Dr. Cameron said the statement was based on the condition found in Neill's Cabinet specimens, and he knew of no corroborative evidence save that furnished by analogy, that in other flat bones callus is often found only on the external surface.

Dr. McFarlane reported a case of fracture extending across the face, caused by impaction between the floor and a descending elevator in a warehouse in this city. The alveolar processes and hard palate were moveable en masse. Favourable progress has been made in the case, the parts being simply maintained in position by a bandage passed under the chin, as is done in fracture of the lower jaw.

On motion, a committee consisting of Drs. Workman, Nevitt and McPhedran was appointed to report on the expediency of establishing, under the auspices of this society, a directory for nurses.

Nov. 16th, 1882. The President, Dr. George Wright, in the Chair. Dr. Cameron showed a part of the ileum from a woman who died from bowel obstruction, symptoms of which existed for a week prior to death. She had a small femoral hernia, which was soft, dull and reducible within the saphenous opening, but not within the abdominal cavity. It was evidently omental and had no bearing on the symptoms present. There was severe pain in the epigastric region; vomiting was persistent, becoming stercoraceous 12 hours before death. The symptoms not improving, the hernia was explored and found to be omental as anticipated. It was adherent, but there was no inflammatory trouble present. P. M.-Pyloric orifice of the stomach contracted from a deposit, possibly syphilitic. The last few inches of the ileum were much contracted, so much so that water could scarcely be forced through it. The caput coli was much distended with fluid fæces. There was another constriction at the sigmoid flexure.

Dr. Cameron also showed the larynx and trachea from a woman, between 30 and 40 years of age, who died in the General Hospital. She was syphilitic. For about ten weeks she suffered from laryngeal trouble, expectorating pus and blood. Dyspnoea was severe at times, but in the intervals the breathing was easy. Anti-syphilitic and seda

of the attacks of dyspnoea she died suddenly from suffocation. Tracheotomy had been decided on the day before death, but was postponed in order that the students might be present to witness the operation.

P. M.-A carious cavity full of pus was found in the posterior part of the larynx, the cricoid cartilage being the seat of the disease. There were also a few ulcerated patches in the trachea.

Dr. Nevitt showed a ruptured stomach from a man injured by a piece of wood thrown back from a saw against which he was holding it. The accident occurred shortly after dinner. He was able to walk from the conveyance in which he was taken home to the house. The pain was severe ; no vomiting; could take a full inspiration. There was retention of urine. During the night the pain became diffuse and evidence of general peritonitis developed. At 8 o'clock next morning he asked for a drink of water, sat up to drink, and then fell back dead.

P. M.-Much gas in the peritoneal cavity, slight exudation on peritoneum. A rent one inch long in anterior wall of stomach near the pyloric end; this was under the seat of injury. The posterior wall was absorbed. Some extravasation behind peritoneum.

Dr. Geo. Wright showed part of the spine from a man who was injured on the railway. There was a good deal of shock. The lower extremities were partially paralyzed; the paralysis became complete a few hours after the injury. The bladder was also paralyzed, and consequently there was retention of urine. Death took place suddenly next morning.

P. M.-There was great infiltration of the soft tissues about the seat of injury and of the psoæ muscles. The spinous processes of the 10th, 11th and 12th dorsal vertebra were fractured, as well as the laminæ, and the spinal cord was lacerated.

The report of the committee appointed at last meeting was read and adopted, recommending the establishment of a directory for nurses, and sug gesting a plan for giving effect to the report.

January 11th, 1883. Dr. W. J. Wilson, 2nd Vice-President in the chair.

After routine business Dr. Graham showed part of the ileum from a patient who died of enteric

a few minutes after the injection. The immediate effect of the treatment was to cause much swelling of the knee, but this began to abate in a few days, and the joint returned to its normal size. The ultimate results remain yet to be seen.

Dr. Graham said he had a similar case about a

year ago with Dr. Armstrong, of this city. One drachm of tincture of iodine was injected. Both knees were treated and are now well." Other joints became affected subsequently. The iodine taste was present in this case also.

Dr. McPhedran reported a case of trouble in Scarpa's triangle, characterized by excessive pain and tenderness, slight swelling, but no other evidence of inflammation. The limb was extended, and flexion gave great pain. There was no history of injury nor evidence of any rupture of any of the soft tissues. If the bursa beneath the psoas were the seat of trouble there would have been flexion of the limb. Complete recovery resulted in about three weeks.

Dr. Rosebrugh then exhibited his modificatiou of the McIntosh battery, galvanic and faradic combined, and gave a detailed description of it, which

will be found in another column.

January 25, 1883.

The President, Dr. George Wright, in the chair. Dr. Mackenzie, Riverside, was elected a member. Dr. Graham exhibited a placenta containing two cysts filled with dark brownish fluid. The case was premature.

Dr. Cameron showed for Dr. Harrison of Cambray, an acephalous monster. There was no neck, and the spine was bifid throughout the dorsal and cervical regions. Birth was given to a similar monster in pregnancy previous to this one.

