich wiq Lf^ i sl'-w,.,! that the hiccpH roactll „' , T """' "'" "?"■'••■"!"■., I'he movements at the , hVv """"l ""'' ''»"""' absent July 8, -83.) •" '" """ al">»" noraal. (Zm«, of the ,ho„He,. a,: t^,^^^^ -'•-"« disloeat " poet of Deoe„,h„n la,t ha I t „ « T) '^' ''""■"■'"'^ R-tros- '0 olhowjoint It i, as olws if ""'""""" "'■•''''"O-'ion at of n tahie, „, „,„ „„, ^^ J™"; ^' » operator ,its „„ the corner Tho injurcl li,„h i, dra, e ,! "' " "'f ''" "'»" " o''-- wWeh rest, close to the ^ "'^ ™'Soon'» proximal thigh, •""•oms, while the olj LC t™ -"'orior surface of tl,e' toner surface of the lower thir of r-" f"™'' °" «'o «»- pro.™al foot is -hitched" heh It, t, ,'"' '"""'■' •''"'' "-o fi™ly .-.gainst the frame of t |2 '"'' '"* "'""' '■' "o.vod most favorable fuler„„,, the sur 'e „ fi T-'"'' '" "^'"i" the :«r" "" ^"toro-internal aslf of ^ ''™'"'"' ^'^°" «nd grasping the wrist ol the ,!at In '",''»'■?'"'"''"'=' thigh, of the muscles of the arms l„nl , , • '"-oporative action oountor.exte„sio„ are .ZlitZ ""='" ^™"o'> »-> operator, and coaptation \ etc cd Ir""'?' ''"="'' "^ *o ackward pressure of the femu, a^i'„ t 1 °™ "'°''^' ''^ *o *e umerus, while the distal ^CIZ TZZ^l '' o;^^.- extremitie; aft*"::;; tK, ^^ '"^ ™* »" *» --o--™.eon,Ld,whl:\;--r^t^- :^Hi 'Up additional force is derived from the muscles of the back, the glutsei, and the other extensovs of the thighs. (The description is much more easily understood when reference is made to the excellent illustrations accompanying the article.) The Treatment of Hordeolum. — Mr. Fitzpatrick gives his recent experiences in the treatment of hordeolum {Lancet, iV\\v\\, 1883), or the common stye, during the time he was in Egypt, The plan of treatment adopted is to dispense with hot fomenta- tions, &c., and to apply locally tincture of iodine to the lids, care being taken to keep them apart till dry A few applications in the 24 hours is often sufficient to arrest the development of the stye. (^Practitioner, Aug., 1888.) I have found that the application of spirits of wine to the lid, when a stye is commenc- ing, often arrests its progress, probably by causing contraction of the blood-vessels, and so driving on the stagnated corpuscles. The alcohol should be applied with a camel's hair pencil every few minutes for an hour or so. The application is quite pleasant, and will not disfigure, as the iodine application is sure to do. Ancesthefics. — Deaths occurring during and after the ad- ministration of anesthetics are reported from time to time in medical journals. The exact conditions which lead to a fatal result are not well understood, perfectly healthy individuals often rapidly succumbing, whilst others, who are in a very bad general condition, escape. The dose of the anoBsthetic seems to have little to do with the fatal result, as many deaths occur at the very commencement of the administration, before more than a few drops have been inhaled. We have yet much to learn about the administration of ana3Sthetics. So far, I think, with- out doubt, ether has proved to be the safest, yet chloroform still holds its place from the ease with which it is administered and the rapidity with which it produces anaesthesia. The mode of administration is yet disputed point. Some say to give ether rapidly and safely, keep out air, and, when giving chloroform allow patient to inhale plenty of air ; others, again, say that safe administration lies in giving plenty of air with ether and none with chlor. form. A valuable paper by Dr. R Marcus Gunn, in the British Medical Journal of July 21st, 1883, on 153 °" t o»e point,. Dr. Gunn^S "floL T ™™'^' '=™"'™'»'" Ophthalmic Hospital, MoorfieM ' 1 "''8"™ '^ ""^ Koyal S^f-. 4,U8 times. In 4r^lttfZT:'f ""««■''-» »'<>■ »taes3, and fron, the taWes e 'ii.: •!'^°'""""'='"'ore,vas a much greater tendency to sicLr * *™' """ ^^^les had '» sickness is at its maxta 1 "T . "u"'"''''- Reliability Puberty, and decreaseaTraduLo."" ""'""'"cen.ont of G»an considers age the l,,^ '*'''''='' "'""f 'ife. Dr after*l " -«"- of oUoroforn, and ether (in pr"!, 11 "' '"'""""^ "'<""■<". aree) was used. The !Xl'ZlT°'"-'' """"' '" ""d oqual, the tendency to after «\'^'"°° " «"". ages being f-aschloroforJEt!,Ser,T "'"■^^ "■« »™ ^ s'omaeh is en,ptied ; eh o oformrcr "V°'*" '°"=""'«'- «>o sovera hours and leads Tg 7!^/"°" ™"''""^» f»^ "e .mfluenoe of food, Dr Gu™ ' '""■ ^^"'' '■''«a^d '» ■""^ns: 1. Toolongafeti,,V T' '° "'« ^'"'"""g con- ™ry J-oung and a-ed o c "> *»'"'™"tage, especiallyln the *o;'Jhegi.enab::t-fo:rh! :t"ftftr""^' '"^ '-' "■- Me weather has an infll "'" "Poration. ^ays nearly every cas"wf;;":™ ""T''^"^''^ » -'- enhrely absent. There w=^ le's! ^ ""'" <'"^' '''"^'■«» was ;^»<«riy. The highest pe cenZo t""'' 'l''™ "' ""'' «» lowest in March. OnlyoLrM "'''■"'' '"Januarv; the '-'ion ofa-,ni..t„re ot ter and 'cirT'"'"'"^ «■" ^^"' " a stout woman, aged 46 Aut '''''"°^''""- '-fko patient was '» 1>0 fatty. The^author thin ' „ tl'-""'^' "■" ''""' ™ f"™" *°ok, as the anaesthetic had ol b^ ""1' ^°'"' ™ ')»" '» "mute when the pulse failed and tb. "."""'"islored for one Another case died after removal .""'"'r' '^"""^ shallow delieate-looking girl, a.ed 8 Th '• ^''"■'"" ^as a fair i" *o usual wfytandXke't ft::™"^^™"' '"» --theZ' ''"d began to be sick an hour afte? he \"' """"'"''^ P*. ">^ui dicei tbe operabon Sho -, - r --<-«. oae rtas taken ?fi '■^■F^: ■I::lf: .|i...- ..(..' •r- H i ^-^m home by her friends, and never spoke after leaving hospital, but died that evening. I should certainly attribute the death to the anaesthetic, because, if it had not been administered, the girl no doubt would not have died ; but the author is doubtful about the case, as no autopsy was held. Ether was introduced into Moorfields about the bemnnin"- of 1874, and from that date up to the present time anaesthetics had been administered 13,000 times, with only one death (the case of the woman described above) that can be fairly attributed to the anxstiietics. Dr. Gunn says that, next to carelessness, nothing is more calculated to increase the death-rate than wide- spread dread of its dangers. Mr. Roger Williams gives the death-rate as 1 in 350 inhalations. This the author thinks very exceptional, and he does not believe the majority of fatal cases are hushed up. Alarming symptoms will, he says, unavoidably occur occasionally during anaesthesia ; but the greater the pro- portion of such cases to the actual number of deaths, the smaller the real danger. The ansiesthetic must not be blamed for all cases of death. Chloroform vapour, without the admixture of air, Avill paralyze a strong heart, not to mention a fatty one ; the shock of a severe operation will kill without an anresthetic. A moribund patient may die of mere shock of removal to the theatre and dread of the operation, nor is the risk removed till perfect anaesthesia is produced. Dr. Gunn concludes by stating that he believes Mr. Roger Williams' statistics give a much too high death-rate, as many of his fatal cases were not <1irectly due to the auiiesthetic. lie believes that a mortality of one (or at least two) in 13,000 cases, as at Moorfields, corresponds more nearly with general experi- ence. He states that his paper has been principally written " to prevent an unwarranted popxilar dread of anaesthetics — a dread, I am convinced, in itself most dangerous." Treatment of Warts and Oondi/lomata by Carbolic Acid. — M. Jullien has described, in the Annales de Bermatologie, the treatment used by Tommaso de Araicis and himself in cases of warts and condylomata. It consists in repeated cauterizations by means of pure carbolic acid, and is best adapted to large 155 aciJ are kept i„ a small honk t' T" "^ ^'"' "»'■''<'"= *« bottle is „.a„„e,, i„ atte' , r,, ;,:".;^' "-" "-'-'• the crystals toucl,i„g tl,e -lass mel T, 7 ' ' "■■"<''•' '■"'<' 'vhole sttrfaee of tl,;„arts rtl, a 1 '"' " "P'''''"' '" "'» warts soon assume a si, y ," ' '' "'"* "' =»"»" »-»«l- The -on ftlls Off; a„<, next .^ t ^ Sr"; ■'■'^" "'"'" '"^^ carbolic aci,l causes mud, less Zl T '■°'*'''"'- P'"'° i'l.o >ast cauterisations are Xa^ ^^Z'' :»-«« ^«^- In a ease of vegetations on the .^-n, ':, ' '^^'' "'■'"' "'« «■•"■ oompioto after two applieation^icB, ' ^'f' '"= «-« wa. kinson's ol-n,o rop„r'c"4" r sr']!""^ ^/^^»»-* ■n g.v,ng eve,y two hours a tablespoo , ,1 If °""''' ''""P'^ parts of ca,.b„„a,e of ammonia w t 2 1 , of""'"" "'"='" monsti-uum. Unna's case nn. P"' ''"^ "".J' convenient sleeplessness, and deliri™ l:^::^'^'^ ^'«'' f""' confol and amendment had oo^r ;" a„d 'Itt'"" T ""''" pat,ent was -.veil. No externil ,„ , •■ ""''"' '"^)'» *<• in Great Britain' The ^tl odd"'' ■??''''™ f" *» «"' 'i-no April, 3883) is the usua ^ne !'" ^•^"'- ** •^""™'''. vortical incision in the ," tie ^ fus't^r^l '"^ "'""^^ ^^ " the quadratus iumborum, and e^teCn" f™ 1 ™'" <"'«<' »f the erest of the ilium, onenin,, '2 ^ T *" '"""s' "h to stitching it to the sidls o'thTwoundT'd t "" '^'""^^ »" >n this case were passed throui rt! i "'° "^'«"' ™"»-e3 external wound wL closed byfutt ft " °' *' '"''"^^- ^ho entirely relieved, and so „ C t" fT \ J"^ P^"°»' ™' operation. Dr. Weir of the W v ? *" "'f'""' "f the ^'aature of the Innominate Arteru for S.hol !' -The operation of ligature of the i^:^:^:-^ r:r <••■ m\ I :^1; ! 1^': performed by Mr. Wm. Thomson of Dublin, at the time excited great mterest and a hope that the case would turn out favorably, but, unfortunately, hemorrhage occurred on the 30th and 39th days, and the patient died on the 42nd. The account of the case given by Mr. Thomson in his pamphlet is most i.iterest- mg. The hemorrhage did not occur from the point of ligature, but from an ulceration in the artery a quarter of an inch away.' The coais of the artery were not at all divided by the ligature, and though the lignture had entirely disappeared, the artery was' quite occluded at the point of ligature. 157 IlEPRrXTED PBOJI Tim "r,vi„. , ^^(^^^lon of Knee Jnutf \it t>. , of the kneo joint, „|,i„, ^•,2^,'^ T "f'"' "f '•''»""™> -«.«.) consists in ,.„.„,;: ^'^^'Tf ^"V-^^n. The :,' "Ojge shape, the wedge ^lopLfrolt/"""'"" "' "> ''^"^ •"■•ward, a mortise i. then cunril, 7 , ''' '^°"""'* and »i' i3 pushed the tenon, ™ Vend om f " '"'" •''°" """ placed in a spHnt speeial, d si i, , ' j^n ' -'■"'«« '» sure .s kept up on the foot'until ° ' ■ "'■''' "'' P™s- tenure." JI . Davy ll" t "'T"™ ''''^'"'' '" "^^Vof 'ion are, " thnt „ss L ,^1 "' ■'" "''r'''»S^^ «f l"» opera- ^ofore the patient lca::t':, ;:„:':*«' ^- "• 'f-fc) contentions are removed, such Tt ?' ^ ""'' """^ ■'-■S^'"'! s'a.tin,.s,Jerb, or ineffi i™ ' a", "'''1^--- "f ^ones „y consKlerahle shorten osults fi- ™ .f : "^ "''"■''^ "'aS not think this an ohieeti , L ke ""^ j'™/"'"^-. !•«' ho does »o>.lties, we fcar'tir e„'* .:7„f f'.^"^'' ""-^"^ ceitamlyanew oue and should bo\.lir.f.l '"'''7^^'^^'™ ^^ mechanical sur-erv Mr n . ^ ""'^'''* ^^'^ '^ead of " ^- '^'- ^^'^ '^«« Pe^formed excision now m t if .I'.j I f 1 1 1 1 iji UJ I i ^'r- X twenty-one times, in every case without special antiseptic pre- cautions. He has never lost a case and has only been coia- pellcd to amputate once. Dr. I'onwick, Prof, of Surgery ia McGill University, has lately puMished a work on e.vcfsi- i of the knee joint, in which he r.norts twenty-eight cases of excision with one death (this occurred before the introduction of antiseptic surgery), and two wlure ampviini-m had to be afterwards performed. Dr. Fen;vick's raetlind ot operation, which is original with him, is to round off the end of .iie femur by removing a thin slice witu a Butcher s saw, and then savving out a concavity in the head of the tibia, fits the convexity of the femur into it. i\,' this roeans osseous ankylosis is secured, and also early fixity of the lai-^^ thus he accomplishes in a much more conservative way, m-\ v-^hom the sacrifice of the epiphysa^ onds of the bones, all that Yu: Davy claims for his wedge and mortise operation. Dr, Fenwlck performs all his excisions with the strictest Listerian precautions. His results have been good- as I can testify, many of the cases recovering with less than one inch of shortening, and the majority with less than two inches, besides the growth of the limbs is not interfered with, as Dr. Fenwick proves by reports of cases of excision performed on children whose limbs were measured several years after the operation. The splint used after the operation is that of Dr. P. Heron Watson, of Edinbur ^-» -At the reeent I e' L ^:r;';"-'! ]« /'''"'"-/- tion held in Liverpool ,, ,'° "',™ """«'' M«l,cal Associa- Croft read pap r, C he , "• '?'°''''"' "«■•"'' '■'"'l Jolu. (Brim «4 Z. s ; 7" T,":" "' '"="'■"« f-'"- ""^ lea might he sati "fl „r7 T ''""""'' '«^'''«= «'»«« °f Paris Lnd^ge/ottrtrf *!":'' '™'°'' ^^ "'-'--"f" in children, P„tfs f • ' ' f '"""""<' »' f™"'"™'! thi-hs *c. Mr. ilea It ,i k h'iit'urf ';r f "" '"■™'-' ='-'°'° «- joint should not be it Id ' t n'T '' "°"" " J'»' enclose joints unnecessarii;t th „1 t ^ f f *": "'' """ '» cases for the bone setter i Z '""'"'^'■"'f-Pans, ,3 to provide joints in any ord nar" 'a T, 'T'",'''' *' """"^ " "P femur. Fractures of'tl^ Ltl ""r "'f "' "■" '">" " Heath thinhs nnsuited for tin' m ,1 ," ™'^ ""^^ " "eh Mr. obvious reason that there lud,,.! , '™""''"' ^"^ "« bones together. FralreJof tl T ''""="'• "^ ''™"'"S tbe in« the :rm to a ri 'h a 1 Ld" ll" """" '" '"""-^ ''^ «»- in a sling. Mr John C,^ft ?"'"« "'" P"''"" '» "car it «ine hul^dred ca' o^ ttl: / "' '^ ■■"" "''''' "^^ i-^diate application f'pTster T™" '',°"" "^ *^ best results. Each splint i,7 ^r^'"-fl"'"^ Vhnts with the '- -.er layer ca„£' 'p X'tf / !"» '^^^ »' "annel, in Ttio . 1- . F-d^'fer and thu inner layer i)rotepf<» Th^^Pl-tsare kept in place by niuslin band the the I' y. m '^es. lllTn; i I u B ... ); M 1' Tlie flannel or old blanket for the splint ahould be cut to tlie shape of lunb ; for instance, in applying a leg splint measure cir- cumference at knee, calf, above the ankle, from the front of the ankle just round the heel to the front again, and at the middle of the metatarsus. Then cut the flannel half an inch less in breadth than half the circumference at those points. The four pieces of flannel then make two splints ; the outside pieces are soaked in i)laster of the consistence of thin cream and then laid on their respective inside pieces, whilst traction is kept up and the ends of the broken bones are maintained in apposition the splints are to be applied and smoothed and then the muslin bandage put on. Traction is to be maintained during the hardening of the plaster; this takes place in about three minutes. The bandage should not be too tight and should be evenly applied. The splints should not meet by half an inch down the front or back, as the swelling subsides the splints should be tightened by means of the bandages, and at the end of ten days if the patient be convalescing the outside bandage may be gummed, and at the end of a fortnight or three weeks the patient may leave for his own home. In the discussion which followed the reading of these papers Dr. Gay, of Boston, U.S., said that this method of treating fractures had been in use in the Boston City Hospital for some years with very satisfactory results. Gauze was used instead or flannel and the limb was flrst wrapped in cotton wadding. The gau/e was dipped in the plaster and applied to the hmb and secured with an ordinary bandage. The layer of gauze did not meet in front by about an inch and the case could be sprung open at any time, removed and re-applied. Dr. McColl (Michigan) used the plaster bandages with excel- lent results. He applied the plaster as soon after the fracture as possible, and enveloped the limb first in cotton wadding or flannel, making extension for 10 to 15 minutes, whilst °the plaster was hardening. He allowed his patient up on crutches as soon as possible and did not remove the bandage for three or four weeks. The immediate application of the plaster splint has not been case thi» ,,„m„er /h '"' """"'• ^ l""! "no deformity „,. sl,or,o;!', ""'' "'" """" ™ P«fc<='. "o liozzi, aft...,- »h„„-„ uf f f "* ''f "" ««"«-.-r™f, observes tl.at at the Mill .1° ''"'""""''^ "'' "'" ••'««i'lent, ofe.,,,o,.i,,(„oJ:i^'trr?,^^^^^^^^^^^ c^'I;:t7rir^'*^'-^^^^^^^^^ ducod i„ tl ,„„ d li b ■ TT""' "•"■«'' '' "«n pro- this muaele owin. to the ann™!' ^ ? ""^ "'" '™^'»" "f i'™c.(!(;o„„., Nov., 1883.) ^' ■ ''™'"' "£<"«?« hastt:i;:::-ci:tr f f^r"''-'^he s,„.gicai „„,.,<, Piaoe at Ihe ^dt 'Xaul'd l^'TT "'■'""^ "^ ""'- on the readiu. of an add Z I, p l^ ^"'='""^' oonse to cut the ends short and hammer the twist down on the bon. nd ompletely close the wound, except at the lower end, win -. hi ^ laces a small drain- ago-tube. The silver wire in these eases has given no trouble. ^ Prof Lister said it was very desirable that the lower surface of the patella should be left quite smooth, and the drill-hole should not perforato the cartilage ; if it does, then the hole 163 should be chipped un '" clear co„,,ci „ce Tri 1 io "^ H "' ''° "'"''' '"^ «i"' « -oldin, .1,0 .„„.„ 7"::; ^"«'.<;":..aliy ce,.t„i„ „f a.Kl tliat if |,„ co„l,I sav „, L ' ""^ """ "'" "•»">><1. .i-.iiie.i, ut i,o,„:, r^;:',t z::t "'"; '■= "^ "•" "•" from tl,i» mctl„Kl „f ,,e'^ta„„7 7, " " "'^ »''™"'"oOs .lerivcl does nol operate till tir,nJ\ ■» '"""■'' J"''"'- ''i'ter cases, be always pares th fr! '"' P'""' ""■ ^" »1'1 elusion of the address i! take" In w l" f"""'"''- "'° ™"- earnest ren.uks on antise, tic ,1 ," f'' '■"^^ "'""■)' and ijards antiseptie troatmen 1 1 n rf' °^ """"''' ^ ^ A-' re- thal ,„nv-a.dL^s it isno, a 'e r '" ""'" ""' ■■«"""1'. intheor,„r,fraetie: Fir t r^o"S!rtve'r"T' ""'°' any seientific theory in order t„ llr ' ' '"'' ""' '^'f'"' You need not believe 111,! 1 " '" """''=''"'= "•«'>'""='>'• convinced of theruft of t f ™ 7 '■" ^" ' '^ ^^ "" not -^ septic agencts -elerll nf ™."""7 "' ''''•■'''''"'"' -<> once a„«septic ^:^X'^Z loTr^-' t* ^"^'^- arc 8,K things as putrefaction »„/. "' " ""a' *cre wounds are liable to hese " "' '''"'° "»"™^'^'' «"•" our those things come f^om wlut V .Y^ '"'^ P^™'^»°'' ««' preven4,,„, by virt: .tl^^' '^^ -"» »' «MS carLoIie solution fLalfrTe;? T ^''""' '"^"•"""■"'^ '" I' is not very difficulrtolraruJttTf"^" "''"»'»• lope of antiseptie material. What T,, r . ' ""'* ^"™- ■nostimtiortant things of all is ,f • !, ! ' '° "' "°^ »f "-c violate, which I insU u L 'wV i' ° °"'"'^'" ">'« --"Ic i"" fess, I have insiste upon „: o7', r^"' """ '^'■'"'■> ' ™"- i-. parts with antiseptic solutroUrCrtIt:r,r ■t' it«il 1^ done, ), put a dressing on the wound, but dress the wound first and wash the surroimding prvts afterwards. . . The edgea of the wound are septic ; the wound, if it is as it ought to be, is aseptic." At the adjourned meeting of the Medical Society held Nov. 5th, Prof Lister's paper was discussed. The majority of the surgeons who took part in the diiicussion, including Bryant, Morris, S. Jones, Gant and M. Baker, held that with all caution ankylosis resulted sometimes from this mode of treat- ment, that if tliis occurred in the hands of the most careful and skilled surgeons, what would be the result if this operation were performed by men not trained in the many proceedings neces- sary to practice antiseptic surgery and without the necessary surgical experience. For the present, therefore, they argued that the simpler and less hazardous measures were the best in the majority of cases, and only when these measures failed were the new rigorous measures of Prof. Lister justifiable. Prof. Lister in his reply said it gave him great satisfaction to learn how universally the antiseptic princijilc had been recognized so long as the grand principle of antisepticism remained it mattered not what the antiseptic used was. After replying to the objec- tions raised by the various surgeons, he concluded by saying that he had brought the cases of suture of the patella before the Society principally with the object of illustrating what could be done by antiseptic surgery, more than to advocate its employment under all circumstances. At a meeting of the Clinical Society of London, held Nov. 9th, Mr. Turner read particulars of a case of Ununited Fracture of the Patella treated by suture of the fragments, with strict Listerian precautions. Mr. Turner's case recovered with an ankylosed joint after a long period of suppuration. Mr. Turner also gave a summary of fifty cases treated by various surgeons with a fatal result in two instances, whilst suppura- tion an 1 ankylosis of the joint frequently supervened. Mr. Lister, who was at the meeting, said that no surgeon should perform so serious an operation unless either prepared himself to dress the patient's wound as required or convinced A th c ability of 1(S5 the assistant in cliara to do ,r. IT„ »"'II'ye, fracturoofAo,, °|. ■";,?■' "°'''''""'' "'•"• Vo the ,,la,. ho d„,oril,e 1 , ,„"""''' '"■' *'""""/ "-'o.I o„ ™t, undo,. a„.i.,,.i'',::;!:;„„':, "" '^ '-*""'■'"*• «"-' ''Ir. Ifulmos insisted ffinf f».« „ "■ .-..0 ohi oasos, at. nit in'l'Z " ' ""'' ''" J"^"''"" "any lives, bi,„s"o i,:,.," ,':??' '"-'^ ^■"■■™ if -t of "ntisoj.tic troalmont in, |;"7,'°""""'^' "'''^•'' «"'l-od i>«i3tod that tho oncrSt! ; I ''°°''"' ™*'> ^^'- "'•■»* the |,atolla i,v a.=pir.,t „,yirn„ 1 '"= '■°"°"' '^•^""■'••» "f showed tl,at injured i,nbs tl^T ■ ^ '"'""''• '^''>° '»«<= l-^20,oa.