out of fifty, as I find it used by physicians at large, it is an additional and useless torture to the eye disease from which the patient is already suffering. 2nd. Do not use nitrate of silver. As constant there can be no doubt as to their authenticity. The displaced organ floats in the inferior region of the abdomen, easily recognizable by its form and volume, and can without difficulty be replaced in the right hypochondrium. The laxity of the sus-ly prescribed by general practitioners, it is not pensory ligaments which permits of this condition is always consecutive to repeated pregnancies, but in the case we are abuot to relate there is a new element, viz., incurvation of the vertebral column due to Pott's disease. beneficial in one case out of one hundred, and 3rd. Do not prescribe sugar of lead. The subject, a woman æt. 50 years, relates that in her youth she was healthy, menstruated at 16, and became suddenly hump-backed at the age of 28 years without any symptoms of paralysis. She has had seven children—the last at the age of 41 4th.-Always use weak solutions of the mineral years. Two of her confinements presented ano-and vegetable astringents in the treatment of eye malies. During her last pregnancy she entered inflammations which attack the mucus surfaces, the hospital with an icterus which was qualified as and restrict their application to conjunctival discatarrhal, and which appears not to have coincided eases exclusively. One grain of alum, sulphate or with displacement of the liver. The labor was chloride of zinc, sulphate of copper or nitrate of tedious-shoulder presentation-child lived. Since silver, in an ounce of water, will in the majority of that time the patient has complained of dragging cases of conjunctival diseases, do much more good pains in the right side, with the characteristic sen- and give much less uneasiness than the very painsation of an intra-abdominal mass, according with ful five and ten grain solutions which are so often the movements of the body in the lateral decubi- injuriously prescribed by physicians. The discomfort occasioned by this state of affairs has been so great as to incapacitate her for work and necessitate her entrance to the hospital. The patient is of slender figure. The vertebral column deviates to the left, with posterior convexity. The deformity is confined to the inferior dorsal and lumbar region. The thorax appears well formed in front, but its inferior right border rests almost directly upon the crest of the ilium. Percussion elicits pulmonary resonance down to the sixth rib; then in place of the hepatic dulness, there is tympanism, which increases from above downward. tus. A The abdominal wall is flabby and pendant. little below the umbilicus one sees a transverse projection, constituted by the sharply defined border of a tumor, moderately consistent, easily movable from right to left. At the junction of the right two-thirds with the left third there is a deep notch. The tumor is smooth, flat on percussion, and does not follow the movements of the diaphragm. It is the liver which has become movable in the abdomen. It is found impossible to replace it in the right hypochrondium because of the dorsal and thoracic deformity. All the functions are normal. It is an acquired infirmity rather than a pathological condition, and the patient is afforded appreciable relief by means of a well-made belt.-Archives Generales de Medecine, July, 1882. 5th.-Solution of the sulphate of atropia, from one to four grains to the ounce of rose water, is an essential eye-drop in the treatment of acute iritis, to break up newly formed adhesions. One drop of the atropia solution in an inflamed eye is a most valuable means of establishing the diagnosis whether iritic complications exist or not, and should be used in most cases of eye inflammation to find out whether there are any adhesions of the pupil to the lens. 6th.—Eserine in solution of one grain to the ounce of water is the remedy for purely corneal lesions. 7th. When physicians are in doubt as to the character of an eye disease, they should seek a consultation from specialists who are more familiar with eye diseases than general practitioners can possibly be. Such timely aid often saves the patient a lifetime of trouble. If physicians would commit to memory and keep at their finger ends, and ready for use, these simple aphorisms, the amount of mental and bodily suffering which they will prevent in their eye patients is beyond calculation. While all good rules have necessary many exceptions, they may safely follow their simple guidance.—Ohio Med. Journal. IODOFORM Dressing in ViENNA.—In the general Hospital, Billroth, Albert, Dittel, Weinlechner use it, and so also do the surgeons in the other large civic and military hospitals here. In Billroth's OPHTHALMIC APHORISMS.-Dr- J. J. Chisholm, clinic I have not seen the spray used once. The of Baltimore, gives the following valuable aphorisms part to be operated upon is scrubbed with soap and in a report presented to the Maryland State Med-carbolized water, and then carefully carbolized ical Society at its last session: again. The requisite operation is then made. All 1st.