mouth, endeavored to secure it. Just here the child struggled and swallowed the burr in a mass of mucus then in the pharynx. One suture of silk gut was placed deeply in the lower angle of the incision; a pad of borated gauze was placed over the wound, and patient removed to warm room. (Oil administered that night brought away the burr from the bowel next morning. The child had pronounced bronchitis for several days, but made an excellent recovery.)

You have just witnessed the opening of the windpipe under, I may say, very favorable circumstances; but let me caution you that such is not always an easy procedure. Look again on the picture just presented you. A clear, balmy day, wellplaced sunlight to guide your every step; every preparation deliberately made; competent trained assistants at the operator's elbow; the patient nicely under chloroform, breathing regularly, almost normally; a rather long neck for an eightyear-old child; no adipose tissue on the neck; anatomical landmarks all standing out, and plainly readable throughout each stage of the operation; a few rapid strokes of the knife, and the windpipe is opened; no hemorrhage, no asphyxia, no haste, no excitement,-all so easily done.

But now look you on this: "Tis past the mid- hour of a cold, damp night; the little sufferer is just two years old, a bright-eyed, short-necked, chubby little fellow; two days' and nights' obstructed respiration, so increased, that tonight the family physician advises tracheotomy-shifts the responsibility to the surgeon, and promises that as the only means by which the child may be saved; the surgeon arrived, hesitates, because he sees it's long past "too late;" but the imploring eye of the little sufferer, with blue, whispering lips gasping and straining for breath, is too much to resist; he proceeds hurriedly to give the only chance for life, and which his experience has told him is but the shadow of a chance's ghost; the room and bed show the terrible struggle between life and disease, that has been waged for hours past; no anesthesia, the child is already cyanosed, and almost asphyxiated; the attending physician holds the little one's head on his knee, the body rests across a pillow on a disheveled bed, while the father, head bowed in submission and grief, holds the struggling child's

feet; a neighbor, with head turned away, holds a smoky, dimly-burning lamp; a pocket-case has furnished a bistoury, a tenaculum, a needle and thread; an incision through a thick layer of adipose tissue, and every vein strutting keeps the wound flooded with black blood; all landmarks are hidden to even the most practiced eye; there's no time for sponging, for waiting; no means for controlling hemorrhage; the finger, is the only guide; rapidly through the blood - flooded wound the knife must find its way to the trachea; it is opened; there is a rush of blood into the windpipe; a strangling, struggling child fast asphyxiating; is suddenly suspended head down, while the blood flows from out the windpipe; artificial respiration brings pink slowly back to replace the blue-black lips; the child becomes conscious, and by smiles recognizes, and with those appealing eyes and dumb lips thanks the one who has snatched away the clasping hand of death. But alas! a few brief hours and death is once more at the throat, and claims his victim.

I tell you, you will meet with no more responsible position- no more trying ordeal than tracheotomy under such circumstances.

Case 2. (At St. Joseph's Hospital January 27-section of class present.) "Child, 13 months old, in perfect health, crawling on the floor where corn is scattered, suddenly taken with a fit of coughing, and almost chokes to death." Such is the story of the mother of this babe. Twenty-two days have passed since this occurred, during all of which time a cough has been continuously kept up, with hoarseness. You hear now a whispering effort at crying. Laryngoscopy in so young a child is hardly practicable; but I find no pharyngeal deposit nor cervical lymphatic enlargements. Auscultation detects abundant rales over both lungs, and the child's temperature is 1000. Although no one saw the grain of corn put into the child's mouth, the circumstantial evidence is strong; and corroborated, as it is, by absence of diphtheritic obstruction, I propose to do laryngo-tracheotomy in search of a grain of

corn.

Operation. The child could not lie on the back, but breathed more freely on abdomen; so, in a semi-prone position, chloro

form was administered, with the happiest effect; respiration became even and regular, and cough ceased. An incision one and three-fourth inches long through half-inch of fat exposed the parallel muscles; they were separated, and with blunt hooks the tracheo - laryngeal junction was exposed. There was no bleeding; so the windpipe was opened, as in Case 1. A probe passed upward failed to detect any foreign body, and so downward for three inches; but there was much coughing produced. A pair of delicate forceps were passed about two inches down the trachea, and blades separated; a violent coughing effort came on, and the forceps on being closed were felt to contain something; they were quickly withdrawn, bringing in their bite a grain of corn, slightly swollen and softened by the heat and moisture. The wound was left open, covered by gauze. Child had three days of sharp bronchitis, but rapidly grew better, and returned home on ninth day.

OVARIOTOMY.

