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2. It is non-oxidizable, and, practi- of its incompressibility, and in this cally, non-corrodable.

3. It is separable and easily placed and replaced.

4. It cannot escape from the cavity of the abscess.

5. It can do no "prodding," as is the case, frequently, with the white rubber tubing, and which, in an abscess, soon becomes as hard as bone.

6. It is incompressible, and hence, unlike any form of rubber tubing, the latter, under similar circumstances, collapsing, and thus failing to drain.

7. It furnishes double drainagedrainage at two different points.

8. It can serve for irritating purposes as well as for drainage.

9. It can be kept clean, and, if thought necessary, can be removed and cleansed occasionally.

10. It can be worn indefinitely.

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respect is superior to gauze packing, under the use of which openings tend to close.

13. It permits of painless dressings, which is an impossibility when gauzedrainage is employed.

In short, the apparatus seems to fulfil the indications, inasmuch as it is a drainage-tube that drains. I speak from experience.

When in the treatment of these abscesses the tube is to be placed in position, two incisions, about three-quarters of an inch apart are made at the proper points, and a heavy silk ligature or corresponding silver wire sufficiently long is passed from one to the other through the abscess-sac and brought down to a position where it can be manipulated.

*The cut represents one-half of the instrument, but the complete picture may readily be imagined by the reader,

Each half of the apparatus is now threaded upon the ligature or wire (in case silk is employed wire should be used as a leader), a knot made and drawn, whereupon, with a little manipulation, the instrument will naturally and readily adjust itself, forming a complete horseshoe, the convexity of which-and this is the only portion supplied with fenestræ-will project into the abscess-cavity, the "heels" remaining out of sight and away from pressure within the vulva.

This natural adjustment is much facilitated by the fact that the "heads" of the apparatus are practically solid, plane surfaces, and are not arranged for the fitting of one part into the other.

A small loop of the ligature or wire should be left at the base for the purpose of easy manipulation and to maintain coincidence between the long axis of the instrument and that of the vagina.

By proceeding after this fashion in properly selected cases the surgeon will, in my opinion, obtain gratifying results and will acquire the same in accordance with sound surgical principles and with the least risk to the lives of his patients.

ON SCARLATINA-LIKE RASHES IN CHILDREN. (Dr. Henry Ashby, Med. Chronicle.) There is a strong family likeness between the various zymotic diseases. Various kinds of staphylococci seem to have a suitable soil prepared for their development in the body through the influence of the specific organisms of the infectious diseases, and the presence of the staphylococci may account for the similarity of some of the symptoms common to all. Varicelli mimics small

pox, roetheln mimics measles. Some epidemics of influenza simulate diphtheria, being accompanied by a membranous sore-throat. The similarity in symptoms between various zimotic diseases is apt to give rise to much. perplexity in diagnosis, and in no case more so than when a rash of the scarlatina type is present. The rash of scarlet fever is diffuse and punctiform, covering trunk, back and limbs; its mildest form remains visible twentyfour to forty-eight hours. A red rash, seen by candle-light and gone by daylight, is not scarlatina. Though a scarlatinal rash may appear to be erythematous, the red points correspond ing to the hair follicles are of a deeper color than the surrounding skin. Though diffuse on the trunk, it may be patchy on the limbs. Full diagnosis is often very difficult. Scarlet fever may be practically feverless, and the temperature not more than 99.5° or 100 for a couple of evenings; the fauces may be only doubtfully reddened. A well-marked red-rash may appear in course of other diseases, as pneumonia, or after an operation, or during suppuration of some sort. The association of a red rash with certain epidemics of influenza has been noted by many others besides the author, but every case in which there is a red, punctiform, diffuse rash should be isolated and treated as scarlatina, unless it can be proved otherwise.

