of Philadelphia, Dr. M. H. Richardson, of Boston, Dr. John B. Roberts, of Philadelphia, Dr. Joseph Ransohoff, of Cincinnati, Ohio, and Dr. W. G. Porter, of Philadelphia.

5. Experimental Researches on Gastric Fistula, and the Bearing on Gastrostomy. By Dr. J. Collins Warren, of Boston, Assistant Professor of Surgery in Harvard University. The discussion will be opened by Dr. W. T. Bull, of New York, Dr. Nicholas Senn, of Milwaukee, and Dr. John H. Brinton, of Philadelphia.

6. Forty Years of Chloroform and Ether. By Dr. D. W. Yandell, Professor of Surgery in the Medical Department of the University of Louisville. The discussion will be opened by Dr. Hunter McGuire, of Richmond, Va., Dr. E. M. Moore, of Rochester, New York, Dr. Charles T. Parkes, of Chicago, Dr. W. W. Dawson, of Cincinnati, and Dr. C. H. Mastin, of Mobile, Ala.

7. The Surgical Management of Typhlitis and Perityphlitis. By Dr. W. T. Bull, Surgeon to the New York Hospital, etc. The discussion will be opened by Dr. T. G. Morton, of Philadelphia, Dr. J. Ford Thompson, of Washington, Dr. F. S. Dennis, of New York, Dr. B. A. Watson, of Jersey City, N. J., and Dr. J. Ewing Mears, of Philadelphia.

8. The Choice of Operation for Vesical Calculus. By Dr. Hunter McGuire, of Richmond, Va. The discussion will be opened by Dr. S. W. Gross, of Philadelphia, Dr. D. W. Yandell, of Louisville, Ky., Dr. Wm. T. Briggs, of Nashville, Tenn., and Dr. A. Vanderveer, of Albany, N. Y.

9. Hernia: Its Treatment, etc. By Dr. C. H. Mastin, of Mobile, Ala.

10. The Radical Cure of Hernia. By Dr. George W. Gay, Surgeon to the Boston City Hospital, Boston. The discussion of the papers of Drs. Mastin and Gay will be opened by Dr. L. McLane Tiffany, of Baltimore, Dr. H. H. Mudd, of St. Louis, Mo., Dr. Donald McLean, of Detroit, Mich., and Dr. J. E. Michael, of Baltimore.

11. Certain Indications for Trephining, and their Comparative Value. By Dr. J. Wm. White, of Philadelphia, Demonstrator of

Surgery and Lecturer on Surgery in the University of Pennsylvania. The discussion will be opened by Dr. Christopher Johnston, of Baltimore, Dr. P. S. Conner, of Cincinnati, and Dr. D. W. Cheever, of Boston.

12. Nerve Stretching. By Dr. N. P. Dandridge, Professor of Genito-Urinary Diseases in Miami Medical College, Cincinnati, Ohio. The discussion will be opened by Dr. W. W. Keen, of Philadelphia, Dr. T. G. Richardson, of New Orleans, Dr. John Ashhurst, jr., of Philadelphia, and Dr. T. A. McGraw, of Detroit, Mich.

13. Nephrectomy for Gunshot Wound of the Kidney. By Dr. DeForest Willard, Lecturer on Orthopedic Surgery in the University of Pennsylvania. The discussion will be opened by Dr. W. W. Keen, of Philadelphia.

KENTUCKY STATE MEDICAL SOCIETY.-The Thirty-third Annual Meeting of the Kentucky State Medical Society will be held at Crab Orchard Springs, commencing Wednesday, July 11th. (The date has been changed from the first Wednesday in July, that day being the 4th.) A full attendance is expected. Titles of all papers to be offered, with the names of authors, must be sent to the Secretary on or before June 15th.

The Crab Orchard Springs Company

offer reduced rates of board to members and their families. For further information address Steele Bailey, M. D., Permanent Secretary, Stanford, Ky.

E. R. PALMER, M. D.,
Chairman Com. Arrangements.

sent to the State and Provincial Boards of Health, inviting them to appoint delegates and to formulate questions and topics which they desire to have discussed. An attractive programme has been published.

