dermatic injections of morphia to retain the iris in situ after prolapse, but am familiar with the report of Dr. Smith. The chief reason for not mentioning the subject of eserine in the paper was because I strove for simplicity from start to finish, and also because of the great danger of iritis and closure of the pupil in all of these cases of injury to the cornea. In the cases where eserine would fail, it would certainly be better to use atropine because of its influence in preventing iritis.

In regard to the criticism of Dr. Ball about interfering with prolapse of the iris after six. hours, I will refer to the paper. (Here Dr. Wescott read extracts from his paper, which pertained to the point under discussion.) Dr. Ball was speaking of an operation wound which he had unquestionably made aseptically and preserved in an aseptic condition. It is very different, indeed, opening such a wound and opening one due to traumatism, which has not been dressed, and which undoubtedly has had an opportunity to become infected.

In regard to foreign bodies in the lens, I quite agree with Dr. Ball, and his criticism is an addition to the paper in that respect. We do have small foreign bodies embedded in the lens which do not necessitate the removal of the eye at once, unless we know that they are septic, and it may be impossible to know when they are in such a condition. These small foreign bodies in the lens frequently cause swelling of the lens and an injurious inflammation of the eye, which calls for immediate action. In such cases we can sometimes save the organ by prompt removal of the lens, while in others we cannot do so, and must subsequently enucleate the eye after an attempt has been made to save it. Of course, there are cases of wounds of the ciliary body which have not been followed by loss of the eye or by ophthalmitis. I cannot advise you to assume the entire responsibility in any of these eye injuries if you can call to your aid an ophthalmic surgeon, but we all realize that the first treatment of a surgical injury of any part of the body is very important. You are called upon in emergencies to act at once whether you continue in charge or not. In any of these injuries you will, because of your own science, because of your loyalty to the best interests of your patient, consult an ophthalmic surgeon if you can. I have given what I

con

think to be the best advice if you must act upon your own resources and without aid.

The Hour for Capital Operations.

Of the many questions that present themselves for solution in regard to operative cases, a by no means unimportant one is that of the hour for operating. A good deal may be said for almost any time that may be selected, and for this reason: It may be generally assumed

that the hour selected is the one that suits the surgeon best. For many reasons we cannot find fault with the operator for taking such a time as seems best to accord with his other engagements. It has long been a recognized right of the patient not to be disappointed, if by any possibility this can be avoided, after the hour has been named and the preparations made for the operation.

In following the course of operative cases and various operators for a number of years in the hospitals of a large city, it has seemed to us that the early morning operation had a great many claims which entitled it to serious consideration by operators. A good night's rest, attained artificially if necessary, an empty stomach, the patient all ready for anesthesia upon awakening, the fear and dread of what is coming being crowded into the fewest possible moments, the whole day with active attendants constantly moving about and alive to every demand of the patient, the ability to run in and see for one's self how the case is doing during the first 12 to 18 hours, without encroaching upon the practitioner's allotted time for sleep, are a few of the points which seem to recommend an early hour. On the other hand, it cannot be denied that it may be a source of greater task upon the surgeon's powers, especially if he be concerned and anxious, as always conscientious men must be in regard to capital operations, and if this anxiety interferes with the operator's sleep. Even with this disadvantage we still believe the operator capable of doing better work before he has become tired and annoyed by the variof the day. It would be impossible to comous demands upon him during the early hours pare the results, because we have no data with which to make a comparison, but we believe that the men who have operated extensively in the early morning hours have never returned to afternoon operations as a matter of choice. -Gaillard's Medical Journal.

Strange Record-I remembered having seen the heart of one that was bowelled as suffering for high treason, that being cast into the fire, leaped at first at least a foot and a half in height, and after by degrees lower and lower for the space (as I remember) of seven or eight minutes.-Bacon on Life and Death.

It can be safely asserted that the great bulk of the ills of life arise from ignorance and vice, and this is particularly true regarding disease. It has been repeatedly said, and with truth, that the best and greatest wealth is health; that health is the foundation of all temporal enjoyment; that it is the one supreme blessing accorded to man and that without it all else is without value. Yet modern life, with all its vaunted progress, takes less heed of the health of man than it does of his finances. Hundreds upon hundreds of volumes delve deeply into the realms of thought regarding financial problems, every nook and corner of the brain is made to exhaust itself in explanation of some gilded theory, while the study of health is viewed with seeming commendation, but without the intense teeming and pertinacious thought bestowed upon money. That Godgiven boon, health, is viewed as a secondary consideration until disease takes its place, and then, and not until then, is the bounteous richness of health appreciated. Colton says: "There is this difference between these two temporal blessings, health and money; money is the most coveted, but the least enjoyed;

