are then strung upon the other end of the wire. While the edges of the wound are crowded toward each other and held in contact, the wire is drawn upon and the second bead and shot are slid down against the skin and permanently fastened in place by mashing the second shot upon the wire with pliers. The opposite edges of the wound thus held securely in contact and relieved of all strain, may be accurately adjusted to each other by any requisite number of thread sutures. This beaded suture may remain undisturbed eight or ten days, and produces only a superficial ulceration under the beads, which readily heals after their removal and leaves no conspicuous scar. When primary union has taken place only partially, or has failed altogether, this suture is the best reliance for supporting and holding in contact the opposite edges of a wound; while with the aid of adhesive plaster and supplementary thread sutures the adjustment is maintained during the slower process of union by granulation. b Fig. 2. NOTE. Punchings of harness leather, disk-shaped, such as may be had at any saddler's shop, are a good substitute for shot, and are easily perforated with a glover's trocar needle. Fig. 2 represents the constituent parts of a beaded wire clamp suture. a. The knotted end of the wire, threaded with a leather disc next to the knot, and a glass bead beyond the disc. b. The second glass bead fastened in place by three or four turns of the wire wound around a lucifer-match, which is then cut short with scissors. c. A trocar-pointed needle made for the purpose; for which, however, an ordinary darning-needle is a good substitute. An advantage of this mode of arranging the beaded suture is, that it can be tightened or loosened when neces sary. 3. Preparation of the parts for adjustment to each other. A needle, armed with coarse thread, is passed through the two angles of the lip on either side of the cleft, far enough from the border to be out of the way of the subsequent incisions. The ends of the threads tied together form loops with which to hold the parts on the stretch when required. Each half of the lip being put upon the stretch by means of its loop, and drawn away from the jaw, an incision is made along the line of junction between the jaw and the inner surface of the lip, and carried outward as far as the molar teeth. The separation is also continued upward, in contact with the periosteum, toward the cheek. This being done on both sides, permits the two halves of the lip to be approximated and brought into contact without any strain upon the sutures which are to hold them together. The next step is to pare the opposite edges of the cleft. Each half of the lip is again put upon the stretch by means of its loop, while the lip is transfixed near its angle, and an incision carried upward skirting the border of the cleft, and extending somewhat into the nostril. The strips thus detached from both borders of the cleft, but left attached at the angles, are brought down, with their fresh-cnt surfaces facing each other, and both are transfixed by a threaded needle. The ends of the thread are tied together, and form a loop with which the strips being put upon the stretch, the fresh-cut edges of the cleft above are held evenly confronting each other, while sutures are inserted to secure their adjustment. During this adjustment an assistant should crowd forward the cheeks toward the median line. Two pin sutures, one below near the vermilion border, and one above near the columna nasi, are to be inserted and wound with cotton yarn. Between the pin sutures three or four thread sutures will serve to perfect the adjustment of the edges. The strips still remaining attached at the angles where the two halves of the lip meet, are to be severed by an oblique section, so that at their junction they will form a projection standing out beyond the line of the lip border. Three fine sutures should secure this adjustment at the border. By this arrangement the subsequent formation of a notch, which so often mars the result of this operation, will often be prevented. In making the sections just described, a Beer's cornea-knife is very useful on account of the facility with which it transfixes the lip, and the precision with which the incisions can be made. In illustration of the views just advanced, the following cases are submitted: a CASE I.-Simple congenital hare-lip. John Black, æt. 12, resident of Piermont, on the Hudson, admitted into St. Luke's Hospital, Jan. 18, 1871. The cleft, involving the right half of the lip, divides it vertically, and extends as a shallow furrow upward along the floor of the right nostril. The right middle upper incisor tooth occupies the cleft, and stands forward conspicuously in advance of its fellows, probably in consequence of lack of support from the absence of the lip. (See Fig. 3.) Operation.