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In the first place, by election, I always op. erate upon the patient in the hospital in preference to operating at her own home. the second place, I always refuse to operate hurriedly or upon the diagnosis of any medical attendant without having first carefully investigated and carefully watched the case personally. In the third place, I see that my patients have proper preparatory treatment, that their mental anxiety is allayed, that they have had a chance to acquire confidence in the the operator, and that the gastro-intestinal tract is put in proper condition.

For anesthesia I prefer chloroform instead of ether, because I believe that chloroform carefully administered is, nearly as safe as ether, and because, with chloroform, as a rule, we have none of the bronchorrhea or gastric disturbance which usually follow the administration of ether. The instruments are carefully scrubbed with glycerine soap, and thoroughly rinsed with distilled water. The sponges have all mineral matter removed by being allowed to soak for a few hours in a dilute solution of hydrochloric acid, and are then placed for several days previous to the operation in a solution of the bichloride of mercury (1-1000). The same sponges are used over and over again. For the ligatures I employ different sizes of Chinese twisted silk, imported by Mr. Snowden, of No. 7 South Eleventh street, Philadelphia. For sutures I use silk-worm gut fastened with perforated shot. Both the ligatures and sutures are constantly kept in a solution of the bichloride of mercury (1-500). Previous to the operation, the sponges, ligatures and sutures are thoroughly rinsed with distilled water. The in struments are used dry, spread out upon towels which have been washed in a solution of the bichloride of mercury (1-1000), dried by superheated steam, and wrapped in waxed paper to insure their perfect purity. For cleansing the sponges and for flooding the abdomen I use distilled water at about blood heat. For dressings I use Keith's solution of carbolic acid (twelve per cent. of carbolic acid and glycerine), a few layers of Lister's gauze and upon the layer nearest to the surface of

the wound iodoform is freely spread. Over this is placed a layer of corrosive sublimate wool, and the dressing is completed by a tight bandage of opera flannel fastened with safety pins. For the first twelve hours after the operation the patient gets absolutely nothing; if at the end of that time there is no hyperpyrexia or other symptom of evil import, I commence to feed them with weak tea, ice cold, giving two or three drachms every hour. This I have found by experience to be the best way of quenching thirst, and also affording general stimulation without over-taxing the stomach. At the end of seventy-two hours I commence the administration of food, using preferably milk, if the patient will take it, and after a few hours, if the stomach bears the milk well, which is administered in halfounce doses with a little lime-water and ice cold, I alternate the milk with either beef or chicken tea. On the fourth day, if the patient is doing well, I commence the administration of animal broths and soft food; I take out the sutures on the seventh or eighth day, never changing the dressing in the interiin unless there be some symptoms which demand inspection of the wound.

If the temperature rises and there are other evidences of commencing sepsis, I give the patient a brisk calomel purge, five to ten grains with a little sugar of milk, and follow this by full antipyretic doses of sulphate of quinine, one to two grammes. This usually suffices, but if there be any continuance of the symptoms pointing to sepsis the lower angle of the abdominal wound is opened and the abdominal cavity washed out with a weak solution of bichloride of mercury (1-8000 or 1-10,000). Unless there is reason to believe that, as a result of the traumatism of the operation, or of traumatism arising from the efforts to subdue hemorrhage during the opera tion, there will be tissue necrosis, I do not use a drainage tube.

The last nine cases operated on by this plan of treatment have all not only recovered from the operation with out any untoward symp toms, but have also all either been cured or greatly benefited by the operation. The recovery from the operation is simply an evidence of individual skill, and therefore statistics upon this point count for but little, but the recovery of the patient from her malady or trouble is the end to which every intelligent gynesic surgeon should look.-Nash. Med. News.

-The "Phar. Rec." says that all bases which are due to action of bacteria are called ptomaines by Brieger; the poisonous bases he calls toxines.

THE CAUSES AND TREATMENT OF BARRENNESS.