health is the most enjoyed but the least coveted; and the superiority of the latter is still most obvious when we reflect that the poorest man would not part with health for money, but that the richest would gladly part with all his money for health." This may be true upon general principles; it may be true as a naked proposition, but in modern life the unbiased observer would, we think, come to the conclusion that health appears to be the least valued possession of man. System, application. and intensity from first to last, mark the study of the acquirement of wealth, while there are only isolated instances of the study of health. We have prime ministers and secretaries of finance in the interest of money, but none for health. Money is eternally and zealously guarded, while health is viewed as not precious enough to foster study, not important enough to be guarded by sustenance of government and continuous employment of intellect.

In this electric age of ours, tension, extreme tension, is our constant condition; the grinding wear and tear of intellect, the exhausting, ceaseless labor of mind, the continued neglect of muscular exercise, the faults of living, the emotional excitement of political and business interests, all are tending to cause diseased mental conditions. Health is only thought of when we are menaced by epidemics or when disease manifests itself with the rulers of a realm. Were but half of the thought given to a consideration of the health of man individually and en masse that is given to the acquirement of riches, the result would be a far-reaching benefit in the prosperity of nations. As Voltaire has said: "The fate of a nation has often depended upon the good or bad digestion of a prime minister," and it is likewise true that a nation must depend upon the healthful function of its citizens' brains and bodies for its perpetuity. It is a deep and unknown quantity but yet a readily imagined one, how fertile a cause unhealthy mentality is in the production of violence, discontent and revolution. There can be no doubt that faulty environment, unhealthy habits and the by-play of degenerate minds are potent factors in the production of emotionalism and when once this is created it readily leads to discontent of the masses, violence and revolution.

We believe that a judicious study of the

places, and the proper application of hygienic and preventive measures would result in less agitation. Certain it is that health of mind. and body lead, as a general thing, to healthful and normal products. We believe that nations can become diseased the same as individuals, particularly in a mental way and emotionalism incidental to the faults of civilization has shaken the foundation of governments more than once and will continue to do so until a proper study of health shall be indulged in. Again, we are of the opinion that the nation has not yet existed which has performed anything like its best function, for just so long as it studies and considers its monetary interests as more vital than health, just so long will all government be unstable, discontent continue, upheavals be frequent and wars of constant occurrence.

If man at large was treated with half the consideration that the breeder of cattle treats his cattle, the result would be of eternal benefit to nations and society. All nations which ignore the health of their people engender their own ultimate fate. Commercialism is cold and sordid and never has reached humanity enough to protect the people of a nation as it should.

Humanity, in administration of a nation's affairs, must consider health as a paramount object. Under the existing order of things, this is not done, hence disease-producing elements are rendered potent.

Iowa State Association of Railway Surgeons.

The third annual meeting of the Iowa State Association of Railway Surgeons will be held at Marshalltown, Ia., October 15 and 16, 1896.

There are about three hundred railway surgeons in the state and they should meet and become acquainted. If all will co-operate this can be made one of the best societies in the West.

A program will be prepared in September and we hope to publish a copy.

The following members are chairmen of their respective committees: Arrangements, H. L. Getz, Marshalltown; transportation, D. S. Fairchild, Clinton; Judicial, J. N. Warren, Sioux City.

Physic, for the most part, is nothing else but the substitute for exercise or temperance.— Addison.

Contraction of the Flexors of the Hand Cured by Shortening the Bones of the Forearm.

Contraction is caused by muscles which are too short in proportion to the distance between their points of insertion. Professor Henle of Breslau says that there are two ways of getting rid of this disproportion; either by lengthening the muscles or by shortening the bones. If the first operation is not successful, then try the second; the muscles that are not contracted will easily accommodate themselves to the shape of the bones unless the latter be excessively shortened.

Author operated upon a boy nine years of age, who had broken his forearm. The fracture united well in a plaster bandage, but the fingers and wrist remained contracted in flexion. If the fingers are bent the wrist can be extended, and if the wrist be bent, the fingers may be freely moved.

Áfter chloroform narcosis, author opened the arm over the point of fracture, and resected two cm. of both bones. Movement of the wrist was possible with extended fingers. The bones were then sutured.

A photograph taken three weeks later with Roentgen's apparatus showed an opening filled with callus. Massage was used. Five weeks latter consolidation was nearly complete. Later the fingers move freely and the wrist nearly so.-Centralblatt f. Chirurgie.

Treatment of Ankylosis of the Hip.