-Performed Jan. 24th, after etherization according to the method above described. A moderate degree of inflammatory tumefaction followed the operation. At the end of forty-eight hours the yarn was changed on the pins. On the third day the upper pin was removed, and the yarn changed on the lower pin. Applied two strips of adhesive plaster across the cheeks to support the parts. On the fourth day removed the lower pin, and the remaining thread sutures. Continued the adhesive straps, which were renewed daily for a week after the operation, when the healing was complete. A very slight notch remains at the lip border Patient returned home with the aid of etherization, as was done in the case of her two younger sisters. where the two halves united. Feb. 10. Fig. 4 shows the result. Operation-After liberating the parts on either side of the cleft in the way above described, I proceeded to reak down and reduce into line the projecting portion of the dental arch with Mr. Butchers' bone-pliers-an nstrument devised expressly for the purpose. It conits of two jaws of unequal length, with their confronting surfaces flattened and roughened. The shorter blade is blunt at its extremity; the longer one is bent flat wise to a right angle at half an inch from its extr mity, and looks toward its fellow with a square, blant cutting edge at its extremity. A HARE-LIP FAMILY.-Mrs. Molinieri and her three children, all girls, natives of Genoa, Italy, were admitted into St. Luke's Hospital, Jan. 10, 1871. Mrs. M. herself bears the marks of a successful operation, performed in childhood, for hare- lip. She has a brother and sister with hare-lip; and besides her three living children she has had four others, all of whom diel in very early infancy; three of them had hare-lip, and the fourth only was a perfect child. CASE II.Jacinta, the eldest, æt. 7, has a single cleft, involving the left half of the lip and extending upward into the left nostril. The cleft also extends backward through the dental arch and bony and soft palates. The portion of the dental arch on the right side of the cleft projects forward at its anterior terminus in advance of the natural curve, and being uncovered by the lip, presents a conspicuous feature in the child's disfigurement. The ala of the left nostril is drawn outward toward the cheek, thereby enlarging considerably its orifice. Fig. 6. The bony projection was seized between the jaws of the pliers, with its bent jaw applied to the anterior surface high up toward the nostril. The bent jaw was sunken in the bone, and weakened it so that on bearing down with the pliers I fractured the bone and reduced the projection into line. The integrity of the dental arch was thus restored, and the cleft that had divided it was bridged over. Where the opposite surfaces of the cleft came in contact, they were pared, and subs quently coalesced permanently. This restoration of the bony arch also facilitated the adjustment of the two halves of the lip to each other, and afforded them a good support. The closure of the cleft of the lip was completed according to the method described above. On removing the yarn from the pins at the end of two days, the pin tracks were found already to have sup purated, and the confronted edges had failed to adhere, except at the vermilion border, where, fortunately, adhesion was secured. It now became important to hold the opposite edges of the wound quietly in contact, while healing by the granulating process should take place. This was accomplished very satisfactorily by a beaded wire clamp suture inserted across the upper part of the lip, and at a distance of nearly one inch from the edges of the wound on either side. This afforded a constant support, while the adjustment of the edges of the wound to each other was maintained by strips of adhesive plaster renewed daily. The granulation growth was promoted by the application of solid nitrate of silver. The beaded suture was removed at the end of the fifth day, and the adhesive plasters continued for three weeks after the operation, when the healing was complete. No suppuration or exfoliation of bone fol lowed the violence done to the jaw. A tooth which / was implanted in the projecting portion of the dental arch became loose and was extracted. The dental arch became consolidated and regained its natural curve. A plug of soft sponge was worn in the left nostril to counteract a disposition at its outer margin to fall in after the closure of the cleft of the lip. There was no notch remaining at the lip border where the two halves joined A great improvement in the child's appearance was the result, as shown by Fig. 7. Fig. 8. CASE III.--Marie Anne, the second child, æt. 4 has a simple vertical cleft involving the left half on the Fg. 10. moved. Adhesive plasters, however, were continued for a few days longer, to support the parts and relieve the newly-formed adhesions of all strain upon them. Fig. 9 shows the result without any remaining notch at the lip border. CASE IV.-Rose, the infant, æt. 12 months, has a double cleft of the upper lip, without any complication. A central, tongue-shaped portion of lip intervenes between the clefts, which terminate on either side above, at the orifice of the nostrils. Fig. 10. Operation.