the removal. The inner aspect of the jaw was next scraped, and some affected glands discovered at the outer edge of the geniohyoid muscle being removed, the cavity was swabbed out with a solution of the chloride of zinc (forty grains to an ounce). Two large drainage tubes were secured on each side of the stump, and brought out below the angle of the jaw, so as to secure perfect drainage by occupying the most dependent positions. The wounds in the neck were closed by silk sutures and dressed with dry iodoform wool and gauze. During the operation, which lasted a little over an hour, not the slightest difficulty was experienced by the anesthetist, neither did blood enter the larynx or pharynx. At no time had the anæsthetic to be discontinued, the breathing being good throughout. The subsequent progress of the case has been all that could be desired. By the use of iodoform and good drainage the breath has remained perfectly sweet. No discharge has reached the larynx. or pharynx, and the temperature has scarcely been above normal. The stitches were removed on the third day. When I last visited the patient he was sleeping tranquilly, and was reported to have taken nourishment freely, slept well, and complained of nothing. AUG. 18th. The patient progressed most satisfactorily and left the Home on the twenty-first day. He has gained strength and improved in weight, and has just visited me, having walked three miles. There is not the slightest appearance of return, and the patient experiences no difficulty in swallowing or in making himself understood.-The Laucet, August 22, 1885. THE ETIOLOGY AND PATHOLOGY OF THE SOCALLED "DENTIST'S LEG." BY GEORGE JOHNSON, M.D., F.R.S. Professor of Clinical Medicine, Senior Physician to King's College Hospital. At the meeting of the Odontological Society in June, 1884. Mr. Oakly Coles read an interesting paper on the "Maintenance of Health Amongst the Practitioners of Dental Surgery." The reading of the paper was followed by an instructive discussion, in the course of which mention was made of the pain in the back and legs resulting from over-fatigue in muscles which are engaged in maintaining the body for a long period in one constrained position. 1 One speaker, Mr. Dermant of Brighton, said he had himself "suffered from what then medical friends were learning to call the "dentist's leg." About two years since the pain became unbearable after standing three or four hours, resembling very much the application of scalding water to the outer part of the thigh in the region of the external cutaneous nerves. It seemed to be due to nervous exhaustion from the undue strain thrown upon the part. Medical friends and common sense suggested rest as the remedy, and this to be secured by means of the Lyons stool. He had used this for about two years with great benefit, and could now get through a day's work with comparative comfort. Sometime since I had my attention directed to this subject in consequence of having been consulted by a dentist, about thirtyfive years of age, who described to me a sensation of numbness in one thigh, which he feared might be a precursor of paralysis. I soon, however, relieved him of his anxiety by giving him what I have no doubt, is the true explanation of the perverted sensation. Our every-day experience teaches us that over-strain and fatigue may be the direct cause of pain in the muscle concerned, but, besides this, the long continued rigid contraction of the muscles which are engaged in maintaining such a fixed position as. the operating dentist often has to assume must greatly impede the cir culation, so the state of fixed and rigid contraction must obviously impede and retard the circulation, by exerting a continuous pressure upon the blood-vessels, and more especially, upon the soft and easily compressed veins. The impeded circulation affects not only the muscles, but also the skin and subcutaneous tissues and the nerves which supply the different tissues, and the result of a defective circulation on the nerves is to cause various perverted sensations such a numbness, a sensation of "Pins and Needles," or a painful feeling of heat and scalding. The immediate cause, then of the painful sensations experienced and so graphically described by Mr. Dormant appears to be, not, as he suggests, "nervous exhaustion" but perverted nerve function, directly due to a mechanical impediment to the circulation through the rigidly contracted muscles and their associated nerves. It is probable, too, that direct compression of the nerves by the firmly contracted muscles may have some influence in the causation of the perverted sensations referred to the cutaneous terminations of the nerve. I have often been consulted by men and women beyond middle age who have been alarmed by a feeling of numbness, or "Pins and Needles," in the extremities. In these cases the defective circulation, which is the direct cause of the perverted