Some one whispers into the ear of the busy surgeon: "The patient, I fear, is dying." Restoratives are administered, the pulse gradually rises, and after a few hours of hard work and terrible anxiety reaction occurs. The woman was only faint from the joint influence of the anesthetic, shock, and loss of blood. An assistant, a kind of sentinel, is placed as a guard over her, with instructions to watch her with the closest care, and to send word the moment the slightest change for the worse is seen.

The surgeon goes about his business, visits other patients on the way, and at length, long after the usual hour, he sits down, worried and exhausted, to his cold and comfortless meal, with a mouth almost as dry and a voice as husky as his patient's. He eats mechanically, exchanges hardly a word with any member of his family, and sullenly retires to his study to prescribe for his patients-never forgetting all this time the poor mutilated object he left a few hours ago. He is about to lie down to get a moment's repose after the severe toil of the day, when suddenly he hears a loud ring of the bell, and a servant, breathless with excitement, begs his immediate presence at the sick chamber, with the exclammation, "They think Mrs.dying." He hurries to the scene with rapid pace and anxious feeling. The stump is of a crimson color and the patient lies in a profound swoon. An artery has suddenly given away, the exhaustion is extreme, cordials and stimulants are at once brought into requisition, the dressings are

removed and the recusant vessel is secured.

is

The vital current ebbs and flows, reaction is still more tardy than before, and it is not until a late hour of the night that the surgeon, literally worn out in mind and body, retires to his home in search of repose. Does he sleep? He tries, but he cannot close his eyes. His mind is with the patient; he hears every footstep upon the pavement under his window, and is in momentary expectation of the ringing of the night-bell. He is disturbed by the wildest fancies, he sees the most terrific objects, and, as he rises early in the morning to hasten to his patient's chamber, he feels that he has been cheated of the rest of which he stood so much in need. Is this picture overdrawn? I have sat for it a thousand times, and there is not an educated, conscientious surgeon that will not certify to its accuracy.-Med. Age.

MEDICAL NOTES.

It is asserted that four drops of oil of sassafras added to an ounce of iodoform completely destroys the disagreeable odor.

Turpentine, in doses of 20 or 30 minims, is said, by a recent writer, to remove some forms of headache and produce a wonderfully soothing effect upon the patient.

In nervous headache the following will often be found an efficacious and prompt combination :— R. Acid. hydrobromic. dilut.,

Extract guaranæ, fluid., ää f3ss. M. SIG --Dose, a teaspoonful in half a tumbler of water, repeated pro re natâ.

In insomnia, Dr. J. W. Brayton (Med. Rec.) commends the use of antipyrine. He states that it is of particular value in the neuralgias and spasmodic affections occurring in those persons who cannot take opium or any of its alkalies in any food, but especially beneficial in insomnia, giving refreshing sleep after failure with the usual remedies.

For hypodermic use in neuralgia, Dr. East, of Mayo (Phila. Polyclinic), recommends the following:

R.--Thein.,

Sodii benzoat.,
Sodii chlorid.,

Aquæ destillat,.

Six minims equals half a grain of theine.

Dr. Fordyce Barker, in the American Journal of Obstetrics, says the most valuable remedy for hemorrhages occurring at or near the climacteric, is a combination of equal parts of fluid extract of hamamelis and fluid extract of hydrastis.

I am forced to

In regard to the use of iodoform as an aseptic and antiseptic, Dr. John Wyeth, of New York, says, in the N. Y. Medical Record-For two years past I have abandoned it in dressings, and have never had better results. conclude that it is an unnecessary complication to the aseptic dressings, to say nothing of its persistent and offensive odor. The employment of the weaker sublimate solutions for irrigation, 1 to 3,000 and 1 to 5,000. the sublimate gauze dressings applied moist and kept so by protectives, will secure in my opinion, as perfect asepsis as is possible. Coll. and Clin. Rec.

THE LATE PROF. BALFOUR STEWART.-We regret to announce the death of Professor Balfour Stewart, M. A.,LL.D., F.R.S. Mr. Balford Stewart, who had just only completed his 59th year, was educated at the Universities of St. Andrews and Edinburgh. In 1859 he was appointed to the directorship of the Kew Observatory, and in 1867 to the secretaryship of the Meteorological Committee, which last appointment he resigned on his promotion to the professor's chair of Natural Philo