^ «„:, ed^ e ;ir;Y ""'■■:"«-»'» "f ment. With auol, ■,„ „ '"'^'^"^ "'o'ui as a result of t,.eat- inourredb/M L3er'3rr' '■^ f'""^"" "'« "»" '» "^ 'i'ho gene,.a o, 1„ T """''' '"" '"' J'^^iM. to be ti,tt t ,x r'r"^' ;>"'"' ™'-«-- »-- and ti,at though M Lister IT, "° '" ''""" f™"'"™- seem that his'mo ' ard n d^ei I ""'' ™"™f "'' '' '^^ "»' success. The oneratbrr , ' "•'''' ""P""" »''"•'' »an,o ununited fractu,-" e us™ ^ 'r^'^"' '" ™'"' "' "W bo pcrWd wi^Ts^terttu: ,; ;ltr„r ^ "'"^ anatom,st as M... jI VV jL » f , ""'^™," '"'" ^^ ^'''<' an will happen to sur I'o!?: t^ „^'"lU't ' fd'""",' """' o^pcrienee. It seems to n,e that 7ea,e1f s, r '"""'' '"" demn the operation in ^.„„t ' sufficient to con- operation, m recent eases, at all events. Mr. Wood i ■| i ♦; ■ 1- if . $'t 41 1! :i X found that he could not closely approxinoate the fragments, and if union had taken place it would have been fibrous. The wound was never at any time foetid. Dr. McEwan of Glasgow, in the same number of the Lancet, reports several successful cases of this method of treating frac- tured patella, he insists on operating early in every recent case. Fracture of the patella is much rarer here than in England. Why, I am unable to say. In the Montreal General Hospital only some two or three cases have been treated in the last 7 or 8 years. Prof, Cooper of San Francisco, more than 20 years ago, suc- cessfully treated fracture of the patella by wiring the fraf^ments together, and this was done before antisepticism was thought of. He always allowed the wound to heal by granulation. Lateral Closure of Wounds of Veins. — Dr. Pilcher, in the Angust number of the Annals of Anat. and, Sargeri/, has a very interesting paper on Lateral Closure of Wounds of Veins. He has made a number of experiments on the deligation of veins with aseptic catgut ligatures. When lateral ligature was performed, in only one case did a thrombus form. There is, as a rule, union by first intention, and this preserves intact the function of the vessel. Dr. Pilcher recommends this method of ligature for wounds of veins whenever the antiseptic ligature rcatgut) can be used and the wound treated antiseptically ; otherwise he advises a double ligature of vein and division between. I lately, in operating on the neck for a large tumor, wounded the internal jugular, and performed lateral ligature with com- plete success. There was no secondary hemorrhage, and the case progressed favorably to the end. Still, in wounds of veins of ordinary size— as, for instance, the external jugular— I should be inclined to trust more to complete ligature, with division be- tween, as no one can positively say that the wound will ever, with the greatest care, remain thoroughly aseptic. Aphthous Vidvitis in C/w'Zirew.— Aphthous vulvitis is a well- characterized disease. It is peculiar to little girls from 3 to 5 years of age ; it is rare in private practice, and is observed especially in hospitals. Measles is the principal cause of this 16;' affection ; it ftmishca two-thirds of the ciso, P.„ • ■ , smco Ho introduction of iodofo™ ',',,0 "'"*™- , ^™f »«'« " good with iodoform powder ,, U- ' '? ,'" *™''^ ''» 'f'""'"'"'' interna, adminS:; ,; " ^ i?:!™ '''"'s^'^ "'^ "»'• TI.0 .'-t,^e„t.-(Ars.ne Sazain rM'^^ '^JT 8" •""^ 'T^ m October *»■»«;„/ 6'„(„„f„,„ f, ''™"'"'-^'/*'»"' : 'I'wted 1883) St :n ret^t r''*'"'/ ** *"™'"' «» '■ ''N oponing an abscess, whiti 'S: /" T™"™-'^. before other .inor o^eratio;., tbt^ I.'.e e ta« forT""™'"^' '" a five per cent, solution of ca bo e a d iti! " """""'' deprives tlie part ent;,v.|„ „f r 1 ""' '" 'ome cases, fee tl,e knife and ' r °'' "" ""' "'" P»«'="' '""e^ "»' ^^^.^ Mute, and n> otl.er other cases considerably lessens the convinced "V. '"'"'" '"'''""='' "'' '"'^ f"''*" associrtj w^h dl;:,r ""'"""-■-^"^'^ »f =" ^ast the for. Sfn-ead by hair-dresser, \ih ' ' ,' fn'S't'ors the disease is customers, on af r „'o t 'K' T'" "'"' ''™^''"^ '» "'»- these articles afllr^I t ; "t;:;! "«"'- "'---"^ »' he tbmks, arc less often aiTected'v h t is fo™ 'of' b n ''' because the hair-dresser m^™f V, °' haMness, own homes and 'leT ,; 'r™''^ ""™<'' '» '"i™ »t their prevent, as C'lsLe'T™'"'' ""'' '""''"■' ^" »«'»'■ '» t»™, th haiSt ' '^ ™7"™eemcnt of alopecia prema. implements an h itr " ! "'*"" "' ''°™ "i* ""e's own ment of tS L of htlZ"^''''^ "'"""■ '^'"« '°"»-"S t-at- he daily well soled wit .„:Tr"r'"'' ^ '"'° ""'P '' '» which is to be rubbed fi I,; J" 1 ''?''"''' I'"'"* »ap, to be drenched first i,b "J f '°"""°'- '^'i^e head is colder water • a 2' l..f, "■"'"' ""''"''» S'-»n spirit per cent, of This treatment ?■! J if has now, in many cases, brought the disease not only to a stand, ' but the hair has been to a considerable extent restored. (^Ber- lin. Klin. Wock, No. 16, 1883, quoted in Edinburgh Medical Journal, Sept., 1883.) In ordinary dandruff, 1 have found useful the washing of the head with common or soft soap every other day, and, after dry- ing the head, applying an ointment of equal parts of oleate of mercury (Shoemaker's) and prepared lard. Carholized Sawdust as a Dressing. — Mr. H. P. Symonds (Lancet, September 22nd, 1883,) recommends the use of coarse sawdust soaked in (1 to 10) solution of absolute phenol and spirit of wine, then allowed to dry that the spirit may evaporate, leaving sawdust charged with carbolic acid. When used it is enclosed in a bag made of several layers of gauze, and api^lied outside the deep dressing, the usnal exter- nal dressing being placed over it. The sawdust takes the place of the usual padding of loose gauze which is generally used. Its absorbent powers are very great, and it has the additional advantages of keeping up an even pressure on the divided tissues. Mr. Symonds finds that 14 oz. of sawdust will readily absorb about a pint of fluid. Wood shavings have been used extensively in Germany in the same way with good results. Sugar as a Dressing for Wounds. — It appears that now there are very few substances that are not used in dressing wounds. Every week something new is used and praised highly for its antiseptic qualities and its cheapness. Bismuth, glycerine, earth, wood shavings, and now we have sugar. Dr. F. Fischer, assistant to Prof. Liicke, in Strasburg Hospital, has used powdered cane sugar extensively as an antiseptic dressing to wounds. In cases of wounds united by sutures, the sugar mixed with iodoform and naphthalin, is put up in gauze and applied to the part. • When the skin is lost it is put directly to the part. The sugar dressing may remain on from 8 to 14 days without the sugar dissolving. Dr. Windelschmidt, of Cologne, says he has used sugar alone as a dressing with good results and considers it quite as good as iodoform for small wounds. He also says that powdered sugar 169 carded the use of s,,™,. ;',, ' ^^- ^'"^ "^ '"^ ^is- when .he ,atie„.s S o'^ TlCt^ V^'^^^y ^c.nso ceased to have faitl, m ;t „ j "*' "'^ P""'''" 'hey they ..eatedoLv" LIT ^ ^""" ""=" "'^^ '-^ i3 aseptic if not Z^^^TI^ ^T •"«°'-™«<>"- S"gar used„saperse..™tivot'i„"e. I tinf ^T ="''"'"° "■''^" (lead animal we wish to k ™ ? ° *" '"■''™' »' "'« generally when used t tL, ' ™«n>Posing, but it is nitrate of .>ota h ""'l""'P«^c combined ,vith arsenic and iwrnh -™™..™m™. ..o.».ifL.. . ,,™:o..™u»...„ QUARTERLY RETROSPECT OF SURGERY. P«-.n.„ .V FRANCS J. SHKPHERD, M.D., CM., M.B.C.S, E™ "Catheter Fever," which excierdclderaMed^r " '"^" °" the surgeon, present. By «art2 A" s T f '"" '"°°"°" ana.thno._i^^^^^ the nerves system ; that the distnrhanco of the tr™ „f reacts in the fir. „„, „,„„ „„ ,„„,„'J:;™ -j; - I: tv •", °-"™"" '-;--'. "P- Ae secretory „r.,; .nn.nj, >,„l, tnc K.aney , that the eltect upon the liidnev m-.v co-...st ether .n structural alterations in the Kdney, iSirby m f'\ ,i .1^ \ the aid of our finest instruments of research, or (as seems more probable to Sir Andrew) in alterations of the constitution of the blood, that dynamic condition of its constituents in the renal vessels essential to the elaborative action of the excretory cells thereof; and, lastly, that the concurrence of these conditions may be, and often is, enforced by septic reabsorption into the blood." This definition is certainly vague enough, and may mean anything or nothing. The prevailing healthy condition whinh the subjects of this fever suffer from is only apparent, as Sir Andrew Clarke admits there is low density of the urine, which means deficient excretion of solids, and the need of the habitual use of the catheter (or as Sir Andrew puts it, the entrance upoa " catheter life") indicates the presence of some chronic urinary trouble. To put the matter plainly, tiie apparently healthy patient has been for some time suffering from enlargement of the prostate, with, probably, atony of the bladder. Sir Andrew asserts that where narcotics or anaesthetics are used in these cases, no catheter fever follows, and advises their use in persons entering upon habitual cathe- terism. Quinine, he says, has signally failed in controlling this fever, and he asks : What are the things to be employed on such occasions ? and what is the sort of hygienic management to be followed, especially in respect to food and alcohol, which are so variously used on such occasions ? Sir Henry Thompson, in an able speech, described several forms of urinary fever which follow the use of the catheter, and are familiar to all surgeons. First, four or five hours after catheterism, and after the first passage of urine, the patient ex- periences a rigor, followed by fever, pains in back, and then sweating; these symptoms pass away slowly, no recurrence takes place, and the patient, in two or three days, is as well as ever.^ This Sir Henry calls an '^ acute transient attack," occur- ring in persons who have the most healthy renal organs, and occurs occasionally from a simple absorption into the blood vessels of some small portion of the urine. The phenomenon above described, he thinks, may also arise from purely nervous causes. Another form of urinary fever is the acute ■I T shock, Sir I L vl^t' I f^ '■"" "'""'' "f ^°'- lnrcd for the removal of the entire gland. The method is one which has been practised on the Continent for some time, and IS the removal of the isthmus of the gland only. In Mr. Jones' ciise there was severe dyspnoea, and the structures in front of the isthmus were carefully divided, the veins being tied before division, and the isthmus was detached by the finger and director from the front of the trachea. An aneurism needle, armed with a double ligature, was made to perforate the junction of the isthmus With each lateral lobe, and the double ligature on eanh sirle was 177 tieil as with an ovarian nediel^ Tl,„ ■ .1 a drainage tube was also tas" 'JJl """"'", f"'' ' '■•"ala- .».ial,y disappeared arthl; Srs'^-Mc^r? Re 'T'™' thej appear after total eyt'-^-nation nn/'o I ^'^«^^>n say of the vaso-motor nerves a'ndt: .' ^"f""''^ ^^ ' ^'^'^^^ ;i3snesineonse,ue„eerth:re^.au7t^ Reverdin recommended extirnat;„„ „r .I i The Messrs. are symptoms of imminent dlr, 1 "'^™'' "''^» "-ere and also in cases of" °. ternf „' .V """"" '"' '''«'"=«='«o». ordinary treatment h e^ ^^^^^^^^^ "hen Med. Journal, Sept 29 1883)""^ ™"'-^"'" ^"'- ^.tr:^^:^^'&;--aT-r''^«-' CW. Bee. I5th,I883),Mr. .^at^ Il'ltU^:! Jf iM IMAGE EVALUATION TEST TARGET (MT-S) ^« // V A C ■'' '"ported a series of five suceessful cases „f high amputation for senile gani ne ,„ formed about the middle of the ri!l foot T 1 " " part was separated at the tarso-metaC; „t ^^^Z At one time high amputation was thought of but a line ?t7' n,.Utio„f i„g,ehe idea of amputation wL'ald^d^^^^^^^^ patient s arteries were verv caloirpono n • i . was the priueipal treatment. '*^'°"' ^"^ """'"'""' Vi«.fca;cW„/Ai<,„y,Aa;«._Mr. LawsonTait r£„'( J!f,j W., Doe. 8, 1884) sajs that a hernial protrusiontroit^l- lif ?* n the umbilicus is an exceedingly troublesome condition in the adult. In children, in the majority of cases, it can be cured by the careful use of a well-fitting truss. It occurs chiefly in fat women, or in those whose abdominal walls have been greatly stretched by many labors or by large tumors. In cases occur- ring in adults, trusses are of little service, Mr. Tait says, so he advises operative interference. He has had eleven caces, all successful. He opens the sac, frees all adhesions, removes redundant and irreducible omentum, pares the edges of the ring and stitches them together with continuous silk thread, which he leaves permanently there. He has traced three of the patients thus operated on, and finds that the cure of the protri-.sion is permanent after eleven, eight and five years respectively. Ail the patients operated on have been very fat, and the last one was pregnant. Mr. Lawson Tait, in conclusion, remarks that if he is ever called upon to operate in a case of strangulated hernia, he will proceed by abdominal section, and complete the radical cure of the protruoion at the same time that he relieves the obstruction. N'ew method of treating Psoas Absoess.—Mr. Fred. Treves read a paper at the meeting ot the Royal Medical and Chirurgi- cal Society of London, held January 8th, 1884, on ' ^ Direct Treatment of Spinal Oaries bi/ Operation. He.' Lancet, Jan. 12, 1884) the gravity of spinal caries depends, not so much on any special pathological features in the process, as upon the depth at which this disease is situated and its inaccessibility to the usual operative procedures applied to caries elsewhere. Diseased bone cannot be removed from th3 vertebral bodies, and the morbid products having to travel a great distance in order to be evacuated, are apt to induce immense purulent collections. These collections are usually opened at a point remote from the original seat of the disease. In the operation proposed by Mr. Treves, the interior surfaces of tho bodies of all the lumbar vertebrae and the last dorsal vertebraj can be reached from the loin ; a vertical incision is made near the outer edge of the erectors spinge, the sheath of that muscle and the quadratus lumborum are cut through, the psoas muscle is incised, and the vertebrae reached by continuing the operation along the deep 181 aspect of that structure. Bv means of n,;= tebr» can be readily examh^^d 1 °''^'^"™ ""^ '«■- removed, a readyaifddC exit c '„°r ''■'"'''"'°' '""" ""» ''« lumbar remon can be JT,a u-, '"'"" """'"'« <"• '" 'be abscess exist, it cfn bo et uaTed'at iLoiS'"" " T^' spot that, in its reenml,.,„, . "^ °' ""=""' ""^ »' « pendent ^ t ™WsC"' 7^"'"' '" '" '»™' <>- tebra. most h^lltiZZtT, ° '"'°' *"' *^ '« '»- first lumbar, the o L, n sh„ nT"f7 *° '"'""orsal and Tbe autbor details!::!,' 1 1: Li™^:,? ""i"'"""' recovery. In onp of fh. ■ . ""» operation , all made a good origin a'psoasabsces ontatrfoo ""T'^' ="''^P™' "' from the body of the fir,7r k" T"' °' P"'' ^'"' """e™'' Tbe immedirL Lem t:,7"': "/ '"^^ "«"^"™'"- marked. I„ anotC elr ! P.""' ' ''"°'''"™ ™ '«ry the thigh som:: : XT tr '"' '"" "p^^" '» opening was made at thV^.r^f „il*'r™'' ""'^^-ter lumbar spine, and the ST k ^ ** ''''*'® f™"" ">« tube passngCm . t „rtrof t''''' °"'^ ™' ^''^'"^ ''^ ^ Mr. Treves°added that Ih ZTZT' " !'' '"""»• the patient did well but T 111 f "" ""'" "■ "■« P^l*'. drainVtube had ;t ^ mo^d Id 'h:°d- T^ f """'«■» oavUiesinthel„„,sandam^lri;^,^te:^^^^^^ .sl";te\tsroSa:::s\™''"^''"-p-^"-^-d „ J . "lJ«iiing a psoas abscess at its nm'nf «p ^ • • and so securint^ frpp ^..o;^,^ i . , P^^"' °* origin abscess by cutting down on the tfased spfne"'" '"^" ^'°^' *etnrrx^ter".t"ir^^^^^ cates opening psoa.. absr^.« bv a ; ' ' -''^ ""^''^ ^'"^^^ of procedure is as fo I^w^ An Cv "' • "T' '^'^ '"^^^ loiiows. An incision is made immediately '«'!, fe' iH^ >< above the crest of the ilium, commencing at the edge of the erector spinre muscle and carried three or four inches trans- versely outwards towards the anterior su{)erior spine ; the various structures are divided, as in colotomy, till the quadratus lum- borum muscle is reached. The forefinger should then be passed downwards and forwards on the iliacus muscle till the tense and distended psoas sheath is detected. A scalpel should then be introduced along the finger and the abscess incised, the opening being enlarged by dressing forceps. A drainage-tube should be introduced, and the wound treated antiseptically. Mr. Cha- vasse reports two successful cases treated on this plan. He says that to Prof Chicne of Edinburgh is due this method of treating psoas abscesses. Treatment of JVcevus.— Mr. W. Beatty, in the Brit. Med. Jour., Nov., 188B, notes that he has had great success in the treatment of noevi by the local application of arsenic. The pre- paration used is the ordinary Liquor Arsenicalis of the Pharma- copoeia, with which the naevus is to be painted night and morning until ulceration takes place. The cure is effected in from three to five weeks. Treatment of Phagedcenic Chancre.— For ordinal cases, Vidal (^Bull. de Med. G-^n., Nov., 1883) uses an ointment composed of pyrogallic acid 40 grammes, vaseline 120 gr., starch 40 gr. When the ulcer has a very irregular surface and undermined edges, the best plan is to use a powder of pyrogallic acid 20 parts to starch 80 parts, which can be blown upon the part twice daily by means of a small pair of heWowa.— (London Medical Record, Feb., 1884.) Prevention of Bedsores.— Dr. H. Snow (Brit. Med. Jour., Dec, 1883) recommends the use of the compound oil of hyperi- cum in the treatment of bedsoies. It induces healthy granu- lations, and does not produce any smarting. A bottle should be half filled with the flowers of St. John's wort, olive oil should then be added, and the bottle allowed to stand in the sunshine for some days till the oil becomes of a deep red color, then it is brushed over the sore two or three times daily. 183 m-eatment of Chronic Urearitu.-Guyon sav« th. • . ■ batam, are tho best r mcd 'n ! , ° ?"' f"''''""'' ""'' *» injeo«o„s, instillations, cauterizatio l2tT T"™ -^ '" are too often valueless as tl,.„ ^„ ^ ""• I"JM"ons part of the urethra F i sffla ir 0^' """ *° '"'^"^ vided with n «mnii ■ '"^^'"^''^"' ^»yon uses a tube pro- with the deep „ rt of ll je , ^cTtl ' ■""='"/" "■""""' Gu.o„ advisesi::;:t :: .tsr,o-'ri-^r'''' of a 1 to 2 per cent, solution of nitrate of 1 Co 17 must be repeated everv dn« on^ u , 'nj^ction as old oasesLczS ^. ^^ ^8^7"' "' """ f «!--«;» "/ «>««( Tamor, into Innocent aro.ctU June 888 d'"« 'f ""'"' '" ^™''"' C^"'- mZ ZT accomplishes this object bv the use of n,„ f., '" which instrument a dee,, chaleh^ V '""''""-''^•■'orj,, with "ant growth, thus cuttle ;:: It:'""'" ti ""= ■"""«- other nutritive fluids fro^ t stl, .^ZL"' Th:' "n a::^t: :tr:ri:::it::t:7:i r *- -'^^^-^ - He thin. t,r„ ^^::::::^rc::iszx::z and cultin.' off everv chalJ 7°"™""'' °a«''°<--«™'^s growths )iant future, especnvintZ "' P'=''P'"'™' """■ition has a bril- afford dsatiai^lf '" "" """"^ *'^ ™"'°^ "- ! i83 QUART.KI.yRKTKOSPBCTOFSUR«KHY Prepahkd bv FRANCIS J SHFPHFRn n. r. are caned f„. in'oase/^Cn:! l,™"-" -";--. The, grenous condition of the bowel in !« 7' ^"^"'""g » «»n- to strangulated hernia 1^ , ' "^ "''S"™! «™8 "l-e '0 various oZsZl'Z^TTV''*'''''''' °''=''«^'-" =>"« *«■ As long 1' I m "tL T*' '"""'■"• '"'"' -«P««n. feet of intestine^u d in ' ^"''* fr™'""^ ^'™ =^ '"« o»>y n cases of resection wc Trt 7"' "l' "^ '" ''«*« recoveries, one artif iai .IZ'Z ""f' "'"'^'"i » ^even was not performed a.^„rZ , t'' ''''"'"• ^""^ °P«--»'i<'» i' ««» revived by L^e nil 1/7/' -^'"'^ ''' '«> ""«' "has been porfo^ed 11 . It'it""' "^ '"' ''" ^'^'^ relieving the constriction and inb; K . .°^" '°" '=™™'* '" i-g it out of the opening, exoi Ll 2] ' 'i"''""""' '=""'■ attached mesentery, and then '5 1 ^^ ''""°" '""' ">" together, thus reis'tablfshtg tlclt n^ "' /l'^ °' ""= «"' returning the narts to tb. ..5 f "tinuity of the canal, and oases rep'ortedTd^^ttr'Sr'^; ,^'"' " "'^^ -P.ete CU.S, . rec„ve^„, * artifl -111^ ^l; ^/« - I t I 11 X per cent.) died. According to the writer in the Medical New8 of tlio above date, the following points should command attention : tst, To {)rcvent effusion, the lumen of the gut must be tem- porarily occluded. This may be accomi)li8hed by a provisional catgut or silken ligature, but this method is open to the objection of throwing the intestines into folds, which interfere with the proper insertion of the sutures. The occlusion may be effected with a clamp or forceps, or, still better, with the fingers of the assistants. 2nd, If gangrenous, a triangular portion of the mesentery should be removed, and the edges united by suture after the vessels have been ligatured ; if sound, it may be ligatcd in mass. In either case, the mesentery must not be separated from the bowel beyond the points of severance of the latter lest gangrene of the edges of the wound ensue. The gut should be divided at right angles to its axis, unless one end is smaller than the other, when the cut should be made at an acute angle. ord, The most important step of the operation is the insertion of the sutures, the material for which should be pure silk soaked in a solution of corrosive sublimate. The safest and most eflScient mode of uniting the severed ends of the gut is what is known as the Czerny-Lembert suture. This consists of an inner row of stitches, which are inserted at the distance of one-eighth of an inch from one another, and which include all the coats of the bowel, and an outer row not so close together, each of which includes the serous covering only. If the mucous membrane protrudes too much, it should be cut oft" on a level with the mus- cular coat, but the inner stitches should not include it. The accurate approximation of the edges of the wound will be greatly facilitated if the first suture be inserted on the mesenteric side and the second at a point directly opposite. The intestines should be resected only through a sound and undistended portion beyond the seat of infarctions and eflusions, as the chief cause of failure is the damaged condition of the gut in the immediate vicinity of the gangrenous portion. Cases do as well after excision of eight or ten inches of intestine as after excision of two or three inches. Koebcrld of Strasbnr^, on 187 one occasion, romovcl ,i, „,„i feet ,„cc«f„ny Ti,7,„:;:r •.