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The Choice of the Anesthetic.-At the twenty-ninth Annual Meeting of the American Surgical Association, 1911, a symposium of the very important question, "The Present Status of General Anesthesia," was held. Dr. Bevan submitted the following conclusions as to the choice of the anesthetic:

1. The anesthesia must be placed in trained professional hands. 2. The methods of giving the anesthetic and the apparatus employed should be as simple and uncomplicated as possible.

3. The anesthetic mixture and sequences should be, like the old shotgun prescriptions of the past, avoided, and the patient's life not jeopardized by the exhibition of two or more poisonous agents at the same time which might intensify one the action of the other, or mask the ordinary danger signals.

4. For routine work, ether, by the open or drop method, is the safest and most satisfactory anesthetic, and in the usual run of cases in a hospital service the anesthetic of choice in from 75 to 80% of the cases. Ether should not be employed per rectum.

5. Chloroform must be discarded as a routine anesthetic. It produces too many immediate and late deaths to warrant its general employment. It is only in the exceptional case, as possibly in a laryngectomy where one might feel that the direct introduction of chloroform vapor into the trachea might produce sufficiently less irritation to the tracheal mucosa with less risk of pneumonia, than ether, that we would be warranted in employing it.

6. Nitrous oxide is the anesthetic of choice in short operations, manipulations, and examinations. It is also the anesthetic of choice in patients with seriously impaired kidneys, and often in cases in extremely bad condition, as typhoid perforations, general peritonitis, etc. It should not be employed in patients with bad hearts. It is not as satisfactory an anesthetic as ether, and it should not be employed in preference to ether in patients who are good surgical risks.

7. Local anesthesia with cocaine and similar substances has a limited field of usefulness. The amount of cocaine employed by infiltration should always be short of the toxic dose, 1/10 to 1/4 of a grain. It should be employed in normal salt solution with small amounts of adrenalin. Where the amount does not exceed 1/10 of a grain it may safely be preceded by a small dose of morphin and scopolamin.

8. Spinal cord anesthesia has to-day no place in surgery.

9. The use of morphin and scopolamin before a general anesthetic brings with it dangers which are not compensated by any advantages, and the method should be abandoned or limited to specially selected cases.

10. Finally, the time has come to make a place for the trained professional anesthetist on our surgical team.

These conclusions are in the main very rational. The reviewer, however, desires to take exception to the statement that anesthetic sequences should be abandoned. Sequences are often very useful, practical, and increase the safety and comfort of the anesthetic rather than decrease them. This applies especially to the nitrous oxide-ether sequence.-Medical Review of Reviews.

Cream of Tartar in the Treatment of Carbuncle.-The New York Medical Journal of May, 28, 1910, states that potassium bitartrate has heretofore been used but little if at all as a topical application. Of late, however, some of the Italian physicians have looked upon it as a valuable antiseptic and absorbent. A writer in the Semaine Médicale of May 11th, after remarking that in 1893 that journal mentioned its use by Oteri in chancres, chancroids, and the sores resulting from the bursting or incision of buboes, informs us that Dr. P. Lubò, of Naples, has recommended it as a dressing for carbuncles, and that another Italian physician, Dr. A. Miranda, has found it efficient in the treatment of that disease. Miranda, says the writer, recently had occasion to employ cream of tartar in a very grave case of carbuncle in a diabetic subject, fifty years old. On the back of the neck immediately below the hairy scalp there was a large carbuncle, surrounded by a hyperemic and infiltrated zone, which rendered the least movement of the head impossible. There was intense headache, there were night sweats, the tongue was dry, the pulse was small and hard, and the temperature was above 120° F. After careful disinfection of the affected region a crucial incision was made, each cut being about three inches long and extending down to the cervical aponeurosis. The flaps thus formed were lifted from the underlying parts and the cavity was plugged with boiled gauze impregnated with cream of tartar. Under the influence of this dressing the temperature fell almost to the normal point, the tongue became moist, and the patient's general condition was considerably ameliorated. When the dressing was removed, it was found that the lymphangitis had

almost entirely disappeared and that the inflammatory edema surrounding the swelling was notably diminished. On the gauze there were noticed numerous bits of necrotic tissue. The cavity was thoroughly irrigated with sterilized water and dressed again as before. This was continued until the fourth day, when a solution of corrosive sublimate or of iodine was substituted for the sterilized water. At the end of twelve days the wound was covered with vigorous granulations. On the strength of this case, Dr. Miranda thinks that the cream of tartar dressing is far preferable to the use of the actual cautery and to the application of such chemical caustics. as zinc chloride, iron perchloride, etc., which are very painful and give rise to such great losses of substance as often to call for plastic operations, and lead to scars which are not only unsightly but also crippling. Care must be taken, he says, that the bitartrate is brought into intimate contact with the inflamed parts, and he thinks that the powder is preferable to a solution.-The Therapeutic Gazette.

