the occurrence of sharp hemorrhage from the middle meningeal artery, which took place during the operation; this was checked by the application of a long blade forceps, one blade within and the other without the skull, the handles tied together and compression kept up in this way for some half hour. In case V. the paralysis was limited to the left upper extremity, and the depression was nearly over the motor area for that limb, though a little above and behind it; the general senses of the patient were blunted, but as they became more acute, it was found that sensation in the extremity paralyzed was very much diminished; all functions gradually returned upon removal of the fragments. SO Cases XII and XIII seem to me to represent the ideal form of treatment of a very common injury, a compound fracture of the tibia with a small wound in the skin. Thorough antisepsis in the dressing, with a well ap. plied plaster of Paris splint converts the injury into what is practically a simple fracture. This dressing may be left in place until the fracture has united, unless there is some indication for changing it before that time, e. g., rise of temperature, chills, great pain at site of wound. Should there be such indication a fenestrum may be cut in the splint and the wound examined, but if the antisepsis has been absolute, I believe that in all instances the case will be cured with but one dressing. In case XIV, I should have stated that the patients had always been addicted to alco Case VI furnishes a striking example of the value of conservatism; the injury was extensive that at first amputation was thought to be the only resort, but it was decided bet-holics. ter to make an attempt to save the arm, and with this in view, the fragments were brought together with silver wire and a very extensive antiseptic dressing applied with a plaster-of-Paris splint over all to immobilize the fragments and keep the dressings in place. Free suppuration took place, and in many places the soft tissues sloughed, but there was no septic infection; the parts below main tained a healthy condition, the strength of the child was carefully supported by a nutritious and easily digested diet, and the case went on to a complete recovery without shortening of the arm or functional loss. Although the soft tissues of the arm were severely lacerated there were bridges of good skin left here and there which did away with the necessity for skin grafting. In case VII. the failure to obtain primary union was due to hemorrhage from the medullary canal of the humerus; this was very free at the time of the operation, and though it was thought that pressure had checked it, it recurred after the flaps were sewed up, and filled the stump with blood which was found to have become purulent when the first dressing was changed. In case VIII the child's life was undoubt edly saved by rectal injections of beef peptonoids, for the stomach rejected every thing, and the constitutional symptoms were of marked severity. Although the tissues at the site of amputation were very edematous, primary union was obtained throughout except at the angles of the stump where the rubber drainage tubes were inserted. Cases IX, X, and XI are excellent examples of the almost perfect results which may be obtained after severe injuries by the employment of thorough antisepsis and the exercise of conservative judgment. None of the remaining cases present anything worthy of note with the exception of the last; in this a bullet of large caliber passing entirely through the lung, the patient recovered without any unfavorable symptoms. The wound of entrance was not probed, the patient was kept flat on his back, and when the first dressing was removed the wound was found entirely closed. In this connection I may mention a case of compound comminuted fracture of the humerus which I treated in April, 1884. A bullet of about 38 caliber entered the arm at its middle, anteriorly, passed through the humerus and lodged beneath the skin, just above the external condyle. re The wound was not probed, nor was the bullet removed; antiseptic dressing and plas ter splint applied, and when this was moved some five weeks later the wound was found closed and the fragments of the humerus firmly united. The functional result was perfect, and as the bullet has never caused trouble, it has not been disturbed. -During what portion of the day are bacteria or organic germs most numerously present in the atmosphere? Mons. Miquel, a member of the Paris Society of Public Medicine, has been trying to discover the true answer to this question, and he has found the number largest between six and at two. These results would indicate that the WEEKLY MEDICAL REVIEW, EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves. All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST STREET, ST. LOUIS, Mo. SATURDAY, OCTOBER 2, 1886. TREATMENT OF CATARRHAL JAUNDICE BY THE FARADIC CURRENT. Relative to the subject indicated by the above title, we find in the Deutsche Medicinal Zeitung, Sept. 9, 1886, an original paper by Dr. Schroeter, of Hagenau, who employed Gerhardt's method of faradization of the gall bladder in two cases of catarrhal jaundice with pronounced success. The cases were especially obstinate in the face of the usual successful dietetic and medicative treatment. The application of the interrupted current was succeeded by such immediate improvement, that, considering the long duration of the cases and the failure of approved methods of treatment, the favorable change should, to a certainty, be credited to the change in action. The cases were characteristic ones, the details of the history need not be given. The faradic current was employed by placing one electrode upon the abdominal region corresponding to the site of the gall bladder. The other electrode was applied to the right of the spine at a corresponding level. The current used was of sufficient strength to cause contraction of the abdominal muscles, and was continued for about five minutes. Among the psychical perversions due to chronic poisoning are mentioned those due: 1. To lead poisoning. 