tion. Niobe, "all tears," and the unfortunate pedestrian with a minute particle. of steel from the rail of an elevated road in his eye, are unwilling exponents of a similar process. They weep the same kind of briny fluid, in exactly the same way, though from widely different causes. Imagination is at times sufficient to excite the nervous system into the production of tears, without external aid or reflex. Writers and readers of good fiction weep over it alike, and the actor loses himself so entirely in the exigencies of dramatic art that he sheds real tears and the audience shed tears with him. Of a truth, the man who never weeps has a hard heart, and the quality of his intellect may also be questioned. Emotion, then, affection, grief, anxiety, incite to tears, not pain or discomfort. The pangs of maternity are tearless, though the influence of ether or chloroform may cause some emotional dream that results in weeping. In the earlier days of surgery patients might scream and utter such pitiful cries as to sicken the by-standers, might even faint with pain, yet there were seldom any tears. These, being pure waves of emotion and a relief to the heart, are almost powerless to mitigate pain. Perhaps one who weeps from pain does so from unconscious. though selfish pity-in other words, from emotion.

An

For the tearful, change of scene, mental diversion, and outdoor life are the best remedies. The author quoted objects to alcohol as fearfully injurious. It disturbs and unbalances the nervous system, keeps up a maudlin and pitiful sentimentality, and sustains the evil. Alcohol is the mother of sorrow. opiate, however, prescribed at night, soothes and controls and really disciplines rebellious nerve centers. Sleep cures tears. And so does Time, the restorer. Persons subjected to many and repeated griefs forget how to weep, and the oldas compared to the young are almost tearless. Tears have their value in the life of humanity, not as tears but as signs. They show that grief centers are being relieved of their sensibility, and that the nervous organization is learning how to bear up against sorrow.-New York Medical Journal.

SURGERY.

SUCCESSFUL TREATMENT OF A PUNCTURED ORBITAL WOUND OF THE BRAIN.

PUNCTURED Wounds of the brain through the orbit are attended with such a large mortality that the report of a successful case is always of interest. Polaillon (Bull. de l'Acad. de Méd., 3e ser., tome XXXVI) had brought into his ward a man into whose left orbit the point of an umbrella was driven so firmly that it was with some difficulty extracted. The patient entered supporting the umbrella with his hands. As it was drawn out by the assistant the crackling of bones was distinctly perceived. Its extremity had penetrated to the depth of two inches, passing upward and outward toward the roof of the orbit. Shortly coma, stertorous respiration, and a weak, intermittent pulse developed.

A large plate of the frontal bone was removed about the size of a silver dollar. The frontal sinus, which was very feebly developed, was not opened. The dura bulged through into this opening, so that the finger could not be entered for the purpose of exploring. The dura was incised, allowing some

blood and cerebro-spinal fluid to escape. By means of the finger the opening into the roof of the orbit was readily found. This was placed far back near the lesser wing of the sphenoid. Five splinters of bone were removed, together with a certain quantity of cerebral matter, and a spouting cerebral artery was secured. The remains of the punctured eye were enucleated, the orbit was thoroughly cleaned out, and a drainage-tube was carried from the trephine opening through the supra-orbital plate and out at the orbit.

In a few hours following the operation the patient regained consciousness, and dangerous symptoms disappeared. The next day the drainage-tube traversing the punctured wound was replaced by two tubes; one passed through the trephine opening, the other through the orbit.

On the eighth day the frontal drain was removed, on the twelfth the orbital drain. The patient completely recovered.-American Journal of Medical Sciences.

UPON THE POSSIBILITY OF INFECTION OCCURRING THROUGH A SUPERFICIAL SUPPURATING SURFACE.

THE author made a series of experiments upon animals for the purpose of determining the susceptibility of superficial suppurating surfaces to infectious influences. Rabbits were employed; seventeen of these animals in whom a superficial wound surface was produced were inoculated thereon with staphylococcus pyogenes aureus, and three with staphylococcus pyogenes albus. Suppuration of the surfaces having been by this means established, Sestini proceeded to inoculate the surfaces by means of anthrax bacillus. For the purposes of a control experiment eight other rabbits were inoculated in the usual manner by means of the same bacillus. Of those animals inoculated upon surfaces, the site of a suppurative process, not a single one manifested symptoms of the disease, while the other group very promptly died of the inoculation. The same results were obtained in the use of the virus of chicken cholera. In the case of the inoculated bacillus it was found that no general infection occurred, although extensive local ulceration followed. This latter was not as extensive as in the control animal, although in other respects the behavior of the two animals were quite similar.-Dr. Leone Sestini (Italy), in Riforma Med.-Annals of Surgery.