■■''"'7''" ''" » • i^ir -turi„« or the",,,. ; : j-;;-' "- "■- -oci .„„ over attempting tl,o ft ma, ' T"'"""^ '"''"'"'W" course, but the JZZZ TT '"""°'""' '"""■ ""^ l^'«^'.' who«;o,.tto leo ti ; *'■'" *"■" "''"'<» "'""l-ose If sucee^f,.,, .her:; ^ZT- ftT 'l"" "T"^" ™"'-- survive, with an arti,i„ia,'a,.„a «;;/,, ;f'°'''' ">V-'-" no^w„.e ,han if the operation had nrhl:; :::;:;L7"""°" '» Ma, L5a •sV/Cirr-'r"" '''"'■ ■■' *-^--^''-«< The patient Ji^^^t^^ "'%»"- "' » f-™l «»tula. and a similar conditi™ It'a l '■* '" °"° '"' "«'" ■>"="''• «de. Three vea „ ev Ll f k '"'™.'' ''°™'"l'"'' °" "'o I"-'!' hernia of the rVhrsi^Wcr s :„!re:n„?"r ' *° performed, a portion of inte,ti„„ i ?"'™"' "" operation was was formed in the rLl , "ot '"^l ' "' '"■""™' """» the l,ernia in left Je LC s ranltYl' '"'"r' '° °"'™- operation. The resnitin!. "^"8" a'eJ. and was relieved by hospital, wa,healedtt"/o:e::s'';„:"' """*'"" '^ '» '"' elosure of the fistula in riX ,M ? °''""''°" f" *<> unsuccessful At The J„ . "" Performed, which was operated for rad'a'l t^Zf:. ^rmrT'J':- '^-^ woman had two fiecal , , 1» „ i, ^' **' ""e the groin, these commni ^^1 ' Th? " *" °"'^^' '" *» "t"" which divided the low r :i J^Jl""'!'''', V"" '"*"" open the hernial sac- the ;1 ■ "'"^"■"■■'al "ng and laid exposed the who si 'matin' a 7. *"•" P"'™^'''' »« two fistulous openinilt't; s:rteta:t:h'™% ■^'''." were connected by a cut made in a dilecL The "'' ' '"'' the bowel was then seen to b. ■„ ... "'""""r- The openmg in their union. The finger on db T ""^ "*""■"•>'' ^' intestine, but not i„t°Te Tnt '"''^ P"''^'' '°'° ""e large involving the iZtT^TCZV'T'''' "■"^''°"""- ---pencil. A dilator w.lT:nnSt:XS: V and then, wltli tho finder in the npcninjj;, the bowel was disscctod iVom the surrounding cicatricial tirtsuc ; this Jiece.seitated a section of tho abdominal nuisclea liom the external abdominal rin^ out- wards for about four inches. The cicatricial margin of tho opening was then trimuicd off, and tho opening was found to involve about four-fifths of the calibre of the bowc). Tho edgog of this wound were then approximated, but as one side was tho small, and the other the largo intestine, tho edges would not lio smoothly. To obviate this dilficulty, a longitudinal cut was made in the small intestine, forming an oval-shaped wound, which could bo approximated accurately to the cut edge of tho largo intestine. The wound was then sewn up with silk sutures as follows : " Tho needle was entered about half an inch from tho wound, penetrat- ing the peritoneal layer, then traversing the muscular layer of the gut, and emerging one-eighth of an inch from tho margin of the wo'uul, having left the mucous layer untouched. Tho needle was then entered at tho opposite side of the wound in a corresponding maimer, traversing tho middle layer, and emerg- ing about half an inch from the wound. Ten sutures were intro- duced in this way. When these were drawn tight, they rolled in the free margin of the wound, thus bringing two serous sur- faces in contact, and turning the cut edge into tho interior of the bowel." The intestine was then replaced in tho abdominal cavity after additional silk sutures had been placed between tho previous ones. The abdominal opening was now brought together with silver wire, the sutures passing through the peritoneum and fascia of the deeper muscles, but not the skin ; tho skin was united separately by silk sutures, a large-sized draiuago-tubo having previously been inserted into the cavity of tho abdomen. The wound was dressed after Lister's method, and the operation was performed under the spray. The patient did well, and, with tho exception of some high temperatures u couple of weeks after the operation, due to a small collection of pus about tho wound, was quite convalescent when the paper was read. At a recent meeting of the London Clinical Society, hold May 0th, Mr. Clutton related a case of Intestinal Obstruction succesHfully treated by Operation. {Lancet, May 17th, 1S3 1.) .tM'Hi:l!r':;:,rr "''*°' "-^-" -- "iti. vo„.i,i,„ a,. ;,:;■, ';;; i;"--;' ;«'>»i™.. t«i<,.„ ...„i^ ™'»> « -n,,,;.;;, :'.;;:'■; ™^^^ >-' *aa e,a„»f,.r,,,l to St. Tl,,,,,,.,,' l , "'"■'■'"'• "'' "■"«"" "I,,,, ar„c,tl,o i. , " ;, ' ' ■■""' "'■"■'■ ""• '"'""'">'■ :-■■" f ^.-vh";, ',';':;;; "", ".'"■■"■'■/ '■"""i-"' force,,, „„, :ii ; „ ;• '";'"' "••;» "I-I-.I .7 .- pair, „f 'livisil,,, „f t,,„ , • , ; ' "■" -'^ l'«'""-l l.y cat.,.,. Alto,. loop of Lowel i 1 T '""'"■" '" "- "■•"! "^ 'I- ,„,„„ stitched un nn.l fi. i '"cnes. J he aMomen was I" .ho ,11:' , ,' ' i r,,™:::n;' »'"«;:' »ny "»-' ».".pt„,„r Trcvea ,,aid that r"v„ nl n" JT''"" "^ "'" '"'''^■'•' Mr. obstruction trcatcl ,v o ! ° '°'°'' -'' "-•»*■' "' io^'inal casc, „„.l .ho ,„„„„;■ :""'„„,"'• '"-» "-' -"-.ci r„> thirty rocovorod. In caaolof „ .• '/'""• ""'■ "'«'"' "•"' to -livorticnla, only In,! "'" " ^°' ""-""oUlati.,, ,l,.o remarked thu .1 o ,,i of T 1 !""'' T""' ^^'- 'J'"™» "^ -n on, .. ont I] '^j^'::!^: ,::^z^ - -< o., nr. Anj-1,., McDonald (/;„„«., j.^i, ,,,,, ,„„,, successfnl case of JleKrtio), „f .J , , ' *^"'> ™1""''" a ofBmalli„to,ti,,owa Zd ,.? °'"."'"« ""^ ■■""1'™™, a loop »nd, in fact, for™,: ',;:, f x'^r'-f,,:'.'' f :.^»-i -, » very unhealthy and friable con iti „ and T" "" ™ empty the foetal ,„. rv i,r ^ '"",'•'"' *"'' '" endeavorin;; to Piece'of disea d 1:1 tj^^ '"J"''^" "« ^"«'' ^V about six inches, was r moved .^'the™?"'':" "'.'™'"' '" ends brought to-cihor with , 7\- '^' "^ ""■' '"■" being talced „„t t'o ..do' of 1:""" ""'" "'""' "" "cmne any o( the raucous membranes. The If •I ■ ''li If: ■: Hi xSl ■ ^-n X stitches were put very close to one another. The gap made in the mesentery was also brought together by suture. A fecal fistula, which communicated with the peritoneum, was closed by freshening its edges and bringing them together with catgut. There was a good deal of hemorrhage from the cut end of the intestine and mesentery, but the stitching completely arrested it. The abdomen and foetal cavity were then sponged out, and a gutta-i)ercha drainage-tube introduced into the wound, to the bottom of the foetal sac, and retained by deep sutures. The abdominal wound was stitched in the usual way. For some days the patient was very ill, fajcal matter coming away by the side of the tube, but after a time improvement set in. The bowels from the first moved rather frequently. By the 30th day the diainage-tube was removed, and from that time everything went well. The patient made a perfect recovery. Prof. S. D. Gross, in a paper read before the late meeting of the American Surgical Association {Med. JVews, May 6, 1884) on Wounds of the Intestines, remarked that the first founda- tioi of a rational treatment of lesions of this kind was laid in this country in 1805 by Dr. Thos. Smith of St. Croix. His experiments, twelve iu number, were performed on d^gs. In 1812, Benj. Travers published a treatise entitled, An Inquiry into the Process of Nature in Repairing Injuries of the Intes- tines. His researches were more especially directed to the elucidation of penetrating wounds, and to ♦he proper manage- ment of the bowel in strangulated hernia. 2lr. Travers availed himself largely of experiments on dogs. After Mr. Travers, French surgeons gave much attention to this subject, and per- formed numerous experiments on the lower animals ; among these surgeons were Amussat, Jobert, Lambert,G'ily and Choisy. In 1843, Prof. Gross himself published an elaborate treatise on the subject, foundmg his conclusions on a series of seventy experiments performed on dogs. The author of the paper goes on to say that the diagnosis of wounds of the intestines is a matter of primary consideration. If the bowel has escaped through the wound, it will be easy to find the injured part by the egress of some of its contents, and so, also, when there is a 191 thebo™ia„„,,,„, ,,,,,,^ "'™ "'^»' " trnle, dirk, or bullot, i' is wounded or n't T .! ', " ""^°'"' '" """"'■'"i" '-''eU'er - in these oa,e. „r„ t,i , tlTdTl "f ' ^''"'' ■""*' «"'''» almost immediately ,.|t„,.,^;';'™f''°f= ^1"= 'f i' supervenes diffused, and n„,; ei;;;~' '7''"™ ■■ooeived. I^ ingofsuol, wounds, I',,!' ,''■ .^"""""eetion with tl,e pro^^. of the profession is , tl t , Tl "'" ""''"'^»' -""-ont do no good, it would of, ; ;: ' ' ° «'°™'' "'«. '«l'il« it can turbin, the relations „,■ 1 '" ^^ "' "''''' ''"'" V *s- I do not think, howove t„at I ,"f "f ""« '^«°"l "'''•'''"'■ wound. Hero „ prol ^Zjl t "'"'!''' ^'^ '» *o ""-al ful information i./re« ,1 ' iV ; ""*^'" '' '°'-'" ^« »»- tcrnal injury." ||o 2 l'™'"" ""'' ''•^"■•" of the ex- » view ii tL tre":: , :„ :::f ;^'^»'7 - «» ^.e 4o of faecal effusion and the oeourre .„ ' ''°«'-">e prevention th-e aecidents, the wonn i Te bol'l T™"' ''' P"'"'^"' should be closed by ,„t«re,. ' '" " ""■ »° ™all, Prof. Gross advised tho iiso of ti,. • » "ounds of the bowel, whate „r t Ve" ^ ^ ,"'"" '" "" long, slender sewinji needl,. ., ,,^'"*"' or direction. A thread, is to be pre W« !,„ :' "" ^'f™* ™"-"xe,I silk than a line and a hal Ir ' ■ . "t'''™''' '"' ^'''"^ "»' ™ore wound. The needle s , ' ""' '"! f"™ "^ edge of the Of the bowel, instead :;':::raei !r 2!f^T'' "" "" Gross, in his paper, hold tl,„, , . i° 'hickness. Prof, is much prefeUle'to ,| " t'7 -"<' "ell waxed, gi™ way prematurely nt ',«"'• "' "«' '""«■■ '» «»l'l^ to .■■esults in Dr. Gross's „.,p;„°.s''i"„ >r'"r ''":"''"'"'''''' S""'' " i» that it loaves the edl" tie ! ° ', "" "'''''''"' '» puckered condition, winel, t! °. •„ """'' '" »" ""'^™n and ■ siniilliicss of the mural opcniiii,', the external wound should be •lilated and the bowel hooked up and sutured, cleansed, and returned To prevent peritonitis, the abdominal muscles should 1)0 relaxed, the bowels locked up with opium, and nothinj^ but a little pounded ice, or iced water, should be ;^iven for the first three or four days, and if much gastric distress, a little dry champagne. Oppression from gas must be relieved by injections of tur[)entine or assafoctida. If peritonitis ensues, it should be treated by leeches and full doses of opium. At the end of five or six days, a laxative of castor oil or sulphate of magnesia should be given. Prof, Gross docs not give any of his own cases, and it does not appear from his paper that he has had any experience in treating wounds of the intestine except in the lower animals. Dr. Chas. T. Tarkes, in his address on Surgery before the last meeting of the American Medical Association, treats of Gunshot Injuries of the Intestines. His conclusions, derived from a large number of experiments performed on dogs {Medical News, May 17, 1884), are as follows :— 1. Hemorrhage following shot wounds of the abdomen and the intestines is very often so severe that it cannot be safely con- trolled without abdominal section; it is ahvays sufficient in amount to endanger life by secondary septic decomposition, which cannot be avoided in any other way than by the same treatment. 2. Extravasations of the contents of the bowel after shot in- juries thereof are as certain as the existence of the wound. 3. No reliable inference as to the course ot the bullet can be made from the position of the wounds of entrance and exit. 4. Tlie wounds of entrance and exit of the bullet should not be disturbed in any manner except to control bleeding or remove foreign bodies. 5. Several perforations of the intestines close together require a single resection Wounds destroying the mesenteric surface of the bowel always require resection. ij. The best means of uniting wounded intestine after resec- tion is by the use of fine silk thread, after Lembert's method. 1^3 suture. ^ ^'"'^^'^ '" ^''^' continued cat^nat can be aocZ^Z ' "''' "'""'' *" '"'«'™' '-"'»«■>' .W,«« 6y M« 4rfm»Wa„„„ ofMlur by tU Rectum - y ra„e, Jn hve others, an India-rubber tube the size nf ,!,„ finger was introduced into the rectum ,„^ , 7 '^ with a bottle containing ethor Ae h„l '" r"?."'"^'™ water r'-in»r ^ . j »i. "'"^ "">« P'a™ /s brings on agonizing colic. In this case he proposes to open the abdomen again, about an inch to the inner 199 tl.at an t,,e o.pe™„„., from »ni Ja ZoLe We' l!"" ' "'" even ll,o „„,t elomontarv facta „f ""™ '7" f"'''"'" ™"l"i« l."™a„ l,ile. Ho has no i„ I"l, L:f ""? """ ""' "' «.at either ,,„a„tit, „. ,„.,„., of fo t." ,' J^; " P™'" :5::s:; isirxri"- »n/Hi;tjr None of the pa^en'ti'^r:'! trrh:;!,,"-,? Tr"""'- through tlio fistula— inHn,.^ • "" *" •"'" "amo and there s not "he s h.~! t "" "'"'"' "'"'•"''''«' deoomposition «hich i/ t 7"^^?^ ""^ "'""'''-ee and biliary fistula. ^ "' """■'"'»''' "> >>« 'he result of and Voloshkeviteh renort !l % ' ' ^'"'' Koltchcvsky i.erni.red„o:nySsr: c:etr!::'f:h™T^ irrigations, &c-, had fail^^rl t ! f ' ^™ ^^*^^' «*^er «sa„eo™p,ish;dt:t:.i zTiitcrr^^r-f '^e«us„ftheC:i:!_t^„We™^^^^^^^^^^ l^'lff 'l ( 201 RE-PBTOTBD FROM Ttre "rivrin. ..„ QUARTERLY RETROSPECT OF SURGERY. PnEPARED nv FRANCrS J. SHKPHRRD, M.U, CM., M.R.CS Enp,. juij,tiy, ftiuUill UuiveiHitv arch of the fool '!'].„ .„ . ■ ! " "'"°"' I"")?!'"! inal one bone, he OS cal ,'"d'I ' T •' "''' ""'' '^ '""-'' ''^ acaphoid three oune ;:,;.;:; ™" "''"""''' '< "'' with their joint, nil > ! '"""' '"'■'"ta'sal hones sinking down b, a ,iga„ent, thf it l;,,!;:;;™;'"! <■■•»'" nects the anterior nirt nF fi.I '» '■'»' ^o scaphoid winch con- -phoid,anda:';ri:::i::t:rttr^^^^^ together and the „h".rCL '" ■*"'""'" "°'"'"« ""^ "»- li fill more tho hone desccnda the more tl,-^ foot is flattened nml the weaker it becoiii''s, because less favniirably arranj^oil for li('ariu;j; weiuht. The ca\»sc of tli." tlcsootit of tlie aatrii;'aliis ih tho ati^^tchirig of the ligaments \. ieh supiiort it and tho aroli of tho foo*. Now there are two periods of Hfo when Hat foot is tiumt hkely to come on. Ist, In infancy ; if weakly chiMi-cn ho put on their feet too early, the ligaments are stretcJKMl, the arch is lengthened, and the astragalus descends in an iiiwanl direction. 2nd, At about the age of puberty, when the body increases raj/ully in size and the various fibrous atructurtfs are softened and stretch easily, the arch of tho foot is freipiontly destroyed, especially if individuals at this critical timo are obliged to carry heavy weights or to stand for long periods. When the arch of the foot is lost, the patient in walking loses his elastic step, the foot is raised as a whole, the s^iriiig of the toes being lost. The continual stretching of the ligaments and the pressure of the head of the astragalus on the mus('leH and nerves of the sole, of com se, would also cause consideral)lo pain, for which tho individual cousults a surgeon. The piiin is often, especially after walking, very severe. It is also natiu-ally worse at night than in the morning. In the early part of tho day the arch is partially preserved by the sole and (lexor muscles, when these get tired out the ligaments are put on tiio stretch and the pain commences. In severe cases, as lately pointed out by Prof. Ogston (^Lancet, Jan. 26th, 1884), a still further deformity ensues: — The heel becomes raised, giving the foot what he calls a canoe shape. This is due to tho action of the calf mubules hilthig the 03 calcis up, as owing to the flatness of the foot tuoy «-ivnnot raise the foot on the toes and so throw the body forwards. Tho astragalus becomes altered in shape. The changes are confined principally to its head and neck, the neck is much shortened i.>i^ to pressure on the head, whose upper and outer part is vn't ~.^fi ag' ^st the scaphoid and hence an abnormal foot is foriu: ,1 Mr. J. Symington {Jour. Anat. and PhyH., October, lBcl4^ has lately ially described the deformities existing in flat-foot, and he gives results of a dissection of one examiiiod by 2 03 «thas.c.c.|,|„.u,.-or„ ,„ r 7'"'"'" '"""'■''"■'"I '««. benolicial. " "' ' "'" """" ««'" <>f "'« foot i, „ftc„ Hi-. W'alsliam (Z(Wfrf, j„,, o,;,,, ,„j,, , ., o™.,os ,„„ic,- ti!^^ ' ::,; : • ? '7' "" "- ouu.,. .:,!» , „,:, the foot .0 just a ',''':; f'T "' ""■ = -"'« "f -OS a val«,.. „a,l al,„ which l,e 1 .ovo,,:' , ",'"■' ', "!' teorac surKoo,,., a.lvise the „so of tli-wT i "'■ """'■ ai'lo of /•„,, to l„,o„ ,1,0 » oil „ ' !" .""'"^"•^ '" '"'"' Mr. Willett, (Vol vvrrr «. u , ;ovoro „a.s a.VLe; tSl,r.:„, ^L^^^^^^ '" tin- down on the iL-ur.\ . f'^^.^'^^es. lie uilvises cut- 'ar..*oe of st;,::;;'^::: :; r::i':;.:-"'f "■■" "■■"""- ■» good podtio,,, o,„leav„„,.i„„ to - lo!^, "•'', "''"""- "'™ He keeps tho hone, i„ positio'n t.t ! 1 t^" 'T an excision of the asti-Tmin .no u • i • • ^^ '"^ '^' '" ^^ct, l>a» performed tl,i, l:!^ .",^"1™" ':'"'• "«^'"" w.ti.out e.eptio,„ re„„i.d freJ C:ZT^;,^,^: •mn X They all were benefitted by the operation, and in most of thetn bony ankylosis and a painless arch were obtained. Most of them resumed their laborious occupations. Dr. Hermann von Meyer (^Studien ilber den Mechanismus des Fusses), Professor of Anatomy at Zurich, after a careful examination of the normal and of the flat-foot, anatomical as well as clinical, comes to the following conclusions which, as may be seen, are not in agreement with views generally accepted. He says that flat-foot does not depend on destruc- tion of the arch of the foot, but on a valgus position of the foot, and chiefly of the os calcis. He holds that deformity is not due to relaxation of the plantar ligaments, but depends rather on exaggerated rotation inwards of the astragalus, and on sub- sequent changes in the plantar bones due to atrophy, resulting from mutual pressure. The fore part of the foot is also turned upwards and outwards. Mr. R. Clement Lucas {Lancet, March 3rd, 1884), says that the flat foot and weak ankles of puberty are always associ- ated with rickets and albuminuria. This condition is char- acterized by relaxed ligaments and also some enlargement of the epiphyses. He also states that this form of rickets with albuminuria is invariably associated with masturbation. He remarks that the absurdity of treating such cases merely by mechanical appliances, &c., when there is an underlying habit causing a general constitutional disease, is very obvious. He never treats a case of flat-foot, knock-knee, or lateral curvature, without first examining the urine, and in the majority of cases he finds that albumen is present. This con- dition in boys, Mr. Lucas says, is most frequently seen about 15 years of age. Mr. Lucas gives two cases in support of his theory. There may be a modicum of truth in what Mr. Lucas says, but his assertion as to the causo of flat-foot and knock- knee is altogether too sweeping, and will not be accepted with- out much more evidence than is offered by Mr. Lucas. Osteotomy for Genu Valgum. — Dr. Wm. MacEwen of Glas- gow read a paper on this subject before the International Medical Congress, held in Copenhagen in August last. This 205 paper has h ''t'n |) ;'l'li»l,c,I i„ the Lancet of Sept. O" MaeEwen firnt i, vit, I , ' , , • T "'' ^"l"' ^^A. Dr. «;:™'«" "" ' oo„, ^1^,':^::;%°^""^ r of these c.|,e,,iti,„„ 1! |)„„. ,, , Y .^^- -i, Iho results bee„roctifle,ll,y„Ht„„,„' 72 f° '''''°™"^ ™'"™ after it has ■method be a,h,,..„,| . 'Z ' f ""^ '»'™- <>' extra-artic„!ar -Icctea for ,h „ ,;„ ";■'<'"'« 'iWa or the femur be operation and it. mM T " *""''''' ''"'"M Ogston's te preferred ..n '' t;; " «'-;P.a-cond„oid Method *ouId Billroth', „r He ed •,' o . 'l" '"'''' ^^ ^»''^«^''. lastly, which of lh,.,„fi*r ?" ™ '" P"f»™od? and (2) The result „."' "'■"'■""°™ " «>e preferable one ? Eleven sur^oonH u 1 . T'"' "f'""'"" ™ ''^ ^^ surgeons, two surgeons userZl-tr ^''Tr'^^'''™''^; '«"'y- occasion*;,,, ; .„esl «, ,t; 'oLt ^^"'^'^'^ -^ ^leve" I» the other liu,h,o„„r„teT™rt T™"^" °" ^80 limbs, have been used. „ Cs! 1',?"°'^' '"" ^"'""''''^ ">««>«* tion have been as f ,! ' »*' ,"'°*"'^ <'"™S *e opera- thirteen of Ogston', nd In^T™ '"f '" '"" "^ McEwen's, Off in the join^t in '„:;" "o"; „?™,tt'J^ ""'^ ™^ '>"''™ surgeons used s„r„v „„d ../uf T !' .thirty-four out of the 87 condueted the opZat" tb ^'"""'" P^^"^"'»™' -''■ile three of MaoEwen-s o^e ^ aft l^" '"'''"'■ ^'■■"^■'™ cases Ogston's, and one «f (" i™7. ^'"^7'°''' "'*=''" <="*' »f suppurated, five (to ■ IV !^ 1^' *^ "'" »' l'"8 have some of these were „t ,t',f '[ "°^""'' "P^™'-"- 'hough were 1,113 reeove ie, „ „ '/t t " ^ °P"^''™'-»» there With regard .„ the, Styj' he ,•!'