ty, Duvall of Jefferson county, Harper and Hunt of Hamilton county, Pollock of Stark county, Howe, Schmidt and Williams of Cuyahoga county, and Mayor Tom L. Johnson of Cleveland, who urged the passage of the Christian Science amendment, unworthy of confidence in matters of public health; and be it further

Resolved, that these resolutions be offered for publication in the medical press. (Signed,) D. N. Kinsman, Yeatman Wardlow, W. D. Deuschle, Committee on Legislation.

The East Side General Practitioners' Society submitted a . communication setting forth that the members of that organization were desirious of establishing a uniform fee bill, and requested the co-operation of the Academy in formulating and maintaining this aim. The communication was referred to the executive committee.

Dr. McKinnis was elected to membership in the Academy.

LE FEVRE'S DIAGNOSIS. A Manual of Physical Diagnosis, including Diseases of the Thoracic and Abdominal Organs. For Students and Physicians. By Egbert Le Fevre, M. D., Professor of Clinical Medicine and Therapeutics in the University and Bellevue Hospital Medical College, Attending Physician to Bellevue Hospital and to St. Luke's Hospital, New York. New (2d) edition, thoroughly revised and much enlarged. In one 12mo volume of 479 pages with 102 engravings and 6 full page plates in black and colors. Cloth, $2.25, net. Lea Brothers & Co., Publishers, Philadelphia and New York.

The first edition of Dr. Le Fevre's work was the best manual procurable on its subject. (2d) edition has been thoroughly revised, additions made so that the scope of the work has been somewhat enlarged. Noteworthy among the new features of this edition are the very complete revision of the chapter on Topographical and Relational Anatomy and the new illustrations in this portion of the book, the new X-ray illustrations of the heart outlines and the new illustrations of cases of cardiac disease.

A COMPEND OF MEDICAL CHEMISTRY, INORGANIC AND ORGANIC, INCLUDING URINARY ANALYSIS. By Henry Leffman, A. M., M. D., Professor of Chemistry in the Woman's Medical College of Pennsylvania and in the Wagner Free Institute of Science. Fifth Edition, Revised. P. Blakinston's Son & Co., 1012 Walnut St., 1905. Philadelphia, Pa.

PERISCOPE OF MEDICAL PROGRESS.

USE OF A MURPHY BUTTON.

Ochsner (Clinical Surgery) says that the important points to be borne in mind in the use of the Murphy button

are:

1. The button must be well made and must be kept open while not in use, in order to prevent injury to the spring.

2. The silk suture must grasp all the layers of the stomach or intestine, but it must be applied very near the edge of the incision in order not to draw too much tissue into the bite of the button.

3. The incision through which the button is passed must not be too large, just large enough for the button to pass through.

4. The purse string suture holding the button must be tied very tightly and the ends cut short, and it is best to arrange the position of the knot so that the knots in the two segments do not meet.

5. If there is any projection of the mucous membrane after the purse string suture has been tied, this should be cut away before the two segments have been tied.

6. When the two segments have been united there should be a perfectly smooth union throughout. If there is any projecting tissue it should be pressed in between the segments of the button by means of a spatula or the flat handle of the scapel.

7. No sutures should be applied over the button.

8. The button must be placed in healthy tissue, never near the vicinity of an ulcer or portion of the intestine which is in danger of becoming gangrenous.

HYSTERECTOMY.

F. F.

Ochsner (Clinical Surgery) says (with regard hysterectomy) that the removal of the uterus in itself is one of the simplest and safest operations in cases in which the condition

for which the operation is performed is not connected with troublesome complications. The success of the operation depends upon the appreciation of a few exceedingly simple facts, namely, (1) The avoidance of infection; (2) The protection of the ureters and bladder; (3) The control of hemorrhage. ....The operator can easily avoid infection if he is careful at the time the uterine canal is opened. He controls hemorrhage by applying two long-jawed hemostats on both sides of the broad ligament, and suggests that the peritoneal flap be cut at a considerable distance up over the anterior surface of the uterus in order to avoid injuring the bladder. After removing the uterus, hemorrhage is permanently controlled by transfixing the broad ligaments with fine cat-gut. A suture is applied around the uterine artery on each side, and tied just firm enough to prevent hemorrhage. Ochsner says that while it seems unnecessary, it is his practice to apply a separate ligature to the ends of the uterine arteries. He advises against too tight suturing in hysterectomy, and says that the pressure should suffice to bring the surfaces together, and not occasion necrosis. Gangrene of the stump not infrequently follows too tight suturing, and is the common cause of death. Since practicing this observation he has reduced his mortality of intra-abdominal hysterectomies to almost nothing. F. F.