sophy in Owen's College, Manchester, in the year 1870, a post which he held until his death. Two years before this distinction was conferred upon him he had been awarded the Rumford medal by the Royal Society for his discovery of the law of equality between the absorptive and radiative powers of bodies. Together with Messrs. De la Rue and Loewy, he wrote " Researches on Solar Physics," and he and Professor Tait published their researches on "Heating produced by Rotation in Vacuo." Besides these he wrote a number of treatises especially on the subjects of meteorology The article in the and magnetism. Encyclopædia Britannica" on "Terrestrial Magnetism" is from Professor Balfour Stewart's pen. Among the many works of which he was sole or joint author may be mentioned the " Elementary Treatise on Heat," "Lessons in Elementary Physics (1871), "Physics (1872), "The Conservation of Energy" (1874), and Practical Physics" (1885). Most of these are text books on the subjects of which they treat. He and Professor Tait also produced the "Unseen Universe," a work of which twelve editions have been published. At the time of his death he was President of the Physical Society of London, and was a member of the committee appointed to advise the Government on solar physics. Professor Balfour Stewart died on Monday at Ballymagarvey, Balrath, in the County of Meath. London Times.

DIPHTHERITIC PARALYSIS OF THE PNEUMOGASTRIC.-SUSS (Rev. Mens. des Mal. de l'Enf.,) draws the following conclusions:

1. In the course of diphtheritic paralysis functional troubles are often observed in the sphere of the pneumo-gastric nerve. 2. The effect of these troubles is seen with reference to the heart's action in slowness, quickly followed by acceleration and smallness of the pulse. Precordial pain and violent pain in the heart itself are usually associated with these conditions. 3. With reference to the respiratory passages, the symptoms are dyspnea and sometimes great irregularity in inspiration and expiration. Less frequently patients suffer from Cheyne-Stokes respiration. 4. With respect to the digestive passages, there are very violent gastro-intestinal pains, and almost always vomiting of food or mucu. 5. Should all these symptoms be associated the disease would usually run a rapid and fatal course, probably within twenty-four hours. 6. If the pulmonary and, still more, if the cardiac-symptoms are isolated, we may look for a cure in some cases, though it is not possible to say with what frequency. 7. All of the accidents occur most frequently in the progress of a paralysis of the velum of the palate. The presence of this condition should compel a physician to give a very guarded prognosis. 8. The only treatment which has been of any benefit for this diseased

condition is electricity, which may be applied over the cardiac region or over the posterior region of the chest. 9. It is absolutely certain that the heart-clots found, post mortem, in the cases which have been studied by the author as the basis of this paper, have no bearing in explaining the phenomena which have been referred to. 10. The bulbar lesions which have been found in the course of these investigations could account for the pulmonary and cardiac disturbances only in isolated cases, and could give no information as to their curability. 11. Changes in the terminal branches of the pneumo-gastric—that is, in the fibres of the pulmonary, cardiac, and abdominal plexuses-can alone explain the peculiar phenomena which were observed in the study of the author's case. The complete explanation must come from histological investigation, which will be supplementary to the author's clinical studies.--Archives of Pediatrics.

HYPODERMIC INJECTIONS OF CARBOLIC ACID IN CASES OF RHEUMATISM.-According to the Vienna correspondent of the British Medical Journal, Oct. 8th, 1887, Professor Benedict has been using with extraordinary success hypodermic injections of a two per cent. solution of carbolic acid in the treatment of rheumatoid affections. He asserts that in even a few moments after the injection into the part the joint will be freely movable and free from pain, as though narcotized, and in recent cases joints in which there was great tenderness on pressure and distinct swelling of the bones, would be apparently free from disease a few days after the injections; not only would the pain disappear in the joints in whose neighborhood the injections had been practised, but would be markedly lessened in distant joints. Prof. Benedict believes that the carbolic acid has not only a local influence, but a general effect in causing the elimination of the rheumatic poison. He has especially obtained good results by the simultaneous use of salicylic and carbolic acids, when the salicylate of sodium is administered by the mouth in small doses, and one to three subcutaneous injections of carbolic acid being given in twenty-four hours, the course of the affection was very much accelerated and no bad consequences were observed, especially if the treatment was carried out from the very beginning of the disease. Extraordinarily good results were obtained by the method in cases of inflammation of the sheaths of tendons, especially after injury. A few injections sufficed to cut short the morbid process, and no local pain or muscular atrophy, etc., was observed, provided the disease was treated in the above mentioned way from the very outset.

-Ther. Gazette.

