ized amount of pus, the wound may be closed for primary union, after removal of the appendix and careful cleansing and disinfection of the limited area of infection. If the mass is behind the right rectus muscle, the incision is made through the muscle parallel to its fibres; the McBurney incision is usually necessary in these cases, however, and is so placed that the intersection of the line of cleavage of the external oblique, with that of the internal oblique and transversalis, corresponds to the middle of the tumor; after removing the pus and disinfecting the area, the appendix is removed; a loose and slender column. of gauze is arranged for drainage; no sutures are placed. The gauze is diminished after two or three days and withdrawn as soon as possible, sometimes by the fifth day. As soon as the cavity is obliterated and granulations have reached the bottom of the abdominal incision, the wound is disinfected, freshened and closed for primary union, as in a simple This suture is buried by closing the skin by means of an intracutaneous suture. On the next or third day the patient may get up; the total confinement is from one to two weeks.

case.

Surgical Interference on the Posterior Mediastinum and the Organs Contained Therein According to P. J. STAGANOV,* the idea of opening the posterior mediastinum originated with Nassilon, a Russian surgeon. Rehn, of Frankfort, first did it on the living. Nassilon proposed the following operation: The patient is placed on the belly, the left arm drawn under; an incision down to the ribs is made parallel to the posterior border of the scapula and the vertebral column; from the extremities of this first incision two parallel incisions are made toward the vertebral column; the flap thus made is raised and the ribs resected are, of course, those covering the part of the esophagus to be reached; part of this organ can then be resected and the ends sewn together; foreign bodies in the bronchi can be thus removed. Milton investigated the contents of the posterior mediastinum in quite a different way. He split the sternum from top to bottom, retracted the two halves, separated the right pleura from the pericardium, and then felt all the deeper structures. Posterior mediastinal abscess is best opened from behind. Fifteen such operations have been done, with a mortality of 20 %.

The Influence of Sodium Chloride on the Bacteria of Meat-Poisoning.-EDWARD STADLER† concludes, as the result of very careful experiments, that those bacteria which must be considered as the cause of most of the so-called meat-poisoning acci dents are not killed during the preparation of salted meats if they already existed in the meat intra ortam.

*Revue de Chirurgie, March, 1899. +Archiv für Hygiene, 35, 1.

On the contrary, they multiply during this process, and their spores retain the germinative power for very long periods. Salted meats should never be eaten raw, but only after being cooked for some time. In this way the danger of intoxication by means of preexisting bacterial toxines, too, is averted.

Successful Excision of Gastric Ulcer. - H. GRAD* presents a new device for the excision of a gastric ulcer. After the usual preparation of the patient, the skin incision is made parallel to the free border of the ribs on the left side. Before making the incision into the stomach, temporary sutures for stretching this line of incision are introduced; a piece of wire, bent into the shape of the letter U, is then sewn about the opening, keeping the wound patent, allowing free exploration of the interior of the stomach and preventing the escape of its contents. A purse-string suture is passed beneath the serous coat, opposite the location of the ulcer; when this is tied, the wall is puckered up, the mass bulging into the stomach and the ulcer appearing on the summit of this protrusion. The excision is then made entirely within the stomach and no blood or infection reaches the peritoneum. In the case reported feeding per os began on the fourth day, and the patient made a complete recovery.

Tertiary Syphilitic Mastitis.-DR. G. REINECKET considers this very uncommon, but avers that it can accompany secondary as well as tertiary syphilis. The manifestation is usually that of a tumefaction, somewhat sensitive, with great tendency to resorption, but slight to microsis. Specific treatment causes its disappearance. Microscopical examination shows a connective tissue growth, involving compression and atrophy of gland substance.

The Limitations of Conservative Surgery on the Female Genital Organs.-G. B. JOHNSTON‡ declares that conservatism must accomplish all that radicalism can in restoring the integrity of parts without sacrifice. In the selection of a final method of operation in cases which admit conservatism, the surgeon will be governed by (1) the age of the woman; (2) the nature of the malady; (3) the extent of the lesion; (4) the patient's physical condition, and (5) the necessity for a second grave operation. In considering the desirability of conservatism in a given case, account must be taken of the relative importance of ovaries, tubes and uterus. The presence of complications, such as the co-existence of pathologic conditions in two or more organs, usually places the case beyond conservatism. Whlle conservatism, properly applied, is both wise and humane, it must accomplish what it seeks to do.

