11. Galvano-puncture needles and the internal electrode should be constructed of material that is not injured by coming in. contact with strong carbolic acid, or 1-1,000 bichloride mercury solution. All internal electrodes should be thoroughly scrubbed with a nail-brush and soap and water after each application, and allowed to remain in one or the other of these standard antiseptic solutions until they are to be employed again, when they should be washed in a weaker solution of the same before using. Before a vaginal puncture is made the vagina should be thoroughly wiped out with a 1 to 3,000 bichloride solution.

12. There is no excuse for any percentage of mortality in the proper application of this treatment. While Dr. Apostoli has had two deaths in 275 cases, he candidly admits they were due to avoidable accidents rather than to any legitimate procedure of the operation.

13. In experienced hands, and by the adoption of the present means of concentration, the most delicate and sensitive patient can receive, without experiencing any severe discomfort, all the benefits to be derived from this valuable treatment.

THE CECUM AND APPENDIX, THEIR RELATIONS IN HEALTH AND DISEASE. (Abstract of a paper read in the section on Surgery and Anatomy, by Joseph Ransohoff, of Cincinnati, Ohio.) The author says, that in the relation of the cecum to its serous coat it is generally agreed that the cecum is covered by the peritoneum in front and on its sides, and that the posterior is connected to iliac fascia by loose connective tissue. He considered this very comprehensive subject in its anatomical, physiological, and pathological aspects, since a knowledge of the first of these is a prerequisite to the understanding of rectal processes. All anatomical writers agree that the cecum is a blunt pouch about three inches in diameter, two and a half in length, and the widest part of the intestine, but, though strange, the topography of the cecum, the vermiformis appendix, and the ileum is greatly misapprehended. In the posterior-lateral aspect of the cecum, about an inch from its base, springs the appendix. This is not so much of a wanderer as is often represented, but is usually behind the cecum, and can only be seen by drawing the latter aside. It points upward to the left toward the spleen; in only seven out of sixty-three examinations did I find the appendix in part a pelvic organ. Its average length is four inches,

its diameter that of a goose quill. It is rarely straight in its course. Its complete absence was noted by Bartholin. As it is nowhere attached to the abdominal wall, abscesses of the ileo-cecal fossa must be limited and perforation must involve the peritoneum. If the cecum and appendix have a function, it can only be inferred by comparative studies. In man the chief office of the cecum is absorption. The appendix has even stronger facilities for absorption, hence its contents are always of a firmer consistency. Its probable function is the secretion of mucus. Like the tonsil, the appendix is a lubricator.

Pathology: There are excellent reasons for separating inflammations into those of the cecum and those of the appendix, each to be subdivided into those of the part itself and of the peritoneal investment. There has been much difference of opinion concerning the relative pathological importance of the cecum and appendix. Dupuytren looked on the cecum as the part primarily at fault, but recently the appendix has been given greater prominence. Whereas, as Kraussold puts it, the appendix was formerly treated in a stepmotherly way, there is danger that now the cecum will share this fate. The position of the cecum, the narrowness and tortuousness of its canal, the tendency of fecal or foreign matter to be retained in it, and the readiness with which it is displaced, all tend to make the appendix the principal seat of inflammation. The history of appendicitis is like that of inflammations in other narrow mucous canals. In many cases of perforative appendicitis the contents of the appendix are thrown into the general peritoneal cavity, and death ensues with rapidity. When an abscess forms, what is more probable than its more or less rapid course toward the surface above or below Poupart's ligament? Or that, burrowing through the iliac fascia, it should open into some hollow viscus like the cecum, rectum, or vagina? Were I permitted an aphorism it would be, "Place not your faith in exploratory punctures; operate early and by laparotomy when the symptoms are the gravest and a tumor is not forthcoming."

THE TREATMENT OF THE CORD.-Dr. A. Jacobi, of New York, recommends the following treatment (Archives Pediatrics for April): After the cord has been cut it is a good rule, which must surely be adhered to in every case of thick cord, to apply an additional ligature between the first and the abdominal wall, to avoid hemorrhage from

the insufficiently compressed arteries, which may take place after the cord has commenced to shrink. The abdominal end of cord is then wrapped up in a dry and soft piece of linen, lint, or cotton, placed on the left side of the abdomen and fastened by means of a soft flannel bandage, which is wide enough to cover the larger part of the chest and all of the abdomen, so as not to slip.

