taxis and give certain modifications of such practice. In the difficult cases narcosis and a position of the patient that tends to relax the abdominal parietes, such as the dorsal recumbent position with flexed thighs, are recommended as adjuvants to the manual practices. In order to demonstrate experimentally the inadequacy of all the measures of taxis, already abundantly shown in practical experience, the author suggests that a section of intestine, about a yard long, be drawn through a piece of rubber tubing, about two inches long, of a calibre that will permit a pretty thick catherer to be pushed through the tube within the lumen or at the side of the gut. If water be poured into the upper portion of the gut, it becomes highly distended above the tubing, but not a drop flows through and escapes from the free lower end of the intestine. Pressure upon the distended portion will cause it to burst, mayhap, but no fluid will escape by these manipulations. However, only a light traction upon the lower empty segment is followed by a free flow of water; the same result follows if the catherer be pushed upward through the tubing. In strangulation the same conditions obtain; the distended gut lies outside of the outer hernial aperture, the empty gut inside the inner hernial aperture. In taxis we compress the filled and distended section, which, as our experiment demonstrates, is not a good method of promoting the escape of the fluid, and which may lead to a bursting of the gut. Gentle pressure upon the distended section, and alternately upon the tubing, alone leads to a gradual emptying of the fluid; this last procedure of alternating pressure upon the strangulated gut and upon the strangulating channel is the mode by which taxis affords relief. Contrasted with this procedure, the ease with which by traction upon the empty end, the escape of the fluid and the liberation of the gut is accomplished, is most striking. These considerations, and the well established observation that hernia, which is irreducible, intra vitam, by taxis, can be reduced, after the abdomen is opened, post mortem, by a most gentle traction upon the intra-abdominal loops, led Nicolaus to seek methods of reduction in which traction should take the place of pressure. Nicolaus refers to the rude methods by which reduction through the weight of the intestines alone was attempted; thus the method of Corvillard of suspending the patient by the feet; the method of suspending by hands and feet; the wheelbarrow method, the inclined plane, etc. The barbarity and fruitlessness of these methods is well known, and they offend all feeling of chirurgical tact. The method of Renaulme, who placed his patients in the knee-elbow position. and thus believed that the weight of the free intestinal loops might accomplish traction upon the engaged loop, was also abandoned on acccount of its inefficiency. The principle, however, as we shall see, is correct. Nicolaus points out that in all these positions the intestines cannot act by their force of gravity, because either the intestines come to lie upon the unyielding posterior walls of the abdominal cavity or meet with the resistance of the insufficiently relaxed anterior parietes. A position, therefore, must be adopted that relaxes the abdominal wall most perfectly and throws the hernial apertures as high up as possible over the level of the most dependent part of the cavity. cavity. This position, according to Nicolaus, is the knee-shoulder position, or Sims' lateral recumbent position upon the healthy side, with the pelvis well elevated. In these positions it may be clearly shown, that not the force of gravitation alone is a factor favorable to the reduction by traction, but much more so, a most interesting physical phenomenon that is so established. Namely, in these positions, the intra-abdominal pressure becomes negative, that is to say, sinks below the atmospheric pressure. This circumstance obtains in the indicated positions to a much greater degree than in the knee-elbow position of which Hégar says: "In the knee-elbow position the viscera on the lower level, the thorax, the intestines, the parietes, must exercise a traction upon the parts at a higher level. This leads to a reduction of the abdominal pressure. It becomes lower than the atmospheric pressure. This can be demonstrated to be the case by introducing a catherer into the bladder. Generally the atmospheric air audibly rushes into the bladder through the catherer." Nicolaus' method, then, consists in the exercise of traction upon the engaged intestine, by establishing a high degree of negative intra-abdominal pressure, and thus permitting a full exercise of the force of gravitation. The patient is made to kneel upon the bed, and throws himself upon the shoulder corresponding to the healthy side. The thighs are to be kept at right angles to the plane of the bed. Bladder and rectum should be emptied, and gentle taxis may be exercised. If necessary the knees may be still more elevated by placing them on a firm bolster. Rotation outward of the thigh of the engaged side may also be made; thus, as Hyrtl states in his Topographical Anatomy, the outer aperture of the inguinal canal is made more patent. In support of his theoretical deductions, Nicolaus reports seven cases of strangulated femoral and inguinal hernia that yielded under the indicated treatment. The circulation of the blood in the incarcerated loop is certainly much. favored by the aspiration exercised by the negative pressure. In cases Nicolaus found that persistence in maintaining the positions indicated led to a good result after a few hours. A change from the knee-shoulder to Sims' position is advisable, when the patient should have the rest and comfort that an alteration of position brings.