-Do not blister. In forty-nine applications the instruments are laid in carbolized water, the sponges also, and before dressing, the wound is thoroughly irrigated with a three per cent. solution. It is then dressed with iodoform gauze instead of the Lister gauze, with no intervening protective. Over the gauze is usually placed a moderately thick layer of absorbent cotton, and then something corresponding to the Mackintosh over this. The whole is then closely and neatly bandaged; the bandage used being quite wide and made out of strong gauze. If advisable, the wound may be dusted with powdered iodoform. In subperiosteal amputations it is dusted in many cases under the periosteum; in osteo-plastic resections, likewise, between the ends of the bone, and after extirpation of tumors many would sprinkle it upon the inner surface of the flaps. The drainage tube is much less resorted to now than when the strict Lister dressings were used; there being less need for it. Under the influence of iodoform there is much less suppuration, and whatever discharge takes place is more of the nature of a serous exudate. Indications for change of dressing are much as they were under the regime of Lister. An absolute indication for change is an elevation of temperature after it has been for several hours or days normal. Relative indications for the same are pain, and burning and itching in the part as they may seem to call for it. with salicylic acid. Vulpian has administered this in doses of three or four grains every half-hour until the daily quantity has reached the large proportion of three drachms. In some patients, especially in young men, he has produced some cerebral disturbance-a light delirium-in others albuminuria has appeared; but this is by no means an uncommon symptom in typhoid when left to its own course, and in some cases the albuminuria disappears when as much as 200 grains of salicylic acid are taken daily. The real cerebral effect which may, then, be referred to salicylic acid, is a slight delirium. Under the salicylic-acid treatment the temperature falls in forty-eight hours, three to four degrees; and this reduction of the body-heat is more persistent than that effected by carbolic acid. At the same time there ensues a notabie amelioration of the general condition of the patient. But Vulpian does not pretend that the mortality from the disease, nor its duration, is notably diminished by the modification in its symptoms thus effected by salicylic acid. In the course of the discussion on Vulpian's observations, it appears that the central idea of the antiseptic treatment of typhoid is to act on the typhoid germs introduced into the intestinal canal from without. Vulpian gives the preference to salicylic acid becauses it possesses so little toxic activity per se. He objects to the use of the carbolate of sodium for this purpose, because, owing to its solubility, it cannot be accumulated in the Inasmuch as iodoform has an actual pain-stilling effect, which is, of course, in its favour, these latter symptoms occur comparatively rarely, and are largely the result of tight or improper ban-blood in sufficient quantity to act on the disease daging. Certainly, as an antiseptic, iodoform must rank ahead of carbolic acid. Further than this it undoubtedly promotes absorption more rapidly than any other medicinal agent. And for this reason it is very largely used by the syphilologists and dermatologists here for hastening the subsidence of buboes and of scrofulous adenoid enlargements. They inject it in ethereal solutions; and for the most part with excellent effect.-Dr. Park, Annals of Anatomy and Surgery. ANTISEPTICS IN TYPHOID.-In his service at the Hotel-Dieu, Vulpian has made some comparative observations on the utility of the various antiseptics employed in typhoid fever. Iodoform has not given any good results. This is the more remarkable, since this agent now occupies an important place as a remedy in septic processes. Salicylate of bismuth is an excellent antiseptic, but it is not readily soluble, and hence the large dose necessary to obtain any result-from two to three drachms daily-presents many inconveniences. It is found, also to increase the tendency to nasal and intestinal hemorrhage. Boracic acid, carried up to the dose of three drachms daily, by regular increment of the daily dose, has not done any good. The best results have been achieved germs. The treatment by purgation during the period of invasion-the prodromal stage-was also considered. One of the modes of the "specific treatment" of typhoid, as pursued by our German colleagues, is the mercurial plan, which consists in the administration of purgative doses (ten grains) of calomel during the first week. Several doses of this kind must act in three ways: sufficient bichloride is produced to act on the typhoid germs as a poison; the germs are removed by a purgative action; the temperature is lowered by the combined result of these actions. The range of temperature has a certain relation to the number and activity of the germs present in the blood. Hence their destruction at an early period becomes very desirable.-Med. News, Oct. 14, 1882. THE NON-IDENTITY OF CROUP AND DIPHTHERIA.