In wrapping up the end of the cord no oil must be used. Warmth and dryness favor mummification; moisture and exclusion of air, gangrene. Fatty substances, and moisture of any kind, must be avoided as much as possible. Powdered subnitrate of bismuth, or oxide of zinc, or iodoform, or salicylic acid, one part with ten parts of starch, may be dusted around the insertion of the cord and over the stump daily. Perchloride of iron, or subsulphate of iron must not be used. Under the hard coagulation formed by its application over the whole wound secretions will accumulate and produce sepsis.-Practice.

TOBACCO AMBLYOPIA.* (By A. R. Baker, M. D., Cleveland, Ohio: Abstract.) There is a diversity of opinions expressed, as well as a lack of uniformity of symptoms described as characteristic of this disease. Some eminent authorities assert that women never suffer from this form of toxic amblyopia, while a number of cases are reported as having occurred in England. Most observers believe that it results more frequently from smoking than chewing, but Dr. Ayres says the opposite is true. Calazowski says it is of frequent occurrence among persons working in tobacco manufacturing establishments. Dr. Ely, who spent much time in examining cigar-makers, says that it rarely if ever occurs among them. There is less diversity of opinion as to treatment, some claiming that it is absolutely necessary to stop the use of tobacco entirely, while others only limit the quantity used and advise a milder tobacco. Many emphasize the necessity of prescribing strychnia; others believe iodide of potash to be the sine qua non, and still others have found that their cases do equally well with no medication. Probably there is no one who has carefully examined the evidence adduced who doubts the existence of a toxic ambylopia, characterized by a rapid failure of sight, a central scotoma for red and green, and no marked changes to be discovered with the ophthalmoscope. Dr. Powers has advised the in

*Read in the Section on Ophthalmology, American Medical Association, Cincinnati, May, 1888.

halation of nitrate of amyl as of great temporary benefit. If there are no pathological changes in the retina, optic nerves, or cerebral centers, then the necessity for specific medication is uncalled for. I may thus summarize my conclusions on the subject:

1. There is a toxic amblyopia due to the excessive use of tobacco.

2. That the excessive use of alcohol or other toxic agents does not produce the same or a similar amblyotic condition, although by their depressing influence on the vital functions they may serve as predisposing

WHAT IS THE INDICATION FOR THE VAGINAL TAMPON.-When the late Dr. V. H. Talliaferro, of Atlanta, Ga., gave to the world his method of treating certain pelvic diseases by the vaginal tampon it was soon heralded as the proper treatment for all forms of uterine trouble. Various articles were offered as best suited for elastic pressure; the failure to obtain satisfactory results being supposed to depend upon the failure to obtain a material that would give the necessary support without losing its own resiliency.

With a view to formulating a foundation upon which we may in future rest the merits of this mode of treatment, Dr. Thomas Addis Emmet (the first advocate for the use of hot-water vaginal injections in the treatment of pelvic inflammation), in a recent paper before the Society of Alumni of the Woman's Hospital, lays down the cardinal point that the vaginal tampon is only beneficial after all acute symptoms have subsided. It has been his experience that unless this principle is recognized, the indiscriminate use of this means of treatment will always be attended by unsatisfactory results, and with much unnecessary suffering to the patient. The class of cases in which special benefit may be derived from the use of the vaginal tampon is that in which the bloodvessels have degenerated into a varicose condition, and where this state of the veins has been brought about from the effect of local peritonitis with adhesions, from the loss of connective tissue and from injury where the fascia has been involved. We must realize, however, that we can only gain permanent good through the use of this agent after a long and tedious application, which may extend over the course of many months.-Practice.

RECTAL FEEDING.-From a study on the subject of rectal alimentation, Dr. Weaver (Transactions of the Luzerne County Medical Society) has formulated the following conclusions:

1. By the use of enemata life can be sustained indefinitely with little if any loss of weight to the body.

2. In a larger proportion of cases in which rectal aliment is used, true digestion of albuminous, saccharine, and fatty food takes place by virtue of inhaustion or a reversal of the normal peristalsis of the alimentary tract.

3. While this is the case, there are doubtless instances in which retrostalsis does not occur, and for that reason the food used

should first be artificially digested before being injected into the rectum.

4. While milk, eggs, and brandy are the best aliment for rectal nutrition, no one article should be used for too long a time, but frequent changes should be made, observing the greatest care to prevent irritation of the rectum, or intolerance of that organ for the nutriment required.

5. The enemata should, if possible, be administered by the physician himself. Where difficulty in retaining the aliment is encountered, the colonic method is preferable, the food being propelled through a rectal bougie. The food should be of the temperature of the body.

6. The rectum having once become intolerant of the enemata, absolute rest must be given to that viscus for a few days, and reliance be placed on nutritious inunctions. of the surface of the body.