- Weekly Medical Review. [We know something of the value of traction from experience and have found Nicolaus to be correct. To his gravity traction may, however, with advantage be added the factor of manual traction. This is readily performed by pressing the abdominal wall backwards at a point near the median line and then making gentle outward traction against the gut, pressing inwards from the constricting orifice. This porticn of the intestine can always be felt in thin subjects, and most often even in those that are quite fat, after they have been put in the genufat, after they have been put in the genuacromial posture. It is apparent as a thick, somewhat tense, cord.] A. H. P. L. Treatment of Incarcerated Hernia. FINKELNSTEIN reduced fifty-four cases of incarcerated hernia in the following manner: The patients were placed on their backs, and of a mixture of 100 parts of æther sulph. and 20 parts of oil, one to two tablespoonfuls were poured upon the hernia-say every quarter hour. (The oil is merely to prevent the burning sensation of the æther.) After three to four such appli cations the bowel was usually liberated and returned with hardly any manipu- | small space, inexpensive, and capable lation. F. explains this effect by the of being used for all surgical necessirelaxation of the abdominal ring caused ties. by the æther, and by the low temperature produced, causing a reduction in the size of the bowel and inducing strong peristaltic motions.-Centralbl. f. Chir-South California Practitioner. [Compare this with the method of Karl Nicolaus, of Baden, appearing in this number.] Hernia Treatment. A. H. P. L. LAWSON TAIT in the British Medical Journal gives his method for the radical cure of umbilical hernia by abdominal section, and considers it applicable to all other forms of hernia. He opens the sac, frees all adhesions, cuts off omentum that may be in the way, pares the edges of the ring, and stitches up the wound with continuous silk thread, which he leaves permanently. The results have been exceedingly satisfactory. -Can. Lancet.-New England Medical Monthly. Passage of a Knife Swallowed, from Intes tinal Canal. Passage of an open knife along the intestinal canal is reported by Dr. C. B. HUTCHINGS, in the Pacific Medical Journal. After swallowing the knife he was fed on solid food. In six days afterwards the knife came away with "an immense" evacuation of the bowels. The knife, with open blade, measured 3 inches.-St. Louis Medical and Surgical Journal. Blotting Paper as an Antiseptic Dressing. DR. BEDOIN, in a recent paper on antiseptic dressing suitable for military. purposes, said that the requisites were that any dressing to be used on the field of battle must be simple, occupying but He believes that he has found a substance which combines in itself all these requisite qualities-blotting or filtering-paper. Before being used for surgical purposes, it should be disinfected by a lengthened exposure to a heat of 120° Cent., and by immersion in an antiseptic solution, and afterwards dried. Wounds are dressed by the application of seven or eight layers of this paper, the whole being covered with gutta-percha tissue, and a bandage applied. The dressing weighs only about 40 grammes, so that each soldier can carry one. In the ambulance, this dressing can be applied by the surgeon with any others that it is thought well to employ.--British Medical Journal.— Medical Record. Hypnone as an Adjuvant to Chloroform. M. DUBOIS (Revue Médicale Française et Etrangère), states that, when a hypodermic injection of a sixth of a grain of hypnone has been given to a dog, the animal can be anesthetized by making it breathe air containing four per cent. of chloroform, a mixture which, as M. Paul Bert has shown, never produces anesthesia under ordinary circumstances. The anesthesia ceases in about an hour, although the dog may continue to breathe the mixed gases. The same result may be produced by giving twice the amount of hypnone by the mouth. The practical value of these facts lies in the probable diminution that can be made in the amount of chloroform required for anesthetization.-New York Medical Journal. Should Old Ulcers Be Cured. fined to bed, the sores poulticed or dressed with unguentum resinæ, disturbed every day for fresh dressings, and the patients dosed with mercury, repeated purgation, or opiates to lull pain. On the whole, I think that, with proper attention to the state of the patient, there is nothing unsafe in healing old ulcers. The closing of an ulcer under means used by a careful surgeon, is widely different from the spontaneous course of acute or serious disease. Here the ulcer is healed, not by outward means, but by an inward condition. In a case of acute spinal meningitis (recorded by me in the Lancet for 1859), an ulcer of the leg of some years' standing healed spontaneously at the commencement of the illness, which was severe. It was easily reopened by the application of poultices, and was thus kept discharging until the patient's recovery.