Read before Tri-State Medical Society of Miss., Ark. and Tenn., Nov. 13, 1894 BY G. B. GILLESPIE, M.D., COVINGTON, TENN.,

Member American Medical Association; First Vice President Medical Society of Tennessee; President Tipton County Medical Society.

The case which I wish to report is one of ovariotomy of more than usual interest, on account of secondary hemorrhage, which forced me to reopen the abdominal cavity.

Mrs. M., aged 28, residence Covington, Tenn.; had been an invalid for two years previous; of nervous temperament, but intelligent and well educated; mother of one child, with history of having miscarried three times; menstruation painful, but generally regular before marriage; but after her first confinement she suffered with profuse hemorrhage at each period; her nervous, circulatory and digestive systems badly deranged; general appearance showing much suffering. On examination found the uterus retroverted, Fallopian tubes enlarged, ovaries prolapsed, very tender and enlarged. Admitted to my private sanitarium and put under preparatory treatment on May 15; operated June 1, 1893; using strict asepsis and the antiseptic method also as necessary for such operations. On opening the cavity the diagnosis was found

correct; the ovaries were four times the normal size, and filled with small cysts; the tubes were also enlarged. The ovaries and tubes were removed, the adhesions were easily broken, the pedicle securely tied, the abdominal cavity flushed, all hemorrhage stopped, the walls were closed, a glass drainage tube inserted, and the wound dressed. The patient showed signs of considerable weakness and shock, and was given several hypodermic injections of strychnia. About an hour after the operation a secondary hemorrhage suddenly began; the tube filled with blood as fast as we could draw it off, and it was clearly seen that the patient would soon bleed to death unless something was done at once. From the condition of the pulse, it looked like death to anesthetize the patient and reopen the abdominal cavity; but this was immediately decided upon. The bleeding artery was found and closed by ligature, and the wound dressed as before. The pulse was 160-almost imperceptible. Strychnine was given, and bottles of hot water placed around the patient. At 4 P.M. the pulse was 150; strychnine repeated, and at 4:30 we drew from the tube two ounces of blood. At 6 P.M. the patient was restless; pulse 140. From this time on improvement was gradual but very slow. The tube was watched closely, and was drawn off every two or three hours. It was removed on the third day. The bowels acted well on the fourth day. She improved gradually, her fever but once going over 101° F., which was on the eighth day.

She is now enjoying better health than for many years. She looks much better, and is gaining flesh and strength; in fact, she is well. She has never menstruated since the operation.

The conclusion drawn from this case is: It is always better to reopen the cavity in such cases than to let the patient die from secondary hemorrhage. Give them the benefit of the last resort, although the pulse may indicate death.

A Good Example.

The city of Sydney, Australia, has imposed a fine of one pound sterling upon any person convicted of spitting upon the floor of public buildings or upon the streets.—Boston Medical and Surgical Journal.

THOROUGH DILATATION OF THE UTERUS

Previous to Curetting A Positive Preventive of Perforation.

Translated from the Spanish, Gaceta Medica, City of Mexico, by Geo. Mott, M.D., Spurger, Texas, for the Memphis Medical Monthly.

Speaking of the danger of perforation of the uterus while using the curette, D. Noriega, of the City of Mexico, says "that neither he nor any of his colleagues are aware that the accident has ever happened in Mexico." He says that on one occasion he was using a curette when the woman suddenly vomited. He instantly released the instrument, and, as the uterus was well dilated, it fell to the floor. He thinks without doubt that if he had maintained his hold the uterus would have been perforated. He believes that, if the uterus were always well dilated previous to the curettement, perforation would be impossible.

THE EARLY TREATMENT OF GONORRHEA.

Abstract of a paper read before the Society for Medical Progress, of the West Side German Dispensary, New York. (Aristides Agramonte, M.D., Sec'y.)

BY WM. S. GOTTHEIL, M.D.

It is difficult to inaugurate a rational treatment of gonorrhoea, on account of the universality of the opinion, both lay and medical, that it is a trivial affection, and unworthy of the expenditure of time and money. It is, however, a most important malady, with serious effects and far-reaching consequences; as witness the complications of posterior urethritis, cowperitis, peri-urethral abscess, and prostatitis; the metastases: epididymitis, rheumatism, arthritis,and tendo-synovitis; the infections: ophthalmia, glossitis, proctitis, endometritis, and salpingitis; and the sequela: cystitis, ureteritis, and nephritis. It causes more deaths than does syphilis, and is more to be feared than the latter disease on account of its refractory behavior to treatment.

The unsatisfactory attitude of the public to the disease is directly due to the erroneous ideas instilled into them by the past generation of doctors, and the remedy therefor lies in the hands of the profession. It consists in instructing our patients carefully as to the real nature and dangers of the disease, in