POTT'S FRACTURE -In a paper on this subject Mr. Robert Jone states that, since the original description given by Pott, a hundred years ago, no

great advance has been made either in the anatomy or treatment of the fracture associated with his name. The clinical signs of this lesion are, briefly, a depression over the side of injury, eversion of the foot, a prominent inner malleolus, and a swell ing round the ankle-joint. The fracture takes place usually about two inches above the malleolus, the deltoid ligament being often ruptured, and the astragalus separated from the tibia. Dislocation of the foot outward, it is held, is not an essential and absolutely diagnostic symptom, as a slight outward displacement may occur on separation of the tibia from the fibula, without fracture of this latter bone, and outward displacement of the astragalus. Reference is made to two cases in which the fibula was certainly intact, although there was marked simulation of Pott's fracture. The precise spot of fracture, which varies in different cases to the extent of three or four inches, is often obscured by rigidity, due to swelling The patient, guided by pain, is often able to place his finger on the exact point. On pressure upon the upper third of the fibula the patient is generally able to refer pain to the seat of fracture As a rule, the surgeon can only guess at the direction of the frac ture. Prominence of the inner malleolus, though always present, is not essentially diagnostic. It occurs in certain fractures of the lower end of the tibia, and in sprains of the ankle where laceration of the deltoid ligament has taken place, a tense swelling is often found sufficiently deceptive to lead to a possible error in diagnosis. It is very often difficult to make out crepitus in cases of this fracture. Eversion of the foot usually fails to cause this symptom It is more likely to be produced by inversion, but the movement best calculated to elicit it consists in combined flexion and inversion. In twenty-nine out of seventy cases the lesion was complicated by fracture of the inner malleolus. The deformity in cases of Pott's fracture occurs and is intensified, Mr. Jones holds, through the continuation of the force which was employed upon the fracture. foot is fractured by inversion, and then the deformity is generally inversion. Patients do not usually realize the extent of the injury, and continue to walk until a trivial becomes a marked deformity. Fracture due to direct force is less prone to luxation. In the treatment of Pott's fracture the reduction of deformity is accomplished the more readily in proportion to the absence of delay. The earliest chance should be seized of replacing the astragaloid luxation, The attempt at reduction should be long continued. If the reduction be completely effected there is no subsequent tendency to recurrence of the deformity, and, therefore, no necessity to employ splints devised to counteract special displacement. Lest, however, a little deformity remain, it is well to apply a couple of side-splints and a posterior splint, the side-splints being furnished with pads suitably ar

When the splints

ranged to minimize deformity. (which in Mr. Jones' practice are made of malleable sheet-iron) have been adjusted, the knee should be flexed and the leg be made to rest on its outer surface; the foot be maintained at a right angle to the leg. The injured limb should be kept in splints for fully five weeks. In conclusion, Mr. Joues offers a few suggestions regarding the treatment of cases in which, long after active treatment of Pott's fracture, the patients complain of pain, deformity, or inability to walk--The London Medical Record.

ANTISEPTIC RULES FOR MONTHLY NURSES.-In a paper introducing a discussion on the prevention of puerperal fever, at the Section in Obsteric Medicine of the British Medical Association (Brit. Med. Jour.), Dr. W. S. Playfair laid down the following antiseptic rules for monthly nurses" 1. Two bottles are supplied to each patient; one contains a solution of chloride of mercury, of the strength of one part to one thousand of water, tinted with litmus (called the 1-in-1,000 solution), the other carbolized oil (1 in 8). 2. A small basin containing the 1-in-1,000 solution must always stand by the bedside of the patient, and the nurse must thoroughly rinse her hands in it every time she touches the patient in the neighborhood of the genital organs. for washing or any other purpose whatsoever, before or during labor, or for a week after delivery. 3. All sponges, vaginal and rectal pipes, catheters, etc., must be dipped in the 1-in1,000 solution before being used. The surfaces of slippers, bed-pans, etc., should also be sponged with it. 4. Vaginal pipes, enema tubes, catheters, etc., should be smeared with the carbolized oil before use. 5. Unless express directions are given to the contrary, the vagina should be syringed twice daily after delivery with warm water, with a sufficient quantity of Condy's fluid dropped into it to give it a pale pink color. 6. All soiled linen, diapers, etc., should be immediately removed from the bedroom.