■• was ankylosis, and in two en™, ^? '" '""'' cases there others were good ^ *^'°° '^ "'"■'"'S^ ■■^"'"cd ; aU the Mr^'ohttr:-!: ,:::itr\^f ^^^^ °°"--'' ■' ™ »- of onset of .elati„„rd,:" '"" 'V° ''' P^*""^"* f™"" the - average dnrati-:r.:t::rrtLTetor: rrll 'Jiibi .;■("■ I Dr. MacEwen then gave the statistics of his own operations. He had, np to July JJlst, operated on 804 limbs in 490 patients (ranging in ages from 7 to 4(5 years), making 820 osteotomies in all for genu valgum. The supra-condyloid method was performed alone, in 810 limbs. The operations were all conducted under the spray and with strict Listerian precautions. In 8 cases su[)pura- tion took place. For ihe last three years no case has suppurated. Two of the patients died. Dr. MacEwon stated that he had performed osteotomy 1800 times in 1207 limbs, on 704 patients, with five deatlis — two from diphtheria, one from tubercle, one from pneumonia, and one from enteric fever. In all the recov- eries, there was improvement in the form, strength and utility of the limbs. Only two cases relai)sed. The average duration of treatment was six weeks in the splints and two in the wards afterwards, The combined statistics of Dr. McEwen's operations and those of other British surgeons for genu valgum give 1884 limbs operated on, with ten deaths after, though not all from, the operation. In the discussion which followed the reading of the paper, Prof. Ogston of Aberdeen said he had not altogether given up his own operation, because he was most familiar with it, and did not like to throw it over altogether ; but he had for some years past told his students that Dr. McEwen's operation was the best, and he wished to make to that meeting of the congress a similar announcement. He would advise every person who wished to osteotomise for genu valgum to adopt it in preference to his (Dr. Ogston's) own. Prof. Chiene of Edinburgh could not go the length of Pro- fessor Ogston in throwing up his operation altogether. Still, on his return to Edinburgh he would give Dr. MacEwen's a fair trial. Piof. Schede (Hamburg) accepted Dr. MacEwen's operation ; in fact, in most cases he had substituted it for his own. iStill, he thought that in many cases the tibia was involved ; he there- fore, in these cases, performed his own operation. Mr. Bryant (London) saii] there was now no doubt that MacEwen's operation was the best one. V- r Tf?;!l 207 Dr. Robin (Lyons) showed an apparatus wIhtoIm, u r , oponaio,, c„„M I,. ,..,,„,.::,e,l with!,!, a Z:!!^""" ''"'■""""'' y<>r ll.c Iinielit of those roa.lers who hivo' not 1. . .u »elv™ po,te,l a» to tho various opo.Itio, o^ "' ^ZTl ;jee.i,,sa,,i,.„,t,:,:::£;:;:^;'~:^.,i-;w^ the corrected position for some six weeks ] " " It certainly is very creditable to Prof. O^^ston that ho .h. u BO gracefully acknowledge that MacEw° 's o e at n i? ! AlacEwen s operation as did Prof O.r.h.n Tu ■ ^'"^O'^ace 'n the ,„i,„.s of the great ^aio't, ^fC.tf t^t ;iarE"""'' ope,.ato„ is the best a„d sita'ples^, as weH T s!f t He^ mn elf has bee,, ,«ar.ello„sly sueeessfui with it. I„ hehant of others, ow,ng, as Dr. MacEwen reinarked to h:l T , not being exaetl, earried out, accidentrhavc C d sfT inwards for ,f the d,rect,on be from within, outwa,* and baek ward., t e popliteal naight be divided. In Canada, th 3 operatt " ""' f \° -"»<• fo^ P-Ple not being so sabj ot to r oC ow„,g to the better methods of living. °Riekets are seen ot„ nough a,nong the French Canadians", but they are u„w I in! tl:: ^ZtZr^'T'' ^ ^ "-« an/mterferene: ^i New Yo^kl : ^"" 'T""" *""■ '■' '^^S^ -■"«« like JNtw Ifork, the ope,-at,on has frequently been performed esne c.a ly on the members of the foreign communities, s^ch a .he" Italians, who are very subject to ,-icket8. Dr. V. P. Gibney, at a recent meeting of the New York Academy of Medicine («&. Med. iY^.foec. 6, •84rre;d » :!«l X paper on The Surgical Management of Rachitic Deformities of the Lower Extremities, in which he said, in cases where osteotomy was necessary foi- ^cuu valgum, MacEwen's operation is the only one that should be performed. Many of the surgeons who discussed the paper spoke most favorably of MacEwen's operation. Tracheotomy for Group. — Dr. Cocks {Archives of Pediatrics, Vol. I, No. 1) of New York relates his experience of 15 cases, which were all performed at the patient's houses, with no more skilled nursing than was afforded by patient's relatives. Ei"ht of the 15 cases recovered. Two died on the first day, two on the second, two on the third, and one on the fourth day. Dr. Cocks or his assistant remained with the patient from three to six hours after the operation, and during that time instructed the amateur nurse in the conduct of the case. The room mpera- ture was maintained at 80 '^F., a warm sponge was kept over the tube, and steam spray was kept constantly going. The nurse was directed to take out the inner tube every 15 minutes, soak it in hot water, and pass a muslin rag through it. A feather is used to clear the outer tube. After the third day the tube was taken out twice daily and cleaned. The tube was finally removed on the sixth to the tenth day. — Lond. Med. Record, Aug., '84. Splenectomy. — At the thirteenth congress of German surgeons Von Hacker of Vienna exhibited a lymphoid sarcoma of the spleen, which had been successfully extirpated by Billroth. Before removal, the oval tum^r measured ten inches vertically and more than seven inches transversely. On median lapar- otomy, the convexity of the tumor was found to be free from attachments, but the omentum and a coil of intestines were ad- herent to the hilus. The splenic artery and vein were divided between two ligatures, and rather more than an inch and a half of the adherent tail of the pancreas required removal with the thermo-cautery. This is the first splenectomy ever performed for sarcoma. Cred(j, at the same congress, exhibited a man whose spleen he had removed two years and a half previously for a larf;e cyst. In this case, as in the preceding one, there had been no enlarge- 209 mrtit of tl.e thyroid or lymphatic ^Mands and thn apparently ,,uite well " ' ^'^'^ "'•''" "'''« Med. News, Aug. 23i-(l, 1884. "oJus.— / /n?«. Mac r? "■"'>' •"' "'° '"'"'™'"""'" M^Ji^^l tW " iitm ac bonenhafpii Pmf T?,. i , ^""^ii/sa, subject, i,,' .1.1^; d : irr ^ •""""■ "" "'° ^''»™ 1 T 1 uown the to owui"- nronntjif-inr.a . possible. 3 The m.JT , •*' ""'" '"' ™™l''«te "8 Ived with l,e di. ed '"'''T'"""* '""'"'^ """^ »« - t'c=d? 5=r f ^^^^^^^^^^^ followed by pera^aneat r v"^ " ' ^ ^^'^ '''''' f ^^ '^^ turn, tlie lymphatic ' ! X the rectum or anus is implicated. 9, In all other cases, ampu- tation of the rectum beyond the points of growth is indicated. 10, The entire rectum, as far as the sigmoid flexure, may bo removed with good results. 11, The principal dangers of the operation are — a, haemorrhages ; b, acute, purulent and ichorous inflammation of the connective tissue. 12, These dangers are to be combatted (a) by very careful hemostasis during the operation; {b) by very careful primary disinfection and provision for the free escape of the secretions of the wound (by drainage and the avoidance of cavities). 18, In amputation of the rec- tum high up, opening of the peritoneum is unavoidable, but peritonitis does not generally follow if the opening be at once closed by suture under strict antiseptic precautions. Drainage of the peritoneal cavity is indicated only in exceptional cases. 14, The progress of operative skill has essentially diminished the dangers of the operation, the death-rate having fallen from 50 to 20 per cent., and even lower. 15, The functional dis- turbance following amputation of the rectum is slight in com- parison with the distress caused by the cancer. Incontinence of faeces is not complete, especially when the external sphincter has not been removed. Systematic cleanliness and the use of a suitable apparatus for closure commonly relieve the diflSculty. 16, Resection of a portion of the intestinal tube in its whole circumference, followed by suture of the two ends of the intes- tine, is not to be recommended, since the lower portion of the intestine generally sloughs. It is better to preserve the external sphincter and fasten the end of the amputated rectum to the lower edge of the wound. 17, Extirpation of cancer of the rectum is, in all cases, rendered easier by dividing the posterior wall of the gut as far as the coccyx. Removal of the coccyx is generally unnecessary. In the discussion which followed, Prof. Verneuil (Paris) stated that he had done his first colotomy thirty years ago, and his first extirpation fifteen years ago. He found that removal of the disease was impossible. He found that division of the can- cerous stricture removed all complications, and gave all the advantages of colotomy. The whole length of the stricture 211 must 1,0 split. The incisio,, „■„,, m„do from tl,e tin of n,o coco,. ,y a t,on„„.oa„tc,., ,,lun,c,l i„ to ,„,.et ,h„ -, , a tn','' : i ° "" "™"""- ■""■'"■•'" "- "l--'.t a can, ul ,. neccsarj-, an ^.-aseu,. chain wa,, passci, a-,,1 the rest 01 the ,l,v,,„„„ „s co,„,,lote,l. No 1,1„„< .as eve ■ lo and the .y,„p,o,„s at once ceased. N„ deaths followed ' ProlTrclot (Paris) denied the a.lvantase claimed for rectal -t,rpat,„n, an,l pon.ted o„t the rapidity and mali,„it, of,::::' of h!:;.inZ::„mr'"° ^''"""""^"■^ '-'--' "■- °'--="" P,.!rf; ^r""?"" '""""' ""'■''■''■'"'' "•»' «°'<""n>y. oven in Mr ■ c in. P ■'! P ""■" ''°""- "'^" "'»- »f oolotomy u. 0,1 n;- to B ja„t Cance,-s in the rectum had little tendency to mfiltrate early and recur soon. Even in desperate ca es hf a had no re,„,.„ nnder long periods, in one e ,e ot ft n ^ea s The .-esults of excision of the rectum had improved and woul.l go on do,ng so with imp,.„ved methods. Asepsis and di .nfeet,on were nor,nally powerfnl when the peritone J a 't" opened, hut when this was opened the dang .-s were .r at and loans,„g d,fficult. P„t dangc-ous as extirpation wl vas ,IIeft 3> Dr. G. Ileuck, of lIcidelhcrjL^, ij;iv(H reports of forty-three cases of this affection treated hy I'rof. Czerriy, during a period of six years. In two only were the [jntients under thirty years, and in twenty-nine cases tho disease .'ominencod between the a^esof forty and sixty years. Thirty were males and thirteen females. In one case only was there any secondary cancerous disease of the in^minal lymphatic ^lan » es, of wluol, 1,„ ,iv.. „„ „„„,,,, , ,,^^,^,^ ^ •■ ' - tistics sl,«w most conclusivoly lliat the ,l„,.-or. or , ■ «ro ve,, few, a„„ t„at the/, .o;:f'::r ^^^ .:,;;:;: r;" g ™t , on the „„,„„ of the adoctio,, f,„. „,,icl, it U ,'.„/. -^^ or 02 por cent, of tl,o total ,.,„„l,c,. (*n), ..ocovce,! ' f^""""" ft '*™'«.-M,-.Wal,c,. \VI,iteiK.a,l .-ocoatlv oxoi»,.,l at 1,0 Manchester Infi™>ar,, the e.cnn, an,l col.l „, ' t,' sulleim- (rom a carcinomatous growth encin-li,, , .1 of tho liowel \r, ..","""■"<"'>-""« iiiargo extent tic No»tl. Alter excision, tlie ileum was attacliej to the sk.n l.elo„ an,l tlie ti-an.vei.e colon in the skin aho „ tiio uctus Ihe operation was very tclious an.l dillieult occn P^-mg nearly two hours. It was eonJnete.l on L ' ." c.|.lcs. tour Jays alter the operation the patient wa "^ m any untowai,! symptom -(*,(. M,:J. jj.r., Nov 8 884 m 'M I [Mi >H| 217 REPRIJH'ED PROM rnp "r>v*n» .,„ QUARTERLY RIOTROSPKCT OF 8.JJiGKKY. Bv PBANCI8 J. SMKPHEBD, M.a, CM., M.R,C.8, E»„ read = paper „,,e„i,., „ discus,' flSu.r" l' T us. M,uy cases wore inont.oned where the kidney had been cat wim t],o tage,. I„ ,|„a connection, Mr-. Men-is pointed onl; Zzz r' "•■"■•"''■"=' ">^ "-'or for impact' cu,::' and m „t,o„e, a case (reported in Amerioa. Journal of m2 .Wtr? ""''"•' "'^'^ '" "•«='' I'O himself Lad LZei .mpacted stone ir„. .,,e „eter near its entrance into theblad incision into its s„Wta„eeadds;f,:;-L"r;:'—,;-: I -Mi - ■ fr' |::! [^ in. [fr X makes the diagnosis sure ; and in cases of early scrofulous dis- ease, which are so frequently mistaken for renal calculus, a free exit would be given to the pus, and the free drainage would be of great service. Mr. Morris, in his address, added but little to what is already known regarding the diagnosis of renal calculus. Its diagnosis will always be difficult and uncer- tain, and many kidneys, apparently healthy, will yet bo cut down upon. The operation, even when performed in these cases, often relieves the pain and other symptoms, the nerves involved being probably cut across in the incision made to reach the kidney. Mr. Morris advised removal of the kidney only when other means of relief failed, as nephrectomy was always a very serious operation and should not be lightly undertaken. He did not consider nephrectomy justifiable in floating kidney. He held that with regard to wounded kidneys many circumstances had to be taken into account, but if the indications of injured kidney or pelvis of kidney are marked and the gravity of the case urgent, an incision should bo made over the kidney at once and drainage or nephrectomy performed according to circumstances. Median nephrotomy or lateral prostatotomy should be per- formed if clots of blood accumulate in the bladder or are forced into the urethra, giving rise to obstruction, pain, and distress. In cancer of the kidney, Mr. Morris held that nephrectomy was seldom justifiable. When large abscesses had formed where peri-nephritic suppu- ration had occurred, nephrotomy, followed by antiseptic irri- gation and drainage, was advised. Nephrectomy sl\ould not be performed in cases of tubercular disease if the system at large was affected. Mr. Morris thought that if the disease was lim- ited to one kidney and there was dan(T,.?r vi exhaustion from suppuration, excision of the kidney mjirht: be advantageously performed after nephrotomy had failed. The difficult point, however, is to tell which kidney is affected, and when only one kidney exists. Tuschmann's instrument for closing one ureter was alluded to, but Mr. Morris thought such methods were likely to be of little value. He also stated that in 8,068 autop- 21!l sies ther, woro h„t two mstAncc. of congenital absence and recently ,„ tl,„ Mantroai General Hospital of inll to e case, aa lar an I know, ever met with in Canada.) In l.yM'onepl.roti,, tnmonrs of tho kidney, puncture or nephro .en(!s/, J7,.,i„.„/ .limmiil, Feb, 14tli, 188,5 ) In the diacu«»ion wbicl, followed, nothing new was elicited Mr Dur a,n »tatod that he believed be was the first to cu down o„ exam- :/.,:*;' '■: '? ™™™' " ''»«• None was f„ 3 n Mr Kn rL ",r'' ,"'" .T"""™ ""-^ "'»^' ^^-acteristic. ew^ T ^. ,"■'"" '""' f™"'' '-^nialuria absent in one case ot stone ,„ .|„, |,i,|„ „„,„ ^j^ " one queney ot ,„,et,„Hi„„ „,„„ „„„ „,.,„„ „^^„^,^ wit s ^1 s' ot tne kidney tb„ l„,„^nig out of the ureter. He had now ner- orn,ed nep rectonty cloven ,i™es, with success in al , bu in'he s.xmw,cbh„b,,u,«l,touttheuretertherccoverywas™st;arld In a letter p„l,|i,<|,„d in the Philadelphia Medical News Mr Knows ey T orn.on nives a «yuo,,sis of'thesc eases of nephre^ tomy all per/ornied by „b„.n,inai scetiou. The eases were !1 Ca c„ „,„ ,,, „,. ^,,^^^_ ^,^_,^^ . ^^^^^^_^^_^ di.,ease of kid. aey, three ; hjdr«„ep|,„™, two ; sarco.ua of kidney capsu c one ; removal of kidney for wound of ureter during ovaZl; two. Ho ment,on« al*, that he has had four nephrotomies -Zll for cyst of ki,lney„„d tb.ee for scrofulous diseasc-wi'tb 1 '''f "''.™°«' 'TK'nt nephrectomy; also three s"ecessM nephrotomies. IVofuMor rino„„ „r r.^ V i '^>- /"""-cesstul Med:,^! f„ 7 ^,"*"^ '"'"™e ol Edinburgh (in BrituA Medial Jourml W.hrmvy 7tli, 188.5), reports a ease of suc- cessful ncpliro.|i.l,.,.„i,iy i„ a man aged 2il. The operation ™.P-:»™«' l-*° -pray; the" stone was ct ct d l! passing ma needle, ,|,c kidney substance was then smteh ^ hrough with the Hnger nail and the stone removed, by me ,s of a vulscllum, witi, considerable difficulty. There ws consid erable coding after ,pcr„,i„n, „„, ,Z^,,,,n.J^.^7l m hve weeks. Tho .tone weighed 48 grains Att ■m In the remarks which follow, Mr. Chiene says the syraptoma which encourage a surgeon to explore the kidney where no swelling exists are (1) long-standing pain in one loin, often intermittent in character, the pain shooting down into the ingui- nal region and testicle ; (2) blood in the urine ; (3) absence of any calculus in the bladder to account for the symptoms. If the stone bo in the pelvis there will probably be pus in the urine, and the symptoms will bo more severe and constant than if the stone be fixed in the substance of the kidney. Mr. Chiene also gives a resume of the cases performed in Great Britain, and alludes to the celebrated case of Ilobson, which has already been alluded to in this Retrospect* Dr. E. Sonnenburg reports (Berlin Klin. Wochensch., Nov. 24) the case of a woman, aged 52, who had suffered from pain in the right loin since last Easter, accompanied by fever, wasting and polyuria. She .ame under the care of Dr. S. in August, when the presence of a large fluctuating tumour in the right half of the abdomen was ascertained, and on aspiration pus was drawn from it. Nephrectomy by abdominal incision was per- formed on August 25th. The operation was difficult and tedious, the thin wall of the cyst rupturing in the removal. The whole pedicle was secured to the wound, but it was found impossible to secure the peritoneum. The organ was con- verted into a chambered pus-containing sac, with numerous thin-walled outlying cysts, and a large branching calculus was lodged in the dilated i)elvi3. Hardly any renal tissue remained. Great collapse followed, terminating in death on the second day, and during the whole interval no urine at all was secreted. There was no peritonitis, the left kidney weighed 190 grammes (8 oz.), was senemic but histologically almost normal. The fatal issue, Dr. Sunnenberg thinks, could not be attributed to shock of the operation and collapse alone, but that the condition of aneuria, the cause of which remains unexplained, was in the main answerable for this result (Lancet, Nov. 29, 1884). In a paper read before a recent meeting of German natural- I'i * December, 1881. 221 i9t3 ami medical (.raotitioncrs at Ma^,lohurs, V.,„ ItcT-raam, road a paper on " Extirpation of Kidney." Tie said a^l^Z hon ,s no longer a rare one, for, since Simon's first case i l,as been per .™ed 121 times. It may he indicated in a ca^ 1' I "";•■■ "' '" """ °' P^^'°-"«l'''ri'- I" '1.0 former ass the operation .s a very dangerous one, as it is necessary to perform laparotomy and to make a double incision of the pontoncum In 21 cases of this kind, death occurred in IT soon alter the operation-in five of which it was due to hi- "orrhage; only our ,,alie„ts recovered. Extirpation of the k dney has much better results in cases of pyelo-niphritis, as of 40 cases 20 have been cured. Von liergma.n, does not approve of simple ,ne,s,o„s m these c,,.ses. During the last 12 months lh,as extirpated the kidney ,o„r times, in each case success- M y (t«,,™»,y ,, c7„V., No. 45, 1884 ; quoted in London For readers interested in the surgery of the kidney, I give the following relei-cnces :— before Roya Medical and Surgical Society of London, with discussion (Lancet, Nov. 29, 1884). Nephrectomy in J taly.~ Lancet, Dec. 13, 1884 : Davv on a oTr H^f ""7-^'"n^''"^^''' ^"■^^■«'' ^^^'"-^ ^'-rnal, Uct., 1884 p. 70 <; Reeves on "Treatment of Ruptured :B^acheotomy.--At a meeting of the New York Academy of Medicine, held Dec. 4, 1884, Dr Joseph E. Winters read a paper entitled, " Is the Operation of Tracheotomy dan-^erou! ;:rm:'d ^^Th'^^^^^^ '''r ''-''' ''- ^^-^- ^^ ^- ormed.^ Ihe author said, at a recent discussion in the Obstetric section of the Academy, it was held that tracheotomy was the most dangerous of all the operations in surgery, and he could not pemit this view to pass unchallenged. The danger from hemorrhage, he thought, had been greatly exaggerated. Alter quotmg a number of authorities to prove 'that 'tracheot- m 1! If ■ ' ■ I ^1 X ouiy was not a dangerous operation, ho next procee(l(Ml to the entjuiry of the manner in which diphtheritic croup caused death, lie said in a hirge proportion t)t' cases the cause of death was the prevention of the entrance of air to the kings, and that in tliese cases tracheotomy aiforded a fair chance of recovery. Wlien the operation failed to save Hfe it was either because it had been resorted to too late or from want of suffi- cient care in the after-treatment. In cases of croup the larynx was given rest, and the operation did not injuriously affect the course of the disease, lie advocated an early resort to the operation before there was venous congestion of the lungs. The indications for the operation are labored respiration, reces- sion of chest walls and alteration of voice, and when ipecac- huana is no longer successful in producing vomiting. Early age does not centra-indicate tlie operation, as the o{)eration has been successful at six and nine weeks. In the prognosis after the operation the following points have weight :— Early age ; previous ill health, especially affections of a scrofulous nature ; the presence of scarlatina or measles in the neighborhood, en- larged lymphatic glands and nasal diphtheria. If after the ope- ration the respiration was not free and deglutition was difficult, it was a bad sign. The conclusions of the paper were as fol- lows : — That tracheotomy, of itself, if performed with care, involved little danger to life; the operation should be per- formed early, but it was never too late to operate ; and, finally, that no patient who died after the operation would have lived if it had not been performed. In the discussion which followed the reading of the paper. Dr. Jacobi said one of the dangers of tracheotomy was from bungling operating ; the operation was not necessarily a bloody one if carefully and deliberately per- formed ; if hajmorrhage should accidentally occur, it was better to arrest it before opening the trachea, as the entrance of blood into the trachea was more injurious than is generally supposed, and might result in broncho-pneumonia. He thought it a mis- take to cut through the isthmus. Since the introduction of anaesthetics, the operation had become much 'ess dangerous. He preferred chloroform to ether. Dr. Jacobi did uot agree H V recea- y dge ; care, 223 with Dr. Winters as to the time of the t.erformur.cc of the o.o- rafon. Whether the case was one of .liphtheritic croup or no whenever there was laryngeal stenosis, accompanied Uy a con^ SKlerable amount of recession, with well-marked and incrcasin.