growth does not start from, or impinge on some tubular structure, the integrity of which is essential to life, pain, loss of rest, etc., tends to cut off the afflicted part, but in the majority of cases, copious and oft-repeated hemorrhage does the fatal work of devitalization. In this case it did it with surprising swiftness.

On the morning of February 5, this year, Dr. James Moran of this city, called me in consultation to see a woman, whom he first saw early the evening previously.

She was of Scotch birth, medium size, rather spare build; she was 61 years old, a widow, who had given birth to seven children, at

term.

There was no history of malignant disease in her family, and she, herself, had always enjoyed fairly good health, up to the present time. For about two months before she had experienced more or less smarting in the bladder on urinating, and lately, had more or less straining and tenesmus, after voiding her urine.

Until the evening before, she was never aware of having passed blood in micturition. She had called the doctor because, in yielding to a desire to urinate she had passed but a few drops, when the flow ceased, and this was soon followed by the most acute vesical distress. The doctor on catherization evacuated more than a quart of urine, loaded with clots, and intermixed with bright colored blood. This brought immediate relief. Three hours later, at II o'clock, he was again hastily summoned to her for further aid; as she was again suffering from the same ensemble of symptoms.

This time the quantity of urine drained. away was less, but it was so thickly intermixed with blood-clots, that it was with difficulty conducted through the catheter.

Chloroform Narcosis and Albuminuria.

V. Friedländer (Vierteljahrsschrift f. gerichtl. Med., Dritte Folge, Bd. viii, Supplement. Heft p. 94) investigated the urine of 100 male patients before and after chloroform narcosis, with reference to albumen and nucleo-albumen. Sixteen cases showed normal urine before and after anæsthetization, the narcosis having lasted thirty minutes to two hours. Thirty-seven cases, in which the urine, before narcosis, was normal, showed afterward an albuminuria which almost invariably lasted only a short time. Forty-seven patients had a slight degree of albuminuria already before narcosis; in 22 no difference in the amount of albumen was noted afterward; in 9 cases the albuminuria was lightly increased; in I case a pathological urinary sediment was passed. In 7 cases the amount of albumen diminished or disappeared completely. This occurred also

in 6 cases in which there was a considerable amount of albumen in the urine before narcosis. The urinary sediment, which was found in 17 cases, consisted of casts and renal epithelium. The author considers that the alteration of the kidney is a tissue lesion which removes the power of inhibiting the loss of serum albumen, the causes of which lie in the poverty of oxygen in the blood, the destruction of blood corpuscles by the chloroform, the injury to the tissues by the liberated chlorine, and lastly, the lowering of blood pressure. As evidence for the occurrence of a tissue lesion, the author regards the fact that in 44 out of 56 cases investigated upon this point, after narcosis, the urine contained nucleo-albumen. -British Medical Journal.

Case of Sternal Dislocation of Second and Third Costal Cartilages and of Clavicle, with Fracture of Fourth and Fifth Cartilages.

Dr. Andrew J. McCosh of New York, surgeon to the Presbyterian hospital reports the following interesting case in a recent number of the Annals of Surgery: A man thirty-five years of age, was admitted to the Presbyterian hospital, February 21, 1895, who, in an attempt to jump onto the front platform of a slowly moving horse car, had slipped, and being caught between it and an iron pillar had been crushed and rolled between them, the space being six inches wide. The patient was a large man, his chest measure being forty-two inches. He fell to the ground and the car was thrown off its track. For a minute or so he was stunned, and then rose, entered another car, and managed with great difficulty and suffering to ride to the hospital, the distance of a mile. On admission it was evident that his distress was very great. He was suffering from severe dyspnoea and was markedly cyanotic. Every respiratory movement caused intense pain. He had frequent cough with bloody sputum. He could not lie down, but sat up in bed. Pulse 140; temperature 100° F.; respiration 48. Urine contained a trace of albumen and of sugar; specific gravity 1030. On examination there was subcutaneous emphysema of the neck and upper anterior part of the chest. On inspection it was seen that the clavicle and upper ribs were jammed backward. On passing the finger along the left border of the sternum it was found that the clavicle, second, third, fourth, fifth, and possibly the first ribs had lost their attachment to that bone and were dislocated backward and inward. The clavicle was displaced upward well above the top of the sternum and inward one and a half inches, where its sternal end pressed against the trachea. The second, third, fourth and fifth ribs were

