cient ether, and add the solution to a mixture consisting of two ounces of powdered chocolate and one ounce of powdered gum arabic. Mix very thoroughly and divide into 200 pastilles. Each pastille will thus contain 1-333 grain of nitroglycerin. Used in angina pectoris, and as a diuretic. Picrotoxin: In aqueous solution. Dose from 1-8 to 1-6 grain. Used in epilepsy. Sulphate of thalline may be given dissolved in wine or water (with some corrigerant). The dose is from 4 to 8 grains, or 1 grain every hour.

Biniodide of MERCURY IN SCARLET FEVER. -In the British Medical Journal (New York Medical Journal) Dr. C. R. Illingworth, alluding to a former communication of his on biniodide of mercury in scarlet fever and diphtheria, says: "That it is a true specific for the former is proved by the defervescence commencing immediately upon the administration of the medicine, instead of upon the fifth day, and by the absence of desquamation in consequence. That it acts as a specific in the latter is shown by the rapid disappear

ance of the membranous effusion and reduction of temperature. The efficacy of the medicine depends, I think, upon the diffusible po. tassic iodide carrying the germicide biniodide to exery portion of the circulation. Prescribed in this form, the biniodide of mercury has not, so far as I am aware, been used before for these diseases."

ANTAGONISM BETWEEN ATROPINE AND MORPHINE.-At a recent scientific meeting in Berlin, Herr Lenharz, of Leipsig, read a paper (Prager Med. Wochenschr., Brit. Med. Journ.,) on the alleged antagonism between atropine and morphine, considered both clinically and experimentally. He had come to the conclusion that no such antagonism existed, for the following reasons: Firstly, the antidotal doses of atropine have far too wide a range. As a rule, enormous doses are given, often without success, while, at the same time, recoveries from morphine-poisoning are recorded after merely nominal doses of atropine (.015 grammes, and even less than this); secondly, the uncertainty of the indications. Johnston, of Shanghai, would resort to atropine in all cases, in spite of a weak irregular pulse, whilst Wood makes the condition of the respiration the criterion, and Binz discards the use of atropine if the pulse be rapid and small; finally, atropine does direct harm. Binz had recommended atropine on had not been sufficiently complete, that is, experimental grounds, but Binz's experiments only enough morphine had been given to make the animal sleep, but not enough to give them convulsions. Animals killed by large doses of morphine did not die from lowered bloodbut from the exhausting convulsions. Of 132 pressure, nor from embarrassed breathing, cases of morphine poisoning, collected by the author, 59 were treated with atropine, with a mortality of 28 per cent; of the other 73 only morphine on animals, atropine made no dif. 15 per cent died. In eight experiments with ference; the animals died just as soon as without it.

IODOFORM OINTMENT IN TUBERCULAR MENINGITIS.-The British Medical Journal calls attention to some cases of tubercular Warfwinge, a Swedish physician, by means meningitis which were all cured by Dr. of an ointment composed of iodoform and vaseline, 1 to 5. This was rubbed into the shaven scalp, twice a day, five grammes of of some impermeable material worn constantthe ointment being used each time and a cap ly. The time required for cure varied in the five cases in which the treatment was tried, from nine to thirty-two days.

We learn that this treatment was first employed, and successfully so, by Dr. Emil Wilsson, another Swedish physician, who used an iodo form ointment of the strength

of one to ten.

DR. HURT said that he would like to state some of the reasons for taking the position he had in regard to the acid found free in the stomach, and to which the gastric juice owed its acidity. That he had referred to several of the leading text-books, among them Flint's, who, after mentioning the various acids found in the course of digestion in the stomach, concludes by saying that it "seems almost certain that the chief acid is lactic acid." Also in the REVIEW of Nov. 27, recounting the conclusions of Reichman, of Germany, who says: "The acidity of the gastric juice is at first due almost solely to lactic acid, and later in the process of digestion to the presence of hydrochloric acid."

DR. POLLAK presented to the society a very large nasal polypus, removed from the posterior part of the nose by means of a Jarvis snare. The patient had had an otitis diffusa, with almost total loss of hearing in both ears, due to labyrinthine trouble. Under depletive treatment inflammation subsided; symptoms pointed to some difficulty in naso-pharynx, and the mirror revealed a large polypus projecting into that space.

The wires of a Jarvis' snare were thrown around base of tumor, some difficulty being experienced, owing to the slipping of the wires from off the tumor. Did not think it could have been removed by forceps, as it was too high up; it appeared to spring from the posterior part of the middle turbinated bone.

DR. DEAN said that he had previously written up the details of the case of sacral teratoma, operated upon by Dr. Mudd, the case having been in the hospital some time before that of operation.