2. To mercurial poisoning. Among the therapeutic agents that may excite grave brain-symptoms are mentioned iodoform,atropine, quinine,salicylic acid, chlo ral hydrate, the bromides, the iodides and cocaine. The substances commonly indulged in, that may be causative of psychical trouble, are al cohol, absynth, chloroform, nicotine, coffee, hashish, opium and morphine. The author is of the opinion that in the determination to psychical aberration after ac cidental exposure or abuse of any of these factors, individual susceptibility plays the chief role, and neuropathic tendency is of The treatment was given in some of the cases for a period of several weeks, success attending all, excepting such cases in which positive mechanical obstruction, for instance by gall-stones, was the cause of the jaundice. | secondary importance. IMPLANTATION OF TEETH AND PERICEMENTAL LIFE. This subject was discussed in an individual report of the committee on Pathology and Surgery, read before the California State Dental Society, July 21, 1886, by William J. Younger, M. D., of San Francisco. To Dr. Younger, one of the committee, was delegated the task of making the report, inasmuch as the only new thing in dental surgery, that the committee was aware of, was the suc cessful transplantation of teeth into artificial sockets by Dr. Younger. over two days, it was by constant immersion in warm water, at a blood temperature; but that the pericementum of this tooth was, as she herself could see, as dry and shriveled as parchment, and as devoid of life." However, after a train of thought the doctor concluded that in that shriveled membrane there possibly lay lurking a dormant life, which, under favorable conditions, would become aroused. Therefore, he consented to perform the operation as an experiment. So, between the first left superior bicuspid and on the 11th of last March, he drilled a socket first molar; and after soaking the tooth in five minutes, to soften the membrane, rewater-temperature 120° Fah.-for twentyin-prived of just thirteen months and eleven stored to the jaw that which it had been deprived of just thirteen months and eleven days before. The doctor had formerly published a brochure on "Transplantation of Teeth into Natural and Artificial Sockets." He recommends the use of cock's combs as a means of preserving the vitality of the peridental membrane, and also mentioned that in two stances the life of this membrane had been preserved for over fifty hours in tepid water. His subsequent experiences that are reported in the paper referred to, prove that these means are not at all necessary to preserve the vitality of the pericementum, which is as nacious as that inherent in the seeds of plants. te The following case we give in the author's own words: "In the early part of March, 1886, a lady, the wife of a well known dentist, brought me a bicuspid that had been extracted at her solicitation, in Sacramento, on the 31st day of January, 1885, in the belief that it was the seat of a neuralgic pain, which had been the cause of great anguish to her. This tooth, brought to me after this long lapse of time, had in the meanwhile been carried about in her portemonnaie, stowed away in her jewel case and shuffled about in her bureau drawer. And this tooth she wanted replanted in her jaw! My first impulse was to laugh, my next to argue with her about the impossibility of success of such an operation, explaining to her that it was due only to the vitality of the membrane covering of the root that the operation owed its success; that, without this living membrane, the tooth was as impossible of attachment as so much bare ivory or porcelain; and that while I had succeeded in keeping this membrane alive for The tooth was firmly fixed in the socket and on the twelfth day, the lady, who had crust of commenced using the tooth, bit a French bread. This wrenched and loosened the tooth, causing the gum to bleed profusely. The doctor reasons correctly when he states that he was glad the accident happened. For it gave the opportunity of determining whether the tooth had been only mechanically retained or whether a true vital connection with the living environment of gum and alveolar substance had been established. The reactive inflammation so excited resulted in the firm fixation of the tooth. Since this first experiment teeth that had been extracted for weeks and months have been been implanted with equal success, proving the tenacity of life in the pericemental mem brane. In regard to his mode of procedure at present, the doctor reports that he simply lays the teeth aside in a clean, cool, dry place, and prepares and uses them as wanted, and has also discarded the flat drill, and uses, instead, graded trephines for piercing the bone and for doing the major part of the work, finishing the walls, as formerly, with burs of various shapes. The author points out the strong points of preference of his method of implantation, over the kindred operations of replantation and transplantation. The causes of failure in these are obvious. In replantation, we have a diseased root thrust back into a diseased socket; the disease is not removed, only