-Medical and Surgical Reporter. He has treated above nine hundred cases. Of these nine hundred cases, a few were of more than twelve years' standing; several were of ten years'; a considerable number between two and ten years'; the rest, under two years'. Fully half the cases were dressed by me, the rest under my supervision. In treating them, I always bore this question in mind, and was on the watch for any sign of mischief produced by healing the ulcers. No harm was ever ob-healing of an ulcer suddenly in the served, though some of the patients were old, infirm, insufficiently fed, or otherwise in bad health. Patients with large chronic ulcers, discharging profusely, found that their health improved as the ulcers healed. Whatever medicine was seen to be required was given, but that was very little. Almost all the ulcers healed, some thoroughly, some in a less satisfactory manner. In very few instances did they refuse to heal. I regret not having followed some short, easy plan of taking notes, so as to be able to give exact numbers. My treatment comprised careful bandaging; strapping, whenever practicable; sometimes zinc or chalk ointment, lead lotion, or black wash; avoiding poultices, caustics, incisions, the administration of mercury or other strong purgatives, and confinement to bed, in almost every instance; and renewing the dressings not oftener than every three or six days; the precise materials employed being of less importance than the right and persevering use of them. The patients mostly went about as usual during treatment, following their ordinary avocations. The treatment may by some be considered old fashioned, as including neither skin-grafting, India-rubber bandages, nor antiseptics; but is was very successful, and was a great contrast to what was done in my student days, when patients with bad legs were con An Ointment for Bruises. DR. S. M. FRENCH, of Philadelphia, writes us that he has found the following ointment to act like magic in controlling the pain and inflammation. dependent upon severe bruises; its anæsthetic properties are truly wonderful: B. Ext. belladonæ, glycerine, ãã equal parts.-Ibid. Contact and Air Infection in Practical By DR. H. KUMMEL (Annals of Surgery), Hamburg. In consideration of the favorable results achieved of late years by operative surgery with the greatest variety of strong and weak disinfectants and even without them at all, K. asks and attempts to answer the following questions: Do we really need at the same time toxic antiseptics for securing perfect | 1-10% sublimate did not in most cases disinfection? prevent the development of a number of Are antiseptics really the active fac- colonies; solutions of peppermint, turtors in the results of surgery y? pentine, white pine or mustard oil 1:500; Is there any quick and surely effect- peroxide of hydrogen or 5% potash soap sufficed in only a few instances to ive antiseptic? What significance has the air in disinfect instruments lying in them 10 wound-infection? As K. puts it, wound infection may occur in two ways, either by the hands, instruments, sponges, etc., touching the wound (contact-infection), or by atmos pheric germs falling on the wound (airinfection). K. endeavors to approach the subject by experimenting under conditions similar to those in practice. He therefore gave less attention to particular micro-organisms from pure cultures than to the ordinary mixture of many kinds as they surround us. His experiments were so arranged that the separate articles to be examined-hands, instruments, sponges, bits of soft parts from wounds, air and liquid-were brought into relation with Koch's culture material and the development of germs awaited. An antiseptic or any specified method of disinfection was only considered successful where no bacteria colony of any kind-neither the common mould fungi and putrefaction germs, nor the so-called pathogenic forms-developed. Experiments with polished instruments taken from the case showed that placing them for 2 minutes in 5% carbolic acid did not stop the development of fungi and bacteria, that even previous brushing with 5% carbolic and remaining 6 minutes in the solution did not in all cases secure perfect disinfection. Similar experiments with 3% carbolic yielded still less favorable results. Subjecting the instruments for 10 minutes to 5% or 3% carbolic regularly, produced complete disinfection. Subjecting them 6 minutes or even 10 minutes to to 15 minutes. Used but carefully cleaned instruments, not exactly polished ones, were still less readily disinfected. After 15 minutes long subjection to 5% carbolic or 1-10% sublimate, instruments used in dissecting lead to the development of abundant fungi and bacteria colonies. According to K.'s investigations the more or less rapidly achievable disinfection of an instrument depends, next to the polished character of its surface, on its form. Ribbed forceps, fourpronged hooks are e. g. much harder to free of germs than smooth knife blades. A series of experiments carried out on such easily disinfected instrumentsscalpels from an etuis-yielded the following results: A scalpel left for 15 or 5 minutes in 3% carbolic was free from all organisms, not so if left only 3 minutes. A 5% carbolic sufficed in 15, 5 or 3 minutes. A 1-10% thymol sufficed in 15 minutes, but was entirely inefficient in 3 or 5 minutes. Chlorine water for 15, 5 or 3 minutes was effectual, after only 1 minute, however, a mould fungus developed. Sublimate 1-10% did not stop all organisms in 2, or 15 minutes. For quick and certain disinfection of instruments, K. finds it best to scrub them with warm water and soft soap, and then place them in an antiseptic. solution. The latter is not essential under favorable conditions and in a well arranged operating room-otherwise it is necessary. Dissecting instruments after the above preparations could be completely disinfected by 1 minute subjection to |