corporate limits" than any other city twice her size in population in this country. On arriving in this city of surgeons the patient fell into the hands of one whom I judge, from his diagnosis and treatment of this case, to have been entirely ignorant of its true character. In this day of our surgical civilization any physician or surgeon who is found so lacking in ability as to be unable to diagnose a sinus from a cancer, and sits by for days and weeks and applies his caustic paste cannot sufficiently be condemned. It was the fate of this old battlescarred veteran to fall into the hands of one by whom this cauterizing process was carried on for weeks with unsurpassed energy, under the impression that he was burning out what he called a spider cancer of the face.

As he failed in his efforts to accomplish a cure, he finally advised the patient to return to his home in this city, as he could treat him there as well and with less expense. The patient, on arriving home, consulted me at my office on the 31st of May, 1894, and on examination of his face I saw at a glance that he was not suffering from cancer. On passing a probe I soon brought it in direct contact with dead and detached bone. Now, with the free use of cocaine I was able to scrape away with a sharp spoon all of this dead material, thus exposing and opening up the posterior ethmoidal cells, as well as the floor of the skull, This accomplished, the dura was exposed, which was much thickened, the result of the long continued inflammation. I now exerted some slight pressure with the tip of my finger on the presenting portion of the brain, and, much to my surprise, a little bloody pus was discharged through a small opening in the brain. I now passed a small probe into this opening some distance, when it came in contact with a hard substance. Now believing that I had a bullet to deal with, I took a pair of Péan's forceps, passed them into this opening and laid hold of this foreign body and drew it out. It proved to be a piece of pine wood measuring in length one and one-fourth inches, by one-third inch in thickness. On removing this body the flow of blood was fearful and could only be controlled by packing the opening in the brain with gauze. This tampon was allowed to remain in situ for twenty-four hours, when it was removed and the parts washed out with plain, clean water. I now inserted a small piece of gauze well into the wound for the purpose of securing free drainage. This method of treatment was carried on for several days, and finally the opening in the brain contracted and pus ceased to discharge. The soft parts were now brought together by means of adhesive plaster and within ten days the external wound had closed. Now comes a very peculiar point in the pathology of this case. Thirteen days after the removal of

this piece of wood from the brain the patient, while sitting in a chair, was seized with paralysis, affecting the same side of the body from which it had been removed. The paralysis was not complete; he could walk by dragging his leg along, while his arm would swing by his side. His intellect was not disturbed; his speech was somewhat thickened, and he found it a difficult matter to express himself to use his own language-the wrong word was always in his mouth. With this turn of affairs the patient began to look upon the dark side of life and expressed a desire to go and live with his brother in St. Louis. Since his departure from this city I have had no communication with him, although a friend of his has received a letter, in which he states that he has fully recovered the use of his limbs and desires to return to this city and engage in his former work. International Journal of Surgery.

Silver as a Suture Material.

Dr. Credé of Dresden, before the last meeting of the German Surgical Congress, stated that, having visited the clinic of Dr. Halstead of Baltimore, his attention was called strongly to the qualities of silver as a suture material. The fact that his father had recommended silver nitrate as a preventive of ophthalmia neonatorum, also stimulated him to make experiments for the discovery of such silver salts as would best answer the purposes of antisepsis. He has found two salts which seem to fulfill the requirements in a remarkable manner. The first is a combination of silver with lactic acid, which dissolves in the tissue

juices, forcing its way into the tissues roundabout, and as a result acting in a deleterious manner upon the bacteria that lie at a little distance. Silver lactate, called actol by the discoverer, has an antiseptic power equal to four or five times that of corrosive sublimate, but inasmuch as it irritates somewhat when introduced directly into the tissues and produces some pain in sensitive patients, another silver salt has been prepared-citrate of silver, known to the trade as itrol, which dissolves only in the proportion of 1 to 3800, and consequently acts even in small quantities for a long time. It is colorless, non-irritating, odorless, finely pulverized, permanent, and possesses evidently the same antiseptic power as the lactate of silver. Credé has used these salts for seven months in the surgical section of the Carola House, of Dresden. Four hundred bed-ridden patients and one thousand ambulatory cases have been treated therewith, so that he is able to affirm that the silver treatment has been sufficiently tried and in all essential points is worthy of professional trial. He uses the remedies for impregnating gauze

and suture materials as well as for powdering the skin about wound-edges. The itrol is especially useful for impregnating sutures, since it only acts when bacteria cause an increase in wound exudate which dissolves the silver salt. Upon decomposition the itrol acts as a strong antiseptic.