GANGRENE OF THE GALL BLADDER.

Ransohoff (The Journal) reports two cases of "Gangrene of the Gall Bladder," and suggests the possibility of a new sign in rupture of the common bile duct. In both cases reported the rapidly developing peritonitis led to the probable diagnosis of peritonitis of appendicular origin. In one of the cases the gall bladder was distended with 10 ounces of viscid bile mixed with blood. There was no pus, and the fluid removed was sterile. No stone or other tangible cause for the obstruction could be found at the time of operating. The operation was completed as an ordinary cystotomy, with gauze packed about the gall bladder to protect the general peritoneum from infection. Five weeks after the operation the gall bladder was discharged almost en masse from the

wound. The biliary fistula healed rapidly, and the patient was discharged from the hospital. In the second case the common duct was found ruptured at the time of operating. A careful search failed to reveal a stone. The gall bladder was drained. The patient made an uninterrupted recovery. In this case there was a marked localized jaundice of the umbilicus. The discoloration was so obviously localized that it suggested to Ransohoff that further observation might give the symptom some value as a sign of free bile in the peritoneal cavity. Total gangrene of the gall bladder is a rare condition, and hitherto no cases have been reported where the affection was independent of gall stones, infection, or malignant disease. Ransohoff is of the opinion that there occurred, during an attack of vomiting, a twist in the neck of the gall bladder which involved the patulousness of both the cystic duct and artery.

F. F.

OPERATIVE TREATMENT OF CLEFT PALATE.

Beck (Annals of Surgery) considers The Operative Treatment of Cleft Palate. He thinks children 6 or 7 years of age are the most favorable subjects for operation. The mouth is sufficiently large, the loss of blood is attended with little shock, the patients are old enough to give intelligent assistance in the after treatment, and can be taught to wear a protective dental plate. The serious disadvantage is that the habit of speech is already formed and the defect in pronunciation is undoubtedly more difficult to overcome. He has had no experience in operating under the age of three months. He places the head in the Rose position, uses intermittent ether anaesthesia, on an open cone, and the Whitehead gag. Preliminary tracheotomy is considered unnecessary. The operation described is essentially the operation of Langenbeck, and is capable of closing the cleft, if properly carried out, in nearly every case of cleft palate in either children or adults. Complete relief of tension is essential, and the division of the salpingo-palatine fold of mucous membrane is important to secure this. Suturing should be carefully done

as in any fine plastic operation, and with needles that are sufficiently delicate to avoid injury to the edges of the flap. The after treatment should be simple. Sterile water is given by mouth after the first twelve hours, and at the end of twentyfour hours sterilized milk can be administered with a spoon. Rectal feeding is unnecessary. The lips, teeth and tongue are kept clean with a boric acid solution, and no attempt is made to cleanse the palate or nasal fossae. The protective dental plate is introduced at the completion of the operation. It protects the line of sutures and aids in the attempt at swallowing. It should be removed every three or four hours and cleansed with a boric acid solution.

THE SURGERY OF THE STOMACH.

F. F.

Gastric surgery will be much more popular with the profession and the laity in the near future, according to W. D. Haggard, Nashville (Journal A. M. A., January 27), and early operation will be as universally advised for stomach lesions as it is at present for appendicitis. Improved technic, low mortality and satisfactory end results, he says, will inevitably do away with the empirical treatment of occult intractable stomach diseases. The laity will also become educated and will criticise unnecessary delay in operating and allowing chronic ulcers to go on to perforation or fatal hemorrhage, or in allowing cancer to go unrecognized. Aside from the malignancy, chronic ulcer and its complications furnish the majority of indications for operative interference in the majority of cases. Medical cures of these are apt to be overestimated, and do not compare as regards permanency with those from operation, while the danger to life is probably far greater. The various devices for gastrointestinal anastomosis are reviewed by Haggard and their respective advantages told, but he says that the ultimate ideal method has probably not yet been reached. The relative safety, even with varying technic, is illustrated by the results of surgeons like Robson, Moynihan, the Mayos and others, in cancer, which is especially favorable for early operation. The article closes with Mayo's description of partial gastrectomy and Petersen's summary of its advantages.