DR. WILLIAMS related a case in which there were several large nasal polypi filling up the posterior part of the nose and upper part of pharynx, which he had removed by a hook, formed by bending a knitting needle, passed around the base of the tumor. Also spoke of another case in which what appeared to be a a small hard polypus, filled with blood, attached to floor of external meatus, so hard as to resemble a pebble. Another one attached to the promontory of the tympanum, which was removed by repeated applications of

chromic acid, but which recurred again and again until the promontory was finally denuded by the acid, when the trouble ceased.

DR.ENGELMANN presented a specimen to the society, a large cyst which he had removed a few days before; stated that he presented it on account of its peculiar origin and history. The patient, a lady, sixty-eight years of age, had suffered for thirty years with abdominal enlargement; four years ago he had tapped her, which operation had been performed twice before at long intervals. Patient felt that an operation was her only hope for prolonging life, as the constant drain upon her strength was rapidly breaking her down. Had had no peritoneal inflammation, yet adhesions were expected to be found on account of the repeated tappings. The cyst was exposed, and presented a peculiar appearance; there was a cyst-wall, reddish and filled with numerous blood vessels, and this appeared to be covered by another cyst or membrane, leading to the belief that it might be a cyst of the posterior part of the broad ligament, and covered in front by the ligament. The outer membrane was divided and clamped, and the tumor then tapped; there was but one large cyst, free from all adhesions. The pedicle of the mass was then found to be connected, not with the ligament or ovary, but with the side of the pelvis. The membrane covering the cyst was found to spring from the tissues above and below the brim of the pelvis, and inside this covering was the cyst proper; there was no pedicle to this inner cyst, it belonging to the membrane outside of it, and no artery was found running into cyst. On the right side neither ovary nor ligament could be found upon hurried examination, which was interrupted by an exigency of the operation.

DR. LUTZ remarked that in these misplaced cysts the ovary of that side has generally disappeared; said that there was quite a large literature on these mesenteric cysts, the causes of which were obscure, but that traumatism most probably played a large part in their causation. Spoke of a case on which he had operated about a year ago, similar to the case before the society, which had occurred after a severe strain, and seemed to be dependent upon it. In that the cyst had been nourished by a large artery which entered its wall, but in Dr. Engelmann's case it must have been nourished by absorption.

DR. HULBERT thought it was a cyst of the broad ligament, from one of tubules of the parovarium, and not an ovarian cyst; that it was probably from the outer tubule of this structure, and its pedicle had been attached

to the brim of the pelvis, and removed from its first situation by stretching.

DR. ENGELMANN had met with cases in which there had been a number of cysts about the abdominal cavity, and had removed a number of them.

Society then adjourned.

subject, and of this, by far the most comprehensive is contained in the Surgical History of the War of the Rebellion, in which are tabulated 653 wounds of the intestines with a mortality of 80.3 per cent.

But here the meagreness of details of symptoms of reported cases is very marked. In a very few recorded cases such symptoms as

ATION.

REPORT CONTAINED IN THE "MEDICAL NEWS."

The third annual meeting of this Association was in Lyric Hall, New York, November 16, 17, and 18, 1886; the President, Dr. E. M. Moore, of Rochester, in the chair. The scientific interest of the meeting cen tered around the special discussion which had been arranged on the subjects of gunshot woulds of the intestines, and on eclampsia. DR. WM. S. TREMAINE, of Erie County, opened

THE DISCUSSION ON GUNSHOT WOUNDS OF THE INTESTINES.

He said that the chief thought that occurred in connection with them is their marked fa tality. The universal opinion being that a perforating gunshot wound of the intestines permitting extravasation into the peritoneum is hopelessly fatal, consequently, until quite recently the attention of surgeons was chiefly directed, in their treatment to some form of euthanasia—and were surgery a non-progressive art, if its recent magnificent triumphs offered no hope for the future, he might well end here and be without excuse to propound certain questions for consideration Happily there is hope. The impunity with which in these latter times the abdominal cavity has been opened and extensive surgical manipulations carried on therein gives reasonable ground for hope, that the "do-nothing system," will generally be abandoned and that laparotomy, where there is reason to suspect that the intestines have been wounded, will become a legitimate and successful surgical procedure. And this, without further preamble, opens to our consideration the first question What are the reasons which lead us to suspect or believe that the intestines have been wounded? Or, in other words, does a group of symptoms exist which would lead to an accurate diagnosis of perforation of the intestines by penetrating gunshot wounds of the abdomen?

In seeking for the answer to this question recourse must be had to the literature of the

are given. The wound of the intestine was either inferred from the direction of the wound or demonstrated by the autopsy.

Without quoting extracts, it is sufficient for the present purpose to say that faint light is thrown upon the subject in most of the standard text-books, and that so far as books go, but little positive information can be gained as regards accurate diagnosis.

A somewhat extensive experience of the speaker, in wounds of this class, in both military and civil practice, leads to the following conclusions: that the caliber of the ball, the proximity of the weapon, and the position. of the wounds of entrance and exit have an important bearing. That as regards general symptoms, the existence of prolonged shock, a lowered temperature, a feeble pulse, great restlessness, marked anxiety of countenance, accompanied by tympanites and great pain, taken in connection with the anatomical location of the wound, afford very strong evidence of a perforating wound of the intes tines; that the escape of blood from the anus rarely happens soon after the injury, and is consequently of little value as a diagnostic sign.

