his later papers were two that were published in this journal, "The Asiatic Cholera as it appeared at Suspension Bridge, Niagara County, N. Y., in July, 1854, and its Lessons;""What we Know of the Cholera" (New York Medical Journal, November 15, 1884, p. 533) and an article entitled "Dislocation of the Head of the Radius downward (by Elongation)," being a commentary on certain views that had been expressed by the French translator of his book on Fractures and Dislocations," Dr. Poinsot (New York Medical Journal, January 3, 1885, page 8).

At the time of his death Dr. Hamilton was in his seventy-third year, having been þorn in 1813, at Wilmington, Vt. He received his medical degree from the University of Pennsylvania in 1833, and began practice in Auburn, N. Y. In 1844 he moved to Buffalo, where, in conjunction with the late Dr. Flint and the late Dr. White, he was largely instrumental in building up the medical department of the University of Buffalo. In 1862 he came to New York, having been appointed a professor of surgery in Bellevue Hospital Medical College, a position which he resigned in 1875. During the war of the Rebellion he served in the medical department of the army, and rose to the rank of medical inspector. The deceased was a member of the American Medical Association, of the Medical Society of the State of New York (of which he was president in 1855), of the New York State Medical Association, of the New York Academy of Medicine, of the New York Pathological Society, of the New York County Medical Association, and of the Society of Medical Jurisprudence and State Medicine. At the time of his death he was one of the surgeons to Bellevue Hospital and a consulting surgeon on the staff of several institutions.

Dr. Hamilton was a man of sterling worth, and his loss is a heavy blow to the New York profession.

CHOLERA IN THE WEST.-Two cases of cholera are said to have occurred last week at Chippewa Falls, Wis., it being stated that both patients died with well-defined symptoms of the disease.

Editors American Practitioner and News:

I have just returned from Birmingham, where I had been spending a week with Mr. Lawson Tait, and during my visit I had the good fortune to see him do the very series of operations with which his name is permanently connected, viz., three Tait operations, one ovariotomy (with twisted pedicle), one nephrectomy, one cholecystotomy, two perineorrhaphies, and one vesico-vaginal fistula. Had he asked me to choose my cases, I could not have made a better selection. I had heard much of his vesico-vaginal fistula operation, and was exceedingly curious to see how he could possibly do it without the use of a speculum, and, even after being present at the operation, it remains a matter of wonder. A speculum, however, is used during the first step of the operation, viz., paring the edges of the fistula. In this, as in all other plastic operations upon the genito-urinary organs, Mr. Tait removes no tissue. In the present case the patient was placed on her left side the buttocks at the edge of the bed, the operator, kneeling, introduced a short, wooden cylindrical speculum up to the fistula, and then, steadying the part with a tenaculum, he simply split the edge of the fistula around its entire circumference. The speculum was now withdrawn and the stitches introduced "in the dark." A needle, in a handle, threaded with silver wire was used, with the right hand guided by the index finger of the left hand introduced into the vagina. Three stitches were used in this case. In splitting the edges of the fistula two flaps are formed, one of which is turned into the bladder and the other into the vagina, and the stitches are placed in the raw surface between the flaps.

In his perineorrhaphies he uses an angular pair of scissors, making a V-shaped incision with the apex at the lower end of the rent. The blade is carried well into the cellular tissues, the flap is pushed upward and the gap closed with silk-worm gut stitches carried transversely, introduced in the wound on one side just inside the margin of the skin and brought out on the opposite side at a corresponding point and tied in the raw surface. He does not pass the suture through the skin, because he says it gives rise to more pain. (See his

book in Wood's Library.) The operation is much easier done than described. It makes an excellent perineum, and Mr. Tait tells me he has had many women to bear children after having had it performed, without any recurrence of the trouble. Of course the patient's bowels are thoroughly emptied before the operation, and after it the vagina is washed out twice daily freely with warm water, and an enema is given the patient regularly every day. The bladder is not emptied with the catheter but in the natural way.