-Jan. 21st. The central portion of lip was prepared by paring the edges and giving it an angular shape, so as to adapt it for insertion between the lateral halves of the lip. These were prepared for adjust ment to each other in the same manner as was employed in the preceding cases; and the adjustment of the three portions to each other was secured by traversing the three with the upper pin suture. Some difficulty was encountered in reducing the central piece to the same level as the lateral pieces, and it was not entirely overcome. Primary union failed to take place, as in Case No. II., except at the vermilion border, and it became necessary to support the edges of the wound in contact while union by granulation should take place. This was done by the careful application of adhesive plaster, which was renewed daily till the twelfth day after the operation, when healing was complete. A slight elevation of the central piece of lip still remained, which time, however, would be likely to diminish. Fig. 11 shows in this case, as in the other sisters, no remaining notch at the lip border. and water; and that its deficient supply is probably connected with the rise and progress of endemic contagious diseases, such as cholera, typhus, and others,' is questioned in your December number (p. 444), by my learned friend Dr. Peters. He states that cholera has been conveyed in a great number of instances across the sodium-salt ocean; that it has broken out in mid-ocean, and has raged in seaports where the air is loaded and impregnated with the soda-muriate. To this I deem it necessary to respond, that Dr. Peters finds fault with my conclusions, but leaves my premises uncontradicted. It would be difficult, I think, for any one to deny that sodium in the air in sufficient quantity is absolutely necessary to life in its manifold forms and conditions; nay, it is even very probable, as Prof. Roscoe states in his work on spectral analysis, p. 69, "that these minute particles serve to supply the smaller organized bodies with the salts which larger animals and plants obtain from the ground. If, as is scarcely doubtful at the present time, the explanation of the spread of contagious disease is to be sought for in some peculiar contact-action, it is possible that the presence of so antiseptic a substance as chloride-sodium, even in almost infinitely small quantities, may not be without influence upon such occurrences in the atmosphere." Dr. Peters also does not deny that the sodiumchloride possesses great antiseptic properties, by reason of which contamination of air, earth, and water is prevented. Now, it stands to reason that a deficient supply of this antiseptic agent must favor conditions favorable to the development of such contamination, and consequent disease. I think this proposition is logical. That the supply of sodium in the air is subject to daily oscillations is proved by spectroscopic observations, just as the supply of cxygen varies in the animal economy, and is never constant; yet, under normal circumstances, the quantity oscillates only within narrow limits. So also, so long as the supply of the sodiumsalt oscillates within defined limits, no perceptible disturbance in the life and health of the animal economy is experienced. But a deficient supply of this antiseptic element for any length of time must be detrimental to organic life, and favor contaminations of air, earth, and water. Granted, then, that cholera has been conveyed across the sodium-salt ocean. It is most probable that when this disease is once fully developed, the presence of the sodium-salt in the air in sufficient quantity may modify its violence; but we have not claimed that it will prevent its development. Whenever cholera has broken taken on board at the ship's point of departure. Its out in mid-ocean, the germ of the disease has been development in such cases was most undoubtedly favored by crowded steerage, tainted water, tainted food, want of cleanliness and proper ventilation. I deny that true cholera has ever absolutely originated as a spontaneous disease in mid-ocean. So also as regards surrounded with an atmosphere of sodium. No localthe statement that cholera often rages in sea-ports itv is more favorable to the germination of the cholera fungus, or whatever that germ may be, than seaports. It finds there its most favorite soil, provided there is, by the short-sightedness and neglect of man, a crowded population, abundance of decaying animal and vegetable matter, narrow, filthy streets, tainted water, obstructed drainage, foul air, want of cleanliness, want of proper food, intemperance, crime of all shades and forms, and in addition, want of intelligent sanitary measures. In vain does Nature pour out its antiseptic spray to protect the lives of improvident man; the recking foul atmosphere renders the benign influence of the sodium-chloride almost nugatory. When to conditions thus favorable to the development of cholera the supply of the soda-spray becomes deficient from some cause or other, can it be denied that the disease in question will grow in virulency and become boundless in its destructive force? Dr. Peters further states that cholera has frequently prevailed along the who'e Russian or north coast of the Black Sea, where the so-called salt-limous abound, and sodium-chloride is stored in huge stacks of hundreds of thousands of pounds. No amount of sodiumchloride, stored in one particular locality, is capable of preventing the introduction of cholera, for the simple reason that this salt, in order to reach the circulation, must be in a state of minute division, such only as can be obtained by evaporation from a surface covering two-thirds of our globe, and by the action of storms and winds over its surface. The thoughtful physicist will at once recognize that these fifty thousand Russian cartmen, with their million of oxen and a quarter of a million of carts, may become excellent agents to carry along the cholera on the highway of commerce, in spite of their loads of salt. correctness of the diagnosis. Within the past month, post-mortem examination has confirmed this diagnosis, and although at the time the case was briefly alluded to in