Given a case of penetrating wound of the abdomen by a rifle or pistol bullet of from 32 to 45 caliber, fired at ordinary range, accompanied by the above mentioned general symp. toms, the probability in at least nine cases out of ten would be death. Does the surgical art offer any plan of treatment by which this fearful rate of mortality may be lowered? In searching amidst the recorded thoughts of master minds in surgery, one finds this question often propounded, and occasionally the answer hinted at with more or less positiveness.

in dilating the external wound, if it be not already sufficiently large, in hooking up the injured bowel, and in closing the solution of continuity with the requisite number of stitches, at the same time that the effused matter is carefully removed with tepid water and a soft sponge. All wiping must, of course, be carefully avoided, as this would add much to the risk of peritonitis."

The quostion was debated by some of the older surgeons, and in 1836 Baudens advocated the enlargement of the wound and the application of the suture, and reports two cases of enterorrhaphy. Guthrie, after speak ing of the frightful mortality, says: "The do-nothing system' is commonly followed by death. A well-regulated interference is likely to be more successful." In the Danish war, Lohmeyer advocated "a search for the opening, sew up the wounded knuckle, and to return the latter after removing effused fecal matter." In the Crimean war similar views were advocated by Legouest. In our own war, these doctrines were carried out by Drs. Bentley, Judson, Gill and Kinloch.

But in all this the question seems to be restricted to enlarging the wound, and in cases where the diagnosis of perforation was not doubtful, the method of making an incision in the linea alba seems not to have been con. sidered. The propriety of closing by suture a perforation of the intestines is no longer debatable. The question before us is the pro. priety of incising the abdomen in the middle line: First, for diagnosis; second, to arrest hemorrhage; third, to sew up the wounds in the intestines, should any exist; and, fourth, to remove extravasated blood and fecal matter.

The knowledge gained by laparotomy for other troubles, such as abdominal tumors and the like, undoubtedly gave a great impetus in this direction; consequently, we find a great master in abdominal surgery, the late Dr. Marion Sims, uttering in 1882, the following words: "I have the deepest conviction that there is not more danger of a man's dying of a gunshot or other wound of the peritoneal cavity properly treated, than there is of a woman's dying of an ovariotomy properly performed. Ovarian tumors were invariably fatal till McDowell demonstrated the manner of cure, which has now reached such perfection that we cure from ninety to ninety-seven per cent of all cases, and by the application of the same rules that guard us in ovariotomy to the treatment of shot wounds penetrating the abdominal cavity, that there is every certainty of attaining the same success in these that we now boast of in ovariotomy." (Brit. Med.

at

Journ., March 4, 1882.) Let us hope that these bold words may prove, in a measure, least, truly prophetic.

I have stated laparotomy first, for purposes of diagnosticating; this is perhaps a debatable ground, for I take it that no surgeon would now question the propriety of exposing the abdominal cavity and suturing the wounds in the intestines, were such known posi tively to exist. To do so, would be to abandon the case to inevitable death. Let us suppose a penetrating gunshot wound of the abdomen, where the indications are not clear that the intestines have been perforated (a point, by the way, almost always more or less in doubt.)

Is it proper to incise in the middle line and explore? To this, I answer, yes; First, because the intestines may be wounded; second, in any event, it is nine times out of ten required for the removal of effused blood. We have often in abdominal sections realized the difficulty of arresting hemorrhage from an exceedingly small vessel or oozing point. We are all familiar with the danger from effused blood allowed to remain in the cavity of the abdomen; third, the abdominal section adds but little, if any danger, when done under proper precautions, to which may be added, fourth. the assurance given to the patient that his intestines have not sustained a fatal wound, which cannot but have a marked tonic effect, conducive to recovery.

When the intestines are perforated there can be no longer any doubt as to the propriety of abdominal section, for just so certain as there is perforation, there will be fecal extravasation, and with this extravasation will follow peritonitis and death, providing the patient survive the immediate shock of the injury. Happily, the question of the advisa bility of the operation has been set at rest by at least three successful cases in America. It is doubtful if there is any well-authenticated case of recovery after a perforated gunshot wound of, the small intestines with fecal extravasation, so no amount of negative evidence can weigh against the positive evidence of these successful cases of laparotomy with enterorrhaphy for perforating gunshot wounds of the small intestine. The first case, that of Bull, with perforations; the second, that of Hamilton, with eleven wounds; the third, that of Bull, with perforations.

But little remains for us to consider beyond the "when" and the "how," the "time," when laparotomy should be done, and the manner of doing it. I think there can be no question that the operation, having been determined on, should be done as soon as practicable after the receipt of the injury, for the