7. For rectal alimentation there exists a wider range of usefulness than has heretofore been assigned to it. It is not only appropriate in the severer forms of chronic diseases of the stomach and esophagus, but is indicated and should be utilized in the management of all acute diseases when, from any cause, the stomach becomes intractable and rebellious.

8. In diseases of the stomach, even where a portion of the food ingested is retained by that organ only to undergo fermentation, inducing thereby pain and distress, it is more logical to resort to rectal alimentation, not as an adjunct to but a substitute for stomachal injection.

9. Certain organic lesions as well as functional disturbances of the stomach are curable by means of rest to that organ, and by no other means. In rectal alimentation we have a safe and sure means of nutrition, pending the necessary period of rest.-Dietetic Gazette.

NERVOUS RECTUM.-At the Section of Obstetrics and Diseases of Women, American Medical Association, 1888, Dr. Goodell, of Philadelphia, read an entertaining and in part humorous paper on this subject. He described the rectum as being sometimes insane, as it were, while the rest of the body enjoys perfect sanity. One variety of this neurosis is the hysterical rectum, the muscles being thus affected, but the sphincters more so than the other set of muscles. A frequent form is spasm of sphincter, which renders defecation painful, and bence induces costiveness. These victims become easily addicted to opium eating.

When the rectum is loaded a pulsating pain is felt. If there be in addition some ovarian irritation and enlargement the affection becomes very distressing.

Another form the speaker alluded to as the "jealous" rectum. He gave some very ludicrous instances where the rectum put its veto on any attempts at indulging in social intercourse. One lady always began to have an evacuation from the bowels as soon as she received a letter from her husband, and was obliged to delay reading it until the rectal demands had been satisfied. A second individual would soil her bed after any violent mental emotion. All these persons were kept prisoners at home and had to abandon social intercourse.

He

A third form he described as "follicular colitis" or "membranous enteritis." found this affection so often in hysterical patients that he looked upon it as a neurosis, just as pruritus, shingles, etc. are nervous skin affections. He found all these forms of rectal trouble as being peculiar to emotional women of high intelligence: none of them belonged to the lower walks of life. The diagnosis between these neurotic troubles of the rectum and disease of the coccyx is readily made by the introduction of the index finger into the rectum and the thumb over the coccyx, showing that this append age is movable.

The treatment depends on the form of the trouble. He regarded that of Weir Mitchell for nervous prostration as the best. Seclusion, forced feeding, massage and electricity, the latter two equalizing the nervous fluid and stimulating a healthy action of the nerves. As soon as enemata can be borne, they should be administered before bedtime. Suppositories of iodoform act beneficially, and, in case of spasm of the sphincter, stretching of the sphincter ani. Follicular colitis is almost incurable, but may be soothed by means of suppositories of iodoform, antipyrin, etc. Sometimes injections of limewater or Carron oil greatly relieve this trouble. He cautioned strictly against the use of opium in any form, as these patients are very apt to become opium eaters. Altogether the best medication consists in the administration of remedies constitutional in their action. His favorite prescription is the pil. sumbul comp.; Blaud's pill is an excellent remedy, beginning with one pill three times a day, gradually increased until three are taken after each meal. Occasionally he gave as many as five after each meal. Pills composed of the three valerianates (zinc, iron, and quinine) are of great value, also

pills composed of chloride of gold and soda. When malaria is at the bottom of the trouble, Fowler's solution acts well. The bromides are often needed and may be advantageously combined with the bitter tonics, as the tincture of gentian comp. When the paroxysms are sudden, antipyrine and the hydrobromate of hyoscine are serviceable. Absolute rest of mind and body secured by absolute seclusion in a darkened room is sometimes indispensable.

STERILIZED FOOD FOR INFANTS.-It is a curious fact that while all older people are chiefly fed on sterilized (cooked) food, infants are fed on food peculiarly adapted, by its composition and fluid state, to offer a home to bacteria.

In treating some cases of summer diarrhea, directions were given that all milk used for infants should at once, on receipt, be steamed. After this it was kept covered, and on ice if possible. The result was that the little patients began to pick up and were soon well.

The ordinary milk-supply of a large city is a day or more old, slightly acid, and contains many growing bacteria.

Fresh milk sterilized, or collected sterile and protected from organisms, undergoes no changes, even after the lapse of indefinite periods, except the separation of the fats. If bacteria are are present, a great variety of changes may occur. As milk affords such a fine medium for growth, all efforts to rid it of bacteria must be governed by the use of poisons-germicides-or some physical condition inimical to their life.

The first method is not admissible in foods, while the other offers little chance of success except by heat. Cold retards their growth, but does not kill. Boiling is undesirable, but steaming produces but slight changes in the milk, and is efficient.-Amer. Journal Med. Sciences.