*Medical Record, May 13, 1899.

+Centralblatt für allegemeine Pathologie und pathologische Anatomie, May 1, 1899.

Medical Record, May 13, 1899.

Practical Therapeutics.

The Treatment of Traumatic Inflammations of the Joints.-A time-honored procedure in the management of the traumatic synovitis, is to place the joint at rest. Strict immobilization, with the use of hot fomentations, is the accepted method of treatment. As soon as the pain subsides, the patient is commonly allowed to get about; if there is much fluid in the joint, it is slowly absorbed away, and there is usually more or less thickening of the periarticular structures with the formation of bands of adhesion in the joint, seriously interfering with its motion. A joint in the condition here described, is subject to subacute exacerbation, brought on by slight strains or twists, which would be absolutely unnoticed in a healthy joint, and which are accompanied by an increase in the fluid and some exaggeration in pain. These subside with rest, and the patient again gets about, to have the process repeated in endless succession. Stimulating linaments, antirheumatics, and other applications are employed in vain, until in sheer desperation the physician puts the patient to bed and again immobilizes the joint for a period of two or three weeks. This is followed by improvement, but later on with the inevitable relapse. In young persons, and those whose circulation is good, as time passes and there is a vigorous effort to resume the use of the limb, there is greater improvement, followed by ultimate recovery. That this is due more to the persistence of the patient and a determined effort to use the limb, rather than under the advice and treatment of the physician, is apparent to one who carefully studies the history of one of these cases. The error in the treatment of a joint by rest has, we think, come about in two ways: First, the improvement and cure which sometimes results in tubercular and other infected joints by rest, and the improvement which is noted in traumatic non-infected joints by brief period of rest. This latter has undoubtedly led physicians to employ rest, thinking that if a joint was improved by a few days rest, that it would only be necessary to continue long enough to have a perfect cure. The later theories regarding the treatment of such joints tend toward just the opposite treatment. The first few days after a joint injury, rest may be employed with advantage, but very soon it is important to place the joint in active use, even though it is painful and there is considerable fluid remaining in the joint cavity. This is to prevent adhesions. If the adhesions have already formed it is absolutely necessary that they be broken up and full motion must be given to the joint, otherwise the recurrent inflammations and accumulations of fluid will inevitably take place. Instead of rest therefore, the latest treatment of traumatic injuries to joints includes a

thorough and deep massage, which should be so vigorous as to stimulate the synovial membrane to absorption, and of passive motion which should include the whole range of joint movement. In this way, joint adhesions are avoided, or if already formed are broken up and stretched. Joints treated in this way show a much higher percentage of recoveries and much less danger of secondary inflammation than those treated by rest, in which the periarticular surfaces become edematous, the synovia eroded, together with the destruction of tissue which results from long chronic inflammation. A quick cure is essential to a permanent one in these cases.

Normal Salt Solution.-Of late marked attention has been paid to the use of normal salt solution subcutaneously administered in cases of hemorrhage and infectious conditions. It is claimed that such solutions are diuretic and are rapidly eliminated, not only by the kidneys, but also by the skin and bowels. The theory upon which such treatment is administered, is that of diluting the blood and in this way lessening its toxicity. BACON has shown that the ordinary solutions varying from toper cent, are not sufficiently strong, as the object of adding the salt to plain water in the injection is that it shall approximate the specific gravity of normal blood serum and thus not interfere with osmosis. He states that in

patients who have sustained severe hemorrhage, or who are suffering from infectious conditions, a solution of at least one per cent or even above, should be administered if we would come near to the specific gravity of the blood serum. gravity of the blood serum. Undoubtedly the intra

venous injection of normal salt solution is attended with some risk, as it necessitates the exposure of a vein, and as there is some danger of thrombosis or infection. In the vast majority of cases, however, the sub-cutaneous cellular tissue can be relied upon to absorb such solutions with sufficient rapidity to meet all ordinary indications. An apparatus of great simplicity may be employed, consisting of an ordinary glass percolator or an enameled iron vessel with an opening near the bottom. To this a rubber tube can be connected with a hypodermic syringe of ordinary

calibre. The introduction of the needle is attended with little or no pain, and if quite vigorous massage is employed at the time of the injection, a pint of the fluid can be injected into the cellular tissue in a few minutes. An apparatus as simple as here described can be extemporized in a short time and is easily sterilized by boiling for a few minutes.