A paper on this subject by Dr. T. More Madden, of Dublin, was read before the Amer. Gyn. Soc. by the secretary. Few gynecological questions, the author said, came so constantly before us, and none probably were of greater practical importance than those connected with sterility, not only involving, as they did, the physical health of patients, but also in many instances intimately affecting the happiness and welfare of married life. For, at least in his country, child-bearing was held to be one of the chief functions of a woman's conjugal life; while to be sterile was commonly regarded as the protean source of marital troubles. In the paper, in tabular form, there was a statement of the causes of sterility in five hundred and twenty-eight of the cases of infecundity occurring in married women within the childbearing period of life that had come under observation in the gynecological department of the author's hospital. The cases might be roughly divided into two classes, viz.: 1. Those in which barrenness was occasioned by sexual impotence or some physical impediment in the passages from the vulvar orifice to the ovaries. 2. Cases of true sterility, or conceptive incapacity from deficiency, congenital or acquired, structural disease, arrest of development, superinvolution, etc., of the uterus, or from analogous morbid conditions of its appendages. 3. Cases of barrenness from constitutional causes. 4. Cases in which the causes of infecundity were apparently moral rather than physical, such as sexual incongruity, etc. According to the table, the most frequent of these causes of sterility was stenosis of the cervical canal. And, as the author believed that the operative treatment of such cases, simple as it was deemed by some, required more consideration than it generally received, and frequently proved worse than useless from the disregard of certain details and precautions which he considered essential, he ventured to recommend the adoption of a method of procedure and the use of instruments which he had found advantageous in the curative treatment of stenosis in three hundred and eighty cases of obstructive dysmenorrhea and sterility traceable to this cause. The essential feature of the method was the separation by cutting and simultaneous forcible expansion of the affected parts, followed by dilatation during the period of cicatrization, so as to prevent their subsequent contraction, and thus to secure the

permanent patency of the occluded passage. To attain this result he employed three instruments-namely: a special form of uterine director, which could, generally speaking, be introduced into any cervical canal, however narrow, and along which a serrated triangu lar, guarded knife was made to travel up through the os internum; and a uterine dilator of great power, by which any required degree of cervical expansion could be effectually secured and accurately gauged. The influ ence of uterine flexions in the prevention of pregnancy and the treatment he adopted in such cases were next described, together with the management of aphoria when it re sulted, as was frequently the case, from chronic endometritis. In like manner, the methods found most serviceable in cases of infecundity due to other causes commonly met with, vaginal, uterine, and ovarian, were briefly reviewed. The author dwelt more fully on the subject of conceptive incapacity from morbid conditions of the Fallopian tubes, as he regarded stenosis, as well as occlusion of these ducts by elytritis and its results, such as hydro- and pyo-salpinx, as far common causes of sterility than was generally recognized. Moreover, he also held that such tubal diseases might, in many instances, be efficiently dealt with without resort to the serious operative procedures, i. e., the removal of the uterine appendages, which, by some surgeons, were considered invariably necessary, and were by them so freely employed in such cases. He referred at some length to those less heroic alternative measures, such as aspiration and catheterization of the Fallopian tubes, the feasibili ty and the successful results of which, in appropriate cases, he had demonstrated clinically. Finally, the question of sterility arising from constitutional disorders, and in some instances even apparently irrespective of any physical cause, and the method of dealing with such cases, were also discussed in the paper.

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THE TREATMENT OF SUMMER COMPLAINT.

BY WILLIAM F. WAUGH, A.M., M.D.