^ dyspnoea, especially in the morning, with cyanosis and a fre^ quent n-regnlar pulse, the indication was to perform tracheo- omy whether the obstruction was due to presence of m^ . brane or not. Pneumonia was a contra indication, [n cases where the symptoms above-mentioned existed to a limited extent or were absent, it was better to wait ; and there was all the' more encouragement to do this on account of the recent ad- croup, ihe bichloride <.f mercury, especially, ha 1 practised, diod on the tabic. A necroft^v showed that the tube had been passed dowM between the trachea and false membrane, thus pressing together the sides of the lining tube of false mem- brane. This source of danger, from the absence of its mention in text-books, Mr. Osborn thinks, bus not often been met with. If Mr, Osborn had u)ade it a pra(!tice, before introducing the tube, to hold the cut edges of the tracheal incision apart with hooks for a few minutes, and search for false membrane at the site of and below the wound with forceps, this accident would not have happened. It seems to me that most operators insert the tube too quickly ; there is no reason for hurry, and mucus and false membrane can always be removed i'rom the trachea better before the tube is inserted than after. Diagnosis of Perintio-Tihial Sprain. — M. Labbd, of the Beaujon Hospital, says there are four traumatic lesions which arc usually found about the ankle. (1) Tibio-tarsal sprain and (2) medio-tarsal sprain, which aie easily distinguished from each other, but (3) perineo-tibial spi'ain or distension of the ligament which unites the tibia and fibula is not so easily distinguished from (4) fracture, with tearing of the external malleolus. In order not to fall into an error which would be decidedly disad- vantageous to the patient, it should be noticed that in perineo- tibial sprain the ecchymosis is seen a little in front of the anterior border of the fibula, while in 8e[)aration of the external malle- olus, it is behind the bone, in the depression which separates it from the teudo Achillis. With regard to the pain, in ihe case of fracture it is seated immediately over the bone itself; but in the case of sprain, the greatest pain is found in front of the anterior border of the bone. It is in these cases that the elastic bandage has such excellent effect. Marc S^e has recently recommended the treatment of sprain by the elastic bandage. It is the only method, he says, which fulfils the two indications (1) to cause as rai)id absori>tion as possible of the blood extravasatod around the joint and (2) to favor cicatrization of the torn ligaments and ruptured parts by complete immobilization. The antiphlogistics and blood-letting formerly advised by Hunter and Guersant only partially fulfil 2127 the former indicatior.. Tliore is the ^nmn ^k- .• . , .non. whiC, Ki„e .,„ ^„J, IV wler ' r, ;„ t 'T ••^fngcrants and cold water hitlm ,...,. ' •' "^'*;''""^- A^o la much su|,erior to mnwi^.r.- It. ■ l«"'lago favors iJo,,i,i.aL, r 'j L T;,e'V"T'''''°''r ""'" " aPlJied to tl,o ski,, itself, ca,.c ,1 ; tak , n, "^ ■"'°"''' '"' aepressod ,,,acos witi, co t" , 2 sj as" "" ""■'""' 15, 1884, ,p,„te,l ,„ l^nictitiomr, Ja„ '85 ) '^' ^ For several j-ea,-a past I l,ave treate.l all sprains of the ankle — B. this means i,m„o,^ir:: rsjete ttlinllf ':;z,t:::':: ""'°"' '""- '™^'"" '» »^'« "• «- ^^o-t Boroylyoeride in Mingworm of the Scain Dp <^i i ^Jo.rna, of C„,„eo„. .„, ,.„„„„, j^^^V , l"™: ^ yyomdc until the ent,re scalp ,3 satu,-ate(i with it. He believes 1 horax to be one of the ,nost eflicaeious antiseptic andanti paras,t,c agents, l,aving at the same time a niild astrin!el; ac^.on and thus tending to alia, n.,.itat.o„ and s 1; e S Ihe glj,ce,„,e at the same time penetrates and car,r.- tte/l stance into the follicles to the paLites. G Cce, 'e Us a ™ .' aft,nty for „.atcr, and withd,.a,vs this fro™ th ,1 s t Lf de pnv,ng the tungns of one of its main elements of dl;, !„ " He cannot sp„ak too higl,l, of this application, from whthZo he has observed rapid cures in some ea.ly oases of ,ingw ™ of the scalp. Bo,-oalvoeride i« d»void of 4v» fc""™ »' the .est i..ritable s-cal, „,U bear i" 1 2^^ ^^Z^l^ I;' K : 'i ■ •: I " m and morninf^ with a spon;i;o or mop, and must be rubbod woll into the foUiclca with the tips ot the fingers. , Treatment of Gumhot Wounds of the Intestinef:. — At a meeting of tlio New York Surgical Society, held January 27th, 1885, Dr. Wra. T. Bull read a paper on " A Case of Gunsiu-t Wound of the Intestines," treated successfully by laparotomy with suture of the intestines. {Medical Neivs, February 14th, 1885.) He commenced \m paper by stating that the majoi-ity of surgeons are still oi)pD8r(l to an exploration of the abdonren in gunshot wounds, notwithstanding the very favorable results following operations for the various abdominal diseases. Most surgeons advocating laparotomy for gunshot woimds have been compelled to frame their conclusions on theoretical grounds alone, not being able to support their views by a single success- ful case. Dr. Bull finds that up to the last twelvemonth there are biit two recorded cases in which thorough abdommal explo- ration was resorted to by laparocomy. Kinloch, in 1882, opened the belly and sutured five pistol shot wounds in mesen- tery and intestine ; two other wounds escaped observation, and the })atient died in thirty hours. Mr. Lloyd, of Queen's Hos- pital, Birmingham, performed abdomina' section for supjjurative peritonitis three days after a pistol ball had perforated the small intestine in two places. Death followed in two hours. Last summer, Kocher, of Berne, performed laparotomy for pistol shot wound of the stomach ; he sutured the wound, and the patient recovered. The case reported by Dr. Wm. T. Bull is the second success- ful case on record, and is briefly as follows : — Wm. E., a truck driver, aged 22, was brought to the Chambers Street Hospital, New York, Nov. 2, 1884, at 10 p.m., suffering from a pistol shot wound of the abdomen, which he had received half an hour before. On admission he was in good condition — tempe- rature, 978° ; pulse 96, and of good volume ; abdomen tender, but not tympanitic or swollen. He was troubled with frequent retching. The wound was not probed, but merely dressed with dry antiseptic dressing. Twelve hours after, when seen by Dr. Bull; he had a pulse of 102 with a temperature of 100'2*, and IS: 22U St::::,-;;-:— :::t;^r-rr- per rectum ; ab.lomon f .n.ler all ove hi T "'''""^' con.Iiti,,,, was u„cl,a.i.-o,l ,o I), n r • '"''™' '"' of pulso tompemturo a,„l ,-c,„in i^ „^^ ^ '^ .'""™'"' usual ,no,„o„ ,va,, ma.le i„ ,l,c ,„o,lia„ n'„„ ,,,„„ „,J , ^^ ' Dioo.1 do 3, but „o ftocal matter. On tl,e Wr.ler of tho fir,t par. of the «„t ,„.e.c„ti,„ wa. a slight i„ci,ea wo „ f " e erous coat only, p,.ol,al,lyn,a,lo Uy tl,e ,,cia.,™. Tln-eo or f „r fo of n.test,ne. wore the,, p„Il„,| „„t of ,l,„ wo,n, a nd e re Miy e..a„n„e,l The intesth,es and „e,,e„te,.y wer , . , i Jaces „,th flakes of fihrin. The gut pulici out was nh ' be„vee„ la.e,. of antiseptic towel./and^ceasionali; ^ Z «.th wa,m water. The gut was .slightly congeste^I h , h' coils wei'e not adherent The fi,..t „. 1 " ° '' '"" '"« aheut l,.lf . ■ , • V """"' «n«»u'iterea was abou half an ,„eh ,„ d,ameter, situated midway between the et: : The'"" '™"" "' "'« ""-""». -eraf fe:' Z eoeemn. The sc'ous coat was cut through and the mucous membrane lacerated and everted. It bled easily .ZnZ e.lgeswere sepai^ated, but not till then did yellow f«cr th! eo„s,s e.uey of gruel, escape. In all the wou'ds this wis' tie r^w u""' '■7,'^\^^^"^ "^"^-""^ raemhvam acted as a plu-r which prevented the escape of feces. The abdominal wounl .' f '1 ''" . Li I ii 1^ waa plugged with largo sponges, and the wounded part of intestine laid on a towel and emptied of ficcal matter tliroiii'li the wound, a id held with hoth hands hy an assistant. Tlut mucous memhrane was inverted by making traction with two hooks 80 as to make the wound liolo a longitudinal slit. Tho peritoneal edges were then brought together by fino sutures, applied according to Leinbort's* method ; iodoform was rubbed along the hue of suture. After removing several more Iooj.h, tho cavity of tho pelvis was empty, and the cjccum, sigmoid flexure, rectum and bladder were, after sponging out a consider- able amount of bloody fluid with clots, examined. Tho buUot was soon found lodged in tho upper surface of the sigmoid fU'xur(!, close to its mesenteric border. Tt was immediately beneath tho poritimeum, but on removing it tho bowel was found to be perfor- ated. Three sutures closed the wound. The open jielvis was then protected with sponges, and more intestine was drawn out. A third perforation was seen, similar to the first in size, but situated near the free border of the gut ; then a fourth and fifth close together, and separated only by a bridge of serous mem- brane ; a fifth and sixth wound was found a little further on ; these four last-mentioned wounds being all withhi a length of four inches of intestine. The two wounds together were converted into one, twelve sutures being required to eh-ie it; all tho wounds treated as the first had oeen. A seventh wound was found in the intestine still remaining in the cavity ; this was closed by five sutures. All the small intestines we; o now out except the duodenum. The jiclvis was then sponged out with a 21 per cent, solution of carbolic acid, the intestines replaced and tho line of sutures inspected as returned. The wound in tho abdomen was closed by heavy silk sutures passing through tho entire thickness of its walls ; the incision enlarging the bullet wound was cloned in the same way, a drainage tube being left at its lower end. Iodoform and borated cotton were used as dressing. I'ho opera- tion lasted two hours. Ether was not well borne, and at one * See Retrosi)oct, June, 1884 ; also in saino uumlHa- (iHkt oiK^ratioTiB in tho Intestines, especially paptir by Parkos on " Gunshot Wounds of til6 InieStUiDo." hut 2:n time tho hroathin. conned htkI artificial respiration had to ho rosortcMl t., The patient did well after the operation, and in '>4 days was able to eat a hearty Tha„ka;^ivin^^ dinner. Wf.en shown to the Sur-^ical Society three months after, was in excellent health. Dr. JJull is to 1,0 con,^'rat..Iated on tho ahlo way he treated the case and the successful result. No doubt ha.l the tnan been left without operation, ho would have died as so many have done before, under the expectant treatment. The -wl result of this case will oncoura;rc others to follow in Dr IJull's footsteps and actively interfere in ^mnshot wounds of the intes- tmes, with the result, it is hoped, of savin- many lives In the Lan.et of February 7th, 1S8:,, Mr. Albert Wri-dit relates a case of perforatin;^ bullet wound of the abdomen which resulted fatally. It was the case of an inspector of police who was shot m the abdomen by a bur:^lar, and wh.. after bein.^shot ran half a mile after the burglars, and then walked back two miles to the police station. He was seen by Mr. Wri^'ht two hours after the injury. At that time there >va3 n-" ^uch shock The bnlbt ln-1 entered two inches below, and to the Jett of the ua.o.licui.-. The wound was closed and morphia injected hypodermically. Durin- the ni^dit all doubt as to the intestine hem- wouiuled was removed by the patient vomitin.^ a laru^e .juantity of dark blood. The pationt still bein.^ in -rood condition, nothing was done ; later, fluid an.l fiatu. exuded from the wound, and the abdomen became tympanitic. A counter- -pemng was made below the wound and a draiua-e tube inserted. Patient kept clotting worse ; vomited at timel ; great tympanitic and abdominal pains, uud finally died on the fifth day. At the autopsy a largo wound was f .und in the descend- ing colon, 18 inches from the rectum ; tho wound was plugged by a fragment of clothing, and there was a good deal of extra- vasation in the areolar tissue between the sacrum and the colon The bullet was found imbedded in the centre of the sacrum. OapiUaru PiweUire of the Urinary 5^aJt7er.— Rosenberger advocates this mode of treatment wherever it seems desirable" to submit the urethra to a rest-treatment in stricture, hsemorrhage, ': 11 l» • ^ 18 prostatic affections, etc., etc. In the case of strictures, even those which are permeable improve much more rapidly when they are subjected to this mode of treatment. In one case & capilary tube was passed daily from the anus, and the bladder washed out through it without any reactionary fever being set up. Contrasted with the old operation, in which a large and powerful trocar was employed, its results are greatly superior, and the death-rate, especially among older people, much dimimshedi.— Centralblatt fur Chir., p. 376, Nov., 1884; quoted in Praefitioner, Dec, 1884. This mode of treatment may be superior to the old one of using the trocar, but offers no special advantnges over treatment by aspirator. Beseetion of Large Intestine, — Mr. Sidney Jones, of St. Thomas' Hospital, lately resected the caecum and part of the colon for scirrhous growth in a female patient, aged 54. The diseased part was completely excised and the ends of the intes- tines sewn together— ileum to colon. Patient lived three days. Cause of death, peritonitis. Operation performed under the spray. — Lancet, Jan. 10, 1885. Mr. Walter Whitehead {British Medical Journal, Jan. 24, 1885,) reports a case of excision of the crecum for epithelioma in a man aged 88. Tlie lower two inches of ileum, all the caecum and the greater portion of the ascending colon were removed. The cut ends of gut were brought out of the inci- sion in right lumbar region, the tumour itself having been removed by means of a median incision. The patient did well for a time, but died on the fifteenth day of peritonitis. The operation was performed with strict antiseptic precautions, but without the spray. Mr. Whitehead thinlis if the man had pos- sessed a better constitution and had been more temf)crate in his habits, recovery might have ensued. Portable Antiseptics.— M.v. T. E. Hayward advises as a port- able antiseptic, corrosive sublimate. He says if 10 grains of cor- rosive sublimate, in the form of powder, be carried in the pocket wrapped roniid with gutta percha tissue to avoid deliquescence, a a33 water a «ol„tio„ of 1 hlgO : '" T''"' '» ' ?="' "f method to that aav„J„;Vs" Jo,: Tl ''^ T'^^' ""' of the biehloriilo in glycoriao ' ""' "" '"'"'i'"' whom he ha,I ,how„ to hW.f't, ,"''"''='' ™ " P""^"' tendo.,,of ll,e, o„,„r .1 -^ i ^''^^^ '" "''om the affection of the hacVoTAr°n'"'!."°' "'' " P^'^g^noas dons by a ,,lait of il 1 "''• J"-'^''"'' '^P'»»«d *e ton- phalangera Urticul,,£„?w' ""^'"^ ^""^ *" "^'aoarpo- had performed the ll o ° ,■ " "u' '="'' ^«' ™ '''■om he withequally good rlTt TH' ''"'? '^'^ "^'™«''''='y- b»' experiment with divid„,l „ ''""f^"-. "o has tried a 8im ar eaeh end of a dVaieMod h I 'f'''"^ ™^ '"''^^'"i'^ '» become united S"metrd''haTb """ *=" *^^ "-- Dr. Vendoit, of uZ t «, ^'f recommended also by t»be„sseuJ.-^f£' *''j:iJ-;^^^-oti.ation ^ 4SSt:dtt!:tt/.r*^^^^ external employment of ioi!r ^ ' '""""''' '" "''!'='■ 'he affection, eharacto "id I !t™f ' °™™"°'' ^" -7"'™atous closely resemCll^' °™f°" "f ™all vesicles and application a dp'rX;, of b /" ' ''" ''°™ "«« *» by violent burn L ' "l Lf *' 'f"''" ™™' "»' accompanied fluid appeareTand «!?*!; *'" ''''*' '"'='' ™* "'^ar cases, bo^:l7Z p--arpecu:s;xi:a:rrii-rs:-tr^::^ ■ m m 20 iodoform in any application will cause this eruption to appear. (Journal of Out, ^ Ven. Bis., Feb. 1885.) I have seen this eruption several times following the application of iodoform to wounds, and at first it looks very like as if the wound was taking on an erysipelatous action. I well remember the consternation the appearance of this eruption caused me in the first case of amputation (of the leg) I dressed with iodoform. I felt sure, especially as the temperature was somewhat elevated, that ery- sipelas had set in. This was within 48 hours of the application at the time of the operation. The patient, however, kept getting better instead of worse, and soon the case was recognized as one of iodoform rash. 23S i : ' QUARTERLY RETROSPECT OF SURGERY Bv FRANCIS J. SHEPHERD, M.D., CM., M.R.C.S, E.vo ^-,eou to the Montreal General Hospital ; P.ofe.sor o.AnatLnv Lecturer on Operative Surgery, McGill UniverJit; ' Treatment of Acute Peritonitis hy Abdominal Seofin. a meeting of the Roval Medical and vZT T^ ^5'^*'^— ^C don, held March 10th lH«r ,r ^^'^/S'^^' Society of Lon- vJa rvT ''^''^''^ }^^^^^^^^ {Lancet, March 14th '85) Mr Fred Treves read a paper on the above subject. H remarked oe treated by the same methods that are successfulJy anriied t„ ^er acute, „flammati„„s_vi... by free incision and dfa nate He urged the adoption of this principle of treatment in 3: ponton,t,s. and ilh.strated the snocess'of this t Z Lw h in* e r Ir r:lf r^^""" -'-'- -Oadrai^ 0.1 v. J , '^^ *"^* °^''^ ^ooian affed 21, who wis amttted ,„to hospital suffering from ehronic'pelvic erko J« M o..ng gonorrhoea. Three months after the eommen" men of the chrome peritonitis, an acute diffused peritonearMamma .on suddenly developed, due, as was afteri.ds™lv ^ " t he bursting of an abscess and the extravasation of'iis Jo^'uL" ■nto the general peritoneal cavity. After the oporatl, tht « , ^5 patient made a good recovery, and was in the garden on the 40th day. At the same meeting, Mr. Howard Marsh read a paper on a case t ■ " Acute Circumscribed Suppuration of the Peritoneum treated by abdominal section, with recovery." The patient was a medical student, aged 19, suffering from symptoms of sudden and acute pciitoneal inflammation. The inflammation was local- ized, a swelling about eight inches square existing to the left of the umbilical region. An incision was decided upon, and gave vent to about two pints of foetid pus. The abdomen was washed out thoroughly with a 1 to 60 solution of carbolic acid, and a large drainage-tube, eight inches long, introduced. This was graduUily shortened, and the patient slowly recovered, the wound healing completely at the end of three months. In the discussion whioh followed the reading of the papers, Mr. Thos. Bryant said he had long felt that the practice advo- cator! by Mr. Treves was one that had not been sufficiently fol- lowed. He had, however, for ten years past, performed surgical operations on cases of localized suppuration in the peritoneum about the caecum and pelvis ; the cause of peritonitis, he thought, musi determine whether the surgeons should operate or not. Mr. Knowsley Thornton said there was a form of peritonitis which appeared to be due to the mere presence of the tumour and not to any perforation — an acute dry peritonitis. He had operated in two of these cases ; one died and the other recovered after a very severe illness. In cases of perforation, he con- sidered the proper course was to operate at once. Drainage was most important. He thought that, unless the surgeon could be certain of obtaining absolute asepsis, antiseptic irrigation should not be used. When asepsis was impossible, he should use large quantities of boiled water, with free drainage. Drs. Douglas Powell and Goodhurst, and Messrs. Barwell and Meredith, agreed in commending the practice advocated by Mr. Treves. The p»'actice of opening the abdomen in cases of peritonitis due to perforation or wound in stomach and intestines is now advocated by all antiseptic surgeons, and this method of treat- 237 ment is one which has already saved manv Hvp. tj effusion. No doubt ILjT.i' " """ '" P'™™^ *'* to perforation or , b "t,t of 1™"""""" '?""''"' ""^ cavitj., are more 8uito,nrM ,'" """ "'" P""'™""' apt to be morflv bt t . . r'"'"'' ""' *^ ™™"' ^■■« drained away and mnv f,T" 7 °?™"' '' """ "»' kave of the peritonei would ',' T' ' "'"■""''' "'^ '™=»^ »»« careful drainage " *"'" ""i""-™" by 'he most U^:f^ l^ >^ '-'">-^>, No. 45) says *e stomafh or i^l" jtoXs: is:;;::™' 7" '' or some pathological nroceas Tl,„ ".^" "'"'*'««" ™lenoe operation is extrf^eZ s"n. mX:'^-"''''^^ '° rof-nmv '^rr.