A Simple and Effective Treatment for Boils.-Dr. George Thomas Jackson, Professor of Dermatology in the College of Physicians and Surgeons (Columbia), New York, outlines a method for treating boils which he states-and we agree with him—is simple, safe, and effective (American Journal of Medical Sciences, June, 1909). All that is necessary is a little stick sharpened to a fine point, a little absorbent cotton, liquefied carbolic acid (i. e., 95 per cent), and a 5 or 10 per cent ointment of salicylic acid. As soon as the boil has pointed (and it usually has when the patient comes to us), a small bit of cotton is wound about the pointed stick, dipped in the carbolic acid, and bored into the softened point of the boil. This allows the pus to escape and thoroughly disinfects the cavity of the boil. The boil is not to be squeezed. The surface of the skin in the neighborhood of the boil is then washed with H2O, or a solution of corrosive sublimate, 1 in 1,000, and the salicylic acid ointment spread on washed rags or several thicknesses of gauze, laid over the boil and the adjacent skin. And that is, as a rule, the end of the boil. If it is a very large boil, the operation may have to be repeated the next day. The ointment is to be kept constantly on the affected part for a week. Dr. Jackson denies that boils or furunculosis have a constitutional basis.-Critic and Guide.

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Thread Worms.-In the American Journal of Medical Sciences for May, Oscar M. Schloss summarizes the treatment for thread worms, there being several observations not generally recognized which have a direct bearing on the treatment for this parasite. An experiment of Grazzi shows that the worms may arrive at maturity in the intestines during the last four or five weeks following a single infection. Since it is probable that fresh parasites constantly develop through auto-infection, the treatment should be continued for six weeks. The normal habitat of this worm is the cecum or appendix, and not the rectum and colon, as often stated. When the females become impregnated they migrate to the lower portions of the large intestine to discharge their ova. Thus the treatment should be given with two aims; first, to remove the worms which have migrated to the large intestine, and next, to expel those in the cecum or appendix. For the former the usual irrigations of salt water, quassia, garlic, etc., are effective, but as fluid injected per rectum may not always reach the cecum, internal treatment is of importance. Santonin is probably the most useful drug in this condition and is best given in doses of one to three grains, with the same amount of calomel for three successive evenings. On the first and third mornings of treatment a cathartic should be given. This treatment may be repeated two or three times during the first three weeks. During the first two or three weeks the irrigations should be given each evening, and from 6 to 20 ounces (depending on the age of the patient) can be given in each injection. Later the injections may be given every alternate evening, and finally twice a week. Every effort should be made to prevent auto-infection, as this is a potent factor in keeping up the disease. At night a mild mercurial ointment, 10 to 20%, may be applied around the rectum. The child should be prevented from scratching and putting his fingers into his mouth. The usual treatment is often unsatisfactory; the mothers usually give the irrigations only during the period of active symptoms, or while the worms are passed, and often within two or four months the patient again shows signs of severe infection. Although this parasite rarely if ever produces dangerous symptoms, yet the continual irritation which they set up may undermine the general health; this serves as a sufficient indication for thorough treatment. -The Cleveland Medical Journal.

Calomel. It is 301 years since calomel was first described (in 1608, by Beguin). No other chemical had so many and such fanciful synonyms. Beguin described it under the name Draco Mitigatus (the tamed dragon).-Critic and Guide.

CONCERNING BOOKS.

H. W. FELTER, M. D.

Retinoscopy (or Shadow Test) in the Determination of Refraction at One Meter Distance, with the Plane Mirror. By James P. Thorington, A. M., M. D. Sixth edition, revised and enlarged; 61 illustrations, ten of which are colored. Philadelphia: P. B. Blakiston's Son & Co., 1012 Walnut Street. 1911. $1 net.

This useful manual as a guide to refraction is best explained by the following extract from it: "Retinoscopy gives the following advantages: The character of the refraction is quickly diagnosed. The exact refraction is obtained without questioning the patient. Little time is required to make the test. No expensive apparatus is necessarily required. Its great value can never be overestimated in cases of nystagmus, young children, amblyopia, aphakia, illiterates, and the feeble-minded." It offers a valuable aid to the trial case. The author has wasted no words and has carefully illustrated every important step. Handbook of Physiology. By W. D. Halliburton, M. D., LL. D., F. R. C. P., F. R. S., Professor of Physiology, King's College, London. Tenth edition (being the twenty-third edition of Kirke's Physiology). Nearly 600 illustrations in the text, many of which are coloured, and three coloured plates; pp. 923. Philadelphia: P. Blakiston's Son & Co., 1012 Walnut St.; 1911. $3 net.

To select from the vast amount of physiological material now at the command of compilers is an arduous and delicate task. There is such a mine of physiologic data that much of the histology and embryology and allied sciences that once made up a large part of text-books on physiology is now incorporated into separate volumes, and belongs more properly to anatomy than to physiology. This is what has been done in the volume before us. Just enough of allied sciences is retained to make plain and intelligible the truths of functional action, while most of the space has been allotted to the latter, thus giving the fullest and most comprehensive account of the processes of life, with rare discrimination as to the material selected. Moreover, the book is readable and so simply and charmingly written as to be within ready comprehension by the average student of medicine. Halliburton's Kirke should find a ready reception by American students, which evidently is the case, for it is now in its tenth revised edition and twenty-sixth edition of Kirke. The present volume is revised to date.

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