Lorenz (Berliner Klinik, June, 1896) is opposed to the practice of subtrochanteric osteotomy in cases of osseous ankylosis of the hipjoint. He asserts that by division of the femur below the trochanters, the malposition of the lower limb cannot be overcome without further shortening due to the angular bend of the shaft of the femur at the seat of section. A much better treatment, it is argued, is subcutaneous division by chisel and mallet of the osseous bond between the head of the femur or the remaining portion of the neck of the bone on the one hand and the external surface of the ilium on the other. The operation, as applied to the most frequent conditions of ankylosis of the hip, in which the head of the femur has been absorbed, is called pelvi-trochanteric osteotomy. Several advantages are claimed for this method. The osteotomy being what is termed a linear one, the external wound is very small, and the operation may be easily performed, and produces very little disturbance of the soft spots. As the correction of the deformity is affected by an immediate attack on the angle causing the malposition of

the limb, there is no interference with the shaft of the femur, the length and normal direction of which are still maintained. It is stated that no difficulty will be experienced in restoring the normal position of the limb if, at the same time, the adductors and the muscular and fibrous structures in front of the joint be divided subcutaneously. The relations of the surfaces of the divided bones to one another are very favorable to a restoration of the proper direction of the limb, whether this be fixed in a position of flexion, abduction, or adduction. The after-treatment in cases in which pelvitrochanteric osteotomy has been performed is extremely simple, as there is no necessity for long confinement of the patient, who, by the application of a plaster apparatus to the affected limb, and by elevation of the opposite foot on a patten, may be enabled to leave his bed on the fifth or sixth day. This operation, it is held, besides'effectually removing the fixed osseous deformity will, provided the after-treatment be carefully attended to, in all probability, result in the formation of a movable joint, and in the restoration of the seriously impaired muscular action of the limb. These conclusions are based on the results of six cases in which pelvi-trochanteric osteotomy has been performed by the author, full reports of which are given in this lecture.-British Medical Journal.

Death Under Chloroform.

J. Hopkins Walters, M. R. C. S., Eng., surgeon to the Royal Berkshire Hospital, has recently reported the following two cases, one of death and the other of threatened death while under chloroform, in the London Lan

cet:

Case I. A boy aged six and a half years was anææsthetized by chloroform on March 27, 1896, for the removal of tuberculous cervical glands. In other respects he seemed to be healthy and had returned only a few weeks previously after being five months at the seaside. The operation was performed at 10:30 a. m., a breakfast-cupful of beef tea having been taken at 8 a. m. in lieu of breakfast. The glands were large and numerous; the surrounding tissues were infiltrated and unusually vascular, rendering the dissection down to the sheath of the vessels delicate, difficult and prolonged. There was free hemorrhage, amounting, probably, to three or four ounces (but this is always most difficult to estimate; it possibly might have been more; not much). The operation was almost finished when sudden arrest of oozing from the raw surface was noticed to take place, while at the same moment the experienced anæsthetist who was kindly giving the chloroform drew attention to the patient's pallor. I give in my friend's

own words the notes he has made on the case: "The boy had been under chloroform for about forty-seven minutes, during which time he took the anaesthetic in a manner that gave rise to no more than ordinary anxiety. The first unfavorable sign noticed by me was a sudden and extreme pallor, not the bluish gray of respiratory failure, but a deathly whiteness. After a few seconds the breathing stopped. Immediately the radial artery was felt, but there was no pulse. The heart was auscultated, but there was no pulsation. Artificial respiration was at once performed, with the result that a very irregular sighing or gasping respiration was established. During the artificial respiration the air entered and left the lungs quite freely. The tongue was pulled out forcibly with tongue forceps and kept out while artificial respiration was maintained for three-quarters of an hour; nitrate of amyl was administered, and brandy and strychnia were hypodermically injected." In addition to the above friction was made over the heart while the head was depressed and the body raised, but all to no purpose. The child was dead.

The case of threatened death under chloroform presents similar features to the above fatal case, but was followed by a happier result.

Case II. A child aged seventeen months, the subject of large double inguinal congenital hernia, was put under chloroform for the operation of radical cure. The child took the anææsthetic well and was fully under its influence when the incision was made. Two sweeps of the knife were followed by the application of a sponge, and on making the third sweep I noticed that blood ceased to flow. Looking round I found the child deathly white and apparently dead. Neither radial pulse nor heart pulsation could be felt. Artificial respiration was at once performed, the pulse returned, and in a few minutes the child had so well recovered as to enable me to complete the operation I had begun. In consequence of this contretemps I decided to postpone operating on the other hernia until after recovery from this operation. Owing to a little gastric disturbance the second operation was not performed for two months, and previously to the chloroform being given I warned the administrator, who had also been the chloroformist on the former occasion, to take especial care on account of the previous narrow escape. At the same stage of the operation apparent death recurred in a manner precisely similar to the previous occasion, with like treatment and fortunate result, followed, as before, by completion of the operation. This time we all were quite on the alert, and were thus able to make sure that it was a case of heart failure, the pulse stopping before respiration ceased.