THE CANCER CRAZE.-We are living under the sign of Cancer. Cancer is the subject of discussion in all medical assemblies, from the cancer bacillus of Dr. Scheuerlen to the operative removal of carcinomata in the different organs. Cancer forms the subject of private conversation among medical men, and also among the laity. “What do you think of the illness of the Crown Prince?" the principal question till lately, has now been altered to, "What do you think about the illness of the Emperor?" Our Emperor Frederick enjoys an extraordinary popularity, and the whole interest of Germany is concentrated on the great question, "How long?" In these questions the position of Sir Morell Mackenzie is very much discussed. There is a large party of laymen, and, unfortunately, also of medical men who hate him. The former do so from Chauvinism, because they are foolish enough to believe that the honor of German science is wounded by an Englishman being the first physician of the German Emperor. His professional detractors accuse him of having, by his optimism, prevented a radical operation being undertaken while there was yet time. However, happily, there is a much larger number who are thankful to him for having prolonged for some time so precious a life; and he enjoys in full measure the confidence of His Majesty the Emperor himself, and of his illustrious consort. It is just announced that Dr. Herman Krause has been named Professor.-British Medical Journal.

MEDICOMANIA.-It consists in a mania for medical and surgical curiosities, and even operations, which is said to prevail in Parisian society. The scenes of the dead-house, the dissecting-room, and surgical theater, all matters of purely professional interest, have, thanks, no doubt, to a diseased realism in

the world of fiction, become the spectacle of the hour, the twin diversion with social small talk. It is a singular and not very worthy feature of the present day that various matters of the most serious character are apt to be discussed in general conversation in the lightest vein. In some circles religion is no longer sacred. It is hardly remarkable, therefore, that pain, sickness, sorrow, and death are to some who have not known them no more than means of pleasantry, nostrums for the cure of an idler's leisure. We have better hope of mankind than to believe that any such morbid flippancy will long escape its due censure at the hands of all true exponents of good taste and right feeling.-Lancet.

HOW TO CURE GOITRE.-French army surgeons have been profitably employed in drawing up medico-geographical reports of the French departments. Surgeon-Major Aubert has already reported to the Académie de Médicine on Calvados, Loire Inférieure, and La Vendée. On February 14th his report on the Medical Geography of the Ain was read. In reference to ninety-three men with goitre from the mountainous districts of that department, who were exempted from military service from 1872 to 1886, Dr. Aubert makes a most reasonable suggestion. As most cases of goitre between the ages of eighteen and twenty are curable, a great service would be done to them by enrolling, instead of rejecting them, and placing them in the territorial army in healthier parts of France, particularly in coast stations. By sending these men far from their mountains to naval arsenals they might be permanently cured, and at least could not fail to derive great benefit from the change.-British Medical Journal.

OXYPROPRYLENDUSOMYLAMINE.-This is a new alkaloid prepared by synthesis. In moderate doses it is said to be a good heart tonic, and doubtless the rapid repetition of the word itself would be found a very useful gymnastic exercise in cases of stammering. Record.

THE ASSOCIATION OF AMERICAN MEDICAL EDITORS. The following programme has been arranged for the meeting at Cincinnati, Monday evening preceding the meeting of the American Medical Association, May, 1888: Meeting called at 8 P. M. Reading of minutes. President's address, Dr. William Porter, of St. Louis. Report of Committee on Organization, Dr. McMurtry, Chairman, Danville, Ky. Election of officers for ensuing year. Extraordinary business. Questions for consideration:

1. Is the multiplicity of medical journals an advantage to the profession? To be discussed by Drs. Crothers, Hartford; Sim, Memphis; Wile, Conn.; Love, St. Louis; Culbertson, Cincinnati; Cushing, Boston; Coomes, Louisville, and Gray, Chicago.

2. How far do medical journals, distributed by drug houses and manufacturers, interfere with regular medical journalism? To be discussed by Drs. Reynolds, Louisville; Davis, Chicago; Shoemaker, Philadelphia; Bond, St. Louis; Connor, Detroit; Kiernan, Chicago; Thacker, Cincinnati, and Fulton, St. Paul.