Under the view that it is probable that the symptoms of summer complaint are due to the circulation in the blood of a poison generated by micro-organisms in the gastro-intestinal tract, the writer considers that he has a definite basis for therapeutics, and proceeds to lay down the following plan of treatment:

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As we are ignorant of the peculiarities of this particular germ, we can only ascertain the most suitable germicide by experiment. I concluded to begin the season with the sulpho-carbolate of zinc, and not to lay it aside until I had demonstrated its inefficiency. Thus far the success of the method has been such that no reason for a change exists. Out of nearly thirty cases treated by myself and Dr. Taylor there have been no deaths. These cases covered every grade of the disease, including catarrhal gastro-enteritis, inflammatory entero-colitis, and true cholera infantum. At first the zinc salt was given in doses of 6 grain every two hours, with one to five grains of bismuth. As the remedy was well borne, the dose was increased to one fourth grain for a child in its second summer. The first and invariable effect has been to stop the vomiting. The stools became less offensive, although in some cases they continued to be copious and frequent. In these cases we gave enemata of flaxseed tea containing five grains of the sulpho-carbolate and half a drachm of bismuth. This proved effectual in all cases. Intense fever was met by antipyrine in doses of one to two grains. This drug appears also to have a disinfectant action upon the stools. When the child has improved somewhat, mutton broth with rice has been added to the diet; then weak coffee, brandy, meat (to be sucked), especially salt meat, and chicken jelly. Whether this plan of treatment will withstand the test of subsequent experience remains to be seen. The sulpho carbolate of zinc has the advantage over naphthalin and salicylic acid of being more palatable and less irritating to the stomach. Antipyrine has the same advantages over quinine, when an antipyretic is required. That the bismuth had but little action except as a vehicle we proved by occasionally giving it without the zinc salt. Coll. and Clin. Rec.

PROF. BROWN-SEQUARD ON THE PATHOLOGY OF THE LARYNGEAL VAGUS.

Whatever of scientific truth may event ually be established concerning the reflex relationship of the cervical region with the brain and bulb, now set forth by Prof. BrownSequard, there can be no question of the remarkable suggestiveness of his conclusions. He showed some years ago that puncture of a certain region of the floor of the fourth ventricle, in close juxtaposition to the vasomotor and cardiac centers, but not identical with them, has the effect of reducing to the

lowest possible ebb the nutritional changes of the organism, so that the blood in the veins runs as red as that in the arteries; for the protoplasmic tissues neither absorb oxygen nor disengage carbonic acid, being, in fact, in a state of suspended animation. But this is not the only cessation of activity that may be brought about as the effect of puncture of the floor of the fourth ventricle. The activity of the cerebral cortex may also be suspended by a similar operation; and actual death may also occur. To sum up in a few words the latest conclusions of the distinguished experimental pathologist, we may state that the skin of the neck covering the larynx has, like stimulation of the larynx, though in a less degree, the power of inhibiting the sensibility of the body, and, further, that mechanical irritation of the larynx, trachea, and perhaps of their subjacent skin, possesses the power of causing death, in the same way as though the bulb and medulla oblongata were irritated. These are extremely important conclusions, and it will be well to examine the evidence on which they are founded. The following is the gist of Prof. Brown-Sequard's communication to the Acadèmie des Sciences.

It has often excited surprise that suicide by cutting the throat should be carried out with such determination, and apparently at the cost of enormous suffering, indicating an almost superhuman courage. The surprise, however, would be considerably lessened, if it were true, as is now asserted, that mechanical irritation of the skin covering the larynx, as well as the larynx itself, causes total analgesia, as seems possible from the remarkable experiments Professor Brown-Sequard made some four years ago. After having made a longitudinal incision through the skin of the middle line or transversely from one side to the other, in the anterior cervical region, the Professor observed in a great number of experiments, especially in dogs and monkeys, that he could lay bare, cut, bruise, galvanize and even burn the various structures in the anterior two-thirds of the neck without causing any great pain, and sometimes without appearing to cause any great pain, and sometimes without appearing to cause any pain whatever. Such facts-verified hundreds of times during the last five or six years-prove that these structures have the inhibitory property of causing general analgesia, though in a varying degree, according to the precise structure stimulated-viz.: (1) The maximum effect is produced by stimulation of the mucous membrane of the larynx-i. e., of the parts supplied by the terminal ramifications of

the superior laryngeal nerves. (2) In a less degree irritation of the trunks of these nerves, and in a still less degree of the trunks of the vagi above the point of emission of the superior laryngeal nerves, causes the same result to appear. (3) A transient analgesia of variable completeness may be caused by ligature of the trachea. (4) The minimum effect is caused by the irritation of the skin covering the throat, and especially of that over the larynx proper. Although incision of the