displaced backward and inward, so that their sternal ends were situated opposite the middle of the sternum (inward displacement one inch), and about two inches behind that bone. The exact position of the first rib could not be ascertained. The depression for the second and third ribs on the left border of the sternum could be distinctly felt, and it was evident that the costal cartilages of these two ribs had been dislocated from the sternum, and apparently were still attached to the ribs. The sternal facets for the attachment of the fourth and fifth ribs could not be felt, but in their place attached to the sternum was felt a projecting piece of cartilage about half an inch in length. It was evident that these two costal cartilages had been fractured near their middle, and one-half remained attached to the sternum, while apparently the other half remained on the end of the rib.

The sternal end of the clavicle was raised without much difficulty onto the anterior surface of the sternum. This gave marked relief. It was necessary to hold it in this position during the further manipulations, as it was easily displaced. Attempts were then made to spring the ribs into position. The shoulders were pulled back and the spine hyperextended, both by steady pressure and by jerks. These attempts caused pain and were only partially successful. The inward The inward displacement could be reduced, but the backward could not be perfectly corrected, a displacement of half an inch still persisting in spite of the use of very great force. In order to keep the shoulders back, and thus reduce the deformity, various appliances and bandages were employed, but all they caused so much distress and so increased the cyanosis of the upper extremities that after repeated trials they were abandoned, and the patient was left sitting up in bed against a bed-rest with a pillow between his shoulders, and with the caution that he should keep them as far back as possible. He faithfully followed out the order, and he also found he was more comfortable in this position.

February 22. Distress and dyspnoea during the night had been great. Cough almost constant with bloody expectoration. Temperature 100° F.; pulse 130; respiration 24 to 36. Arms were tied behind, the pillow pressed into the hollow of his back.

February 23. Temperature 101° F.; pulse 124 to 140; respiration 46 to 56. Subcrepitant râles over left chest. Dyspnoea and cough

severe.

February 24. Temperature 100° to 102° F.; pulse 130 to 136. Delirious. Consolidation of entire left lung and effusion in pericardium.

February 25. Temperature 100° to 101° F.; pulse 120 to 130; respiration 34 to 44.

February 26. Dyspnoea less. Temperature 101° F.; pulse 124; respiration 32 to 40. Pericardial effusion diminished.

February 27. Temperature 100° F.; pulse 112; respiration 32 to 40. Less cough; more comfortable; lung clearing.

March 1. Steady improvement. Temperature 99° to 100° F.; pulse 110 to 120; respiration 30 to 36.

March 5. Temperature 99° F.; pulse 110; respiration 28. A broomstick handle was placed through his elbows behind his back. Cough almost disappeared. Dyspnoea slight; appetite good; free from pain. Clavicle retains its position on anterior surface of sternum, and ribs remain displaced backward for a distance of one inch.

His pulse, temperature and respiration soon sank to normal. He sat up night and day with the staff behind his back and through his elbows, which were bandaged to it. On March 8 he sat up in a chair. On March 23 he began to walk. On April 5 he was allowed to pass part of the day without the staff. The ribs and clavicle seemed firmly fastened in their new situation. There was no pain on manipulation of his chest. His general health was excellent. No cough. On April 6 he was discharged cured. On May 1 he was able to resume his work, and since that time has felt perfectly well. He suffers no pain, and would not know that he had been injured except when he attempts to lift a heavy weight, when he feels some weakness of the left side of chest.

Removal of the Entire Clavicle for Osteomyelitis; Complete Regeneration of the Bone.