The Progress of Surgery.

At the recent meeting of the Missouri State Medical Society, Dr. Jabez N. Jackson of Kansas City read the report of the committee on "Progress of Surgery." It was chiefly an appeal in favor of conservatism and of fewer operations. There has undoubtedly been an excess of zeal, especially on the part of inexperienced operators; it has only too often been the object of the rash surgeon to merely prolong life or even to obtain a desirable "specimen"-without due regard to the future of the patient. Every operator should have three things in view: (1) To save life. (2) To preserve function. (3) To conserve form. In brain surgery not as much is now being done as some two or three years ago; and it is better so, since incurable conditions were attacked by over-zealous enthusiasts; such operations have greatly advanced our knowledge of pathology, but have not proven of therapeutic value. In epilepsy it has been proven that excision of the cortex is of no benefit, except in a very few cases of the local or Jacksonian variety, and even here the resultant scar has often proven as bad as the original lesion in producing the epileptic seizures. But tumors having epilepsy as a symptom should be removed. Traumatic epilepsy should be prevented rather than cured, as late operations have not been followed by cure in as large percentage of cases as was hoped would be the result. In microcephalia operation is once more receiving attention, as it has been found that operation has a good disciplinary effect upon the parents or guardians of the idiots, and in this way considerable benefit is ultimately obtained; but it is doubtful if it is advisable except under unusual conditions. In abdominal surgery there have been entirely too many exploratory sections, by amateurs; such operations should be done only by the masters, and in cases of extreme doubt; the average surgeon should not enter the abdomen unless he knows exactly what the condition is and that he is capable of properly treating it after opening the belly. In fact, there are entirely too many attempting to do abdominal surgery; the time has now come to call a halt and to say emphatically that the ordinary doctor should not attempt to do any abdominal surgery excepting emergency work; chronic cases should be referred to the skilled specialist in surgery. In appendicitis there should be more medicine and less surgery, unless expert operators and

experienced ones are at hand; but the tendency is perhaps just now a little too strong to drift back to the do-nothing plan; this also is extremely wrong-worse even that indiscriminate operating-and is to be combatted; the happy mean should here be the rule. Extirpation of the uterus also seems about to be carried to an extreme, especially in inflammatory disease which ought to yield to less radical measures; neither the uterus nor its appendages should be removed for pain alone; ovaries should not be removed save for gross lesions. Hysterectomy for fibroids is to be condemned unless the tumors are causing serious trouble or are liable to do so soon. Conservative, or at least non-mutilating operations upon the female pelvic organs are gaining groundsuch as resection of the ovary, drainage instead of removal of diseased tubes, myomectomy rather than hysterectomy, vaginal drainage in pelvic abscess and some forms of extrauterine pregnancy, currettage instead of salpingectomy in chronic inflammatory but non-purulent disease, removal of an ovarian tumor without sacrifice of the ovary and tube, etc.; and they have much to commend them.-Medical Fortnightly.

The Strengthening and Sterilization of Catgut.

Dr. Donald B. Pritchard of Winona, Minn., writing to the Medical Record, says:

Having seen in some sample journal a two or three line item recommending the preparation of aseptic catgut by first treating it with formalin and then boiling, I thought it worth while to try it. Being much pleased with the result, it would seem but proper that I should bring it more generally to the notice of the profession. After trying various strengths of the formalin, I find the twenty per cent to be the most satisfactory, leaving the gut immersed in it for three and one-half hours. It should then be at once transferred to boiling water for fifteen minutes or longer, if one so desires, when it will be found in excellent condition. Raw gut that bears a weight of thirty pounds will after the formalin treatment lift twenty-six pounds, and boiling it for fifteen minutes does not weaken it. It is curious that the gut which has been prepared for several weeks seems to become nearly as strong as the original raw article.