The scarlatinal form of rubella (epidemic roseola) most closely resembles mild scarlatina, just as, at other times, it resembles measles. Whether these two forms of rubella are distinct diseases or types of the same is still an open question. The author does not think that the scarlatiniform type can

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always be distinguished from scarlet fever, as Clement Dukes believes. The great difficulty is in isolated cases. Where an epidemic exists the long incubation of rubella-eighteen to twenty-one days-distinguishes it from the short incubation period of scarlet fever, namely, two to three days. called surgical scarlatina is usually true scarlatina in a surgical sense; but where there is an excessive amount of suppuration there may be a red rash. due to septicemia. Such a rash may occur in empyema cases and sometimes in diphtheria. There may at times be a second rash in scarlet fever cases, where there is much suppuration about the fauces and neck, but all these are a duskier red than the true scarlatina rash. The only drug eruption which is likly to be mistaken for scarlet fever is the erythematous eruption that some times follows the administration o belladonna or its alkaloid. The rasi of antipyrine is more of the measles or nettle rash type. An erythematous rash may occur in mild or ptomainic poisoning, accompanied by gastro-intestinal disturbance and vomiting and diarrhoea, but in the child. this combination should always suggest scarlet fever in an early stage. Ashby does not lay much stress upon desquamation as a symptom of recent scarlet fever, unless there be other evidence from the history or sequelæ, such as nephritis. "Peeling" may follow other diseases, as typhoid-pneumonia or influenza, specially that of the thick skin upon the hands and feet. In fine, a diagnosis in any case can only be arrived at by collecting all the evidence available, and not by giving one piece of evidence a fictitious importance.-Kansas Med. Jour.

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NEW METHOD OF PREPARING CATGUT.

Dr. Cunningham, before the New York Academy of Medicine, described the following method for preparing catgut :

Since the discovery that a solution. of formalin, 1-5000, is capable of preventing the development of microorganisms in beef-juice, many observers have demonstrated its potency as a germicide. It must be used in a very dilute form, otherwise it produces a peculiar form of necrosis. Formalin unites with gelatin and albumin to form insoluble compounds. Commercial, surgical catgut is loosely wound on a glass spool and soaked for two days in equal parts of alcohol and ether, then rinsed in alcohol for a few moments and removed to a small jar having a tightly-fitting cover. This jar contains a mixture of equal parts of formalin, alcohol and boiled distilled water. After two days the catgut may be removed and washed several times in alcohol, or, preferably, boiled in normal salt solution. It is then ready for use, and is to be preserved in alcohol. The catgut does not become stiff or brittle, and even after boiling for a considerable time it does not disintegrate. By this method of boiling the irritating formalin is very thoroughly removed, and the catgut rendered thoroughly aseptic. Other normal substances, such as bone drains and rings, may be treated in this way with advantage, provided not too early absorption is required. Unless a considerable percentage of water is present in the formalin mixture, the catgut will be rendered brittle. The proportion of the other ingredients is not so important. Experiments on animals.

have shown that in the skin these cat

gut sutures are absorbed in from ten to twelve days, and that about the seventh day they begin to show softening. Provided there is not too much alcohol in the mixture, the desired chemical change takes place in the course of a few hours.

The chairman, Dr. Curtis: This method seems to me exceedingly useful, for it enables the surgeon to readily prepare his own catgut, and in a short time. There can be no question as to the sterility of the catgut, for it has been used with success in experimental brain and peritoneal surgery.

APPENDICULAR ABSCESS BURST INTO ABDOMINAL CAVITY DURING EXAMINATION; OPERATION; RECOVERY.(Jas. Daniel, Brit. Med. Jour.) M. W., aged 27, first came under my care about ten months ago. She complained of a severe pain in the right iliac region, accompanied with vomiting, constipation and fever. It had commenced about three days previous and was gradually getting worse. Purgatives, instead of relieving, had rather increased the pain.

On examination there was a distinct circumscribed swelling, very painful, but no distinct center of softening that would lead me to suspect suppuration, and she had no rigors. I therefore suggested the application of six leeches and hot fomentations, and gave her a saline mixture with large doses of belladonna internally and a one-fourth grain of morphine hypodermically. The next morning she was much better, the bowels had acted copiously, and in three or four days she appeared quite well again. Since then she has had several other attacks, coming on after intervals of three or

four weeks. After the fourth attack I suggested operation, which she declined, and consulted another practitioner. The last attack had commenced while she was away at Blackpool, and had lasted for three weeks without any material improvement. Her doctor told her she had better get home, as he had done all he could do, and that it might require an operation.