MENTAL SYMPTOMS AFTER SURGICAL OPERATIONS.

KIERNAN (The Medical Standard, Volume X, Number III) cites a formidable list of authorities from Ambrose Pare to Horatio Wood, showing the profound nervous effect produced by operation. He has found one hundred and eighty-six cases of profound mental change following operation; thirty-five cases after operation for cataract; sixty-five following gynecological operations, and the remainder resulting from plastic operations, amputations, manipulations, etc. In fifteen cases there was larvated epilepsy precedent to the operation; in ten hysteria major was present; in thirty cases a neurotic element existed; in thirty-five cases the patients had arrived at periods of involution when instability of the nervous system usually results. In ten cases only was the influence of blood-poisoning demonstrated.

The acute types of mental affection following operation are aptly designated as "acute confusional insanity." In the larvated epileptic cases, the neurotic, and the hysterical, the prognosis is good. In some of the cases occurring at periods of involution senile degenerations are precipitated. The majority of blood-poisoning cases died. Typho-mania is sometimes observed.

The moral treatment of the patient precedent to the operation is the best prophylaxis. If to the dread of the operation be added dread of the operator the nervous perturbation will necessarily be far greater. Sedatives and other measures tending to calm agitation are necessary. Quinine is strongly indicated. Opium and not chloral hydrate or the bromides will, as a rule, be found a most. valuable aid in most of the cases. In many of the hysterical cases salix nigra. and monobromate of camphor give good results.-American Journal of Medical Sciences.

RADICAL CURE OF REDUCIBLE HERNIA BY INJECTION

OF ALCOHOL.

HINK reports (Wien. med. Blätter, Number XLVIII, 1891) fourteen cases of reducible inguinal hernia under the care of Professor Weinlechner, which were treated by repeated injections of alcohol. This method was first proposed by Schwalbe, who found that alcohol when injected into the soft parts causes chronic inflammation, and the consequent formation of indurated deposits, which in the course of time gradually disappear. By frequent repeated injections of absolute alcohol and distilled water, the proportion of the former increasing with the duration of the treatment from twenty to seventy per cent., inflammatory action is set up around the neck of sac, which is followed by adhesions and retraction of the soft parts. In this way, it is stated, the conditions of a radical cure of hernia are fulfilled; the neck of the sac is fixed by adhesions to the inner margins of the inguinal openings, and the peritoneum is so firmly attached to the surrounding structures as to be incapable of further extension. The injections have in many instances to be repeated very frequently. In one case the patient was under treatment for nearly seven months, during which period one hundred and nine injections were made. The results in all but two of the cases are stated to have been very satisfactory, but in one case only was any observation made after the patient had left the hospital. In one case an injection was followed by alarming symptoms of syncope; and in other cases inflammation of the tunica vaginalis, epididymitis, and suppuration were observed.-British Medical Journal.

A NEW METHOD FOR RESECTION OF THE ELBOW-JOINT. THE author, after considering the advantages and disadvantages of the different methods (Erichsen's, Koenig's, etc.), describes his own new method, which is as follows: The inferior extremity of the humerus is sawed through obliquely so as to resemble the adjusting surface of the corner of a picture frame, and with its surface looking downward and forward. Then the superior articular extremities of the bones of the forearm are sawed through, also in an oblique manner, to form the other adjusting framelike surface, the latter looking upward and forward.

The surfaces of the bones are now joined, the forearm being placed in a position of semi-pronation and semi-flexion, so that the forearm rests now at a right angle upon the arm. The particulars of the procedure are: The posterolongitudinal incision is made, followed by separation of the soft parts and the periosteum; the articular extremities are then exposed and dislocation produced, after the method of Langenbeck, the humerus being fixated by an assistant.

A line is drawn which unites the lowest point of the external condyle with the lowest point of the internal condyle. This horizontal line divides the posterior inferior articular surface of the trochlea in its median part.