If one wishes to boil it on spools, care should be taken to wind it very Joosely, as it swells and contracts during boiling and might easily be broken. The better plan is to prepare it before winding on spools; then with aseptic hands it can be made ready for storing away in alcohol for future use.

One day I left some gut in the formalin for eight hours and found it rotten. It would lift but six pounds. After boiling for fifteen min

utes I was surprised to find that it would bear a weight of sixteen pounds before breaking. So far as I can ascertain, twelve minutes is the longest time that bacteriologists consider that anthrax spores can resist boiling water. Surely, then, fifteen minutes' boiling ought in every instance to render catgut sterile.

Fracture of Skull; Prolonged Unconsciousness, With Probable Laceration

of Brain.

The following interesting case is reported by Dr. H. Morell of Slayton, Minn.:

On April 27, 1895, G. N., aged 13 years, a large, strong boy for his age, while riding was thrown from a horse, and it is supposed that the animal rolled on him. He was carried to my surgery about half an hour after the receipt of the injury, in an unconscious condition. The pupils were equal, there was hemorrhage from the nose, breathing was easy and pulse 130. The forehead was bruised and was swelling rapidly; nose and upper lip contused. He was sent to his home on a stretcher, where he was undressed and wrapped in warm blankets, his head shaved, and ice applied, with warmth to the feet. He lay in a semiunconscious condition all day, passing water involuntarily. He did not speak when spoken to, but if roused would seem to understand. He vomited four or five times.

April 28: Patient's condition practically unchanged. Examination of the head showed no depression. From the severe bruise on the forehead, he seemed to have fallen directly on the frontal bone on the left side. Another physician was called in, who agreed with me that bleeding was indicated, and it was done to the extent of sixteen ounces, from the right arm. After this there was marked improvement; the pulse was softer, and he answered a couple of questions in monosyllables. The pupils were equal and reacted to light. At this stage another surgeon was called, who approved of the treatment but gave a dubious prognosis.

April 29: Patient still unconscious. The bladder was emptied, as he had not passed urine for some time. The integument over the eyes was puffy and extravasation of blood beneath the conjunctiva well marked. At 2 p. m. he seemed more conscious and opened his eyes occasionally; pulse 74; respiration 20; temperature not taken. At 5 p. m. he was restless; injection into the bowel was given, which was followed by a movement. Cracked ice was given and relished.

April 30: Condition improved. He seemed to take more notice of his surroundings; took nourishment well, as beef-tea and iced milk; rested better than since the injury.

May 1: Took nourishment well, as beef tea and iced milk; rested well; seemed to un

derstand what was said to him, but would not answer questions.

May 2 and 3: Condition the same; no improvement.

On the 5th 2 grains of calomel were given; in the evening the bowels moved, after an injection. Patient seemed conscious; opened his eyes, but would not speak.

May 20: Up to this date the patient had gained physically every day, but mentally there was not much improvement. Sometimes when spoken to he would answer very slowly, then immediately cry.

His parents took him to St. Paul for two or three days, and when he returned the change in his mental condition was remarkable. He seemed as well as ever he was. Up to the present time, nearly a year, he has been perfectly healthy mentally and physically.

The above is an interesting case from a clinical point of view. In my mind there is no doubt that this patient suffered from a superficial laceration of some of the frontal lobes of the brain. Authorities maintain that in those cases where consciousness is delayed over twelve hours there is more or less bruising and laceration of the cerebral substance. It is plain that the laceration occurred exactly at a point underneath the point where the frontal bone was struck, i. e., the orbital plate of the frontal bone; at the same time, possibly, the ethmoid and sphenoid bones were fractured. The bleeding from the nose and ecchymosis of the lids seemed to confirm this. The aphasia also seems to show that the lesion was in that region, pointing to the inferior frontal convolution of the left side. Again: cerebral irritation usually follows blows on the forehead, temple or occiput, the symptoms of which were so well marked during this patient's illness, as great restlessness, eyelids firmly closed, irritability of mind shown by frowning when spoken to in a loud voice, and when convalescent crying at the least provocation. Medicine.

