SOME POINTS IN THE TECHNICS OF ASEPTIC OPERATING.

Dr. Henry T. Byford, of Chicago, in a paper with this title, said he did not offer any new method, but emphasized the necessity of more thoroughness in those already used. The method he employed consisted in (1) twenty minutes scrubbing with green soap and waer; (2) three minutes in dilute acetic, or citric, or oxalic acid; (3) five minutes in strong alcohol; (4) five minutes in a 1-2000 solution of mercuric chloride in water.

The author considered the use of rubber gloves open to the objection of macerating the cuticle, with danger of their being punctured and allowing septic sweat to escape. He deprecated the mixing up of the steps of the preparation by using a combination of green soap and alcohol, or by dissolving the mercuric chloride in alcohol, since aqueous solutions were more efficient than alcoholic. He advised disinfection of the hands one or more times during the course of long operations. Attention was called to the necessity of unusual care in the preparation of the field of operations in operating about the pubes and vulva. He recommended absorbent rather than occlusive dressings in the dressing of wounds after operation.

THE SIGNIFICANCE OF EXTRAVASATED BLOOD IN THE HEALING OF FRACTURES.

It is a much mooted question, whether the blood poured out between the fractured ends of bones serves any function in the process of healing. Prof. A. Bier, the surgeon of Bonn, Germany, (Medizinische Klinik, No. 1, 1905) believes the fact to be unquestionable, that the blood extravasation is a direct agent in the healing process. It not only acts as a stimulus to, but also serves as a matrix for, new bone formation. Subcutaneous fractures heal much more quickly than those that are opened up and wired, because the surgeon is always careful to quell all bleeding, and thus to prevent hæmatoma from forming. All the methods of causing pseudarthroses to unite depend upon the fact of increasing the blood supply, to the part, e.g., massage, friction of the bone ends, percussion of the fractured site, and having the patient walk about. When the tibia is injured, a subperiosteal hæmatoma forms, and extensive callus formation results. When a hæmatoma forms in the muscles about the knee, bone is deposited in it. All these facts show that these blood extravasations tend to ossify. Bier has verified these facts clinically by the following procedure: In eight cases of pseudarthrosis due to delayed union, he injected about 20 c.c. of blood about the

ends of the non-united bones. In seven of these cases, bony union followed the treatment. Bier contends that the injected blood sets up the necessary reaction around the fracture site and stimulates the osteoblasts to activity.

THE BUFFALO EXPERIMENT ON CANCER.

The following statement has been given out from the Gratwick Pathological Laboratory of the University of Buffalo: "Drs. Gaylord and Clowes, assisted by Mr. Baeslack of the cancer laboratory of the State Department of Health, have recently performed a series of experiments on mice infected with cancer, which have led to the discovery of an antitoxic serum which visibly affects the growth of cancers in mice, and in a number of cases has been sufficiently active to cause the total disappearance and cure of tumors of considerable size.

“ The field which is opened by these primary experiments is apparently a difficult one, but they should prove in principle that not only is cancer curable, but extend the hope that some means may be found to develop a similar immune serum which could be applied to human beings."

GANGRENE OF THE EXTREMITIES IN YOUNG PERSONS FOLLOWING INFECTIOUS DISEASES.

S. Barraud (Centralblatt f. Chirurgie, No. 50, 1904), has collected 103 cases of gangrene in young persons exclusive of senile or presenile gangrene and Raynaud's disease. As causal factors, embolism 10. per cent. ; arterial thrombosis, the most frequent, and venous thrombosis, rare, are found. The mortality is high, 51 per cent.

INTESTINAL OBSTRUCTION IN CHILDREN.

Dr. John W. Erdmann (Journal Amer. Med. Assoc., Jan. 21, 1905) says: The diagnosis is not difficult, although the symptomatology, as given in former textbooks on diseases of children, etc., should be rewritten, with a view to placing all the stress on blood or bloody mucous stools and not on the presence of a sausage shaped tumor. In over 60 per cent. of a series of 28 cases seen by him in 24 of which he operated, no tumor of any kind was palpable per rectum or through the abdominal wall. He does not find on searching his histories, a single acute case in which blood, bloody stool, bloody mucous, or bloody serum was not fcund, either on the diaper or expelled from the anus after digital examination.

GYNECOLOGY.

Under the charge of S. M. HAY, M.D., C.M., Gynecologist Toronto Western Hospital; Consulting Surgeon Toronto Orthopedic Hospital.

ROENTGEN RAY IN GYNECOLOGY.

The New York Post-Graduate quotes Delphey as saying that the Roentgen ray offers no special diagnostic inducements to the properlyschooled gynæcologist. Plevic tumors, excepting dermoid cysts, can hardly ever be determined by the x-ray. The main use of the Roentgen ray in gynæcology is in the treatment of malignant neoplasms. The proper treatment, when diagnosis is made early enough, is to remove the growth entirely. When this is impracticable, or the growth can only be removed in part, resort should be had to X-ray treatment. Quite a number of cases of carcinomata have been very much improved, and epitheliomata has apparently been entirely cured by this means; and, as certain death is otherwise the only outlook, the patient should be given the benefit of the chance. The rationale of the treatment is not yet completely understood, but is plain that the X-ray in some way interferes with the life of the adventitious tissue, probably in two ways: by causing an inflammatory exudate, which chokes off the blood supply and which is followed by a fibriod change; and by causing a degeneration of the cells of all the tissues which are absorbed and excreted through the ordinary chanels. Consequently these cases must be treated cautiously watching the pulse and temperature lest too large an amount of waste products be thrown into the general circulation for the eliminative organs to dispose of, in which case there would be likely an acute septic infection or at least a severe toxæmia.