various structures is the most effective in bringing about the analgesic effects, it is not the only irritation that possesses this proper. ty. The trigeminal and other sensory cranial or spinal nerves in their trunks or ramifications do not appear to be endowed with the special power that the vagus nerves and the nerves of the cervical region possess. Surgeons performing tracheotomy during the asphyxia of a patient may be incorrect in supposing that the asphyxia confers immunity from pain, for doubtless the analgesia is part ly owing to the very inciaion of the skin of the front of the neck. Other experiments on animals seem to show that stimulation of the anterior cervical region, especially the larynx, but also the trachea, and probably the superjacent skin, has the power of stopping the heart, inhibiting the respiration, and suspending consciousness. When Prof. BrownSequard has killed dogs by cutting their throats, he has found that nearly always, if not always, death occurred without convul sions, without agony, in a state of perfect syncope, permitting the protoplasmic tissues of the body to preserve for a long time their special properties; the blood running red from the arteries to the veins, and thus presenting an absolute contrast to death due to asphyxia, where the arteries are filled with black blood. -The London Lancet.

A SURGEON'S LIFE.

From the Autobiography of the late Dr. Gross.

I have always held that it is impossible for any man to be a great surgeon if he is destitute, even in an inconsiderable degree, of the finer feelings of our nature. I have often lain awake for hours the night before an important operation, and suffered great mental distress for days after it was over, until I was certain that my patient was out of danger. I do not think it is possible for a criminal to feel much worse the night before his execution than a surgeon when he knows that upon his skill and attention must depend the fate of a valu

able citizen, husband, father, mother or child. Surgery under such circumstances is a terrible task master, feeding like a vulture upon a man's vitals. It is surprising that any surgeon in large practice should ever attain to a respectable old age, so great are the wear and tear of mind and body.

The world has seen many a sad picture. I will draw one of the surgeon. It is midday; the sun is bright and beautiful; all nature is redolent of joy; men and women crowd the street, arrayed in their best, and all, apparently, is peace and happiness within and without. In a large house, almost overhanging this street so full of life and gayety, lies upon a couch an emaciated figure, once one of the sweetest and loveliest of her sex, a confiding and affectionate wife and the adored mother of numerous children, the subject of a frightful disease of one of her limbs, or it may be of her jaw, if not of a still more important part of her body. In an adjoining room is the surgeon, with his assistants, spreading out his instruments and getting things in readiness for the impending operation. He assigns to each his appropriate place. One administers chloroform; another takes charge of the limb;

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screws down the tourniquet upon the principal artery, and another holds himself in readiness to follow the knife with his sponge. The flaps are soon formed, the bone severed, the vessels tied, and the huge wound approximated. The women is pale and ghastly, the pulse hardly perceptible, the skin wet with clammy perspiration, the voice husky, the sight indistinct. Some one whispers into the ear of the busy surgeon: "The patient I fear, is dying." Restoratives are administered, the pulse gradually rises, and after a few hours of hard work and terrible anxiety reaction occurs. The woman was only faint from the joint influence of the anesthetic, shock, and loss of blood. An assistant, a kind of sentinal, is placed as a guard over her, with instructions to watch her with the closest care, and to send word the moment the slightest change for the worse is seen.

The surgeon goes about his business, visits other patients on the way, and at length, long after the usual hour, he sits down, worried and exhausted, to his cold and comfortless meal, with a mouth almost as dry and a voice as husky as his patient's. He eats mechanically, exchanges hardly a word with any member of his family, and sullenly retires to his study to prescribe for his patients-never during all this time, forgetting the poor mutilated object he left a few hours ago. He is about to lie down to get a moment's repose after the severe toil of the day, when suddenly

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he hears a loud ring of the bell, and a servant, breathless with excitement, beg his immediate presence at the sick chamber with the exclamation, "They think Mrs. -- is dying." He hurries to the scene with rapid pace and anxious feeling. The stump is of a crimson color and the patient lies in a profound swoon. An artery has suddenly given away, the exhaustion is extreme, cordials and stimulants are at once brought into requisition, the dressings are removed and the recusant vessel is secured.