^ ti i. relates tour cases ot lana- Two pta fir; rr::" ""■'""'"'' '"'™ >■« "-"- operation.' to h ^ ? vo iL 1"'"™' *^'' ""^ ""^^ ""- was found and theob r o "lt:i "" p! "' f '^f '" """' recovery from the operation bu7dld frr^ ' ' «""'' weeks after. The tl i.H „. pneumoma some he came under Prof Milt,,. . "'■'^ ■"""■' ""er this incareorati n and at ce ' f"'"'^"'' '" *'*°°''' '"'"""' dominal cavityt t^ „ "rpi :tthi'L''fLlr'°"^d ^" "■" ""^ ^ •■''I I'' w J, t. I together, after being ireshened, by a dozen silk sutures. The subsequent course of the case was satisfactory. The fourth case was one of ruptured stomach. Death followed the operation in three hours. Kronlein has also resorted to the operation of laparotomy for peritonitis due to perforation of the appendix verraiformis. Removal of Foreign Bodies from the Intestines. — At a meet- ing of the Clinical Society of London, held May 8th, 1885, Mr. Charles Symonds reported a case of removal of a calculus from the vermiform appendix for the relief of recurrent typhlitis. At first the attacks of typhlitis occurred almost once a month, but the last five weeks he had had six attacks. Three days before admission into hospital he had a severe attack. On examination, a small hard lump was felt in the left groin, a little above Pou- part's ligament. This lump, which was painful on pressure, gradually increased in size. It was decided to make an explo- ratory incision under the spray. This was done two inches above and one inch internal to the anterior superior spine of the ilium. The swelling was incised, the appendix opened, and a calculus removed. There was no pus or faecal odour. The opening in the appendix was then stitched up and the abdominal wound closed. Some time after pus escaped from the wound, and a sinus was left for several months, but when last seen the sinus had closed, and patient was able to do his work. Dr. G. E. Fenwick of Montreal reported a case in a young girl to the Canada Medical Association in August 18th, '84, in which he had successfully removed a large concretion from a Meckel's diverticulura. The presence of the concretion had given rise to an abscess, followed by a faecal fistula. The abdo- men was opened, the concretion removed, and the opening in the diverticulum stitched up. The girl made a slow but complete recovery. Bullet Wound of the Abdomen ; Operation. — Mr. Annandale of Edinburgh (Lancet, April 25th, 1885) reports a case of a young lad aged 15 years, who was shot by the accidental dis- charge of a revolver through the abdomen, half an inch below, and to the left of, the umbilicus. The boy gave evidence of but 239 little shock, and walked 100 vnrrlc nA • . were found i„ the small intestine two „ t^ ' . ""'""'' and two in the pelvic portion o the r„ . ,1 'ZT ' °:'°"' wound of one of tha lo "'« rtctutn. ihere was also a consider be helh"e"iT7'n™ ''""' "'''"'■ «"'» *» '» a-:;ci::^h^rrr^--"^- ,,. *= "'' ^^"'' "icnlonde so ution CI to 2000^ Ti pat,c„t rallied from the operation, but died wi i„ nl' I the accident from exhaustion A ,. """ "^ were much distended w" and he 77'''' f" '"'"''"" tained six ounces of bricLd ^erul ""l'""^°°!'»'" «''"'3' con- given wav • in hM ,1 ?, °°* "' ""^ ™"'res had buuct raic/: 't^^,irsid:' /:r^'"f "'^"'^"■'- ■^''- front .• the ischial s,j:ii:::;!:^^;;:zt^^ portaifofir^^^^^ dmm then stomach, diaphragm again, and lower border of 2 r bs. fhe wound m the stomach was closed, and at the aulonsv showed no perforation. Dr. Deschamps thinks that the patient dr-: 1:";:?^ 'i ^^ ™' '»« «■' ''»p"»' »d;c and v:^ light to " "''™'^' " '" '^ ""^ *-'=^' °P«'- Surgery of the Stomach common occurrence now of so —Operations on the stomach are give rise to but little com- ■Ml I as to M i ! I! X ment when they occur. Still, the surgery of the stomach is' only, as yet, in its infancy, and records of many cases will be required before exact rules can be formulated as to the proper procedure in the various diseases and accidents which call for surgical interference. In the American Journal of the Medical Sciences for April 1885, Dr. Winslow of Baltimore has collected nearly all the cases of pylorectomy and its substitutes— gas- trectomy, gastrostomy, digital divulsion of pylorus, &c. He tabulates 61 excisions of pylorus, 18 gastro-enterostomies, 1 gastrectomy, 1 gastrostomy, 8 duodenostomies, and cases of digital divulsion. The following is the summary given by Dr. Winslow ; — 1. In cancer of the stomach not i)roducing stenosis, give ano- dynes in quantities sufficient to relievo distress ; do not operate. 2. Pylorectomy for carcinoma is followed by 70 per cent, of mortality, hence it should only be exceptionally performed in those cases where, with marked stenosis, the pylorus is not adherent to the neighboring organs, and the patient is young and fairly strong. 3. In other cases of carcinomatous stenosis, as only very temporary benefit can be obtained, {)erforra gastro-enterostomy. 4. In cicatricial stenosis, peform digital divulsion ; but if this is impossible, owing to great thickening of the walls, resection in those who are well-nourished and gastro-enterostomy in the debilitated will both be followed by good results. 5. In the opinion of the writer, heuiorrhage or perforation from ulcer or other causes than stenosis does not present indi- cations for pylorectomy. 6. Duodenostomy, gastrostomy for the passage of a tube, and complete gastrectomy should be replaced by gastro-enterostomy. According to an editorial in the Medical News of April 11th, 1885, of the 56 operations performed on the pylorus up to the present time for carcinomatous stenosis, 75 per cent, were im- mediately fatal— that is, perished as the result of the operation ; in 72.72 per cent of the survivors, there was a return of the disease ; and in 27.27 per cent., there was freedom of recur- rence for less than one year. Not a single patient was perma- -gas- He 241 nently ouml. I„ co„se,|„ence of thoso result,, t|,e fee ,Ut the „,,e,.a.,o„ „ not justifiable is rapi.ll^ j-aiuini ,,,ou„cI ° Oastro-enterostomy l,as been |,crformea 11 «me, with tbr„„ rocovenes. One of the survivo,, died fou,. .el' ' Z «.e othe,. two .ve,.e alive after two and four ,„„ntl.., resp e dvei; eesn,::V'"rr'°"'""^"'-'^ ■'"' ''^■'•'^'°^» »--• ocsslul Halm kept Ins patient alive two weeks by feeUin- UMy ■ , all the above operations inelines the author of the edi- onal above cjuoted to believe that '■ such eases should be lei to ment being attorded per rectum." In Fiirou.Ol.str,u,lion of tU PyU„,, several operations have been performed. Exeision of .be pj-lorus bas beo 2" ■oed in nine cases, of wbieli five havi'recovered, GaZ enterostomy has been done three time,, with one death. T U op ation consists in opening the stotnaoh and also the „„ pa t of the small intestine, and uniting these two artificial open She^rrmtdO " ""*™'' """" '"" '''"'^ '-" -'O Duodenostomy and jejunostomy have also been performed Tlie first once and the second twice, hut with a fatal iss'uo in Tach m the Bnt. Med. Journal for Feb. 21st, 188 ;, Mr T Holme, gives an interesting summary of two papers by Prof. Lore a^ Bo ogna on the operative dilatation of the orifice' of the stomach thT™L ^^rV f "'' "'"•''"'' ""^ '°^ <='■"=*'««! ^"traction of he cardiac end of the oesophagus, i, a ,ubstitute for pWorec tomy or gastrostomy. The operation is performed by maKn. an i„oi.,io„ two inches long on the anterior surface of the stoml near It, py oric end ; the two index finger, are then int dl^ mto the pylorus, which i, then forcibly dilated. The chief diffl- culty of the operation is the great resistance offered by the 1S82, had suffered from dyspeptic symptoms for twenty years, n F.i" t If', 5 a ' i \ and had been treated for ulcer of tlio stomach for throe or four years. Wliou the operation was undertaken he was in the last Jtage of emaciation and exhaustion. Di;^ital divulsion of the pylorus was entirely successful, and " five monLJis after the operation ^the man was in perfect health and doing his ordinary work." The operation has now been performed eight times, with two deaths. Dr. Russell (Brit. Med. Jour., Feb. 21st, '82) reports a case of non-malignant constriction of tlie pylorus, with great dilatation of the stomach, where the use of a syphon-tube for washing out the stomach had succeeded in restoring his digestive powers, and for five years he had lived in comparative comfort, and was'well when last seen. Before employing Loreta's operation, it would perhaps be as well to j)ut in practice this treatment of washing out the stomach, as no danger is incurred, and the oi)cration o*f divulsion could bo performed later if needed. This treatment by irrigation is not a new one, but the patient's life in this case has been remarkably prolonged. Dr. D. G. Zesas, in the last number of Langenbeck's Archiv fur Klinisch Chirurgie, gives an exhaustive article or ''Gas- trostomy and its Results;' in which he analyzes 1(J2 recorded cases, and also gives an extended history of the operation. Of these 162 cases, 107 were in men and 33 women, the sex of the remaining 22 cases is not recorded. It was performed 129 times for carcinoma, 31 times for cicatricial contraction, and in 2 cases for syphilitic disease of the oesophagus. The results of the opera- tions were as folio vs :-0f the 129 cases with carcinoma. 111 died and 18 recovered ; of the 31 cases of cicatricial contraction, 20 died and 11 recovered ; both the syphilitic cases died. The causes of death in order were : Exhaustion, pneumonia, periton- itis, and collapse. The great majority of fatal cases died within thirty hours of the operation. After discussing the line of in- cision, and speaking favorably of Fenger's incision (a finger's- breadth below and parallel to the edge of ribs on left side, cross- ing the rectus muscle), and the question of immediate or delayed opening of the stomach, he goes on to describe the various methods of suture used and disf^usscs the propriety oi feeding 243 as soon aa the atomach is ononed or waitinr^ fnr on i , an,, foodi„«po„ect,.™. Hc^.W.; Jr^l/L "Zi t t .tomach ,„fi,o.e„t to alio™, a ,ofe cnll.oler to pa„ ITtl , part can ,0 kept closed a„,l ,.,.„„,,„ clean, a„7 her ml! e growth on the ex- surlace. ih.s growth was removed by a snrgical opera- It I.' i I!* ''"mm ^ A- .ill' i tion, without any immediate injurious results on the intelligence or genera! condition of the patient, who lived, relieved of his former symptoms, for four weeks, and who, at the expiration of that time, died, not from any special failure of the nerve-centres, but from the effects of a secondary surgical complication. Dr. Bennett said the case, however, taught important physiological lessons, and suggested practical reflections which might prove useful to future medicine and surgery. The history and condition of the patient on examination were detailed, and the reasons given for the diagnosis. The subsequent surgical operation, the progress of the case, and the post-mortem examination were also described. In the discussion which followed the reading of the paper, Dr. Hughlings- Jackson, after congratulating Dr. Bennett and Mr. Godlee, said there was a kind of monoplegia, often passing into hemiplegia, which was almost certain evidence of cerebral tumor. A paralysis beginning very locally, for instance, in the thumb and finger, and spreading slowly week by week. In such a case he should not advise trephining, since there would be a great probability of a large tumor of the centrum ovale. The convulsive seizures of localizing value were not cases of epilepsy proper, but epileptiform seizures, convulsions beginning one- sidedly, and only locally in hand, cheek or foot. These seizures did not always to a certainty point to tumor, for in some cases there was local softening. When, however, there was also double optic neuritis, such gross disease as a tumor might be confidently predicted. We also require some local persisting paralysis of the part convulsed. So far then. Dr. Jackson remarked, three things were required for the diagnosis of cerebral tumor — local persisting paralysis, epileptiform convulsion, and double optic neuritis. He strongly advocated operation where the tumor could be localized, but said that we should not overlook three difficulties coi.ectod with operative interference — that the tumor might be very large, that there might be softening about it, and that, besides he tumor localized, there might be others. Cases were narrated illustrating these difficulties. Dr. Ferricr l>,ad v- -tched the case with the greatest interest. 247 that death wa, ,Imo t,rri I '''^°'/'"' ""='« "-"■''i ^o ■» doubt wi«' a„; ™. :T:',::;::;ir"'^p'-"^' -" - »^ -.',aec believed that ™ 2,"'°"™; '''P'™^"'^ °" "'""-'^ ^^ operation «, thrz: ^r« :';':,-™d,^'. "-^ «»<• -^ *« operation, that „e „„ ,,,„ °|""d 'J.' 7 ""''' '" '"«"'■'' '" "-o «h™e„ha«„a„,l.L:'l ll*;tt:lTS ""'"^ '» ^ which were indefltiito I„ 1,1= • ™ , """"'• '"o deeper parts of the cause of thetl cl Li''.' i':"' "^ ■""""'™'"^ -«»» «- occur without aom„3rIrI!r ',"'''.™7"»n """I''' Probably not the deep part ot thot „ ^ ,'?" '''''" ''=' ""■ '" '-Roving answered be ter T. "J ""'' """'" '™"11 Probably have rience, bee . wdl uZ^T '". "'" '"" ""'' '" ''i' ^^P- olosod and he c „ Z "''""'.'' ™""' "- oomplctely compfetely anaIaZ tl ,' " '"""' ^''™'"' ''"° "»' Br. Macewen trr.lmir /^ T"' " """ ^'= ''^-^^ "'"' therewouldbc „; rXf^ ''""" ."« -" i otherwise and blood to ,„ake S^^Z As't't™'™ '''"'''" "' ^'™"' in his case, he had noTub that i V T' "' "^ '''''''' 0'- and t,r::;;Tif : :r sXt: :r ■::■ oTora -r"'"' ■"" "^ -^- ' ' -™s ^tio^f ™'at;::l:;tZ;'-— «;^ns„,ical. Zt pointa in the case wl.i.l. ■^"'''"- ^^^^ there are many which .ore nr:, :ttd"v;::™;«r i"f ^"^' """ » should be closed „erm»„„„,l V ^ "'""'""■ "'" ''ound potmanrntly, as has been so successful io 11 1 4' m 1 1 n I '• X monkeys, or treated by drainage ; and secondly, as to the mode of dealing with the haemorrhage from the parenchyma. Gummata are frequently very vascular, and their removal would necessarily cause haemorrhage. In Mr. Godlee's opera- tion the haemorrhage was great, and was controlled by the actual cautery. In monkeys Mr. Horsley has successfully employed morphia, injected hypodermically, to lessen the haemorrhage, and it is worth trying in man. In the Lancet for May 16th and 23rd, Dr. Macewen, of Glasgow, has a paper on Oases Illustrative of Cerebral Sur- gery. The first case, that of a man aged 36, was admitted with impairment of power of the left arm, accompanied by mus- cular twitchings of right side of face and pricking sensations from the shoulder down, to the fingers of left arm. He, some months before, had fallen down stairs and was unconscious for twelve hours. When he recovered consciousness, the only thing he complained of was giddiness. Gradually the symp- toms for which he was admitted came on. There was no external mark of injury on his head. From the history, as well as from his condition at time of examination, a lesion of the motor cortex in upper half of right ascending frontal convo- lution was diagnosed, and, as the patient was very desirous that something might be done to alleviate his condition, operation was determined on. Under chloroform a portion of the right parietal bone was removed one inch behind the auriculo- bregmatic line, and one inch above a line drawn from the external angular process of the frontal to the upper angle of the lambdoidal suture, thus expojing the middle of the ascending frontal and parieta' convolutions. A crucial incision was made into the dura mater, and a considerable quantity of clear fluid alon;^ with clots of blood about the size of a bean escaped ; other clots adhering to the under-surface of the membrane were removed. No brain pulsation was seen, but a membrane-like patch involving the arachmoid and pia mater along with the external surface of grey matter was exposed. This was re- moved, and now the pulsations of the brain became distinct. The dura mater was replaced, and the disc of bone which had 249 and the skull for draina-^. Thl . ''"' ^''^ ''"^'^'F spa, an. ^..^^tJ^X^^T 'r^X^T ''' was done after 48 hour, and tl,„ !' , V '''''"""S when the wound was fZd 1 lalej Z ' ""'' '^'"' s^^pton,. A. the end of s we ks he h^d" """ '' " '"" there were no twitchings, and he ft s ef T^'f'^^' ever ; eight months after he reported himelf , , ■;= "' wc^, and with the power in his lefrl''Xt,^,:r^:^- -^;rirrLii:r.:LX^^^^^^^^^ clear history of syphilis of four years' standin !' A u' -nifestations of the tertiary period ^1 llu ovetri! f Pi al Ime, principally of the left side. There was a hhto " -jury over the same part, to which patient a ibuted t u U Eight months after the uicer healed .Hp hJ T ' eg On adnnssion three months later, patin, ws found t uni.npaired"^S- in X^ts'lt afr'f ""^' ™ aSeoted. Tapping the held garrLt'dis^ ee Me fX7 Ihe absence of anaesthesia from the beginning pointed to tt ■n ngl t motor area, superior half of ascending frontal and panetal eonvolu.ions with probable mvolvement o^f p e „« lobule, was diagnosed. As treatment by eounter-irritaZtd r sVetiitr; ■" -' """■'^■"""'^ --dirri: aH„,ed T - ? '"'F-e^ent, operative measures were . „e(l^ l.„ „^„ration was performed June, 1883. The hair havmgbeen parti, shaven and the sealp thoroughly eleanseX I \] w first with soap and water, then with turpc »tine, and finally with antiseptic solution, a disc of bone over an inch in diameter was elevated from the right side of the skull, its anterior border touching a point half an inch between the auriculo-bregmatic hne, whilst its upper margin reached a point about an inch from the centre of the longitudinal sinus. The internal table of the osseous disc removed showed osteophytic deposits (some projecting 1-lO'^h of an inch), the dura mater was thickened, and a plastic, membrane-like efl^'usion was found over the ante- rior and posterior ascending convolution and bridging fissure of Rolando. The brain towards the paracentral lobe°was resist- ing, and so was incised, which caused the escape of a gummous fluid with pultaceous particles. Previous to the removal of this matter there were no brain pulsations, but when it was removed they were seen to,a slight degree. The interior of the skull was now explored with a probe, and osteophjtic pro- jections discovered in the occipital bone, to remove which a second trepanning was perforned. As in the previous case, the osseous fragments were reimplanted and the case dressed with gauze, and drainage used. The patient did -ell, and when last seen, a year and ten months after the ope tioii, the power of the left leg and arm was restored and she .as able to walk about to perform household work. Dr. Macewen has had seventeen cases under his care in which operations have been performed upon the skull and its contents for the relief of cerebral pressure or other brain lesion In fourteen trephining was performed, and in three elevation of the bones. There were three deaths, but it was believed that trephining m no way hastened it. In eleven the bones which had been elevated were divided and reimplpnted. Hernia cei-ebri has not followed as the result of any of these operations Dr. Macewen remarks that if inflammation in the brai" .x: s at the time of the operation, hernia cerebri may form, ,o v, . standing the use of antiseptics. Cerebral surgery is still in its infancy, and the cases of Dr iMacewen will help to give confidence as to the resu;^ of opera- tive interference in cases which were formerly considered hopeless. 251 Treatment of Cold Ahcess.—Vvoi Vernonil r /?.,. 7 mi . peutique.kwr 1884^ ohHJn^ n , •''^"^^'H^^^-'^^^^^m- r.f oeL I . ^ ^ '■^P'^^ ^"''6 i" almost all his caso. of cold abscess abscess from diseased bone or fro. c nges" n &c., by ethereal injections of iodoform of the stren-.th fl ■ twenty. The abv. Morse of San Francisco ' ^olfi. Med # Surg. Jour., May, 1885) reports a case of 11: . u. /of the common carotid an y prior to removal of a g. .r :. ,om the pharynx. Fearing tf, • je of anesthetics, he irr]- , :.d over the site of lififfttiirfi fhr'^p-nnirf-pr'' "f n < — a' e • "^ ^-ii.-- .1.1 „„ ijuciioero vi agtaui ui cocaine ana a quarter 2.6,3 grain of morphia. The artery was li.-nt,.^ ,1, u omohyoid, without the patient feel. aClin' °'"* ""' New OpemtionforNam-PUryngealorFihro,,, P,, Mr. Furneaux Jordan ^Bri,. MU iur S! XfZ'''-; ;;,. i..o the affected nostriCrlr ll^r™' r «*" l.e soft part of the nose is divided on one sWerf th ! 7 line, m a line with the eut in the lin ? , °' ?" ""'"'o knife permit the flap to be tur,': lu tt^u^Xf "'1 cav,t, ,s fonnd, expanded, well deflned, and ,e„ t„ ,„^ "f" ---hri,^r:e:rrirr*--- C: m p & m m > 1% f'' II ' t 1 m !. ' , M 1 i 'i u . 1 1 I 255 RE-PRINTED FROM THP "P4WAr>* .,„ QUARTERLY RKTROSPECT OF SURGERY BV FRANCS J. STKPdEED, „„., CM., M.B.C.S, Ev„ ■.«.„,„ „„ operative .S.^gei, M^IM uZrC" ' "'' read a paper before tl.e Sur<,ical seoton „Tff . 7 ""'^ Medicine of Ireland on the " 5^!.: ^ t*Lt^ t^f °' on to ,a.y that if a stricture be tolerably recent and if til . c,rc„„stance, will per,„it, gradual dilaLion mat be .rieT and W.M for a hmited period be successful. Cases are met t where frequent catheterization will not be horl ,>,' """' o:frterpt:r:i;tt;rT— ffT :ord^::::rarld^-{x-"'^^ Natation or disposed totc'ontl ' .: T^t Z f 'd '"'^' were healfhv. In cases of nlrl =^.- . u ^ ^''^"^^^ jnternal,- .eeptinre:lt::lt^^^^^ M m r I Dr, Stoker, in |.tMforniing internal urethrotomy, prefers cutting from hofore bac" ,', aftf^^ the method of Maissouueuve, and he stated that iic had r.u.ormed the operation 25 times without a death. In one case only did troublesome hreraorrha«^e occur. In but otic <,xse had there been any return, and some had been operated -n ten years a<,'o. Dr. Htoker prefers incising the upper wall of the uretiira, because Ip'*- 'Mcmorrhage follows this incision. If luemorrhage sIk u.d occur, tiien In; ties in a large catneter. After the operation, a large catheter should be passed and immediately withdrawn ; then every other day, fur a month, a No. 12 to U should be passed, and after that once a week for th.; rest of the patient's life. 'J'he following are his conclusions : 1. Internal urethrotomy is superior to any form of dilatation. 2. Maissoncuve's method is much better than that of Civiale and his followers. 3. Certain details should be followed out, as (a) completeness of division, (b) disuse of annesthrtics, (c) incision of uppev wall of urethra, and (d) non- retention of catheter m the urethra sub- sequent to operation. To this latter procedure Dr. Stoker attributes the freedom of his cases from inflammation and other troubles. In a paper by Mr. Reginald Harrison in tlie British Medical Journal oi: J a\y 18th, ]«85, on the " Treatment of Urethral Stricture by combining Internal ind External Urethrotomy;' he says he diff^ ' materially fr< i many surgeons of large ex- perience as to the advisability of the operatic.' of internal urethrotomy in the majority of cases. He thinks that a person with stricture had much better er-iMloy dilatation in some form or other, so long as he can keep himself comfortal L and the size of the urethra is not progrer 'aiy diminisiiing. luierual urethrotomy, Mr. Harrison ' 'ds, i^: extremely liable to be fol- lowed by a form of fever w' i ■ exceptional, uuexplainable, and occasionally fatal. It not iuq ordinary wound fever of operations ; it is generally ushered in with a rigor, and, in its course, presents every degree of mildness and severity. It is occasionally attended with suppression of urine, and it sometimes proves fatal iu cases which seem well adapted to operation, and 3 2.77 after death no satisfactorv exninnnfmr. « i • lo,y can be offered. H CoH a ' ".V" . " """"' "' ^"*"- doe, not f„,.