At a recent meeting of the New York Medical Society, Dr. F. W. Murray presented a boy, fourteen years of age, with the following history: In May, 1895, he accidentally fell from a canal boat into the river, and was thoroughly chilled through. A few days afterward pain set in over the outer end of the left clavicle, febrile symptoms soon followed, and an acute osteomyelitis of the bone rapidly developed. In June he entered St. Vincent's Hospital, where the abscess was opened and the bone was scraped. In August he entered Dr. Murray's service at the New York Hospital. His general condition was fair, the local symptoms had abated, and three sinuses were to be seen leading down to the diseased bone. One was situated over the acromial end of the bone, another just above and a third just below the center of the bone, and each sinus was discharging a moderate amount of pus. With the probe it was ascertained that practically the entire bone had been denuded of its periosteum, and that it was a case of total necrosis. Under ether the entire bone was exposed through an incision extending from its acro

mial to its sternal end and was easily removed. The periosteum was covered with a layer of granulations of unhealthy appearance, and at one point on its under surface a small amount of new bony tissue had formed. The granulations were thoroughly curetted with a Volkmann's spoon and the wound packed with iodoform gauze, which was allowed to remain for a few days and then removed. The wound healed steadily and rapidly and the boy was discharged at the end of September with all the evidences of the formation of new bone. The boy did not appear again until two weeks ago, when it was found that an entire new bone had been reproduced. It is thicker than its fellow on the right side and there is some upward displacement at its acromial end. The left shoulder is slightly lower than the right, but the functions of the joint are perfect. There is a wing-like projection of the lower part of the dorsal border of the scapula, but it causes no interference with the motions of the arm and shoulder. While in the hospital the arm and shoulder were kept in proper position by a sling and bandage applied as in cases of fracture of the clavicle, and on his discharge the boy's parents were instructed to see that this position was maintained for several weeks. The instructions were neglected, and this fact may account for the slight drooping of the shoulder and the projection of the scapula at its inner border. Five years ago Dr. Murray exhibited a similar case, where he had moved the inner two-thirds of the clavicle for necrosis, following acute osteomyelitis. In this case, also, new bone was rapidly formed and the result was perfectly satisfactory.-Annals of Surgery.

Local Peritonitis.

re

Robinson (New York Medical Journal, January 25, 1896) concludes an investigation of local peritonitis as follows:

1. The local peritonitis of adults is hardly every directly fatal, but may produce a train of symptoms, such as indigestion, malnutrition, anemia and neurosis.

2. The peritoneal adhesions which demand operation belong almost exclusively to those involving the organs of high mobility and peristalsis, such as the small intestines, the sigmoid, the bladder and the Fallopian tubes (especially amputated ones).

3. Local peritonitis occurs at fixed bowel flexures, and at the longest range of muscular action associated with the peritoneum.

4. The etiology of the adult local peritonitis is infectious invasion through the gut wall.

5. The methods of transmission of infection are through abrasion of the mucosa aided by the trauma of muscular action on a bowel containing pathogenic microbes.

6. Local peritonitis does not occur in infants at bowel flexures, or especially over the long range of muscular action.

7. It is extremely rare to see an adult with a normal peritoneum, i. e., free from peritonitis.

8. The constant adhesions found around the gall-bladder and ceco-appendicular apparatus teach us that operations in these regions cannot be justified merely on account of the adhesions.

9. Adult local peritonitis seems to increase with age.

10. Peritonitis is nature's method of repair and prophylaxis. Peritonitis saves life, while infection kills.

II. Peritonitic adhesions seem to be able to organize and appear and act like normal peri

toneum.

12. Local peritonitis occurs chiefly in the dorsal region, at the points where the mesenteries fix the digestive tract and close to the highest range of muscular action. Muscular trauma, abraded epithelia and infection tell the tale.

13. The track of the infection from mucosa to serosa cannot always be traced. A healthy mucosa (and even muscularis) may underlie many peritoneal adhesions, or a healthy serosa may be adjacent to diseased mucosa.

14. The dense adhesions of local peritonitis may result in strictures, malignancy, dislocated viscera, pain, restriction of peristalsis and immobility of organs-disease.

15. The peritoneum may have its endothelium abraded traumatically by muscular action, and the resulting healing be cicatricial; the matter of local peritonitis being a slow, gradual, evolutionary process of adult life.