Members are requested to limit their remarks to fifteen minutes, and if possible to ten. The place of meeting will be posted in all the hotels by the local committee.

Arrangements can be made at this meeting for a "press dinner" for another evening during the week, but it will be impossible to conclude the business of the Association and have the dinner the same evening.

IMPURE ANTIPYRIN.-The extraordinary demand for antipyrin is very much in excess of the supply, and great pressure is put upon the manufacturers to increase the amount of the manufactured article in the market. The consequence has been that due care has not been shown in the purification of the drug, a certain proportion of benzine having been detected in samples submitted to analysis, according to Dr. Dujardin-Beaumetz. This impurity may account for some of the toxic symptoms which have been reported, such as cutaneous erup

tions, gastric troubles, and even grave cerebral symptoms, more particularly in the aged.-British Medical Journal.

QUARANTINE At Mouth of tHE MISSISSIPPL The Board of Health of the State of Louisiana has resolved that its secretary be instructed to respectfully request the Governor of the State to issue his proclamation of quarantine in accordance with the following recommendations: Such quarantine to go into effect from and after the 20th day of April, 1888, simply for inspection and fumigation-this to remain in force. until the 1st day of June, unless changed by direction of this Board; from and after that time all vessels subject to quarantine treatment shall be detained for observation, etc.

THE WESTERN PENNSYLVANIA MEDICAL COLLEGE, Pittsburgh, held its Second Annual Commencement, March 24, 1888. Thirtyfour graduates received the Degree of M. D., being an increase of exactly fifty per cent above last year's number. The valedictory address was delivered by Prof. James McCann, President of the Faculty. A banquet to the Alumni was given by the Faculty.

IN MEMORIAM: AUSTIN FLINT, M. D., LL. D.-A bust of the late Prof. Flint was unveiled, with the proper ceremonial, at the Carnegie Laboratory of the Bellevue College on March 10th ult. Dr. Abram Jacobi delivered an address suited to the occasion. Many invited guests participated in the ceremonies.

A STATE SANITARY CONVENTION, under the auspices of the State Board of Health, will will be held at Lewisburg, Union County, Pa., on Thursday and Friday, May 17 and 18, 1888.

S. MORIYASU, from a study of a large number of Japanese girls with reference to the age at which menstruation began, concludes that the first appearance is, on an average, between the ages of fifteen and sixteen.

VOL. V. [NEW SERIES.]

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

GUNSHOT WOUND OF THE HEAD-A CASE.*

BY WILLIAM O. ROBERTS, M. D. Professor of the Principles of Surgery, University of Louisville.

March 4th, at 9 P. M., I saw, in consultation with Dr. Godshaw, a case of gunshot wound of the head in a child three years of age:

At 2:30 P. M. the day before, the child while at play found an old pistol (thirtytwo caliber); in taking it from him the mother accidentally discharged the load. The ball entered the child's left lower eyelid, ranging upward and outward, passing through the eyeball and into the cranium. Dr. Godshaw arrived an hour after, and found the child in profound shock. Brain matter with blood issued through the wound; behind the left ear was a large, tense swelling. The child soon became very restless, and the doctor gave grain of morphine hypodermically; and, to relieve tension back of the ear, introduced a trocar and drew off several ounces of dark blood and some brain matter. In two hours a second hypodermic injection was given, and five hours after the accident the child became sufficiently conscious to be able to swallow, and grain morphia was given

by the mouth. During the night this dose was repeated every two hours in order to quiet the restlessness. 9 A. M., March 4th,

*Read before the Louisville Surgical Society, April, 1888.

No. 9.

reaction was well established-pulse 130, temperature 98.5°, surface warm, child still restless and fretful but quite rational. As

the grain of morphia now failed to procure sleep, Dr. G. doubled the dose, and continued giving grain by the mouth every three hours up to the time I was called. He had taken altogether over one grain of morphine. I found the child sitting up in bed talking. He had just taken half a glass of milk. Pulse 130, temperature 100°, respiration 24, intellection perfect. All oozing had ceased at the wound. The swelling behind the ear covered a space as large as the palm of my hand, and was not very tense. Pressure over it revealed crepitus. Dr. Godshaw thought the swelling had diminished materially since the use of the tro

car.