These two cases present the following iden

tical features: (1) both were children within the age at which chloroform can be given with the greatest immunity from accident; (2) auscultation indicated a sound heart in each case; (3) on each occasion a Skinner's inhaler was used; (4) in neither instance was the operation commenced before the conjunctival reflex had disappeared; (5) in each the first indication to the operator was blanching of the wound coincidently with the observation by the anæsthetist of sudden general pallor; and (6) uniformly the cause of death and threatened death was cardiac failure. The differences between the cases are that while the fatal case showed no unfavorable symptoms until the end of the operation the other exhibited them at the beginning; the one had taken a quantity of chloroform and the other little; the one had suffered loss of blood and shock from the operation and the other none. These probably were the determining factors between death and recovery. On comparing with the "respiratory failure" dictum from Hyderabad the statistics of the Lancet commission appointed to investigate the subject of the administration of chloroform and other anaesthetics from a clinical standpoint,* one is struck by the enormous majority of reported primary pulse failures, which, together with the numerous cases of accidents occurring in the very earliest stage of chloroform administration, indicate that much has yet to be learned of the causes of these calamities. The observations of Rosenberg and Guérin seem to throw on them some light, and their conclusion that respiratory and cardiac depression are due to reflex rather than direct action deserves careful investigation. Certainly, until such conclusion is negatived or confirmed, the suggestion to avoid nasal inhalation or to neutralize the local effect of chloroform by thorough cocainization of the nasal cavity is worthy of universal adoption. That ether is so much safer than chloroform as to outweigh the great advantages of the latter has still, I think, to be proved after the honest tabulation of its delayed disastrous aftereffects.

Report of Two Fatal Cases of Hæmaturia. ·

Dr. Thomas H. Manley of New York reports the following interesting cases in the Indian Lancet for April 1, 1896:

It is well known in genito-urinary surgery that the sources of hæmaturia are exceeding numerous, and, that it is a symptom of a vast number of various pathological conditions along the urinary tract. It is seldom, however, that mortal exsanguination directly follows from it, inasmuch as we are usually able *Reading:

to control or moderate it, by appropriate meas

ures.

But, one case of it has come under my care in the male.

The patient was a vigorous young man, a carpenter by trade, who had fallen from a staging, about forty feet and fractured the body of the second lumbar vertebra. When he entered the hospital he was wholly paraplegic.

Shortly afterward, the house-surgeon noticed that there was a marked distension in the hypogastrium, and watery blood was trickling from the urethra. In the meantime the patient. was deathly pale, with a thready flickering pulse, but, whether this was dependent on shock from the injury or the loss of blood was doubtful.

A catheter of larger caliber was now introduced into the bladder, when an enormous quantity of urine, thickly mixed with clotted and pure arterial blood issued through. In fact, fresh, warm blood continued to flow away after the urine was evacuated. Acided, acidulated drinks and stimulants were given, the bladder washed out with astringent solutions and ice applied over the loins.

The bladder soon filled again, and unconscious to the patient the discharge of blood recommenced from the penis. The housesurgeon now "rattled," tied a string around the root of the penis and sent for me. About an hour later, when I arrived, the patient was near the moribund state. The bladder had distended again, so that its summit reached the umbilicus. Over the region of the left kidney there was a tumor, fairly well defined, that produced a distinct bulging.

It was now evident that there was an extensive renal laceration of the cortex. It was evident too, that his only hope now lay in an immediate nephrectomy.

It was a serious question, though, if he now could survive this operation, which, in his sinking condition, might be impracticable, without serious consequences. After the various aspects of the case were submitted to him, he declined to undergo it. It was fortunate he did not, for he soon showed signs of approaching death and sank six hours later. His family peremptorily denied us the privilege of an autopsy.

This case, now on the records of Harlem Hospital, was entered on the 5th of November, 1892, in the surgical division, then in the immediate charge of Dr. Frank Hammond, the resident house-surgeon, and is recorded here, as a contribution to the literature of fatal traumatic hæmaturia, of a renal origin, dependent on spinal fracture.

The woman whose case will now be related, succumbed, from hæmaturia of pathological origin, in the bladder. She had cancer. In the vast majority of cases of cancer when the