Cure of Internal Hemorrhoids.-J. A. GARDNER* prefers the ligature operation to the clamp and The last cautery or the injection of carbolic acid. method, however, does not confine the patient to the

house.

*Am. Jour. Am. Med. Assn., May 20th.

Miscellany.

DR. C. W. LILLIE has been elected secretary of the College of Physicians and Surgeons.

PROF. R. L. GARNER of Chicago delivered a short address upon "Simian Speech," before the St. Louis Medical Society, on May 20, 1899.

THE following is the program for the St. Louis Medical Society of Missouri, Saturday evening, May 27, 1899: Report of a Case of Pyometria," by DR. JOHN YOUNG BROWN. Discussion of Dr. N. B. CARSON'S Case of Spinal Injury.

A COMMENDABLE feature of the program of the section on Practice of Medicine of the American Medical Association as published in the JOURNAL, is the short abstract which accompanies each paper. This affords each one who takes part in the discussion an opportunity to prepare his debate upon the points touched by the writer. In this way it conduces to the limitation of debate and greatly enhances its value.

THE St. Louis Medical Society has appointed a committee composed of Drs. N. B. Carson, W. A. McCandless and P. Y. Tupper, to consider the discipline of members of the society who have been guilty of unprofessional conduct. The Missouri State Medical Association at its recent meeting declared that unless the city society succeeded in disciplining such members, recognition would not be accorded to any delegates from the society.

THE Walker-Gordon-Laboratory of St. Louis offers to the profession a Kefir-buttermilk which will prove of great value in private and hospital practice as an addition to the list of easily digestible and strengthening foods. Here follows the analysis of this milk, which is put up in hermetically sealed quart and pint jars: Lactic acid, 0.6525; sugar of milk, 3.0940; casein, 2.9975; albumin, 0.2500; nuclevalbumin, 0.4035; pepsin, 0.8815; salts, 0.7000; total solids, 8.3315.

A bacteriologic examination of the product gave a comparatively very small number of germs present.

THE faculty of the medical department of Washington University as announced comprises the following:

Emeritus Professors:-J. B. Johnson, Principles and Practice of Medicine; J. M. Scott, Obstetrics; J. K. Bauduy, Psychological Medicine and Diseases of the nervous system.

Faculty:-E. H. Gregory, Principles of Surgery; F. F. Prewitt, Principles of Surgery; G. Baumgarten, Practice of Medicine; H. H. Mudd, Practice of Surgery and Clinical Surgery; W. E. Fischel, Clinical Medicine; H. Tuholske, Clinical Surgery; J. P. Bryson, Genito-urinary Surgery; R. Luedeking, Diseases of Children; H. Schwartz, Obstetrics; N. B. Carson,

Clinical Surgery; Justin Steer, Clinical Medicine; W. A. Hardaway, Diseases of the Skin and Syphilis; H. N. Spencer, Otology; J. B. Shapleigh, Otology; W. C. Glasgow, Clinical Medicine and Laryngology; P. Y. Tupper, Applied Anatomy and Operative Surgery; E. W. Saunders, Diseases of Children and Clinical Midwifery; S. P. Budgett, Physiology.

Special Professors:-John Green, Ophthalmology; F. R. Fry, Diseases of the Nervous System; C. E. Michel, Clinical Ophthalmology; F. A. Glasgow, Clinical Gynecology; A. J. Steele, Orthopedics; H. G. Mudd, Fractures and Dislocations and Clinical Surgery; E. M. Senseney, Diseases of the Nose, Throat and Chest; Joseph Grindon, Clinical Dermatology and Syphilis; A. V. L. Brokaw, Clinical Gynecology; A. Ravold, Bacteriology and Hygiene.

THE following cases of small-pox have been reported to the Surgeon-General of the U. S. Marine Hospital service during the week ended May 20, 1899:

United States:-St. Louis, (Jan. 21-May 12), 65; Kansas City, 32; Las Cruces, 19; Louisville, Norfolk, 16; Cleveland, 11; Portsmouth, 9; Galveston, 7; New Orleans, 8; Newport News, 6; Edgefield county, Savannah, 5; Shreveport, Steelton, 4; Washington, Barnwell county, Beaufort county, Clarenden county, (S. C.), 3; Mobile, Chicago, Evansville, Emporia, Allegheny, Laredo, Milwaukee, 3; St. Paul, Borough of Brooklyn, Johnstown, Philadelphia, Providence, 1. Foreign:-Athens, 21; St. Petersburg, 18; Moscow, 8; Odessa, 5; London, Calcutta, Constantinople, 3; Bluefields, 1.