In the cases of removal of the uterine appendages, one was done on a young girl, for the relief of uterine hemorrhage that had been going on almost continuously for many months, and, having resisted all other methods of treatment, her physicians had sent her to Mr. Tait to have the appendages removed. The girl was not only very anemic from the loss of blood, but quite anasarcous. Both ovaries were enlarged, being about the size of a hen's egg, and filled with small cysts. I saw this patient five days after the operation, and there was quite an improvement in her general appearance. In the other two cases the operation was done for the relief of suffering due to chronic inflammation of the appendages. In both cases one side was chiefly affected. The adhesions seemed very strong; the tubes were greatly thickened, tortuous, hard, and impermeable. In one case one ovary appeared perfectly healthy. The last case was one in which Mr. Tait had, as on a former occasion, removed both ovaries, but without arrest of menstruation and consequent relief from suffering, so he now removed the fundus of the uterus. Upon introducing his finger into the pelvis he felt a thin-walled cyst, which he broke, then he passed a stitch through the fundus by which the uterus was drawn into view, so that he was enabled to pass a needle armed with a large, stout thread through the center of the organ. This was now tied as tightly as possible with the Staffordshire knot, and the portion of the uterus above the ligature removed. There being some slight oozing of blood from the stump, Pacquelin's cautery was applied. The pedicle was now dropped into the cavity and a drainage-tube used. The

uterine adhesions seemed so very strong that it was with much difficulty he could pull the organ upward sufficiently to apply the ligature.

The nephrectomy was performed with the view of removing a calculus, but none was found. The usual lumbar incision was made, and, on reaching the kidney, Mr. Tait guided the bistoury with the index finger of the left hand and made an opening in its posterior surface, in order, I suppose, that he could with his finger explore the pelvis of the organ. Following this incision there was, I thought, considerable hemorrhage, from two to three ounces of brightred blood escaping. After satisfying himself of the absence of a calculus, he introduced a rubber drainage-tube and then closed the lumbar incision. I did not see the case any more, but was told that it had gotten along well.

The cholecystotomy was performed on a very large, fat old lady, who had been deeply jaundiced for quite a time, had great pruritus, but no distinct attacks of biliary colic. Before doing the operation Mr. Tait was strongly of the opinion that it was a case of malignant disease, and so told the patient, but advised an exploratory incision. The incision, about three inches in length, was made longitudinally over the gall-bladder. The gall-bladder was found tightly distended. A long, curved trocar was introduced, which was followed by an escape of thick, viscid bile. Just as soon as the bladder became sufficiently emptied to admit of being seized with a pair of forceps, it was gently drawn out of the abdominal wound, a sponge introduced beneath it to protect the peritoneum, and when the flow ceased through the canula, an incision, an inch in length, was made in the wall of the bladder itself. Now, with a scoop, he removed nine calculi, three the size of a plover's egg and the remainder as large as the first joint of a lady's little finger. The edges of the opening in the bladder were then stitched to those of the center of the abdominal wound, and the latter above and below this point were closely approximated. A large rubber drainage-tube was introduced in the gall-bladder, and the usual dressing applied. This case certainly illustrates the great importance of exploratory incisions in obscure cases, as so strongly urged by Mr. Tait.

The

The ovariotomy was done on a case which had been brought him the day before by a country practitioner. The tumor had not been noticed until the family physician was called in to treat the case for what was considered cramp colic. He recognized the existence of peritonitis, and upon careful examination discovered a tumor. In four days after his first visit, suspecting a twisted pedicle, he brought the patient on a litter to Mr. Tait, who agreed with him in the diagnosis, and advised, of course, immediate operation. The tumor was found to be adherent to the front wall of the abdomen. Upon puncturing it about two gallons of a dark bloody fluid escaped. operator then broke up the parietal adhesions with his fingers, when the sac in an almost gangrenous condition was delivered. There were two points of adhesion to the omentum, which were ligated with silk and divided. The pedicle was tightly twisted. After removal of the tumor, the abdominal cavity was thoroughly washed out with blood-warm water and the wound closed with the interrupted silk suture after the insertion of a glass drainage tube. He made no examination of the cavity to see if there were any bleeding points. In cleansing the tube after the dressing was applied, he drew out over an ounce of very bloody fluid. I saw the woman on the fourth day after the operation, when her condition was splendid-temperature normal and pulse 84; it was 120 when the operation was done. The drainage-tube was removed at the end of twelve hours. The wound healed perfectly.