another place, I think it worthy of further remark, not only as additional evidence that certain organic changes in the capsule of the kidney, and pecular symptoms to be described, are directly related to each other as cause and effect, but as a conclusive illustration of the somewhat remarkable constitutional tonic properties of general electrization. The patient, a man aged 45, was referred to me by Dr. H. F. Gregory, of this city, as a fit case for some form of electrical treatment, since it had resisted persistently all ordinary tonic medication. The history of the case is briefly as follows: The patient had enjoyed all his life most excellent health until Nov., 1867, when he observed slight symptoms of exhaustion, a loss of appetite, and some evidence of anæmia. His condition rapidly grew worse, and through the month of January, when he first detected a little discoloration of the face and hands, he was unable to leave his bed. He improved somewhat during the spring, and was able to engage in light labor. August, 1868, he suddenly relapsed into a state of utter exhaustion; his skin became several shades darker, and his general appearance was that of an ordinary mulatto. In Almost every function of the body seemed to suffer derangement, and especially the offices of secretion. The bowels became distressingly constipated, never moving except by artificial means. Sleep was fitful and unrefreshing. The Russian cartmen are none of the cleanest; they subsist on inferior food, are fond of alcoholic drink, in which they liberally indulge, and on their long journey they and their animals are exposed to exhausting influences. But yet, true cholera has never originated in these salt-limous. Whenever the cholera reached these regions, it was in the line of its migration, and had ere this obtained its characteristic destructiveness, which could not be arrested by the tons of stored-up salts of His mouth and throat were excessively dry and which the air may have been defectively supplied. On parched; the skin was shrivelled and devoid of moisthe contrary, the mixed crowd of men and beasts, pro- ture, while the finger-nails were so brittle as to break miscuously thrown together under the circumstances rather than bend. The left arm was so stiff and powabove enumerated, was weli calculated to give the dis-erless, that it was impossible to bend it beyond a right ease a high degree of virulence. In addition to this, it angle. nor could he lift it more than a few inches from must not be forgotten that this vast deposit of silt in his side. these Russian salt-limous results from the evaporation of sea-water in swampy grounds, favoring the development of malaria and mephitic gases during the hot months of June and July, just as our sea-marshes do along the Atlantic coast, where, in spite of the modifying antiseptic influences of the sodium spray, intermittent fevers abound. It is to be regretted that in 1817, when the cholera first appeared in Jessore, not far from Calculta, after an uncommonly long season of rain, spectroscopic analysis was unknown, and observations were not instituted registering the daily supply of sodium in the air. Such observations alone are destined to offer a satisfactory solution to my proposition, which, notwithstanding the formidable array of figures presented by my learned friend, I shall consider unshaken and not disproved. DISEASE OF THE SUPRA-RENAL CAP- NEW YORK. SOME two years since I presented, for the inspection of the members of the Medical Library and Journal Association, what seemed to be a well-marked case of disease of the supra-renal capsules. At this time the patient had been treated by me some two months, and under the influence of general faradization and galvanization of the sympathetic, his strength had returned in such a remarkable degree, that grave doubts were expressed in regard to the Lastly, the man suffered from excessive fatigue after the slightest exertion. It is proper to add that the sexual desire and power were entirely lost. These symptoms persisted with but slight variation until June, 1869, when the case fell under my observation, and shortly after I referred it to Prof. Austin Flint, who unhesitatingly confirmed the diagnosis of Addison's disease. In submitting the patient to the general influence of the e'ectrical treatment, it was found that a most profound anesthetic condition of the whole body existed. and a decided impairment of the electro-muscular contractility. It may be safely asserted that a degree of tension of the electric current was borne by this patient, and without the slightest discomfort, sufficient to prostrate a strong healthy man. One peculiarity, however, must be noticed. By placing the negative pole at the pit of the stomach, and the positive a little above the seventh cervical vertebra, distressing nausea was invariably produced. The same result was noticed during mild galvanization of the cervical sympathetic. Improvement was manifest from the first day of treatment, and after having administered thirty general applications of the faradic current, and galvanized the sympathetic nerve a number of times, the following is a fair summing up of the condition in which our patient was left: 1st He had long been completely cured of his constipation. 2d. Sleep was perfectly sound and refreshing. 3d. The dry and parched condition of his mouth and throat was entirely relieved, and all the secretions of |