„l,l, „et,e,. peritt ";„"":' '"■°""°"""' treatment, besides nltJthT^Z ™""V'""" ""'«'■ ™='l""l» "f operation, the pati;; (;":'::: '■'.'>"*"™"- of the vals for tl„. remainder of hif ife ! , ' ?"""""" "' '"'"■ partial good at „,e best i' fbol fo^^r ^ """ °"'^ " «n theoretieal ..rounds Mr H , " ""' or'Oration. m..cb to ree„„;, J '^ • ""'■'•'7, An,k, the operation ba, ->.jee., it seelr; ::" ™r::'; f;;-'''-i%' «.e wbole forraanee of !„ter„al ur. »,rotZv T ""'""''■'"' "'" 1'"" "- ..^ar, apparatn::.br.r tx: :Tr "'; Muonti, manifes e :r,ll"'f '^ ""-• "-h »»•>-- formed bvZ t u "'"'' "^ •"^^^•°^' «rethroromy per »ic...rition. Htire2l:z.*";™7,t:.b::it"i"°-" 2-ion to tbe poisonon. effeets of nor:":!,' '^ ^ ™ into the blood, even m small quantities. '^ Mr. Harrison, in certain cases which would unt vi w ^-i . from outside, of course be nd . stric „1 T ™ 'r"'"^" brauous portion. Thus .be urine V td Co J t '^C and the w„,„,d made in the strieture by the uretll, ' nove. been a ^ o^W r::e^^;,r:t^h:r:;LtI 4 X at rest, the process of repair has been facilitated, and tho urethrt has healed up, or, to use his own words, "a eicatricial splice has hoen formed and completed without contact with urine or other possible s' irce of irritation." The perineal operation is performed as follows : Patient being placed in the lithotomy position, and a grooved staff introdu(!e«l, the membranous urethra is punctured with a long,8trai;.^ht fitig«r knife one inch in front of the anus, the back of the knife being toward.^ tho rectum, the incision is slightly enlarged forwardn ho as to permit tho introduction of tho index finger. If the staff be found exposed at tho bottom of the wound, all \h well and good ; but if not, along the finger, reintroduced to the bottom of the wound, is passed a blunt, though pointed knife, with which the few remaining fibres that remain between the tip of the finger and the groove are cut away. When the groove of the staff is felt, Wheelhouse's small probe-pointed gorget is slid along it, the staff is withdrawn, and the drainage-tube passed along the concavity of the gorget into its position. The drainage tubes are of gum-elastic, four or five inches in length, and som'e- what thinner than an ordinary index finger. The tube should be just within the bladder and no more. They are secured by an eye on each side, through which a tape can be passed. Mr. Harrison believos that he, by this double operation, not only avoids urinary fever, but that the cicatricial slice formed in the urethral stricture has not so much tendency to contract as the scar tissue would when the surface is being continually irritated and exposed to septic influences. To facilitate this he washes out the urethra with an antiseptic solution, and occa- sionally introduces a small drainage-tube into the meatus and out of perineal wound, and keeps this aseptic by washing out with some antiseptic injection. He says this operation is not ai)pli- cable to penile strictures or those behind the scrotum, and ifl suituble only to those cases of bulbous stricture which do not yield to dilatation. The proper method of treating organic strictures of the urethra has been for years a much-vexed question. Each writer recom- mends a certain form of treatment as th« only sure way of I, and tho cicatricial with iiririo ticiit hv\u^ ntroducod, i;.^lit finder :iiif« hoirig )rwanlH ho f tlu) Htafl' 4 well and ;he bottom nifo, with the tif) of ^r<)ov(} of got in slid be paHHod » draiiiu;i;o and Homc- be Hliould 3curod by sod, ■ation, not ;o formed ) contract ontinualiy itato this and occa- is and out ; out with not appli- m, and ifl ih do not e urethra er rocom- i way of 2A9 nto nal urethrotomy not only in cas.s of old ntaudin. re apsin- Btr ctures, but u, eoer^ case of stricture, even tho.e wh : on y detected by .eans oi . No. 25-.0 sound. S le 1: ev nyet „.bad cases invariably perform e.vternal urethro'; nv' and extol the wonderful benefits of this operation; "w Hi' rec mn.end d.vulsion, and some the combined ..e a i n 1 urethrotomy and p '^•'afo'! f- i^i • ^ ~t ^ "^ 'rh. ,- r~ -r""'::'^ ""^ted tu mc size of a ^r. o bougie : if Che stricture be tight, then a small bougie is introduced and tLd IBM! in for two to four days, and when it is witiidrawn, the stricture' is dilated sufficiently for the passage of the urethrotome. Im- mediately after division a large sound is passed, and if there is any difficulty, the urethra is again incised. A gum-elastic catheter is now tied in for at least 24 hours. In cases where the stricture returns after urethrotomy, Sir Henry Thompson repeats the operation. This he finds necessary in the majority of cases. In a very few only is the relief permanent. Last year, at the meeting' of the British Medical Association (Brit. Med. Journal, 1884), Mr. Walter Coulson read a paper on Internal Urethrotomy. After describing the various methods practised by different surgeons, he stated his preference for the operation, cutting the roof of the urethra from before back- wards, and the instrument recommended is Teevan's modi6cation of Maissoneuve's. After the cutting is over, a full-sized silver catheter is introducted, the bladder emptied, and the instrument immediately withdrawn. Then the patient must remain in bed, with hot bottles to the feet, and take three grains of quinine in half an ounce of brandy. If no rigors occur, the patient has a hot bath at night, and 48 hours after a large-sized bougie is introduced and the patient allowed to get up ; afterwards a bougie is passed every three or four days for a fortnight, when the patient is instructed to pass one fo himself once every week. As to the results— out of 206 operations performed at St. Peter's Hospital, 10 terminated fatally. In many cases no anaesthetic is used, and the cure is permanent and radical in the cases that recover. In my experience, the cases that cannot be treated success- fully by gradual dilatation are few indeed, and I have rarely, except in penile strictures, which do not dilate easily, found it necessary to perform either external or internal urethrotomy. If the same treatment recommended after internal urethrotomy (that is, regular passage of bougies or sounds) be carried oi t faithfully, I think quite as few strictures will be found to recon- tract after gradual dilatation as after internal urethrotomy. Of course dilatation takes time, which cannot always be afforded, and tests the patience of both the surgeon and the sufferer, but p '■ e stricture' ome. Im- if there is ;um-ela8tic ises where Thompson e majority Lssociation id a paper IS methods ice for the Fore back- odification ized silver nstrument lin in bed, quinine in ient has a bougie is erwards a ght, when ery week. 5t. Peter's iiiaesthetic cases that d success- ve rarely, r, found it throtomy. sthrotomy arried oi t to recon- tomy. Of afforded, Ferer, but 261 it is infinitely nal.f ihnu any other method of treatment It seems to me that a mortality of 5 per cent is too \T ^ertake the o,.«eion haLy J, :^:;:: t^i;::: per cent. Ce, Umly „, «ome cases, such as old indurated multiple n.urethro4^Ul-l:;-~^^ -ecanbesu^^:-— ^;-^^^^^ Ihe fever foilowin;^ catheterization is often controlled by full doses ot quunno ( urn ^ nr in v r^ , -^ confine J„, t„ Wf,*;iav Fl* , "" ""^"""""^ ture with advanccl a«,a.c of the kidneys. That the naasa.-e of unne ove,. the „„e ,. ,„„, ,„Hace of the ....etlKaTay expa,„s the oeeu,™,«, of urethral fever I can hardly he ve- .f 30, why ,8 u that i„ «,„o eases of strieture a cathefer canno la"::'!:*;"".*" """T'" "'"=" ^"^ '--• '^^- a large dose of ,ju„m,„ or 1 grains of Dover's powder be given n the same ease, th»«„ untoward symptoms do not appeal I have seen several ..d. e^,. The fact that opinion Is divided as U, tymg m a cathMer after the operation shows that the cause of „re hral fbv«r i, not yet understoo,!. Mr. Uarrton' doubk opera , on ,,, douht offers eertain advantages, but iTel U w,l never be ,„ore popular than preliminary trachotomies in perattons on the mou.h. It will be hard to persuade sZoZ that a double operation doe, not increase the risk In Amenea e,peei.||y ha, the treatment of internal urethro- omy been earned to .,u.m ; „„t only is it performe.1 for evTy ca^e of real and ,uppo«,d ,triet„re, but even for gleet S r, . . i '" *<™'"''' *''"»«™ '"> »<" popular is (first-, hat .t „ ted,oua, and that the immediate result, L not ,o b ,- hartaa urethrotomy.and f^condly , that the fashion has changed 1 atn sure, .f a ,urg«„„ h„d to treat himself for an ordinary ;( "v". X stricture, he would much i^refer gradual dilatation to the cuttiriL' operation. Dr. Robson {Brit. Med. Journal, March 7th, 1885) reports a case of traumatic stricture treated successfully by excision. He recommends this operation in all forms of relapsing strictures and those which do not readily yield to treatment, especially if situated anterior to a point half an inch in front of the mem- branous urethra. After the exci.ion, a catheter is tied in, and the cut surfaces of the urethra sewed over it. Six months after the operation, a No. 13 sound passed easily, Mr. Swinford Edwards, F.R.C.S., in the Brit. Med. Jour. of July 11th, 1885, publishes a lecture on " Bougies, their Use and Abuse," in which, after describing the various kinds of bougies and the method of using them, says he is no friend to the treatment of stricture by continuous dilatation, for he believes it to be more fraught with danger to the patient than internal urethrotomy. He, however, gives no reasons for tliis statement. He also says that he does not hold with the practice of tying in a catheter after the operation of internal urethrotomy, as he is of opinion that the irritating presence of an instrum'ent in the urethra will almost certainly set up inflammation of the urethra and bladder, and that we may congratulate ourselves if our patient escape urethral fever leading to suppression of urine and death. Perineal abscess, extravasation of urine, and orchitis, are other local complications. Any, or all of these, may succeed the passage of a bougie, " but," says the author, " they are certainly more likely to occur in treatment of stricture by con- tinuous dilatation." I confess that I am somewhat surprised at these opinions of Mr. Edwards, which are at variance with the experience of most surgeons. Sweeping statements such as these, unsupported by facts, do harm, and only tend to show the marked bias of the author in the direction of his own private method of treatment by urethrotomy. Operative Treatment of Enlarged Prostate.— Frof. E. Bot- tini, by an operation entirely original, has succeeded in perma- -V re.ievmg ischuria uae to prostatic enlargement. The 263 he result. g„e8 prom„e of a noteworthy addition to the 8umcal treatment of prostatie disease, »hieh heretofore has been ot ..dered as almost entirely tentative. The patient „:"' Z tur t,on. This mereasmK, and the patient losing stren.-th Dr Bottm, proposed cauterisation. Previous to the „pera[l n «,e bladder was treated with solutions of boracic acid and "Uo ot'tni: :"";"'• *^ "r"'™' ™^^ ^streng.,::!!: con rac il.ty of the bladder by cold injections. After a few weeks the c„„d,ti„„s becoming .ore favorable, the ien, Z cu roforn,ed and the galvano-cautery introduced into L ure.Z w,th the cauten.i:,g blade against the enlarged prostate Te .nst™u,e„t was so constructed that all parts'save'that ^ which heat ng was necessary, were kept cool by a current of ice water Cauter,zat,on of the prostate was continued 45 seconds, which tabe,„g deemed sufficient from the inclination of the ins tu ment, the current was broken. On the withdrawal of the instru- ment all parts were found to be cold. The patient wa p to bod and a catheter left in the urethra. pJur days after the operatton the patient was without fever ; the bladder «swahed inc" "ot'th: ' I 7 """■ '"'"'■"" " ™'Pl--earboto :^> zmc. On the seventh day, small portions of eseharotic tissue began to escape w.th the urine. The (i.st spontaneous discha ! f me occurred about three weeks after the operation, and ta heoperat,on,mprovementst,il continued, and the general health of thepafent was excellent.-( "'npk'e cure enaucl after wearing a weii luted elastic bag for al examination of the patient 15 months hate still Feb. 1885.) , - ..•».^_» i^nv^ »» t;\ I Ilia entirely free from the former (lisoase.~(/:«,u^. Med. I'out six weeks. An showed that he was Heaord Treatment of Gonorrhea by a New Dray.-'i^lo new dru-^ here referred to (Lancet Feb '^Hth 1««••^ • t "f'\^'"i; folinH -. ,1 . >^,.'"''''' ^^^'' -^fh, 188,,) IS Jacaranda lanci- us d b7 h " • '" f """ '" ^^'•^'"'^''^' «-^h America, and Wight s hands has proved most efficacious in diminishing pain and soppmg discharge in acute cases ; while it has been suc- cess ul m several cases of gleet which had resisted previous treatment A liquid extract is made from the leaf, and may be given in doses of 20 to 30 minims three or four times daily - {London Med. Record, June, '85.) Hebra^s Treatment of Soft Chancre by Salicylic Acid.-Ahor washing the penis with lukewarm water and soap, and drying it well, the powdered acid is applied to the sore and its edges, and maintained in place by pledgets of cotton wool. The application IS renewed alter 24 hours, and on the third day simple intmen •s substituted for the acid. Twelve hours late'r thireslr dt appears, and after about three days the sore is healed. -(X.nrf. Med, Record, June, 1885.) ^ ^ff " h . ft «.-..a,.v-™» ™„M .„ .. o.«j. ^M,.:,,,.w, . .„„„„„, ,,,„,,,. QUARTERLY RETROSPECT OF SIRGERY. liv PBANCrs J. SHKPHKIin. M.l)., CM, M El (; s ,iv,. Surgeon t„ t|„. JI,.iitf,.al c^,.|,„„,| ll,„,,i„,, • ].„,,„. , , , ' u..,„™r „„ o„„..,ivc »m,,.;';;';',,a!;,'t;;:;.r;v."""""'' """ Surgery. f,k,, i„(««„™..-Au|,„ ,, j |,,^, ._, my re,-,.„ Batrospects, devoted co.^idc-able s|,„oe to tl,e sur- Vianfly „f „„„. ,„f„™„t,„„ „,-„,, ,, ^^^^ ^,,^,„,( it,„,r n th,8 co„,pa,at,vely „e>v department of surgery, to a..am trea of ,t at some length. We are »,ill i„ ,|,;,|aA „„ „! '" pomt, and much work i, yet neoessary before the surgeon ea^ determme the bast mode of treatment in the many a^ ei dents diseases and mjuries to which the intestines are subject cI'T'fTi '" ^■""^ '■>' P^-f"'"""' Prritmd,h.-Vro! M Obers of lalle, m a paper on a case „f perforative peritonit s treated ly laparotomy (ft„,™(H„«/fi, Chiraru., No -^0 'ffi states. „„h regard to the operative treatmerit ^f acute '.se.rtc por,.on,t,s thata favorable result from incision, antiseptic, t the mfecl,ve focus has been localized through adhesive inflam- matron and a more or less circumscribed abscess has been formed or, when w.th diffuse peritonitis operative treatment has been' apphed early, and before the formation of extensive adhesions between the vanous coils of intestines. In most cases however of acute septrc peritonitis, it is difficult to make out whether the inflammafon he diffused or circumscribed. In the ler c 1 there would be a risk, in the performance of laparotomy of IMAGE EVALUATION TEST TARGET (MT-3) // 1.0 I.I 1-25 ii.4 2.0 1.6 a""^ ^;^ ruulOgrapmu ^Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 1 iV "^ % s o^ .<^'A<' c Ua breaking down the adhesions hy which the infective macerial is confined. _ In acute peritonitis due to intestinal perforation, the dmgnos-s 18 not, as a rule, attended with any special difficulty. Acute peritonitis sets in with unmistakeable symptoms, and ex- perience teaches that with expectant treatment death almost invariably ensues as a ivsult of diffused inflammation of serous membrane. It is thought that by performin-^ aa early laparotom.y m cases of this kind, and by washing out the peritoneal cavity and closing the wound in the intestine, many a life might be saved that otherwise would be doomed. Prof. Oberst has re corded a case, in which he operated, which commenced by strangulation of an old scrotal iiernia. The patient was admitted into hospital on the fourth day, mucli collapsed and presentino. symptoms of intense peritonitis. Herniotomy was at once per! formed, when it was found that the sac contained no intestine but was distended with turbid and fa^tid fluid. The abdomen was then opened, and a considerable quantity of faetid fluid escaped ; the intestines were found much distended and covered by a deposit of recent lymph which glued the coils to-^ether After a lo.ig search a sm.ll orifice, from which exudelf^cal fluid, was found m a loop of intestine de.ply secluded in the abdominal cavity. The intestine was completely divided at the seat of lesion, and the two ends fixed by sutures to the marcrin of the external wound co form an artificial anus. The cavTtv was washed out with a warm solution of salicylic acid, and the inflammatory lymph was scraped off from the intestines Several drainage-tubes were introduced, and the wound closed by sutures ■ The patient recoverod rapidly from the collapse, and did well for two weeks ; afterwards he became weak, and died on the ninth week the fatal result being hastened by a hypostatic pneu- monia.— (Zowrf. Med. Record, Aug. 15, 1885.) Milculicz's successful case of laparotomy for perforation has ah-eady been noticed in the Retrospect for June. The Operative Treatment of Intesthtal Obstruction -At the recent meeting of the British Medical Association, a discussion was held on the above subject. iBrit. Med. Jour., Ang U '85) Mr. F. Treves opened the discussion by a paper, in which he nacerial is •ation, the difficulty. 3, and ex- th almost of serous I)ai'otoray !al cavity might be : has re- !nced by admitted 'esentinji- )nce per- ntestine, abdomen tid fluid covered ogether. 2d faecal i in the d at the margin 5 cavity and the Several sutures • lid well on the ic pneu- ;ion has -At the cussion t,'85.) lich he %72> said that the operative treatment of intestimi oh=fr„nf be classed under three heads • 1 The t ! ^"^f "^^'^n ra.ght +:« f. m. "^^iiLcms. 1, ine treatment of acute oh<»<^rn/. t.o„^ 2 The treatment of dnonic „S,truc.i„„. 3, The . *!„; <-f chrciie cases that have hecomc acute He l,„ , hi» rape,. ,„ a consideration of the acute fe m '°T"""'. ""'"=" symptoms to t:,ree anatomical c. „ m o . 7t ahT "' ' " strangulation of the ho«el ■ ■-> T , ' . ', l">raia-iike .. ,,,° ™<>t""iho»el, -.Jo volvulus of the sij-moid flexure- i, lo acute invasniation. nexuie , Under Hernla-Uh. .ImnguUtim of th, howcL Mr Trev-s P aces slrangulat,„n by peritoneal bands of ad kinds st,™™ anertiiulum > ■ hy an adherent appendix or Fallopian tube ■ and a,ty, strangu at,on through slits and apertures. vJeX'e last head ,3 classed n.tcrnal hernia.. The treatment he pr so bv ,neV '" «"'"• ""'' "'"■»' »•'«>« !>■= relieved L et :i'? Tb"",""° "r '^■"- '"'^ ■"'^^'''- "-M be k ; per ect,j at rest by hypodermic injections of morphia and hot apphca.,ons may he used over the abdomen. The eolo'n should op urn thuat may De reheved by copious enemata of hot water w.lh ut mcreasmg the intestinal disturbance. The next stn should be an attempt at r.lief of the obstruction by apalmT f!ur ho""" ™" ■''"' '"P^'-o'^Vbe performed Jithin t e„T four hours wnen possible, provided, of course, the dia-no is is clear, for the course of the malady is rapid, its average d r t In 2^\:i ": ':™"'f '"" '^ '^'"- ™« '-.eon.: e : :: should bodnected to the speedy relief of the !l,in,. intestine s^we.says he has been unable to find any recorded case or museum specmen that affords an instance of it. He sTys hlr tomy, ,„ ,tself, is not a serious undertaking, and the h h Ir- a period. Ihe same rule, he says, should be ea.ried out in these cases as ,s strangulated hernia where taxis has failed. He I demns massage and the use of the aspirator as entirely empirical proceedmgs. With regard to the operation, he ad^ca an MS f 1 , ^ > \ iLi? incision in the median line, below the umbilicus, large enough to admit the entire hand at once. The operation shouM be done under the spraj, with strict Listeiian precautions. The intes- tines should be prevented from protruding by flat warm sponges. Ihe caecum should be first examined, and if it be found flaccid and empty, it may be assumed the obstruction is in the small intestmes. The right iliac region should then be examined, and If the affected loop be not readily found, the collapsed coils below the obstruction should be searched for. These are .generally found hanging in the pelvis ; by passing them through the lingers the constriction can be reached without loss of time The author stron.