NINETY TAPE-WORMS AND ONE GIRL. - In the Correspondenzblatt für Schweizer Aerzte, Dr. Roux, Surgeon of the Cantonal Hospital in Lausanne, describes a singular case in which the patient, a girl aged twenty-one and a half, discharged (after two six-gramme doses of extract of male fern) at least ninety bothriocephali lati. The worms passed out in a bundle, the patient assisting the delivery by tearing the package with both her hands, and at the same time uttering shrieks like a woman in labor. The agonizing delivery lasted ten minutes. The mass of parasites filled up half of a chamber utensil. The disentangling and counting took exactly four hours and a half of the author's time. As an individual only such a worm was considered which had a head, and at its other end measured not less than 3 or 4 millimetres in breadth, or

which had an absolutely thread like (though headless) anterior end, and measured not less than one metre in length. Numerous very long ribbons, which did not answer those conditions, were left out of the reckoning; neither were any of the ribbons which had been discharged several times by the girl for a couple of weeks, previously taken into account. There could be no doubt, therefore, that the number of worms, given as ninety, in reality far surpassed that figure. The length of individual bothriocephali varied between 250 and 60 centimetres, a large number measuring only be tween 100 and 60. Except some slight nervous phenomena (such as occasional headaches, vivid dreams, semi-somnambulism), the patient did not present any morbid symptoms. She was a robust, and ruddy, and even cheerful and active, country girl, with excellent appetite and digestion, and with ninety-five or ninety-seven per cent. of hemoglobin in her blood (as Gowers-Sahli's hemoglobinometer showed). The case seems to give a support to Dr. Zschokke's theory, according to which the prevalence of bothriocephalus latus among the population residing around Lake Leman should be attributed to the eating of infected fish, mainly that of perch (perchette) At least the girl, who had come to the locality from Argovia about the Easter of 1884, during a period of several months' duration, in 1886, was dining on perch (and bothriocephali) once a week, or even still more often, the patient residing at the time at Bonvard, near the lake mentioned.—Br. Med. Jour.

THE TIME FOR THE ADMINISTRATION OF ACIDS

ALKALIES, etc.-A correspondent of the Brit. Med. Jour. says: "My teacher, Sir Robert Christison, as far as I can remember, taught us the following rules: Alkalies should be given before food. Iodine and the iodides should be given on an empty stomach, when they rapidly diffuse into the blood. If given during digestion, the

acids and starch alter and weaken their action. Acids, as a rule, should be given between the digestive acts, because the mucous membrance of the stomach is in a favorable condition for the diffusion of the acid into the blood. Acids may be given before food when prescribed to check the excesssve formation of the acids of the gastric juice. By giving it before meals you check the osmosis stomach-ward of the acid-forming materials. Irritating and dangerous drugs should be given directly after food, such as the salts of arsenic, copper, zinc, and iron, except where local conditions require their administration in small doses before food. Oxide and nitrate of silver should be given after the process of digestion has ended; if given during food, chemical reactions destroy or impair their special attributes, and defeat the object for which they were prescribed. Metallic salts, especially corrosive sublimate, also

tannin and pure alcohol, impair the digestive power of the active principle of the gastric juice, so should appear in the stomach during its period of inactivity. Malt extracts, cod-liver oil, phosphates, etc., should be given with or directly after food, so that they enter the blood with the products of digestion." -N. Y. Med. Jour.

FECAL ANEMIA. Sir Andrew Clark did good service recently in calling attention to the importance of constipation as a factor in the production of anemia or chlorosis in young women. Whether or not this theory of the mechanism of their causation by the absorption of the products of the decomposition of retained feces be correct, clini cal experience indicates plainly enough that a very close relationship exists between the two. Not only with regard to fecal accumulations, but in respect to retained excretions anywhere, the same observation holds good. This fact accounts for the good effects which attends purgation in so many disordered conditions more or less dependent on the non-elimination of the excrementitious products. When the effect of decomposition compounds are superadded to those of non-elimination, it is not surprising if a morbid condition of things be engendered. It was incidentally remarked that fecal accumulation may take place without constipation. In other words, there may be daily but imperfect action of the bowels. Although this is a trite observation, it is but too frequently lost sight. of in the treatment of these conditions. The role of ferrugineous preparations, in restoring the blood to its normal condition is an important one, but it is quite subsidary to the necessity for effecting a thorough clearance of the overloaded colon. this purpose our forefathers resorted to a combination of iron and aloes, which fulfils every indication and has the merit of being less nauseous to take, if given in the form of pills, than the horrible blend of Epsom salts and perchloride of iron which figures in every hospital pharmacoopeia. -Med Press and Cir.

For

CONTEMPT OF COURT.-Of all the curious reading that we have enjoyed in some time, we think that offered by a communication from Dr. F. E. Stewart to the current number of the Druggists' Circular, certainly caps the climax. It affords a splendid illustration of the wisdom of the adage which advises the shoemaker to stick to his last. Wherever a physican strays from his own profes sion into the intricacies of the law, and especially of the patent laws of this country, his feet are in dangerous and slippery ground, no matter where his head or heart may be. In the present paper, Dr. Stewart attacks the recent decision of the United States District Court in the matter of the suit of Battle & Co., against the Grosses (Daniel W. and Edward Z.) for infringement of their