Dr. G. T. Vaughan, Surgeon United States Marine Hospital Service, gives this description of the Dome at Bremen: "The Dome is an interesting structure, not only on account of its thousand years of existence, but from the peculiar properties possessed by an anti-room, namely, that of preserving animal bodies indefinitely. This room, built of stone, is some 30 or 40 feet in length, 15 or 20 feet wide, with an arched ceiling about 15 feet high. The air felt damp and cool. Its peculiar properties were accidentally discovered about four hundred years ago when a body placed there was found, after a long time, well preserved. Since then other bodies have been added, until there are fourteen in the chamber. The bodies are not specially prepared before being placed in this room. Every year the bodies of animals, as cats, dogs and birds, are placed here in order to see if the preserving property is still retained. They simply dry up without odor.-Marine Hospital Service Report, 1895.

Notices and Reviews.

BOOKS AND PAMPHLETS RECEIVED.

"The Western Medical Review" is a new candidate for favor in the field of medical jour nalism, and if we may judge from the copy which has reached our table, it promises very well. Number 2, volume 1, contains six wellchosen, original articles; an able editorial and a large number of interesting miscellaneous items. The Review is issued from Lincoln, Neb.

"A Treatise on Appendicitis." By John B. Deaver, M. D., Philadelphia. P. Blakeston Son & Co., 1896.

"Vaginal Stenosis and Atresia, with Report of a Case. By Edward H. Lee, M. D., reprinted from Medicine. July, 1896.

"Bassini's Operation for Inguinal Hernia put to the Crucial Test." By E. J. Senn, M. D. Reprinted from the Journal of the American Medical Association, May 2, 1896.

Perhaps the very newest medical journal which has come to our table is the "Laryngoscope," a monthly journal devoted to the diseases of the nose, throat and ear. It is ably edited by Drs. Frank M. Rumboldt and M. A. Goldstein of St. Louis, with the aid of ten associates. It is a handsome journal, the paper and press work are excellent, the articles well selected, and we wish the new venture success.

Manual of the United States Hay-Fever Association for 1896, containing a report of the annual and adjourned meeting of 1895.

COLOR, VISION AND COLOR-BLINDNESS. A Practical Manual for Railroad Surgeons. By J. Ellis Jennings, M. D., lecturer on opthalmoscopy and chief of the eye clinic in the Beaumont Hospital Medical College of St. Louis, etc. Illustrated; cloth, 109 pages. Philadelphia: F. A. Davis Co., Lakeside Bldg., Chicago, 1896.

This very interesting work is intended to aid the railroad surgeon in his examination of the employes of the transportation lines for the detection of color-blindness, and as such will meet the end it has in view. It will also be found instructive reading by the general practitioner. The author has taken pains to present the theories of the leading investigators of this subject, and their methods of detecting color-blindness, and has succeeded in compiling a manual which will commend itself

to all who read it. The historical sketch in the first chapter is a pleasant introduction to the subject. Chapters two and three are devoted to the physiological anatomy of the retina, and the physics of light and the sensitiveness of the retina to color. Chapter four treats of the theories of Young, Helmholtz, Hering, Preyer and the correlation theory, as expounded by Oliver. Chapter five is given to the classification of color-blindness, with its frequency dangers and the laws of heredity. Chapter six gives the methods of Holmgren, Thompson, Oliver and the author for detecting color-blindness. Chapter seven explains the tests for the quantitive estimation of the color sense. Chapters nine and ten are devoted to the Pennsylvania Railroad company's instructions for the examination of employes as to vision, color-blindness and hearing, and to a description of Oliver's series of tests.Guilford.

We clip the following from a metropolitan paper:

"A cure for Apoplexy.-The Furet de Londres informs us that a German doctor has hit upon the following expedient to cure apoplexy, namely, to apply three or four brisk slaps (de frapper fortment) on the cheeks of the patient."

Slepidum caput! Verily, this looks like a dead sure cure, and doubtless is as equally effective as to pull just three hairs out of the extreme end of the tail of the gay, graceful and plethoric hippopotamus in order to cure "hippop" of an inflammation of the brain.

The rich patient cures the poor physician much more often than the poor physician the rich patient, and it is rather paradoxical that the rapid recovery of the one usually depends upon the procrastinated disorder of the other. -Colton.

A popular physician is a very important member of society, considered merely in a political view. The lives, limbs, health and spirits of a great part of the subjects of a kingdom depend upon his ability and honesty.Knox.