Deaths:-Bombay, 15; Athens, Kansas City, 8; Cairo, Egypt, 4; St. Petersburg, 3; Moscow, 2; Brussels, Odessa, Emporia, 1.

Cholera: 49 deaths in India since March 25th. Plague: 1466 deaths in India, and 394 in Japan. since March 25th.

The Scientific and Practical Medical Aspects of Public School Inspection.-F. REDER* says that one of the most practical problems of public hygiene relates to the mitigation and possible suppression of infectious and contagious diseases among children in the public schools. He discusses briefly the schoolbuilding, ventilation, the seats provided for the children, gymnastics; cleanliness should be insisted upon; slates should be abolished, and the habit of moistening the pencil and of turning pages with the moistened finger corrected. The greatest danger to which. pupils are exposed is disease of infectious or contagious nature; this may, in most cases, be detected in time to prevent its transmission by the systematic inspection of the children by competent medical inspectors. This should be carried out at the opening of the school-session daily, if possible, and particularly during the months when these diseases are prevalent. In addition, tuberculosis should be systematically sought for in all doubtful cases.

*Medical Record, May 13, 1899.

tion to the Rational Treatment of Disease, for the Use of Students and Practitioners of Medicine. By J. MITCHELL BRUCE, M. D., F.R. C.P., etc., Physician and Lecturer on Medicine at Charing Cross Hospital, London. New (6th) edition, revised and enlarged. In one 12mo. volume of 618 pages. Cloth, $1.50, net. Lea Brothers & Co., Philadelphia and New York. 1899. This popular hand-book, which contains 600 pages full of condensed and systematized information, is just the book to place in the hands of students. It is likewise excellent as a book of ready reference for the practitioner. Many of the newer remedies are fully described and their doses stated. Among them the following may be mentioned: Thyroideum siccum, liquor thyroidei, antitoxin (diphtheria, septicemia, rabies, tetanus and anti-venomous), homatropine.

A Review of Recent Legal Decisions Affecting Physicians, Dentists, Druggists and the Public Health. By W. A. PURRINGTON, of the New York Bar. E. B. Treat & Co., New York. 1899. This little monograph contains an abstract of court decisions which affect the physician and dentist in their legal relations. In addition, there appears an essay by the author entitled, "Manslaughter, Christian Science, and the Law."

The Principles of Bacteriology. A Practical Manual for Students and Physicians. By A. C. ABBOTT, M.D., Professor of Hygiene and Director of the Laboratory of Hygiene, University of Pennsylvania, Philadelphia. New (5th) edition, enlarged and thoroughly revised. Handsome 12mo., 585 pages, 109 illustrations, of which 26 are colored. Cloth, $2.75, net. Lea Brothers & Co., Philadelphia and New York.

The fact that within two years a new edition (fifth) of this little work has become necessary, makes a discussion of its merits unnecessary. Among the numberless bacteriologic text-books, Abbott's certainly takes the first place; it is the only American textbook on this branch of science, which is from beginning to end pervaded with a true scientific spirit. Not only to the student and autodidact does it offer a reliable guide, but the reviewer knows of no other book which in the same way is apt to assist the teacher as a basis for his lectures and courses. That

this new edition is fully abreast with the latest achievements in bacteriology, need not be stated; the chapters on technique, disinfection, specific infections. and immunity belong to the best comprehensive representations of these subjects. Perhaps for a sixth

Every physician is interested in the history of the science which, from obscure beginnings, has so wonderfully developed and extended. It has only been a few years since the English-reading portion of the profession could enjoy the glance backward which history affords. In this little work a comprehensive view of the various ages of medicine is spread before the reader. The chapters comprise: the age of foundation, of transition, of renovation, medicine in America, anesthesia, antiseptics and dentistry. On the whole, students and physicians will find in this book not only an entertaining history of bygone medical practice, but also a fund of information which will be of unquestioned benefit.

Pamphlets Received

"Chronic Nephritis Affecting a Movable Kidney as an Indication for Nephropexy," by George M. Edebohls, A. M., M.D. (Reprint from the Medical News).

"Chronic Appendicitis the Chief Symptom and Most Important Complication of Movable Right Kidney," by George M. Edebohls, A. M., M. D. (Reprint from the Post-Graduate).