We agreed to continue the morphine during the night if required to procure rest, and make an exploratory incision through the swelling early next morning.

9 A. M., March 5th, the condition of the patient was unchanged. Had passed a fairly good night, with three doses of morphine,

grain each. Chloroform was administered, the head shaved, and a T-shaped incision made through the swelling, which was followed by a quantity of extravasated blood and a tablespoonful of brain matter. The bullet, much flattened, and several fragments of bone were found immediately beneath the scalp. The wound of exit was situated in the temporal bone just above the mastoid process, and was about one inch in its vertical and half an inch in its tranverse diameter. The opening was filled with a clot of blood, upon the removal of which some liquid blood, with brain matter, escaped. After thoroughly cleaning these parts the eyeball was enucleated. The wound of en

trance in the orbit was found to be to the left of the sphenoidal fissure. No spicule of bone were detected here. It was our intention now to pass a drainage-tube the entire length of the track of the ball, but the child showing every evidence of sinking, we simply passed the tube well into the track of the ball inside of the cranium at the point of exit, and closed the scalp wound immediately around it with a few interrupted sutures, and applied iodoform gauze. Strict antiseptic precautions were observed. When the child was put to bed it seemed almost moribund surface pale and cold; lips livid; radial pulse scarcely perceptible; temperature 95°; breathing very shallow. Whisky and

grain morphia were given hypodermically and child wrapped in hot blankets. Half an hour after pulse began to improve; thirty minutes later there was a marked change for the better. At 4 P. M. reaction was well established: pulse 126, temperature 98.5°, surface warm, intellection good, but child restless and fretful. Had taken three doses of grain morphia hypodermically; had slept a good deal, and taken milk twice; when awake he would have his mother take him in her lap; on his falling to sleep she would put him back to bed.

March 6th, 9 A. M., child sitting up in bed drinking milk, insisting upon putting on his clothes and getting on the floor; complained of no pain; had a good night, with but three doses of morphia; passed water several times during the night, calling for the vessel when he needed it. During the day he had several long naps, but was restless and fretful when awake; insisted that his mother walk the floor with him. Attempts to count his pulse or take his temperature annoyed him so much that they were omitted. Calomel was given at night, and as the restlessness increased Dr. Godshaw increased the dose of morphia to, then grain hypodermically; but the morphine seeming to make him worse, he substituted for it bromide of potash and chloral with the happiest effect. Within ten minutes after taking a dose the child quieted down, and slept for an hour or more.

March 8th. Child passed a fairly good night; temperature and pulse not taken; seemed perfectly at himself; bowels moved in the morning; drank over a pint of milk during the day through a nursing-bottle.

March 9th. Child had a restless night. While sleeping this morning temperature was taken, 102°; pulse 130; face alternately flushed and pale. No cold stage had been noticed nor any sweating. The chloral mixture had been continued at intervals of three to four hours. On removal of the dressing the wound around the drainage-tube was entirely healed, except at the lower angle through which some pus escaped. The entire dressing was stained, showing that it had been well soaked with sero-sanguineous discharge, except immediately over the seat of the wound, where there was a small spot of purulent discharge. The mouth of the drainage-tube being dry, I thought the tube itself must be closed, and withdrew it. This was followed by the discharge of a thin, brownish fluid in small quantity. The tube was found plugged with broken-down brain matter and pus. A fresh tube was now introduced a distance of three inches before meeting with resistance, and the wound dressed. During the day the child was much less restless than before, but also much weaker. He took the nursing-bottle four or five times, drinking in all about a pint of milk. At night his temperature rose to 104°. Red splotches came and went over the body.

March 10th. Child comatose, with temperature 105°, pulse 160. Death took place late in the afternoon.

Post-mortem made next day. On removal of the dressing there was a slight discharge of pus through the drainage-tube. The tumefaction of the scalp had disappeared. The skull wound was found located in the temporal bone above the mastoid process, in close proximity to the upper border of the lateral sinus, and about as large as previously mentioned. The vessels of the brain and membranes were deeply congested. The membranes of the vault showed no evidence of inflammation. The tube was found lying in a groove on the under surface of the middle