ROUND-LIGAMENT SHORTENING BY AN EASY METHOD.

Dr. M. C. McGannon, of Nashville, Tenn., writes an instructive paper on the above subject in the March number of the American Journal of Surgery and Gynecology. We quote the doctor's description of the operation, and also the advantages claimed for it, as follows::

A central incision, at least two inches in length, is made through the abdominal wall, immediately above the pubic bone. The uterus is freed from any restraining influences, and is brought forward to its normal position. The round ligaments are in turn picked up, about one and one-half inches from their origin in the uterus. A small incision through the peritoneum at this point is now made, and a piece of pedicle silk is passed through the opening and under the ligament. A pedicle needle or

Drag

a curved forceps is next inserted at the margin of the wound at its lowest angle, underneath the peritoneum, and made to pass outwards until the round ligament is reached, then along that structure until the point of the instrument emerges through the little slit in the peritoneum previously made over the ligament, about one and one-half inches from the uterus. The eye of the needle or the opened forceps is next made to engage both ends of the silk loop, by which the ligament was surrounded and the instrument is withdrawn conveying with it the thread. ing upon this thread draws the ligament upon itself immediately under the peritoneum, and out at the lower margin of the wound, where it appears in the form of a loop. This loop of ligament may then be so manipulated as to place the uterus in the exact position that the operator desires; in other words, the proximal part of the ligament may be made any length that is found necesary to hold the uterus in its normal position. The ligament as it is drawn forward to emerge under the peritoneum, and out at the lower margin of the abdominal opening, puckers and shortens the broad ligament, and tends to elevate both the ovary and the Fallopian tubes. The looped ends of each ligament is secured by stitching with the catgut to the posterior part of each rectus muscle near the lower angle of the abdominal opening, and by uniting them together in the centre line by means of catgut sutures. The abdominal wall may be closed by the usual method.

The advantages for this operation are:

1. It produces a round ligament of normal length.

2. The ligament is left a post-peritoneal structure.

3. It leaves no injury to the peritoneum by which adhesions may be invited.

4. It utilizes the strongest and most muscular part of the ligaments, and throws out of commission the weak, atrophic, fibrous, distal end.

5. The ligament is attached firmly and efficiently to both the uterus. and the abdominal wall.

6. The broad ligament is shortened. This I consider essential to success in all operations for shortening the round ligaments of the

uterus.

7. It produces a minimum of trauma and does not penetrate or weaken any important structure.

8. The operation is easy of performance.

9. The time consumed should not exceed fifteen minutes, and in many cases the operation can be completed in five minutes.

OVERLAPPING THE APONEUROSES IN THE CLOSURE OF WOUNDS OF THE ABDOMINAL WALL.

Dr. Charles P. Noble, of Philadelphia, writes an interesting article on the above subject. He says the method is applicable in the closure of all wounds of the abdominal wall, no matter what the location of the particular wound may be.

The writer says it is now a generally received principle that the proper closure of incisions in the abdominal wall involves the union of homologous structures, and it is almost as generally accepted that this is best secured by the employment of the tier suture. There are surgeons who still claim that equally as good results can be obtained by means of the through and through suture, but the claims of these are contrary both to the theoretical considerations involved and to the general experience of the profession.

While the object of the suturing of incisions is to bring the homologous structures of the wound in apposition and to restore the abdominal wall to its original anatomical relations, it is nevertheless true that from the standpoint of the prevention of hernia the most important point is to secure firm union of the aponeuroses; because the strength of the abdominal wall, from the standpoint of resisting intra-abdominal pressure, depends more upon the integrity of the aponeuroses and fascice than upon the union of the other structures involved. The usual method advised is to suture these structures either with a running or interrupted suture so as to bring the cut edges in apposition. When it is recalled, however, that the aponeuroses of the transverse muscles are quite thin (about a line in thickness), it becomes evident that the cicatricial union of these edges when merely brought in apposition will be weaker than were the aponcuroses before their division. Impressed by this fact the doctor has made it a practice to overlap the fascice from one-third to one-half inch as a routine method. And he says the results thus secured in the prevention of hernia have been such as to convince him that this method insures a firmer union and a more certain safeguard against the development of hernia than any other method in use. Since 1897 there have been approximately eleven hundred and fifty wounds in the abdominal wall closed by this method, and of this number only three cases of hernia are known to have occurred.

In practice the method is quite simple. The incision in the hypogastrium for operation on the female pelvic organs may be taken as the type. This incision is made by choice through the inner border of the right rectus muscle. In closing the wound, the peritoneum is first closed with a