"The Hernia Guarantee and the Minimum of Confinement After Operations for Appendicitis With and Without Pus," by George M. Edebohls, A. M., M.D. (Reprint from the Medical Record).

"The Relation of Movable Kidney and Appendicitis to Each Other and to the Practice of Modern Gynecology," by George M. Edebohls, A. M., M.D. (Reprint from the Medical Record).

"The Question of Inflating the Bladder With Air Preliminary to the Bottini Operation," by Bransford Lewis, M.D. (Reprint from the Medical Record).

Publisher's Department

“Vin Mariani" is essentially the brain and nerve tonic of those who have talent and genius. These it is who compose the great army of intellectual workers, and the ravages made upon their nervous systems by the demands made upon them are at times truly appalling. This damage and consequent drain yield to nothing more quickly than to "Vin Mariani." The most noted European physicians, literateurs, musicians, singers, artists and diplomats have sent the most flattering letters to M. Mariani extolling his product. Not only these, but crowned heads as well have been mentally invigorated and rejuvenated by "Vin Mariani," and never tire of speaking words in its praise. It must be acknowledged that unsolicited testimonials, couched in such glowing terms, from such sources, are the best evidence possible that can be offered for the merits of the preparation. When "Vin Mariani" becomes as well known in this country as it is in Europe, it will be adopted as one of the indispensable remedies of the household. - The St. Louis Medical and Surgical Journal, May, 1899. Resinol as an Application to Septic Wounds.I have been using Resinol with marked success for some time. It is seldom that I recommend in writing any medicine or pharmaceutical products, but the time has come when I would show my ingratitude were I not to speak a good word for Resinol and cite my own case. About four weeks ago I received a very slight cut on my finger while performing an operation. I thought nothing of it at the time, supposing it would heal rapidly, as my flesh. usually does; but, to the contrary, I found in about five days that I had blood-poison. I used everything I could think of for two weeks, but the finger was growing worse. The wound would heal over every night, but the inflammation and pus were increasing every day. I happened to take up a sample box of Resinol that lay in my office, and on the first application I found a great change. Applied for three days, and effected a complete cure. Would time and space permit, would give full details of case.

I

Ammonol in Pneumonia and La Grippe. have tested Ammonol in pneumonia and la grippe, and find it reduces temperature very rapidly and aids expectoration. In diseases of the respiratory organs I find it excellent. JAMES S. RIDGE, M. D. Kingston, R. I.

Reduced Rates to Columbus, Ohio, account National Meeting of the American Medical Association, June 6th to 9th inclusive. For this occasion the Missouri Pacific Railway will sell tickets at one fare for the round trip, plus $2.00 from certain points on the line. See local agent for date of sale and further particulars..

Utero-Ovarian Pain. - Prompt relief, unaccom- ' panied by habit or untoward after-effect, is what the up-to-date practitioner desires most in these cases. If the pain is over the lower border of the liver, or lower part of the stomach, or, in short, be it headache, sideache, backache, or pain of any other description caused by suppressed or irregular menstruation, it will yield to two five-grain tablets of Antikamnia. This dose may be repeated in an hour or two if needed. For very prompt relief it is advisable to crush the tablets, and swallow them with a little wine, diluted whisky, or toddy.- Ohio Medical Journal.

The So-called Clotting Centre.-ARNOLD* does not believe with Hauser and Benker that a "clotting centre" within the leucocyte accounts for a consequent coagulation of fibrin around it; he believes the fibrin to be deposited first and the change within the cell to be secondary.

Typhoid Epidemics and Drinking Water.†It is hardly ever possible to demonstrate epidemiologically the importance of a contamination of drinking water through typhoid bacilli, although from a bacteriologic point this seems to be necessary. First, such a water contains great numbers of bacilli of the coli-group, so that a reliable testing of the single colonies would far exceed the time and working capacity of the investigator. Secondly, a water suspected of having caused cases of typhoid may have contained the bacilli two or three weeks before it is examined, a time sufficient to eliminate all of the pathogenic germs. R. PFEIFFER followed another method to demonstrate the contamination of the water with typhoid germs in two epidemics, proving by localization and temporal development the source of infection to a well which two or three weeks before the beginning of the epidemic had been contaminated by the feces of some sporadic cases of typhoid. The little paper is a model of epidemiologic research.

*Centralblatt für allegemeine Pathologie und pathologische Anatomie, May 1, 1899. Klinischer Jahrbuch, vii, 2.