CONIUM.--In the Practitioner, Whitla calls attention to the treatment of rectal pain by conium. He directs two ounces of succus conii to be evaporated down to one tenth its bulk, at a heat below 150° F.; to this is added enough lanolin to make one ounce of a smooth ointment.

This he recommends for local use in rectal cases characterized by pain and pruritis, such as fissures, fistulas, villous growths, ulcers, and hemorrhoids. These were markedly and quickly relieved by conium after nearly every other known remedy had failed.

The ointment should be freely applied inside the sphincter ani. He attributes the

good effects to paralysis of the terminal filaments of the motor nerves distributed to the muscular coat of the bowel. Sensory paralysis is caused at the same time.

In vaginismus, and also in some painful conditions of the male urethra, relief is obtained from the use of the same ointment; which is also a good lubricant for sounds and catheters.

In fissure Mr. Cripps recommends the addition to the above formula of ten or twelve grains of the persulphate of iron.Philadelphia Medical Times.

I

An

A CASE OF INTESTINAL OBSTRUCTION WITH RUPTURE OF THE BOWEL OPERATION-RECOVERY.-W. V., a grocer's assistant, aged about twenty-nine, sent for me early one morning in July, 1885. He stated that on the previous evening, when chopping up firewood, he felt a pain in the stomach, which had continued until morning. There had been slight sickness, but the bowels had not acted for twelve or fourteen hours. found the patient in bed, complaining of pain in the hypogastric and right inguinal and lumbar regions. The pain was increased by pressure in the hypogastric region. There was neither dullness nor tumor. aperient pill and dose of castor oil were given, but both were rejected with vomited food. The castor oil was repeated, and one pill of opium (half a grain) and belladonna (quarter of a grain) given every three hours. In the night vomiting was distinctly greenish and sour. As there was no action of the bowels, an injection of soapy warm water. castor oil, and turpentine was given. This succeeded in clearing out the colon, and it was followed in six hours by a very slight action. Vomiting continued every few hours. The abdomen was increasingly tender, and there was dullness over an area of four or five square inches to the right of the umbilicus, and three inches below. There was slight tympanites. But no improvement followed, and the patient having been removed to the hospital, it was decided at midnight (four days after first symptoms) to operate. The patient was almost moribund; the abdomen was greatly distended: temperature 104.5°; pulse 135, and quite characteristic; respiration was short, rapid, and labored. The A.C.E. mixture was administered. The usual median incision was made through the abdominal wall, and afterward carried two inches above the umbilicus. (By the courtesy of the surgeon of the hospital, I was asked to assist in the operation.) The peritoneum was carefully divided.

a

grooved director. No sooner was the abdominal cavity thus laid open, than out there gushed a large volume of horrible fecal gas, followed by a copious outflow of thin yellow-greenish fluid, containing a quantity of flakes of lymph, and bits of fecal matter. The small intestines were distended with gas. The peritoneum was intensely injected. We baled out the abdominal cavity with a teacup. Then slight bilateral pressure caused a small fountain to well up from the deep part of the abdominal cavity. Taking this fountain for my guide, I passed the idex finger of my right hand through the aperture into the bowel, upward and downward. I strongly advocated resection, but was overruled, and consequently sewed up the parietal wound. The man to all appearance seemed on the point of expiring. The wire sutures all in turn gave way, quantities of fecal matter and fluid continued to escape from this wound for several weeks. The ruptured bowel became disengaged, and rose to the surface of the parietal (operation) wound. The latter became agglutinated in a mass of granulations. The abdominal cavity was once more restored. Feces passed per anum, and the patient, passing through a long convalescence, escaped with a very small fistula, the size of a hempseed, and is now otherwise in the enjoyment of perfect health and strength.Thomas P. Harvey, M. D., British Medical Journal.

COCAINE IN ACUTE TONSILLITIS. Recently I began to suffer from a very sharp attack of acute tonsillitis of the right side, with a considerable injection of the surrounding parts. Two days after I experienced the most excruciating pain in swallowing, also severe pain in the right ear, and I could only with great difficulty speak. In the afternoon of this day my friend Mr. Thomas swabbed out my throat three or four times with a four-per-cent solution of cocaine, and poured a few drops of the same into my ear. The relief which I experienced was so great that I could soon after speak fairly easily, and swallow with very much less difficulty. I continued to apply the cocaine every two hours during the day with continued success for five days, then a day in the country put me right.-P. Rhys Griffiths, B.S., M.B., Ibid.

IT is a remarkable fact that inflammation of the vulvo-vaginal glands is much more frequent upon the left side than upon the right.