-ly objects to the practice of allowing intestinal loops to protrude and then examining them in detail. He ad- vises the placing a large warm carbolized sponge deep in the pelvic cavity, it saves much manipulation of the pelvic viscera and intestines by sponging. Should the bowels protrude, he thinks puncture should not be resorted to. When the obstruction has been found, small bands may be torn across and large ones divided between catgut ligatures. An appendix or diverticulum may be excised, and the bowel closed by Lembert's suture, so as to bring the serous surfaces in contact. If the bowel be o^' good color, it should be returned ; but if gangrenous, should excised, and an artificial anus established. He condemns tht; immediate suture of the divided bowel for several reasons : it prolongs the operation, and it does not relieve the obstruction and distension completely. Again, it is difficult to define the limits of the gangrenous action, and, lastly, there i^ great me- chanical difficulty in uniting a large distended b^.vel above with a shrunken, collapsed segment below. The abdominal wound should be closed in the usual way, and unless there is peritonitis no drainage-tubes are required. If there be peritonitis, the abdominal cavity should be washed out with a weak carbolized solution of a temperature of 98°F., and the sac should be drained He condemns the after use of a supporting bandage as unneces- sary, and likely to perpetuate the very condition it seeks to avoid. In acute volvulus of the sigmoid flexure, the treatment should be rest anu starvation ; opium should be given and the rectum ^75 emptied by enemata. These cases are not so hopeful as the foregoing. Laparotomy should be performed in the middle line the gut punctured by a capillary trocar, and reduction attempted ;' f th.s fa.1, then the gut should be evacuated in the summit of the flexure and an artificial anus established In acute intussusception, if no benefit follows the treatment by opmm, bellaaonna, starvation and rest in twelve hours it will be expedient to attempt reduction by means of insuffla'tion or torcble eneumta ; .f this fails, laparotomy should be resorted to and the mvagmation reduced if possible, if not, the bowel should be resected and an artificial anus established. Mr J. Greig Smith, F.R.C.S. (Bristol), also read a paper on ne OperaUoe TreaUnent of Acute Intestinal Obstruction, ^vluch IS pub ished m the same number of the British Medical Journal. He agreed with the general principles which ou^ht to guide us in the operative treatment of intestinal obstructFon as laid down by Mr. Treves, but differed from him in two points of operative procedure. (1), As to the method of finding the cause of the obstruction he considers that the best guide to the seat of obstruction is not manual exploration, but visual exami- nation, assisted, if necessary, by extrusion of the bowel (2) As to the treatment of the ;,owel after the obstructing cause has been removed. He is strongly of opinion that no case of opera- tion for intestinal obstruction is properly concluded until the over-distended bowels are relieved of their contents. He would in searching for the obstruction, in the first instance, ignore the' c^cum, substitute the finger for the hand, and supplement both t>y sight. He woiihl permit the bowel to extrude, and if this were any help to fi.iding the obstruction, would encourage it to do so ; he would do all this before he inserted his hand to grope for the cause. Mr. Smith considers the condemnation of extru- sion of the gut in these cases as a remnant of the pre-abdominal era of surgery, when exposure of the peritoneum and extrusion of the gut was considered to be almost certain death. If when extruded, the bowel be protected by warm carbolized sponges It will come to no harm. Ho considers the search for the pclnts of obstruction in an abdomen filled with distended intestines one X of the most difficult undc'rlakings i„ surgery. On opening the al» .»n«u, ,l,e prc,e„,i„, bowel »l,„uld be keeulv ubJrved and a, c,„„,t dilated „„r.i„,, „f U,e b„„l rises'to tl,o su'rf'e 1 » " »"'«;o ..Lanee „1 ,t, being near tbe abdo.ninal openi,,., move tl,e bowels u,, and ,l„wu, .„ tbe rigbt and to the left, and fix upon tbe „„«t d,la.e,l and eonges.ed portion. VsJ. 1,1 portion a, a gu.de, and running ,l,„ forelinger along one srde dom e, , let ,t eseape as ,ts eseape will help us to find the cause of obst u „o„ W.tl, regard to the seeond objection, Mr. Greig Snnth 1,„ Is that tbe presence of an excess of intestinal contemf s m .tself a cause of obstruction, and tnere drainage of the in- testtnal contents should be fre,,„ently successful i^ saving life, although the obstruction may not have been overcome I in''!";;iu, 'T !' "'^"7""''"='' ^y "'»«!<"' and in^mediate sutur- ng, all the better ; ,f „„t, Mr. Smith thinks it our duty to estab- hsh for a short time an artillr-i,! anus. ing on Me J^reatmenl of Utmlinal Ohstnami (Brit Med ^bs"t;'ett:'- '\T^- ■ "" ^"'" '"»' '" -«-« '-"'-tM a tiC n' ''■"S"°;'V» ""'■" ""P-"*- H" .iividescaacs as follows : („) Cases of obstruction as a rule chronic, the ob- st,uct,on be.ng the prominent symptom, acute troubles only commg on at a later period ; (S) Acute cases, which may be roughly d,v, ed n,to three classes : (1) those of i^ernal strli^gn! lation, as mtussuscept.on, volvulus, bands, etc. ; (2) enteritis a tended w,th acute per,ton,t,s. Mr. Uobson went on to say that Ae post-mortem records of our large hospitals show us that in ot fsTr r'f"' '"""'■"'"'' '"■«'" '■"- '-k»„ia.io„,i,:„ei. lIZe^-JTr' '"' T"" °' rpllpf* \¥r. , ''""'''^^'*^" » ('•*) as a means of i: v na .e he , f no cause can be f„u„,l, by opening .be bowel abote Z pom of strucfon a„,l earCull, »„tuH„;i. to .he aurface Ihese . hree papers a.e well ivor.l, reading i„ the „ri„i„al r have merely g,ven as .nil „ synopsis as I bad spac o^ Wi.h ^■■,'ard ,0 .he operation, surgeons arc now eonvin d that U oug t to be performed early, if only for purposes dia™ i A a rule, these cases are banded over .„ be sar.-eon by e attending pbys.can a. .„o la.e a period, simply CaJ he cl.ag„os,s was not accurately made out and the fear la"! ust less eperahon would bring discredit on the medical a tendVnt!' rU:de:s,.";3r:nr Ce trr .-r^ t ut in actual practice ,t is difficult <: Ja out IrT blTae there ,s obstruction with or without neritonitis , ,„ sev«.al post mortems whore death has -oc^rrrwi. »';".::: de , , . d r"^ """ '"" '"■«•=■" ''" " fow hours before death, and where operative interference would have been on! ava,l ; others, again, where the disease was ronic h 1* aten , and acute symptoms r„pi,lly developed. The prof si notyete ucated up to early operative interference t .eailXit't i:;r;s '^^ 't"-^--^ ^^ f- '-^''- t^ * 1 ue ciangei ot the operation per se is not great, hd and soon will bo performed as a moans of diagnosis in most cases an.l pormauen. relief i„ many, I„ obsouro ahdominaT oas l>vJ,te,l,„al Okln,cUon earned by the Vermiform Apvendir In t ,s oaso ,l,„ eon.es.ed and distended bowel was oaHif/,r„td' and tl oo„str,e.,„. band, wbieb was found to bo an abnorma append,. l,,at„rod i„ two places and divided. The r oov" ' was uninterrupted. itcovery TlvsiJ "■' " """ -'°™ ''^' "•""■"' '-y E. S. Bishop M., Mayo Robson also reports a case of £«<,,<,„(„„,, ^.r Ae.te nt.,m,.,eei,tlon in the £rU. Med. Jour, for October 8rd More than our feet of bowel was removed. The nation o7lv l.vod a few hours, dying apparently from shock, ^ 3rd 1885?'' ""' y^ ^^"""' *''■ ^ *'-^- ■^"''"""' Sevt t.«al ObHruetionfrom lnt.sm.ceptior, , in a man 2.5 yolrs oM operated on by Dr, John 0. Irish. The symptoms h'ad las d three days and were attributed to a fall, tLo abdomen as opened m the median lino, but nothing could be learnedby " pec ,„,, owmg to extreme distension of intestines, so abou! 5 e . fo ItfV":,'' '^^■■'^.f""^'^'-"" »"'. wl.™ some resistance bemg folt, the hand was mtro.luced and a piece of iuva-inated gut drawn out. The invagination was relieved and the ext" d d w r r 17' "'""'" '''""""^ ' "' -™ - ">o obstru t ' was ,el,e od the pat.cnt passed per rectum a quantity of thin f^ces and a large amount of gas. During the manipuht on of he m ostn,es. and after, there was profound shocrb the ng : Tth^ m r"""' ^ " '^"p'-- -^ ™ ^- img up on the fourteenth daj. Laparoton,!, a» an Aid to Berniotomy.-E. Hury Fonwicic, J.R.O.S (Lanee Sept. 26, 1885), reports a case of left inguina hernia which had become strangulated, and taxis failing, E 97.9 Snr.i.^ /''"^'/^^'»'^'» -I, ^o), at a ijQeetiii.r of the riinir'fll i..« of tl,e s i 1 : ','"'"■ ""'°"""^' '■» "'"-^^1' "- "I'en- .an::;.- 1 ':: ^:r:, :.::? "'^' vt- """ '- ''-«- boivel c„„lH,„. . 1 °''° '■'"''■ °f '^^-"•■"ninalio,, by preve„ut :r ;!,: oTrirrt- r"t7 ^■" '^'° clam,, devised by hiu,self ' ^'""•^Cxlle.v uses a <^^^i^'7^:zr;i - '^^ f *"•-- -■ paper by "v It 'foil '"">"•' "'^''^' '"' "^^'•«^^-^' 1 H y o'vuig the following indications for colotomv • 1. In congenital malformations of the rectum L\r. 2. In intestino-vesical fistulse hfJj'nT'"' °"""*"' "'" '•""•""• "'""'> <«>""'" be relieved tL7r """-" "''^'»''°"' ^'™'»". "»' water, „;:,;:; o „ eaneer, ,vbere the disease can neither be removed nor trueZf "■'''»^"»"«''' -'J >vl.ore death is probab J fZ derived from it. any good likely to be 0. In volvulus or intuasugception of th« ..i flexure, where reduction by aid of lan-m . ."" "»™^ impossible. ^ laparotomy has been found nip. Joint Disea^^e and it, Early Treatment.~Mr .lohuCmf^ (Lantrf.Jnuo I'tth iwar^x • ''J'- ''ofinOrott nfjf ^'i\ ^\ I r ""« "uijutscra in tJ e ater staI,„J ;^ "■"'"'""•'^ '"''""'"'" »'■ '"'^^■''"■» around be perfo.11'!",,""' 'T''""'""'"" """'" "' »--»■' -"ot ned out as easily and expeditious as possible Tho n ! . ' '- "^'^'^ '''^'' '-y ""^^^^'^—{Lwerpool Medico *«« *i/-*<.-TI,e ,o,,o,.t of the committee on spina bifida IZ^rt ',"r. «'■"-' S»-., of London „y I R w A3 re,a,.ded t,.e',.tf..nf C„f tltlf: nS^Lr,:;^ of : :: 6T;;:.f r- ^-'o «'• 'i-.h. ,;» 3,^1:: o whcl,bl_d,edu„dcro„eyearold. The committee held that ,! ;„f ri"T^" »'■ '"- ^-"■' "-e due to .oca,'!::'::; rupture of the sac, drain irii' awa subsequent septic meningitis, yet in a large f 1 — ' J Ox the ccrobro-spiual fluid, and proportion of cases death ensued from the maras.nuH and general defective nutrition 80 fre.,uenty associated with the deformity, and which couM not bo re,ned.ed hy h.eal or other treatment. The tables next dealt ^^■'^ ' ;»'*' tivutuK-nt hy injection with simple solutions of iodine, and HlM.wed a considerable amount of success. Then li-^aturo the sac wa. considered, and here, again, .ood result: were obtau.e,l. Rxc.s,ot, likcwis., had a considerable proportion of success. Iho plan of repeated tapping and pressure gave the least successful results of any. The injection of Morton's fluid showed a percentage success of between oO and 00 The hi-di mortality was thought to he due largely to the treatment bavin, been adopted in unsuitable cases on account of its simplicity and supposed safety. In spite of the favorable results of ligature and excision ot the tumor, as shown in the tables, the corrrmittee felt themselves compelled to report against these methods of treat- ment. Ihere was reason to think that the reported cases mi-^ht be misleading, owing to some cases of failure not being reported vvhile all the successes being regarded as surgical triumphs were' almost certain to have been recorded. ^Moreover, it seemed probable that a careful selection of cases had been made The committee, therefore, advocated the plan of treatment by injec- tion of Morton's fluid. '' [Dr, J. Morton's fluid is made by dissolving 10 grs. of iodine and JO grs. of iodide of potassium in one ounce of glycerine Half a drachm is injected after the withdrawal of a small quan- tity of the spinal fluid J * Treatment of CephaloceU and Spina Bifida.~Vvo^. Schatz of Rostock, in a paper in the Berlin Klin. Wochensck, No 28 1885 and quoted in Medical Times, says that of 105 cases of cephalocele, 59 were occipital and 46 frontal in position Of the former, 24 were left untreated and only a recovered • 85 were operated upon by incision, injection of iodine, or ligature with SIX recoveries. Of tne frontal encephaloceles, 6 out of 82 survived without treatment, and only 3 out of 14 after operation. Frof Lorimer is quoted as stating that no operative interference should e attempted when i' can be clearly shown that a "m! munication exiats between the sac and the vertebral canal. Prof. 285 Schatz cc.s.ders the operation only justifiable when there h no such communication, an.l when the tumor is covered with healthy 8k.n .s fu ly transparent, and not painful. In other cases, ho would endeavor to secure isolation of the tumor from the arach- noi.l cavity hy means of graduated constriction or pressure cal- culated to sut up a procss of plastic adhesion, when applicMl to the hase or pedicle (if thera !,e one) of the tumor. Ho relates particulars of three cases in ^hich he operated by emptyin./an.l removm. the sac, the base or pedicle of which was firmly secured by means of a long clamp. All the cases were severe Two recovered an.l one, a case of spina bifida, died. Compression of the sac by clamps may be found of use in those cases where there js a pedicle and the case is a simple one. Wrist Gan.;llon.- -Dr. R. Falkson (Archiv fur Klin Okir., ii cases of total extirpation of wnst ganglions. Removed with antiseptic precautions, perfect preservatum of function was secured, an.l primary union took place .„ all but two cases. These ganglia often .lip under the carpal ligament, and in Vi of Dr. Falkson's cases extended to the joint capsule, but did not communicate witl- ".e joint Volar ganglia always occur on the radial side, and .. tirpat.n.^ them •tis sometimes necessary to tie the v^^^^l-i^Qaoted inlnnah oj Surgery, Oct. 1885.) Palmar Ganglion.-Tho treatment of palmar ganglion has never been very satisfactory. It is an affection which interferes considerably with the function of the hand, and at times renders •t completely useless. The old forms of treatment by pressure counter irritation and tapping, though occasionally successful' cannot be relied on. Injections and incision of the sac have been frequently followed by failure, and occasionally by fatal septicaemia. Again, if there is free suppuration, the tendons become adherent and the hand is rendered useless. These ganglia nearly always contain '' melon-seed bodies" ; when these are {^esent injection is useless. In an interesting editorial in the Lancet for June 27th, 1885, the writer advises early opera- tion, free evacuation of the cvst. and r«innval of the '' melon seed bodies." For this purpose a free incision is necessary over s»'arp Hp„ot. Hhould be introduced and tI,o uT T' Tvln. V ; '" •''"^•"P^i"S to wash out these bodies „ ■ . ' solution of zinc ch ondo, 40 .rr'1-g.a„„lalio„ J " ■ II »o, .1 has no tendency to recur, as hydrocele ha/ Tniii,i,l,i„i,,iio„„f, ■ . ■''^ceichas. Esraarch l,ro„«ht forward atXro" "'"" "'°""*- ""^"' ""1 «H. ,ear w„, quite t^fiant"^;: I' necoMnry for »„cces8 -ire tJt ,n = '"'^''"'- ■""' conditions out «w„y „„d t fl n, -^ , . '""■•"'»"™"' 'i«^'>es should be Ootober, 1«8,-,.) '"""^''^''"■■^- '-*»•■. luoied in P™c a,ul FenerealMseases, Vol. Ilf No ' found the most satisfactory results follow i„ ringworm' when 1 pam of chrysophanic acid was used. The preparation i made hy addmg one part of chrysophanic acid to ten of liouor "ta cut or ,,haven, the scalp thoroughly cleansed, and epilation by forcep o d,seased hairs on the spts. The pigment should now be apphcd to the diseased spots with a stout brush. Nothin! more ,s done t,ll the growing hairs push their way through th^ pamt, when the application is renewed. This is done aboul once or tw,ce a wee . I„ many of the eases thus treated, even with! out ep,lat,o„, the disease was cured by one or two applicltb^s Jr^Minent of Ncevm hy Ethylate of Sodium-Uy. S Welch (Br^t. Me4. Jour., Aug. 1885) says that he finds ethylate of aod.um very eflieacious in the treatment of n»evus. Twoeoatin^.s of the ethylate are painted over the „a,v„s on two consecutirc days, eare bomg taken to protect the surrounding skin. In all :r'rr'w,"'''"f"" """'"■■^ '^^'"°'^"' >' completely sue. cessful. When the na^vus affects the subcutaneous tissues a Taif , li , r'""'" *''"^'«-'«» following is Mr. Lawson Xait s method of prepanng sponges, and but one person is entrused to do this: New sponges are first put into a large quaut,ly of water, with suflicicnt muriatic acid to make the water taste disagreeably acid They remain in this mixture until all effervescence has ceased, and all the chalky matter is removed For th,s purpose ,t may be necessary to renew the acid several hmes. The sponges are afterwards carefully and thoroughly washed to free them from every rough particle. After bein^ used at an operation, they are first wa3l>ed free of biood and hen pu ,„to a deep jar and covered with soda and water (e pound of soda to twelve sponges.) They are left in this abou wenty fonr hours and then they are washed perfectly frrfton. V ry trace of soda. This take, several hours' hard work, u in" hot water, s.,ueez,„g the sponges in and out of the water an,! ang,„g the water constantly ; allowing the™ to soak t ^ „' hours ,„ very hot water greatly assists in the cleansin. W en u, e clean, , ey are put in „ Jar of fresh water contanHn.rou 1 per cent, of carbohc aci.l, and after being in this for ai'hou ! a squeezed ,u,te dry and tied up in a white cotton 1,!™ „' w ch they are lelt hanging from the kitchen ceiling (bein.r I," dryest place ,n the house) till they are wanted.-(S,L/ 1, ofOJstet., quoted in Pacific Med. .f Sur,. Jourto7lm\ J « f '*f fw'-'"'™'^"''^'''"''''--Aecord!ng toProf X M,kul,cz (Arc/uy. Klin. OUr., 1884), for the prophylac ic po t,on of wound-antisepsis-disinfeetion of spon -e ,, be sutures operator'., hands, and the part to be operated "„ i-aptaily of ,ts action. It ,., not, however, suitable for metal mstruments, since they are attacked by it Durin , and altlr co.p^t,on of an operation, on the other'hand, we Iv to d w.h album.nous secretions, which form insoluble combinatL wtth mercury, and for this the sublimate does not answ so «" as carbohc acid. Mikulicz found that solutions of 1-ToOO r . tarded and d.mm.shed the development of miero-organls «aker solutions not perceptibly, while only a strength ^f iZo or .,00 completely prevented their appearing. Comparative ess showed that it only needed double'lhis st^ngth o7ca h I acd to g,vc as good .esults. Since the excretion of pat .enic m. ro.organ,sms usually occurs in connection with albumC ^ catena s, sublimate is probably less trustworthy for sue 1 yTn L it 117 ""*'"""'''• ■ • ■ M"e"y albut; readdy There are, therefore, good reasons for considering ca^ bohc acd a far more constant and trustworthy wound anfalc than subhmate, althoui-i. >•.» i ■- " JuiBepiic i.gh the latter is the str onger agent. If 287 . sublimate is used in preparing for an operation, and full precau- tions be taken, then even pure water may answer for wound wS "■ K, 7'u ?r''""' '°"^^^'°"«' '' i^ questionable whether subhmate should be used, since either stron. solutions or frequent „-ngation may prove toxic. As a wound-dressin. iodoform, thymol, etc., are not inferior to bichloride, and leTs dangerous. Again, sublimate, contrary to general impression IS volatile. . . . Finally, sublimate may be absorbed n fatally to)ac amount. Its local caustic action-principally seen under subhmate dressings-has repeatedly LJeLZ, erythema, urticaria, etc. Not a few cases have ended fatally Mikulicz gives SIX cases, and says the first case of amputation of the breast, ui which he used sublimate dressing of sawdust containing 1 per cent, of sublimate, had a fatal termination J {Annals of Surgery/, July 1885.) Surffical Treatment of Cysts of the Pancreas.-l)v N Senn iAmer Jour, of the Med. Sciences, July 1885) has an exhaustive and able paper on the above subject. After giving a full report of a retention cyst of the pancreas recently under his care, which was successfully treated by laparotomy, he summarises in a com- pact form the clinical history of similar cases, and draws con- elusions founded on his own and other cases as to the proper method of treatment At the end of his paper he sums'up' follows:--!, Cysts of the pancreas are true retention c/sts -, Cylindrical contraction or obliteration of the common duct or its branches and impacted calculi are the most frequent causes of cysts of the pancreas. 3, A positive diagnosis of a cyst of pancreas IS impossible ; a probable diagnosis between it and some other kind of cyst amenable to the same surgical treatment is adequate or all practical purposes. 4, The formation of a pan- creatic fistula under antiseptic precautions recommends itself as the safest and most expedient operation in the treatment of cysts of the pancreas. j"^" Treat,„ent „/i»^„,._Tl„ method of interstitial cautematioo by the aid of the thermo- or electro-cauterv suits a <.reat number of ca.e, of lupus. Old. very extensive cases, „ith destruction eafected, arc, mdced, refraclorv, in a measure, to all medication 'J'liS i^? Here we can have recourse to suppurative dermatitis in the manner indicated by Schwiramer. The lupus surfaces are painted over with a saturated solution of pjrogallic acid in ether or receive a pulverization of this ethereal solution. In either case the surface becomes covered immediately with a white and ad- herent layer of pure pyrogallic acid, which is now at once covered over with a layer of traumaticine. Afterwards, an irritation analogous to that of a strong vesicant is produced on the diseased tissues, and at the margin a little swelling without redness The resulting cicatrix is smooth, and the paintings are renewed until every deposit of lupus has disappeared from the tissues This method suits lupus vulgaris hest.-CAnnales de Dermatoloaie et de SyphUigraphie, Janvier 1885, quoted in Edinburgh Med Journal^ May 1885.)