The Illinois Steel Company has constructed a very complete and elaborate hospital at their South Chicago works, that will accommodate about fifty patients. In its construction the most modern ideas have been embodied and it stands to-day as probably the most satisfactory building of the sort in this or any other country, its purpose being to meet the emergency cases that arise among the thousands of operatives in this enormous plant. It is under the immediate care of Dr. James Burry as chief surgeon for the company, and an able staff of assistants. It was opened October 5 and a very pleasant opportunity was afforded a number of medical gentlemen of Chicago to see the building. They were particularly struck with its novel heating and laundry apparatus.

Notices and Reviews.

"A Treatise on Appendicitis," by John B. Deaver, M. D., surgeon of the German Hospital, Philadelphia. 32 full-page plates and other illustrations. Philadelphia: P. Blakiston, Son & Co., 1896.

A new work on appendicitis at this time is received with open arms, so to speak, by the medical profession. There is no disease which is claiming more attention at the present time and which is fraught with more serious dangers, and, withal, is so erratic in its course, as the one presented in this book. Every practitioner has felt the want of a clear, concise, systematic treatise on this subject, and I suppose that each of us have formed a mental opinion of what such a book should contain. The author of this volume has treated over five hundred cases of appendicitis, upon which clinical experience he bases the opinions expressed in his book. Such a large experience, should, indeed, place a man of Dr. Deaver's close observation and faithful devotion to details in a position to teach all of us something, if not much, about this varied and dangerous condition.

While it is really a pleasure to read the book, and I think one derives considerable benefit from the perusing of the various pages and from the study of the numerous illustrations, we are impressed with the fact that the work is particularly free from argument and that the author simply states his position, leaving the reader to accept it without any reasoning on his part. In a book pretending to be a treatise on such an important subject, and one concerning which there are so many different views, it would appear to the student of the subject that an author should give us argument, and where justifiable, conclusions. A careful study of five hundred cases should have enabled the author to give us some very valuable data in support of the conclusions. which he has stated.

Dr. Deaver is known as an advocate of early operative treatment of this condition, but unfortunately this book does not convince us that such a course is always the best one to pursue. We need a great deal of light on this subject, and the sooner our writers give us the detailed results of their observation, the

safe conclusions. A mere statement of conclusions at this time is not warranted by all of the facts thus far presented.

The great questions of when to operate and the relative advantages of early and late operations, the mortality of non-operative cases and the dangers of recurrence, are still open for discussion, and there are others upon which we not only need light, but also safe and definite conclusions. While it is true that this book will serve as an addition to our literature on the subject, it must not be considered as a complete treatise carrying with it the authority of the present knowledge of the subject, but rather the opinions of a single surgeon. Most operators will take serious exceptions with the author concerning the advisability of the invariable removal of the appendix in all cases of appendicular abscess, even in skilled hands. There can be no question but that the subsequent removal under aseptic conditions will enhance the patient's chance for recovery.

As a product of the printer's art this book. is certainly to be admired. The colored illustrations are, however, too highly tinted and present an exaggerated appearance, which is detrimental rather than beneficial, and the index is entirely inadequate. While we are somewhat disappointed in the book, as a whole there are numerous features presented which will make it a valuable work to the student of this subject and worthy of a place in every physician's library.

A Manual of Anatomy, by Irving S. Hayes, Ph. B., M. D., Adjunct Professor and Demonstrator of Anatomy in the Medical Department of the New York University, With 134 half-tone illustrations and 42 diagrams. Philadelphia: W. B. Saunders, 1896. 12 mo. Price, $2.50

etc.