Bob Bowdry used to say, when passing a chemist's shop, that he could always tell whether the medicine which was preparing was for a rich or poor man. If for the former the pestle would move slowly and said: "Linger longer, linger longer." If for the latter, however, it would travel "at the devil's own rate," saying: "Die and be d-d, die and be d-d."-(An old print.)

Miscellany.

Modern Medicine says: "A late English medical journal reports that Mr. Waterhouse has recently succeeded in constructing a new heel-bone from the collar-bone of a sheep! This is certainly a most astonishing achievement, as it includes not only the constructing of the heel-bone for the man, but a collar-bone for the sheep also. Our English cousins, with their superior advantages for medical learning, ought certainly to know that the sheep has no collar-bone." This reminds us of that anomalous anatomical proverb which says of a tardy person: "He has three hands, a right, a left and a little behind hand.”

A new method of wound treatment has been suggested by Salzmann, it consisting in application of protecting capsules of celluloid, made of a size and shape corresponding to different portions of the body. They are transparent, prevent pressure upon the wound, keep it clean and act as a warm, moist dressing. When applied securely by means of good, adhesive plaster, they are said to make every other form of dressing superfluous.

A Novel Remedy for Drunkenness.

An American journal contains a new remedy, proposed by Dr. Brincil of Philadelphia, for curing habits of intemperance. The first experiment he tried was on a man who was in

the habit of drinking two quarts of rum daily, besides four quarts of porter. The man's wife was advised to put a dram of oil of vitrol in a pint of rum, which was done, and it produced a species of nausea and disgust at liquor. Having symptoms of mania é potu, opium was administered to him with success. On the recurrence of his desire for liquor recourse was again had to the acid, which at length effectually prevented every relish for spirits in future. Dr. Brincil adopted the same system in several other instances of habitual drunkards with

equal effect. He also found that tincture of ipecacuanha produced similar effects. From an old London newspaper.

An Advance in Roentgen's Photography.

Professor John MacIntyre writes Nature. that he has been pursuing the study of photography of the soft tissues in the living subject, and made attempts to see shadows thereof in the fluorescent screen. Success attended his efforts as regards the neck, the tongue, hyoid bone, larynx, etc., and recently he has been able to photograph and see shadows of the cardiac area. In one photograph taken, the diaphragm was clearly indicated. The

pyriform shape of the cardiac area is well shown, the base downwards, apex upwards, and the right and left borders of the photograph showing the relationship of the spine and ribs.-The Medical Age.

Silkworm Gut Sutures Left Two Years in a Cervix.

Dr. H. J. Garrigues, writing to the Clinical Recorder, says:

"I was recently consulted by a patient because she had not had her menstruation for three months. In making a vaginal examination, I found a pregnant uterus of corresponding size, but on either side of the cervix were felt two silkworm gut sutures. They had been forgotten there two years before when a trachelorrhaphy and colpoperineorrhaphy had been performed on her. She had never been inconvenienced by them. They were easily removed, and were found as fresh as when they were inserted. They had not given rise to suppuration, and illustrate the excellence of this material.

"On another occasion I removed a silk suture from the cervix, where it had stayed for six months, but that had given rise to a profuse suppuration, which brought the patient to seek advice."

Lung Surgery.

Péan (Presse Médical, October 23, 1895), in concluding a lengthy address on the surgery of the lung, gave the following results of his

personal experience, and of his study of the

numerous published reports on this subject:

viscera, has of late made much 1. The surgery of the lung, like that of the progress, thanks to the perfection of our anatomical knowledge, and to the improvement in operative procedures for the arrest of hemorrhage.

2. Equally favorable conditions for surgical intervention do not occur in all affections of the lungs.

3. Wounds caused by contusing bodies, by stabbing and cutting instruments, and by gunshot projectiles of small and medium caliber usually heal well without causing suppuration or troublesome reaction.

4. The danger which results from such injuries is due, not to the injury of the lungstructure itself, but rather to the multiplicity and extent of the wounds and to the lesions of important neighboring parts.

5. The surgeon should not intervene too hastily in these injuries, either by making a simple exploration, or by attempting to extract a projectile which can be seen near the surface.

6. Large projectiles, such as fragments of shell, give rise, especially on the field of battle, to disorders which in a large majority of instances are so severe that it is impossible for