After this line has been marked out, the saw is conducted through it, being held obliquely, so as to bring it out anteriorly at the inferior border of the coronoid cavity. Thus a surface is obtained which forms with the longitudinal axis of the humerus an acute angle of forty-five degrees. If, however, the morbid process should involve more than the articular processes, the reaction may be practiced more extensively, with the same facilities and equal results. As regards the bones of the forearm, the saw is applied about one and one-half centimeters below the apex of the olecranon, and carried through obliquely below the articular cartilages of the glenoid and sigmoid cavities to come out at the base of the coronoid process of the head of the radius. One obtains, thus, a surface, which forms with the longitudinal axis of the forearm an acute angle of forty-five degrees. Through the above procedure two ample section-surfaces result, which can be well adapted to each other and permit the forearm to rest solidly upon the arm at a right angle. In cases where the junction of the two surfaces is not sufficiently secure, this may be assisted by sutures which are to be introduced at the apex of the angle to be formed. It often happens that one of the surfaces overlaps the other posteriorly. In such cases the osseous projection must be removed in order to avoid irritation of the soft parts, which may cause gangrene. It is, also, of importance to saw through the articular extremities, while an assistant is holding the forearm in a position of semipronation, as this position is the most favorable as regards the function of ankylosed forearm.

The author finally remarks that this method of resection of the elbow-joint perhaps has been used by other surgeons, here and there, but as he has not found it stated in the text-books, he thought it not inopportune to put it on record. Dr. C. Zatti (Bologna, Italy), in Gazzetta Degli Ospitali.—Annals of Surgery.

A NEW METHOD OF SUTURING THE INTESTINE, WITH EXACT AND RECTILINEAR APPOSITION OF THE MARGINS.

THE writer has devised a method of suturing the intestine which promises to overcome the disadvantage of Lembert's suture, namely, of the rolling in of the line of sutures. He proceeds as follows: The entire mucous layer of the cut and flattened end of the intestine is so seized with a clamp that its entire circumference, after it has been slightly drawn out, may be clipped at one cut with the scissors. This is easily done if the small intestine be not dilated. If this be the case then a narrow ring of mucous membrane must be excised with

the pincette and scissors. By this process one obtains a margin composed only of the serous and muscular layers, while the mucous stratum lies a few millimeters within the intestinal tube. The margins are then apposed; the needle is so introduced through the serous layer, that the puncture comes to lie two or three millimeters behind the line corresponding to the margins of the mucous layer. The needle then passes obliquely on through the muscular layer to penetrate the layers of the opposite tube in the contrary direction, namely, muscular and serous layer, and appear beyond the line of the mucous layer. Sutures are then introduced in the above way around the entire circumference of the intestine at a distance of three millimeters, one from the other. They are then tied. Care should be taken that the muscular layer lie against muscular layer and the sutures only be drawn tight enough to bring one mucous layer in contact with the other. Exact contact of the mucous margin sutures secures the sutures against infection. This single row of sutures is sufficient to closely coapt the margins; supplementary sutures in the serous coat are unnecessary, as the surfaces of the wound lie well and broadly against each other. The writer cites three cases of incarceration of the intestine treated by resection, which, as regards the intestine, had an uneventful course.-Dr. D. Morisani (Naples), in Il Progresso Medico.—Annals of Surgery.

GYNECOLOGY.

REMOVAL OF OVARIES FOR EPILEPSY.

F. HOWITZ and Leopold Meyer (Gynük. og. Obstetr. Meddel, 1891) describe four cases. The results are, on their own admission, discouraging. The cases were under observation for from two and three-quarters to four years. In all the ovaries were more or less diseased. In one case only was the patient cured. The fits increased during pregnancy. In the second the same symptom was observed, but after the operation the patient's condition but slightly improved. In the third and fourth no improvement followed lactation, yet in the third the epileptic fits had always increased in number and severity during catamenial periods, and from thirteen months after the operation no show ever appeared. In the fourth the fits had ceased for four years, and recurred when the patient was suckling. All the four patients had been subject to fits for over seven years, the first or successful case having been epileptic for thirteen years at the least. In three out of the four complete amenorrhoea followed the operation. In the third there was a typical irregular hæmorrhage from the sixth to the thirteenth month after the oöphorectomy.-British Medical Journal.

THE ULTIMATE RESULTS OF REMOVAL OF THE ADNEXA. In view of the general interest recently exhibited in this subject, the following statements by Tait, made at the recent French Surgical Congress, are important. He divides these cases into three classes-those in which the adnexa are removed for the cure of myomata or metrostaxis, for disease of the tubes and ovaries, and for nervous disturbances. His mortality in two hundred and seventy-one cases of myoma was two and two-tenths per cent.