-Dr. McGillvary, of Sydney, N. S., writes to the Philadelphia Medical News as follows, in regard to the above subject :-In your issue of October 21, there appeared a lecture delivered by Dr. Morell Mackenzie, of London, at Bellevue Hospital Medical College, on "Diphtheria." In that lecture the learned Dr. pronounced croup and diphtheria one and the same disease. This is an utterance ex cathedra, and deserves more than passing notice. Diphtheria has been regarded as a most contagious disease. Croup has not been so regarded. In the other In the one case it has been the rule to isolate the patient, quarantine the family, and exclude the other children, if there are any, from the public schools for a certain specified time. case there has been no isolating, no quarantining, or limitation of personal freedom. If these diseases are identical, why this exhibition of inconsistency, why this wanton trifling with human life in the neglect of proper precautionary measures? If the members of the medical profession are to be regarded as the guardians of the public health, this question of the identity or non-identity of these diseases is of much more importance than a merely "theoretical question." During an active practice of twenty years I have had quite a number of cases of membranous croup under my care. During ten of these years there has not been a case of diphtheria in the district, yet during these years an occasional case of true croup would appear, and in none of them was any attempt ever made to prevent the spread of the disease. Yet no second case ever occurred in the same family, nor were any other members of the household afflicted with sore throat of any kind near the time when the cases of croup arose. In some of the cases that proved fatal, there were quite a number of other little children in the same family. These had constant access to the bed of the suffering one, and after death for two or three days, while the body remained in the house, these little ones would hover around where it was lying, and many fond kisses were showered on the loved form, and yet I have never had a second case in the same family. On the other hand, I have had cases of diptheria when every effort was put forth to prevent the spread of the disease, and while I might now and again succeed, yet in the large majority of cases the disease would spread in the face of all that I could do. Now with facts such as these before me, and my experience does not differ from that of many others, is it any wonder that without something more than mere assertion I should still very respectfully maintain that croup and diptheria are two and distinct diseases, the one a highly contagious disease, the other not in the slightest degree contagious. In order to save the profession from well-merited reproach an account of so much diversity of opinion on this subject cannot a Medical Commission be appointed to deal with this matter and to arrive at some definite finding? ATROPINE IN MANIA.-Dr. J. R. Gasquet (Lond. Pract.) finds atropine useful in cases which had been previously beneffted by hyoscyamin. He recommends the drug on account of its comparative safety and cheapness.—Journal of Mental Science PERFORATING DUODENAL ULCER.-John P., aged thirty-four, a coachman, and a well-built, active, muscular man, apparently in robust health, consulted me in November, 1881, having been suddenly seized with agonizing pain in the right hypochondriac region, extending downward and the skin cool, and in twelve hours he was free from to the back. The pulse was slow, of good strength; pain. Morphia was injected subcutaneously. onal attacks of abdominal pain and sickness, not During the succeeding six months he had occasihowever, of such severity as to induce him to seek medical aid or to interfere with his work. While in the act of stretching himself to hang a picture, after a meal of tea and bread-and-butter, he was on the evening of April 23, 1881, about an hour and when seen was in a chair, moaning, with the again suddenly seized with the same pain as before, knees drawn up, pale, with a cool skin and a slow but not weak pulse. Bowels had acted during the day. Morphia was again injected with but little relief, and by the following evening he was in a state of profound collapse, and died in twenty-four hours after the seizure. The abdomen was examined twenty-four hours after death. Rigor mortis complete, with great. lividity of surface and rapid decomposition. On opening the abdomen, fetid gas and about two quarts of turbid brown fluid, with yellow floating. shreds, escaped, and on raising the transverse colon a round perforation, half an inch in diameter, free from adhesions. The omentum had limited to was seen in the duodenum, which was perfectly some extent the spread of the peritonitis, but there was much soft yellow lymph on the liver and the opening was seen to have a thick rounded margin, On removing the duodenum, the adjacent bowel. firm to the touch, surrounded by folds of mucus membrane radiating from it. Three years ago George S., aged thirty-six years, while jumping on the hind step of a high gig, was seized with extreme pain in the abdomen, and faintness. When seen by me he presented the phenomenon of collapse in the most intense degree, and for about six hours showed no sign of rallying. Gradually the pulse became perceptible, and warmth returned, but the abdominal pain was extreme, and for three days he lay in a dangerous state. eight days he had recovered sufficiently to be removed to his home, a distance of some miles, and when heard of six months ago was alive and well. Previously for some months he had occasional at In METHODS OF AMPUTATION.