Mr. Tait is undoubtedly the quickest operator in abdominal surgery living. In the case just reported he was only eleven minutes in completing the operation. He claims that under no circumstances ought a case to require over forty-five minutes. I have seen

prominent men in London one hour and threequarters at a case. He does his removal of the uterine appendages frequently in ten minutes, the perineorrhaphy in six minutes, the vesico-vaginal in fourteen minutes, and the nephrectomy in thirteen minutes. I did not time him in the chole cystotomy, but it required a very short time only. The abdominal

"

incision in the "Tait operation is not over one and a half inches, just large enough for him to squeeze his first two fingers through. When he has broken up the adhesions, he passes through the opening, by the side of his fingers, a pair of forceps, and after seizing the ovary, he withdraws his fingers, so as to be able to draw the ovary and tube out. He says it is of the utmost importance to remove both ovaries, even if the inflammatory troubles should be confined to one only, or the operation will fail to give relief; and he also urges the importance of applying the ligature close up to the uterus. If the least part of the tube is left no relief will follow. I saw a specimen which was removed at the second operation. It consisted of about half an inch of a dilated tube. No relief had followed the first operation, but the second was entirely successful. As in one of the cases reported, he considers it necessary when relief is not obtained to remove the fundus of the uterus. He practices removal of the appendages in the treatment of hard fibroids of the uterus, so long as the tumor is not larger than a cocoanut. When it is pedunculated, of course the tumor is removed also, and when the fibroid is soft oöphorectomy will do no good. In ovariotomy the average length of the abdominal incision is two inches. The knife he uses is quite short, not exceeding three-quarters of an inch in length (the cutting surface), and he goes down to the aponeurosis in one stroke. Then, after securing all bleeding points with forceps, he carefully goes down to the peritoneum. This he now lifts up with forceps and makes a slit that will admit his finger, which he introduces at once, and with it tears the membrane, knicking it with the knife if necessary. The tumor is next tapped with his trocar, or rather canula. This resembles very closely a silver catheter, except that the point is more acute and flattened. If the sac is thick and strong, he makes a slight nick in it so the canula will pierce it more easily. As soon as the sac becomes sufficiently emptied to be seized with a pair of forceps its gently drawn out through the abdominal incision. Parietal adhesions are rapidly broken up with his fingers, and omental ones are ligated before being

eter is used only when unavoidable. Patient is allowed to lie in any position, but on no condition to rise up either for the purpose of emptying her bladder or bowels. Mr. Tait is careful to examine the abdomen at each visit, and whenever he detects any evidence of gaseous distension he immediately orders either a turpentine enema or a Seidlitz powder, sometimes castor oil or calomel, most generally, however, a Seidlitz powder. In smooth sailing cases an enema is given on the fifth or sixth day.

pump. His operating table is narrow, its top covered with oil or rubber cloth. The patient wears a linen or cotton gown. This is so drawn up as to thoroughly expose the abdomen. A small blanket is thrown around her lower extremities; over this a towel is spread, and one (towel) also is over her chest. No rubber cloth to cover body is used; and when he washes out the cavity he takes no pains to protect the patient's clothing or any thing else. If the gown becomes soiled, it is, of course, replaced by a clean one. The bed is prepared for the patient by being warmed with large earthen vessels filled with hot water. The patient is laid on a blanket, which is afterward folded around her. The nurse now sits by her. No opium is given, unless under extraordinary conditions. The nurse takes the temperature and pulse every four to six hours. He will not allow the nurse to count the pulse with a watch, for the reason that she will so frequently count for only fifteen seconds and then multiply by four. So he has a minute glass, made like the old hour glass, and covered so with brass that it is necessary to count until the last particle of sand escapes, furnished to each nurse, and this they are required to use. He kindly made me a present of one as a souvenir. Mr. Tait sees the cases twice daily, or has a written report from the nurse. For the first two days nothing is allowed but a little hot water. On the third day a little water-gruel, or milk and soda-water. On the fourth day a bit of toast with the milk, and from this on the diet list is gradually strengthened. The cath

During the operation he keeps his instruments in metallic cases containing ordinary warm water. The needles, threaded, are

same water. A visiting surgeon one day expressed some doubt as to the water not containing some germicide, and Mr. Tait had him drink some of it. His dressings are exceedingly simple, consisting of a couple of pads, about the size of a man's hand, made of cotton, covered with mosquito-netting, over these is placed two strips of adhesive plaster, and all confined by a broad cotton bandage. In speaking of his entire want of fear of germs, he says that if he could get them in sufficiently large quantity, and found them dry, elastic, and absorbent, he would willingly stuff his pads with them instead of wool.