The vital current ebbs and flows, reaction is still more tardy than before, and it is not until a late hour of the night that the surgeon, literally worn out in mind and body, retires to his home in search of repose. Does he sleep? He tries, but he cannot close his eyes. His mind is with the patient; he hears every footstep upon the pavement under his win dow, and is in momentary expectation of the ringing of the night-bell. He is disturbed by the wildest fancies, he sees the most terrific objects, and, as he rises early in the morning to hasten to his patient's chamber, he feels that he has been cheated of the rest of which

bones, and placed the osseous graft in the fi brous tissue so as to bring it in contact with the inferior fragment of the tibia. There was no reunion; careful antiseptic dressing was continued. Sixty-two days after the operation the graft was completely covered with fleshy granulations, except in a space of three to four square centimeters in the middle, where the bone appeared of a pale pink hue. The mobility of the pseudarthrosis persisting, M. Poncet decided to make a resection of the osseous suture. In performing this operation he removed the graft from the attached portions of the bone, and observed the following important facts: The graft was intimately united to the tibia at one of its extremities by a somewhat dense, tough, fibrous, non-osseous tissue. Its entire periphery was ered by the fibrous tissue and a layer of more and more dense granulations. The bone itself was perfectly vascular and alive, eroded at some points by the granulations heaped against the surface. This result shows that legitimate hopes may be built upon this method.-Med. Jour. and Ex.

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he stood so much in need. Is this picture ON THE TREATMENT OF THE PEDICLE

overdrawn? I have sat for it a thousand times and there is not an educated, conscientious surgeon that will not certify to its accur acy.-Washington Star.

THE GRAFTING OF HUMAN BONE.

On the 25th of November, 1886, a young man, seventeen years of age, had a complicated fracture of the right leg, about its middle, from which escaped a considerable frag. ment of the superior part. Succeeding this there were severe phlegmonous complications, the fractured extremities necrosed and were eliminated, resulting in a considerable loss of bone. In December, 1886, the fracture had not united, and the bones were from 35 to 40 millimeters (about 14 inches) apart, with a fibrous cord uniting them. The fibula, which was intact, formed a splint for the tibia, and had prevented a union of the osseous extremities. M. Poncet then tried the experiment of an osseous graft, and executed it in the following manner: From a leg which had just been amputated, ou account of traumatism, he took the first phalanx of the great toe, dissected away its cartilaginous surfaces, getting a fragment one inch in length, which he antisepticized in a tepid solution of corrosive sublimate of one to two thousand. The pseudarthrosis having been exposed, M. Poncet cut away the fibrous bridge, polished the two

IN SUPRAVAGINAL HYSTERECTOMY.

Dr. George Granville Bantock, of London, at a recent meeting of the American Gyuecological Society, recited that part of his personal experience which led him to adopt certain measures and to reject others in the treatment of the pedicle in supravaginal hysterectomy. In one case the actual cautery was applied to the stump to check hemorrhage, but, on removing the ligature, hemorrhage took place as if from a wound made with a knife. In another case copper wire was drawn around the pedicle, but he learned that wire made of copper was not able to bear the strain. Steel wire was too difficult to manipulate. Iron was then employed. A further step was to trim the stump, and stitch the peritoneal tissue over its surface. He further learned never to cut away the tumor until the pedicle had been transfixed with supporting pins. In his eighty-fifth case he introduced another important modification. The serre neud was put on just below the level of the ovaries, the broad ligament being seized between the ovaries and the uterus. The peritoneum and tumor were divided all round a short distance from the wire loop, the instrument was now screwed up, tension was removed from the uterine aspect (no difficulty was experienced in holding it), pins were put in, a serre neud was put on behind the pins, and the first was

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