-Prof. Stokes in his Address on Surgery, at the meeting of the British Medical Association, reviewed the different methods employed by different surgeons. According to Von Langenbeck Trelat, and others, the preservation of the periosteum is attended with advantage. The formation of a periosteal curtain to cover the cut surface of the bone and its medullary canal is believed to act as a shield or barrier against septic agencies, and diminish the chance of the occurrence of some of the secondary calamities, notably osteomyelitis, following amputations. The method he has in some instances adopted, and with success, is, making a somewhat quadrilateral-shaped flap at the membrane and letting it fall over the cut surface of the bone. Another method, that of M. Trelat, is to detach the membrane all round the bone for fully an inch below the point where the bone had to be divided, making, in fact, a sleeve-shaped flap. This plan must, however, materially protract the operation. This led him to consider some other comparatively recent improvements in the operation of amputation, and to bear his testimony to the great advantages to be derived from the adoption of the principle of long anterior flaps, the chief credit for establishing which belongs to the late Mr. Teale, of Leeds. 4. The existence of a posterior flap diminishes the chances of any wide gaping of the wound; while the anterior flap, being oval, increases the chances of the stump tapering gradually towards its extremisy and assuming the form of a rounded cone. 5. The preservation of the abnormal attachments of the extensors of the leg. These advantages embody those of both flap and circular amputation of the thigh, and, at the same time, eliminate the defects.-Brit. Medical Fourn., August 12, 1882. INFLUENCE OF OCCUPATION ON SYPHILIS.—A From a review paper recently read before the National Society of Medicines, of Lyons, by Dr. Guinard, on this subject, excited considerable discussion, from syphilographers aud others, at the time. of the question discussed in it, as to the hygiene of glass-blowers and the prophylaxis of syphilis, in the Archives of Dermatology, we learn that RivedeGier, which is to-day, from the industrial point of view, the first and principal centre of the manufacture of glass in France, was twenty years ago, from the medical point of view, the first and principal centre of observation of syphilis transmitted by glass-blowing. It was upon a workman in one of its factories that M. Rollet first recognized and demonstrated, in 1850, the contageousness of secondary lesions. That abundant opportunity for direct syphilitic infection is furnished by glass-blowing, is shown by the statement that three workmen Gritti's operation undoubtedly owes its parent-pass the same tube from mouth to mouth 75 to 85 age to that of Carden; but, although the retain- times hourly. Three epidemics produced in this ing of the patella and consequent preservation of manner are described in detail. In order to guard the normal attachments of the extensors of the leg against their recurrence, bi-mensual inspections of is a plan as good as it was original with Gritti, all the workmen were instituted in some establishstill the details of this method prevented the re- ments, no one being employed without presenting alization of those advantages which in principle it a certificate of health from the physician in charge. embodied. Hence the modification which Mr. These examinations, although successful in preStokes terms "supracondyloid amputation "-an venting further symptoms, being objected to by operation which retaining the advantages of Gritti's some of the workmen, the attempt was made to inmethod, eliminates its effects by lengthening the troduce the use of movable mouth-pieces for the anterior flap, forming a posterior flap one-third the tubes one being furnished each workman. Although length of the anterior one, saturing the patella and this device seemed to answer the purpose at first, femur together, and, lastly, and most important of it was soon discovered that the men would not use all, by making a high femoral section. but one not them, and the occurrence of several new cases of involving the idedullary canal. The special ad- buccal chancres caused the bi-monthly inspections vantages that may be claimed for supracondyloid to be resumed.—The College and Clinical Record. amputation are : 1. That the posterior surface of the anterior flap being covered with a natural synovial membrane, the chances of suppuration and purulent absorp tion are diminished. 2. Any possibility of the split patella shifting from its place on the surface of the femur is prevented by the high femoral section, and by saturing the two bones together. 