On April 7th, the day after her return from Blackpool, I was called in to see her; she was then suffering severe pain in the right iliac region, constipation, rigors, hectic and great emaciation. The swelling which I first saw had considerably increased in size, and was distinctly fluctuating; and, while examining it, to be sure of my diagnosis, I felt it suddenly give way. under my fingers; the patient felt it also and fainted. After coming round she said she felt relieved. I explained to her friends the nature of the case, and they sanctioned my operating. On opening the abdomen, the pus welled up through the incision as I made it. The whole of the intestine was soaked in pus. I washed out the abdomen freely, first with warm water and then with a saline solution, sponged out the abscess cavity, and dusted well with iodoform. The cecum and colon were matted together, and the appendix could not be found. I made a counter-opening over the abscess, and put in a drainage-tube, and dressed antiseptically. The same evening she expressed herself as feeling very comfortable; there had been no vomiting, temperature 102°, pulse 108. Next morning I removed the dressing from over the drainage-tube, and soaked out of the tube about two teaspoonfuls of fluid with pus. On the second day

there was scarcely any fluid in the tube, and the patient was still feeling better; temperature was 100°, pulse 96. On the third day there was no fluid in the tube, which felt firmly fixed on account of the cavity contracting, so I removed it and dressed antiseptically. The wound continued. to discharge for three or four days, and eventually healed up. The abdominal incision never gave any trouble. The woman is now wearing a belt, and is gaining flesh rapidly.

I think this case illustrates another instance of the dangers of delay, and, had it not been for my prompt action, the case might have turned out much more seriously.-Mathews' Med. Quar.

INJECTION TREATMENT OF HERNIA; WITH FORMULA OF FLUID.-(Walling, Med. and Surg. Reporter.) To Heaton and Warren, of Boston, belongs the credit of bringing this treatment into prominence, but it was not until it was considered from a scientific basis that it became really successful. Chemistry has come to our aid in this matter. Substances that are in themselves harmful, by combining them with other substances, or by arranging their elements differently, become useful therapeutic agents. Reducible hernia may be quickly and easily cured without danger, with little loss of comfort to the patient, and no loss of time; the essentials being a deft hand, a proper fluid and a trocar and canula syringe. The technique is as follows: Place the patient on the operatingtable, reduce the protrusion, if out, wash the parts well with some antiseptic fluid, invaginate the scrotum. with the index-finger, and locate the external ring; inject into the skin at

this point five minims or more of a 5 p. c. solution of cocaine, to which has been added one drop of a 1 p. c. solution of nitro-glycerine. Have the hernial syringe filled with fluid, displace the air, wipe off the drop of fluid which may appear at the needle's end, and carefully note how far the canula must be turned off in order to entirely cover the needle point. Allow three minutes for the cocaine to take effect, and, having drawn back the canula, exposing the needle spear, thrust the instrument through the skin and fascia at the point of the cocaine injection. Push the instrument well into the external ring, carefully avoiding the cord. Change the instrument to the other hand, and, again having invaginated the scrotum, be sure that the needle has entered the ring. Then screw down the canula until it covers the point of the needle, and, dipping down with the instrument, pass the canula by gentle manipulations up the canal to the inner ring. In doing this bear in mind that the inguinal canal is from one and one-half to two inches in length, lying nearly parallel with Poupart's ligament, and about onehalf inch above it.

Having reached the inner ring, carefully and slowly inject from 3 to 5 minims of the fluid, a minim at a time; wait one or two minutes, slightly withdraw the piston of the syringe in order to empty the needle, and withdraw the instrument. Gently massage the parts to evenly distribute fluid. Cover the puncture with an aseptic collodion. There will be a more or less burning or smarting sensation experienced by the patient, but by lying quietly for a few moments it will pass off. It may return for a short time

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