mod ified. Again, in transplantation we have a healthy tooth thrust into a socket, where a diseased root has been working mischief in the surrounding alveolus. In implantation, on the contrary, we have a healthy root in a healthy socket. To implantation the doctor therefore gives the preference, but, believes the other operations can be made more uniformly successful by allowing no disease to remain in root or socket. This is to be determined by the practitioner for each individual case after judicious treatment. We cannot enter upon all of the many points of detail interest in which the paper abounds. It would be highly interesting and instructive to study experimentally the successive stages of the process by which a tooth so dealt with becomes an integral. The point as to the persistent vitality of the cellelements of the pericementum could be experimentally demonstrated. No doubt the white corpuscles that come from the granulation tissue of the artificial socket play an important role in the rehabilitation, perhaps as great a role as in the organization of a thrombus. THE TREATMENT OF LUPUS.-In a paper by Prof. Trendelenburg contributed to the Deutsche Chirurgie and abstracted by the Annals of Surgery, the author fully accepts its tubercular origin. He therefore advocates a treatment that fully destroys all affected tissue. Internal remedies are of no avail. Caustics he prefers in pencil form. He prefers nitrate of silver to potash, the latter being too diffluent. The pointed thermo-cautery is better and convenient. Volkmann's method of scraping out the nodules with a sharp spoon is commendable, especially when followed by cauterization with the Paquelin. Various methods suceeed if every suspi cious spot is radically treated. Washings with sublimate solutions are effective. He corroborates the old observation that an erysipelas has a favorable effect. If excision and subsequent plaster covering is contemplated it is well to wait with the later until solid cicatrization has taken place. And even then the transplanted flap is not safe from infection. TREATMENT OF TELEANGIECTASIA.-On the method of treating teleangiectasia by painting the tumor including the surrounding surface, for about 2 mm., for four consecutive days with a four per cent solution of sublimate collodion, we read a note in the Annals of Surgery, taken from the Deutsche Medicinische Wochenschrift. Five satisfactory cases are recorded. A scab is formed under which is a suppurating, granulating surface. The cicatrization is rapid and complete under a borated dressing. The cases were an angi oma of the surface at the inner edge of the left scapula, an angioma over the third spinal vertebra, another situated in the middle of the forehead, one of the right large labium. The contraction of the cicatrix in these cases was slight, which recommends the treatment in angioma of the face. The surrounding surface should first be thoroughly covered with collodion before the solution is applied. Thus little or no pain is produced. The formula used was: of importance in the ultimate result. The results given as a permanent cure were in patients who had remained in health from three to five years after operation. TANNATE OF MERCURY IN SYPHILIS.-In the Medical Times and Gazette (Journal of Cutaneous and Venereal Diseases), Mr. Inglis Parsons reports seventeen cases in the out The following are the figures collated by patient department of Guy's Hospital treated Dr. Poucher: Prof. Billroth's Clinic, (A. v. Winniwarter's Reports), 143 cases; 34, or 23.77 per cent., died from operation or intercurrent disease; 8, or 5.59 per cent., remained cured. Prof. Esmarch's Clinic, (Langenbeck's Arch. fuer Chir. Bd. 24), 225 cases; 23, or 10.22 per cent., died from operation, etc., and 26, or 11.55 per cent., were permanently cured. Prof. Fischer's Clinic, (Langenbeck's Arch. fuer Chir., Band 27), 147 cases, 30, or 20.4 per cent., died from operation, etc., and 13, or 8.84 per cent., were permanently cured. Prof. Volkmann's Clinic, (Sprengle), 131 cases, 10, or 7.39 per cent., died of operation, etc., and 15, or 16.19 per cent., remained cured. Dr. E. Küster, Augusta Hospital, Berlin, (Langenbeck's Arch. f. Chir. Bd. 29), 132 cases; 19, or 14.39 per cent., died. Dr. K. has carefully followed 60 of his patients for over three years, and 13 of these remain well. 81 patients followed for two years, 16 remain well; 4 have become lost, fate unknown. A DEFINITION OF GOUT.-Dr. Milner Fothergill gives the following succinct account of the pathology of gout (Medical Record): "When kidneys first appear in the animal kingdom, the form of urinary secretion is uric acid. Uric acid belongs to animals with a three-chambered heart and a solid urine, (reptiles and birds). The mam malia possess a four-chambered heart and fluid urine. the form of urinary secretion being the soluble urea. When the human liver becomes depraved or degraded, it has a tendency to form primitive urinary products. To the question, 'What is gout?' the answer is: 'Gout is hepatic reversion, when primitive urine is formed by a mammalian liver.'" by tannate of mercury given three times a day in a pill an hour before meals, in doses of a grain and a half to two grains. No opium or tonics accompanied the treatment. The cases came under treatment in periods varying from one month to twelve months from the onset of the disease. The symptoms disappeared in most cases in from two to five weeks. Severe stomatitis or diarrhea did not occur. The cases attended and were under treatment for four or five weeks, and in that period no disturbance of the general health was noticeable. |