3. The vessels are divided at right angles to their continuity, and not obliquely, as in other flap operations. THE ABORTIVE TREATMENT OF GONORRHOŒA. Believing that gonorrhoea is due to parasites, Dr. W. Watson Cheyne (in the Lancet) contends that stroy the parasites. the proper method to abort the disease is to deemployed with the view of destroying the cause The materials which he of gonorrhoea were chiefly iodoform and eucalyptus oil, and these he still uses. As injections are effect are only momentary, he combines these subapt not to penetrate sufficiently far, and as their stances with cocoa butter, and makes them up in ions on his tongue and his wrists. An internathe form of solid rods about 4 in. or 5 in. in length, tional medical commission was appointed to perand about the thickness of a No. 10 catheter. form the post mortem examination, and this body These rods weigh forty grains each, and each con- decided that Evangeli Fornaraki's death was from tains five grains of iodoform and ten minims of drowning; that there were no wounds nor trace eucalyptus oil, introduced into the urethra, over of wounds on his body. A Greek doctor, M. the orifice of which a pad of boracic lint is applied, Counomopoulos, questioned the decision of the and outside this is a large piece of gutta percha commission, refused to accept it, and affirmed that tissue, the whole being fastened on by strapping, the child's death was not owing to submersion, and retained for four or five hours, if possible. The cocoa butter soon melts, and a solution of iodoform in eucalyptus oil bathes the mucous membrane for some hours. Another rod may then be inserted, and a suitable injection be employed afterwards. This method is only of use, in his experience, before or during the inflammatory stage, and he employs it at any time till the inflammatory symptoms have disappeared, but generally within the first seven or eight days after the commencement of the discharge.--Medical and Surgical Reporter. but to an act of violence, probably strangulation. The Israelite community was in a perilous condition, and appealed to the arbitration of M. Brouardel, the well-known professor of medical jurisprudence, who testified to the absence of the slightest trace of violence, and endorsed the opinion of the commission. He pointed out that, the body having remained fifty hours under water, and having been subsequently exposed to the air during twenty-four hours, there was considerable putrefaction, which modified the symptoms of asphyxia due to submersion, and evident shortly after death; but those that were still present sufficed to show that death resulted from drowning. WIRE LIGATURES FOR DIVIDED BONES-Dr. T. Sympson records two cases in the British Medical Fournal, wherein he obtained excellent results in approximating divided bones with wire ligatures. the first case was a crushed foot; he amputated according to Pirogoff, and fastened the os calcis to the tibia by iron wires. The operation wound was completely healed in ten days, but the wires were A NEW METHOD OF DETECTING SMALL STONES IN THE BLADDER.-Dr. S. Cuthbertson Duncan has used for about three years the following method of detecting stone when small or in fragments. He takes a nickle-plated sound, such as is used for that purpose, and holds it over the flame of an ordinary lamp or candle until the point is covered with a thin, black film. After it has become quite cool, it is dipped in a solution of collodion and allowed to dry. He then oils it with castor oil, and introduces it a short distance in the urethra | left in six weeks. The second case was a resection and withdraws it to see if it be injured. If not he proceeds to explore the floor of the bladder with a sweeping lateral movement. If there be a stone or any fragments left after lithotrity, its black covering will be removed in patches, and the bright metal show through. The author thinks this more delicate than Napier's indicator, the point of which is made of lead, blackened by chemical agents; and this very method does not impair the conducting power of the sound in any degree. A short beaked solid steel sound is preferred, with a round handle, which has a flat disk about two inches from the end, at right angles to the curve of the beak, to serve as a guide for the direction of the point. The round handle allows it to be rotated between the index finger and the thumb, the most sensitive part of the hand-two things necessary for rapid and delicate manipulation.British Med. Fournal. of the knee joint. The femur and tibia were SULPHUR IN WHOOPING COUGH.-Dr. Luton recommends in the treatment of whocping-cough, especially in the convulsive period, the adminiA VICTORY OF SCIENCE.-A child nine years of stration of sulphur. Flowers of sulphur 8 to 15 age suddenly disappeared at Alexandria during grains, sugar of milk 16 grains-in ten powders, May last. A short time afterwards his body was one every two hours; carbonate of iron should be found drowned, and the Greeks accused the Jews given to keep up the strength, ten grains in the of having killed Evangeli Fornaraki, after they day. Coffee renders good service, and an emetic had taken his blood for theiy religious rites. It should be given every two days. Belladonna, was asserted that the supposed victim had incis- which has been considered the most efficacious |