Dr. McPhedran showed a diffluent spleen taken from an old man who died in the House of Pro. vidence. There was marked chronic gastritis, and all the organs, especially the heart, were very fri

able.

Dr. Cassidy then read a paper on "Ruptured Perineum." He dealt with the subject exhaustively, relating cases in his own practice in illustra tion. He advocated very strongly, immediate operation in all cases. He preferred keeping the bowels loose, and urged the necessity of keeping the parts scrupulously clean by the vaginal douche. A prolonged discussion followed, in which nearly all the members present took part.

MEDICO-CHIRURGICAL SOCIETY OF WINNIPEG.

A meeting of the medical profession, of Winnipeg, was held on the 10th ult., in response to a circular issued by Dr. Whiteford, for the purpose of forming a medical society in that city. The following gentlemen were present :-Drs. Codd, Thibodo, Patterson, Munroe, McAdam, Blanchard, Minaker, Sutherland, Jackes, Brett, Seymour, Covernton, Turnbull, Jones, Kerr, Gray, Jamieson, McEachran, Mewburn, Phillips, A. H. FerguMcDiarmid and Whiteford. Dr. son, Codd occupied the chair, and Dr. Mewburn acted as Secretary.

The following officers were elected :-President, Dr. Lynch ; First Vice-do, Dr. Whiteford; Second Vice-do, Dr. Codd; Sec'y-Treas., Dr. Covernton ; Members of Council, Drs. O'Donnell, Patterson, Jackes, Brett, Phillips and Kerr.

In the absence of Dr. Lynch, the 1st Vice-President, Dr. Whiteford, took the chair. He thanked the members present for the honor they had done him in electing him First Vice-President, and was glad to see such a large number present at the first meeting, which augured well for the future of the society. He was glad to feel that his efforts in getting the medical men together had met with such a hearty response, and he hoped that in 1884 the Canada Medical Association, sending delegates from all parts of the Dominion, would meet in Winnipeg. He had been informed that it was the intention to do so, and it was pleasing to think that there would be a medical society to receive them. He suggested that the rules and regulations of other similar societies be obtained and submitted to the Committee, and that a meeting be called at an early date to discuss them.

Dr. Jackes suggested that the meetings be called twice a month, but the majority present seemed in favor of meeting once a month for the present. The association then adjourned.

MICHIGAN STATE BOARD OF HEALTH.

(Reported for the Canada Lancet.)

The regular quarterly meeting of the Michigan State Board of Health was held in Lansing, Mich., on the 9th of January, 1883.

The subject of oil inspection was brought up, as it was alleged that much oil is being sold without being inspected. Dr. Hazlewood and Dr. Baker

were appointed a committee to take such action as was considered necessary on the subject.

The secretary made his report of work during the last quarter, mentioning the efforts to prevent the introduction of contagious disease by immigrants; the distribution of blanks and circulars to officers of local boards of health; the general distribution of the Annual Report of the Board for 1881; the issuing of a circular with a view to collecting facts respecting the cause and spread of diphtheria the preparations for a sanitary convention at Pontiac, &c., &c. The following resolutions were passed

Resolved, That the State Board of Health urgently requests our members of Congress to endeavor to secure the passage of a bill to appropriate $25,000 for the remainder of this fiscal year and thereafter at about the same rate, to enable the National Board of Health to co-operate with State and local boards of health and quarantines in efforts to prevent the introduction of contagious diseases into the United States, and their spread from one State to another.

The invitation to hold a sanitary convention at Reed City some time in the spring was accepted.

Analyses of apple-butter and of the tinned-copper such as is used to make wash-boilers, were presented. The apple-butter is often made in such "copper" boilers when they are new. The acid of the fruit attacks the tin which often con tains lead in dangerous quantities, and it is said that the tin lining is eaten off in one or two times using for making apple butter. The analysis of the apple butter showed distinct traces of lead and tin and a faint trace of copper. The ordinary clothes-boiler such as used in our kitchens, if made of this tinned-copper would have 2 ounces of metallic lead on its surface, an amount that must have a serious influence on persons who eat acid fruits and juices boiled in such vessels.

The subject of requiring burial permits, and thus securing mortuary statistics, before removal of the body of deceased persons, was referred to the committee on legislation, with the request to prepare a bill and submit it to the legislature.

The American Public Health Association has recommended making it a penal offense to communicate a contagious disease. The committee on legislation was requested to modify the bill so as to name diphtheria, scarlet fever, and small-pox, and get the subject before the legislature.

Selected Articles.

THE "COAT SLEEVE" METHOD OF AMPUTATION.

BY R. DAVY, M.B., F.R.C.S., WESTMINSTER HOSPITAL.

In practice, there are accidents and diseases which yet call for the necessity of amputations; and I wish to-day to bring before your notice a method of performing these operations which I have already carried out on three occasions-viz., one amputation of the thigh and two of the leg. For brevity's sake, I will style this method the coat-sleeve; and this name has been chosen because my left coat-sleeve has illustrated this procedure to my class, and gives a good idea of the operation. Cheselden (1720), of the Westminster Hospital, originally advocated the circular plan of amputation, which, according to Syme, was modified by Mr. Mynors of Birmingham; and this circular method has held its ground as a standard procedure; but I think good reason may be given for advocating still further modifications in this amputation.