Mr. Tait is a much younger man than I had expected to find him. He is just forty-one years of age; he is about five feet nine inches in height, and weighs, I should say, two hundred and twenty five pounds. His legs are short, body quite long and large; hands short and fat, but how nimble and dextrous! His hair is dark brown, slightly sprinkled with gray, and he wears it quite long. He has a full face, with short side-whiskers. His voice is pleasant and manly, and his whole make-up impresses you as belonging to a person of immense force. His manners are pleasing, and to friends cordial. I should say he was a good lasting hater. He is a native of Edinburgh, and was a pupil and very intimate friend of the late Sir James Simpson, to whose pictures he bears a striking resemblance. He does most of his operations before breakfast, and seems to be in a big rush during all the day-having little or no time for entertaining his friends by

answering questions. It naturally irritates him excessively to have any talking going on while he is at work, and just as soon as he is through with a case he is off immediately. But at his house in the evening he is the most genial and agreeable of hosts. Unlike most other prominent medical men in this country, he does not go away for a summer vacation, but takes his rest on Sundays, driving with Mrs. Tait over the perfectly lovely English lanes about Birmingham. He was so kind as to call at the club the other day, in his open carriage, and take Dr. Johnson and myself on one of these drives. We first went by the hospital, where he did a couple of operations in surprisingly quick time. From there we drove

to Knowl, ten miles away, where Mrs. Tait is rusticating. After a short rest, during which we had some magnificent strawberries-the largest and sweetest I ever ate-Mrs. Tait joined us, and we drove to the Mariana Moated Grange, mentioned, as you know, in "Measure for Measure," where the Taits made a wedding call on the present occupants of the house, its name now changed to Badderly-Clinton. Fortunately the fine old moat surrounding the place remains as in days gone by, it and the house it was intended to protect being constructed in the fourteenth century. The furniture, which is still preserved, belongs to the same period. I am aware you take some interest in these old things, but I must say that they have none for me, at least their age adds no charm for me.

The couple on whom our agreeable hosts called are fit occupants of the "fine old place," and seem quite to have caught its spirit. For instance, they employ none but the oldest patterns of kitchen utensils and farming implements, because the more modern things take work from the working people.

We returned to Birmingham at 10 P. M., having had a thoroughly enjoyable day. Our friend Dr. Johnson has been here now, the daily assistant of Mr. Tait in all his work, for the past six months, and you may be sure has mastered whatever is best and most essential in the great operator's work.

I have already said Mr. Tait is the quickest operator I ever saw, and has any amount of

operating to do. I saw him do two operations daily during my stay, and Dr. Johnson says he was not unusually busy. I was so pleasantly and profitably employed during the time, I was loth to leave, but an engagement in London, and the great number of foreign. medical men who run down to see this remarkable man admonished me that I had best occupy no further space about his operating table.

W. O. ROBERTS.

AN UNEXPECTED CAUSE OF NUMBNESS OF THE LOWER EXTREMITIES.—About two months ago I was summoned to a patient who was stated to be suffering from paralysis. On arrival I found a man about forty-six years of age lying in bed and complaining of numbness of the feet and calves of the legs, even up to the hips, without, however, any loss of either sensory or motor power-that is to say, there was partial suspension of sensory susceptibility in these particular localities. On visiting the patient next day, I found him up and dressed, and noticed a hesitancy in his manner of walking, especially when I asked him to cross the room with his eyes closed. In fact, when he attempted it I had to jump up from my chair to save him from the fire-place. I had attended this patient for years, and there was no history of syphilis to account for all this. His general health was good, and he was a man of abstemious habits. Could it be sclerosis of the posterior or lateral columns of the cord? Could it be due to some tumor or effusion pressing on the cord? Or was it the result of some peripheral trouble, seeing that the patient had frequent attacks of "cramp in the feet?" I asked myself all these questions, when it suddenly struck me that it would not be inappropriate to inspect the premises, which I did, and found, to begin with-which, to my mind, was quite sufficient, hygienically speaking, at all events-the water-closet completely blocked up and running over; a state of things which had existed for six weeks. Now, this hardly seems to bear on the case in point; but if it be considered, as I found out, that pails are substitutes for imperfect or useless water-closets, it comes within the range of possibility that the whole