sensation, is often the result of an enfeebled condition of the heart, with-or without general obesity, and often without more or less general emphysema of the lungs. To return to the "dentist's leg." The obvious means of prevention and of cure consist in rest for the over-strained limb, or such a frequent change of position as is equivalent to a certain amount of rest. Standing in one position is notoriously more fatiguing than walking, and for the obvious reason that while in standing, one set of muscles is in a constant state of active contraction, the circulation through them being thereby retarded and enfeebled, walking envolves alternate contraction and relaxation of the muscles, with an invigorated and quickened circulation. More than one speaker, during the discussion, referred to the benefit to be derived from some form of active muscular exercise after the day's work. It is probable, too, that systematic friction and massage of the affected limb would be beneficial.-(The Lancet, Aug. 15, 1885. 1 Transactions of the Odontolgical Society of Great Britain Vol. XVI, No. 8. New Series. DR. HOLMES TO THE BLIND. The following "Dedication" appears in a volume of poetical selections issued by the Howe Memorial Press for the blind : DEDICATION. "Dear friends, left darkling in the long eclipse A meaning in these ridgy leaves can find Where ours go stumbling, senseless, helpless, blind, To whom the garden's choicest gifts are due ? "Nay, those I have I bring you; at their birth Life's cheerful sunshine warmed the grateful earth; Our stately verse with too aspiring art Oft overshoots and fails to reach the heart, From Nature's lesson learn the poet's creed; A dew-drop fresh from heaven's own chalice hold. BOSTON, June 15, 1885. THE BACILLUS OF TUBERCLE IN THE BLOOD. Sticker narrates a case in which acute miliary tuberculosis was provisionally diagnosed and the "diagnosis was, two days later, placed beyond all doubt by the discovery of six tubercular bacilli in two blood preparations (from the finger)." The patient passed through a very severe period of suffering, but eventually recovered, this adding another to the number of cases of recovery from acute tuberculosis.-Centralblatt fur klinische Medicin.-Edinburgh Mcdical Journal. BACILLUS TUBERCULOSIS VS. BACTERIUM TERMO. Prof. Cantani, of Naples, in the Centralblatt für die Medicinishen Wissenschaften, relates a number of experiments in which the bacterium termo has been made use of to destroy the bacillus tuberculosis. The patient suffering from acute phithisis pulmonum was made to inhale a spray of a culture solution of the bacterium ter mo. The result was quite gratifying, the cough and expectoration diminished, the fever rapidly declined, the bodily weight increased, the bacillus of tubercle disappeared from the sputa, and at the end of a month the general condition of the patient became excellent. Perhaps the experiments may be the means of giving us the much sought weapon against the terrible bacillus of tubercle. If phthisis can be shorn of its terrors the average of human life will be very much prolonged; and as we already so well know the prophylaxis let us hope that the therapeutic specific may soon be discovered. COMPOUND COMINUTED DEPRESSED FRACTURE OF THE SKULL. Mr. Monro reports a unique case of the above fracture in the Lancet, for August 29th. The patient was kicked on the forehead by a horse, a large fragment of bone depressed and pushed up behind the frontal bone. The patient was not even stunned by the blow but immediately got up, and walked 300 yards to his master's house. Mr. M. Removed the depressed fragment, the largest piece of which measured 14x11-18 in., from the pulsating brain at the bottom of the wound. A drainage tube was introduced and the patient made a rapid recovery, being able to work on the eleventh day after the accident. The temperature was the highest, 99.4°, on the fourth day. TREATMENT OF SPRAINS BY THE ELASTIC BANDAGE. Surgeon T. A. Cunningham, U. S. A., in the Medical Times, Sept. 5, reports the treatment of a case of sprain of ankle joint by rest and compression with an elastic bandage. He then generalizes as follows: "I consider the elastic bandage the treatment par excellence, for sprains, if seen early and before much swelling has taken place, for the following reasons: 1. It promotes absorption of the effused fluid. 2. It prevents undue swelling. 3. It can be more smoothly and evenly applied, and by its resiliency supports and relieves the torn and sprained tissues, much more satisfactorily than an ordinary bandage. 4. It allows the patient, after a few days, to attend to nearly all of his ordinary avocations about the house." WE have labored under many difficulties in getting together the contents of this our initial number, which will not have to again be We therefore think we can safely promise that the succeeding numbers will be more valuable than the first. met. |