A new work on anatomy is always received with a great deal of interest, since it is generally supposed that we have all of the facts of descriptive anatomy, as presented in our old standard Gray, and that whatever merits a new book may claim must be in the nature of a new method of presenting the facts, or in new means of illustrating and fixing the same upon the student's mind. This manual is no competitor of Gray's Anatomy, nor, on the other. hand, is it to be classed with the small quiz compends which are decidedly more numerous than useful.

graphical standpoint and describing the various viscera and structures in the order in which they are exposed in a dissection. While the consideration of various structures of the body systematically is necessary for the freshman student, in order that he may gain a complete knowledge of the various systems of the body, the plan of presenting all the structures in a collected manner is by far the best one for the more advanced student and especially for practitioners of medicine and surgery. In this respect this manual partakes more of the nature of a dissector.

The plan of illustrations is entirely new, and while the numerous half-tones give one a splendid idea of the appearance in the.cadaver, there is not as much contrast between the tissues as we find in the living subject. On the whole, the illustrations are not only original, but also new as to the scope of the various regions presented.

The illustrations are unfortunately printed in black only, but notwithstanding the absence of contrast they do illustrate. Some slight coloring would have very materially increased the value of many of the cuts. The diagrams are new and in some instances quite unique. The relation of the viscera to each other and the exterior of the body is given special prominence, and in this respect this book excels all others with which we are acquainted. The descriptions of the bones and joints have been purposely omitted, which we think very proper in a work of this sort.

The index is very complete, occupying thirty pages. As a whole, we believe this work to be really a valuable addition to our list of useful anatomical books and we most heartily commend it to practitioners as well as students.

When Shall We Trephine?

A. I. B.

(1) In any fracture of the skull, either simple or compound, when there are symptoms of intracranial mischief. (2) If there is much localized depression, indicating the probability of either immediate or remote consequences. (3) In all cases of punctured fracture. (4) For the removal of foreign bodies. (5) In cases of compression of the brain from blood, pus, or tumor, when the offending cause can be located with a reasonable degree of certainty. (6) In cases of epilepsy. when the traces of the injury originating the disease can be recognized.-Buechner, International Journal of Surgery, May, 1896.

Sir Spencer Wells' Successor.

The Queen of England has appointed Mr. Rickman John Godlie, F.R.C.S., Surgeon to the Household in Ordinary to Her Majesty, in place of Sir Spencer Wells, resigned.

Fracture of Patella.

Dr. Geo. R. Fowler's method consists in exposing the fragments of an intermediate procedure, i. e., after the immediate effects of the injury have subsided and before ligamentous union has occurred, for the purpose of clearing their surfaces of intervening soft parts, and the application of fixation hooks resembling Malgaigne's, though a single and not a double pair is employed. The incision is made either vertically, transversely, or Ushaped, as indicated, and the hooks are inserted in the line of incision when possible, to avoid separate skin wounds. After carefully removing everything from between the fragments and applying hooks, the parts are stitched with subcuticular silk suture, sterile gauze and cotton are applied, and the limbs are enveloped in plaster-of-paris splints for three weeks, at which time the hooks are removed.-Medical Record.

BOOKS AND PAMPHLETS RECEIVED.

"Tumor of the Cerebellum," by Sanger Brown, M. D. Reprinted from the North American Practitioner, September, 1896.

"Adenoid Vegetations; the Anæsthetics, the Instruments, the Operations; with Special Reference to Operation under Bromide of Ethyl Anæsthesia," by T. Melville Hardie, M. D. Reprinted from Annals of Ophthalmology and Otology, July, 1896.

"Electrolysis for the Reduction of Spurs of the Nasal Septum," by W. E. Casselberry, M. . D. Reprinted from the Journal of the American Medical Association, September 12, 1896.

"Intubation in the Adult," by W. E. Casselberry, M. D. Reprinted from the New York Medical Journal for September 5, 1896.

Diphtheria," by W. E. Casselberry, M. D. Re"Diagnosis and Treatment of Laryngeal printed from the North American Practi

tioner.

"A System of Retaining and Recording Anthropological Data," by William G. Stearns, M. D. Reprinted from the American Journal of Insanity for October, 1896.

Dr. A. C. Abbott, hitherto first assistant, has been elected professor of hygiene in the University of Pennsylvania, in succession to Dr. John S. Billings, resigned.