Let me first describe the details of the coat-sleeve operation, and next point out the advantages that, in my opinion, result from it.

Carry in your minds the essentials of a circular amputation (a very good account of this circular method is given in William Hey's Surgery (1814, page 526); and you will see that the coat-sleeve method is but a modification of a very old operation. Let me insist on the formation of a long integumentary sleeve, from three or four to six inches; and that your dissection should be directed so as to separate the superficial from the deep

fascia; and very much of this dissection is accomplished by firm traction of the skin towards the trunk of the patient, assisted by slight drawings of the knife on attachments. I have frequently, on the dead body, invaginated skin on skin, as the cut end of the finger of a glove may be turned over the kid on the finger; and on the living patient this is necessary, so as to gain sufficient length of skin-cylinder from its end to the point at which division of the bone takes place. I would impress on you not only the importance of making a far greater allowance for retraction of skin in planning an amputation, but also the comparative uselessness of any other structure than skin for making an efficient and lasting pad for the end of the bone. It is the skin, fat, and hypertrophied substructure that give a good cushion; and with stumps, as well as ordinary seats, when once the leather has given way, the so-called stuffing soon wears, and bare boards and bare bone shortly show themselves. The tuber ischii, knee, elbow, and heel are good illustrations of these points.

Having dissected your skin-sleeve accurately, and divided all the structures down to the periosteum, carefully peel this membrane upwards to the point at which the saw is to be applied, and shelter the soft structures from the stroke of the saw by means of a slit bandage, retracted by an assistant; and, within reasonable limits, the smaller the saw is, the easier is the division of bone effected. Next, trim your stump (i. e., cut off with scissors any projecting tendon or nerve), and tie or twist the bleeding vessels. Then tie up the skin-sleeve (3) with a piece of tape (1) passed through a cylinder, as shown in the diagram allowing the ligatures (if

any) to hang through the crucial slit at the face of the stump. Treat your wound either with or without dressings-I much prefer none; and carefully watch that no undue strangulation of the "off end" (2) of the skin-sleeve occurs. Should the stump become oedematous, or any necessity for drainage arise, insert a drainage-tube into the centre of the face of the stump, of sufficient firmness to prevent a too ready collapse of its walls (e.g., a piece of gum-elastic catheter), and allow the excretion to flow into a pledget of marine tow or some absorbent material. As yet I have not had occasion to resort to any artificial drainage. The wound cicatrizes up to one-half or one-fourth of an inch; and a central button of depressed scar-tis

sue results, surrounded by soft, fatty skin-cushions, plaited in a radiating manner from the centre to the circumference of the face of the stump. This method of amputation is applicable to any part of the extremities, in those cases where the surgeon has the opportunity of selecting the precise point of removal, and where the adjoining skin is sound. In my own experience, the middle of the leg, where the muscles of the calf swell, is about as difficult a situation as any for carrying out the dissection of a long sleeve.

CASE 1.-J. Č., aged 6, was admitted on many occasions into Mark Ward, suffering from recurrent acute attacks of synovitis of the right knee-joint. He was admitted on the last occasion on December 2nd, 1880. On March 8th, 1881, finding the boy was steadily becoming worse, and sinuses multiplying, I amputated his right thigh (conjunction of middle and lower third) by the plan now under discussion. His convalescence was excellent. The stump was good; a circular small cicatrix formed in the centre of its face; and linear creases of skin and fat radiated from the centre to the circumference, suggesting the button sewn into an ordinary sofa-cushion. He has been rusticating for the last few inonths at Hurst, near Twyford, or he would have been shown to-day.

CASE II.-T. D., aged 13, was admitted into Mark Ward on June 1st, 1881, for strumous disease of the left ankle-joint and periostitis of the lower end of the tibia, with much skin-ulceration. He was operated upon on August 16th, 1881, by the coat-sleeve method (middle of leg); was discharged on September 28th, 1881; and has walked well with a bucket-leg since.

CASE III.-J. S., aged 42, was admitted into Henry Hoare Ward in August, 1880, drunk, and with a compound comminuted fracture of the right tibia and fibula, which resulted, after six months' treatment, in an ununited fracture. Many fragments of bone were removed on and subsequently to his admission. On October 8th, 1881, he was re-admitted; and on October 11th, 1881, the coatsleeve method of amputating was resorted to, through the ununited fracture. He was discharged well on January 13th, 1882; and has been walking about with an artificial foot until within the last ten days, when he fell and broke his opposite femur (left). He promised otherwise to have shown himself to-day. The instruments used at this amputation were few-Esmarch's bandage, scalpel, artery and torsion forceps. His stump (when I last saw it, in March 1882), was the perfection of what a stump should be: central depressed cicatrix, and good fatty skin-creases around, making, by involution of the scar, a soft circular cushion, on which his weight (and he is a very heavy man) was carried painlessly.

Lastly, let me point out what are the probable advantages of this method of amputating.