PATHOLOGY.

METASTASES OF THE ENTERIC FEVER BACILLUS.

ROSIN and Hirschel (Deutsche Medicinische Wochenschrift, June 2, 1892) say that in the various suppurating metastatic foci in enteric fever, typhoid bacilli alone or mixed with the ordinary pyogenic organisms have been found. In the furuncles and abscesses seen during convalescence from enteric fever, the staphylococcus and but rarely the streptococcus has been found alone by one of the authors. A case of enteric fever is then reported in which there appeared about the twentieth day a swelling of the size of a five-mark piece near the tuberosity of the left tibia. There was also cedema of the left foot and leg. An incision was made into this swelling. No pus came out of it, but a piece of necrotic tissue was found in it. Cultivation experiments amply proved the micro-organism present to be Eberth's bacillus alone. The authors could not absolutely exclude the periosteal origin of the swelling, but the infiltration was apparently in the muscle substance. The thrombosis of some important vein produced the dema. The authors suggest that in the cases of suppuration where typhoid bacilli have alone been found, other micro-organisms being less resistant may possibly have perished. It has, however, been shown that injections of typhoid bacilli may produce an abscess, and it is possible that under certain conditions the micro-organisms may produce suppuration in the human subject. The above case shows that typhoid bacilli may cause an infiltration which does not break down into pus, and which gradually disappears.-British Medical Journal.

MEDICAL MELANGE.

MILITARY SURGERY IN RELATION TO THE NEW FIREARMS.-Von Bardeleben (Centralblatt für Chirurgie, June 11, 1892) says, as the result of adoption of the new military weapons, many of the wounded will recover more readily than in former wars. As a result of the late Chilian war, many more were killed, because the new projectile has much more penetrating power. The author recommends that the military surgeon on the field should simply do what is absolutely necessary, since, by the adoption of antiseptic precaution, the wounded can be sent to almost any distance to military hospitals.-Therapeutic Gazette.

THE PALLIATIVE TREATMENT OF CARCINOMA UTERI WITH ALCOHOL.-Schultz (Centralblatt für Gynäkologie, 1892, Number XIII) reports ten cases of cancer of the cervix uteri treated by injections of alcohol. He uses absolute alcohol, injecting from one to two cubic centimetres at one sitting. In one case fortyeight injections were made at intervals of a day or two. There is little pain, provided that the needle is plunged deeply into the diseased tissue. Most of the alcohol escapes after withdrawing the needle, bringing away with it broken-down tissue. In the cases reported the treatment resulted in diminution of the diseased area, with the gradual formation of healthy epithelium over it. Hæmorrhage and foul discharge ceased and there was a notable improvement in the patient's general health.-American Journal of the Medical Sciences.

FOR difficult digestion accompanied by constipation the following formula is highly recommended:

Misce. Signa.-A teaspoonful t. d. after meals.

THE TREATMENT OF HEART-FAILURE FROM CHLOROFORM.-(Die Methode der Wiederbelebung bei Herztod nach Chloroformeinathmung: Berliner klin. Wochenschrift, 1892, page 265). Maass describes a method in use in the clinic at Göttingen by which the heart can be made to resume its action after apparently fatal paralysis from chloroform. The method consists in rapid impulses given to the region of the heart by the hand of the surgeon. The latter stands on the patient's left side and lays his right hand on the left side of the chest, so that the ball of the thumb lies half-way between the apex-beat and the sternum, while his left hand applied to the right side of the chest steadies it, and then makes rapid compressing motions with the right hand, as many as one hundred and twenty to the minute. Maass relates two cases in which the patients were revived by this method perseveringly applied for half an hour or more, although they were apparently hopelessly lost, for whenever the compression was interrupted the heart-contractions ceased. The respiration, however, continued spontaneously, although very shallow in character.-International Medical Magazine.

PEROXIDE OF HYDROGEN.-The use of this preparation, so effectual in many conditions as a pus-destroyer, has quite recently been remarkably extended. It has not only been advised in the medical press and in society discussions for almost every morbid condition of the throat and nose, but has also been lauded by the daily press as a cure for various ailments and diseases of afflicted humanity. It has, as a natural result, been employed indiscriminately in large quantities, both in weak and in strong solution. Bad results are certain to follow such use even of a less potent drug. A note of warning against its indiscriminate use in the throat was recently sounded by Dr. A. Jacobi at a meeting of the American pediatric society. A weak solution of the purest preparation will irritate some throats. In some patients it seems to possess the power of corroding the mucous membrane or of causing the formation of a thin pseudomembranous coating. It seems also to have a decidedly detrimental effect upon certain diphtheritic throats, and marked improvement at once takes place upon its discontinuance. In view of facts recently reported by reliable observers, the conslusion seems inevitable that peroxide of hydrogen is a preparation to be used with extreme caution in the nose and throat.-New York Medical Journal.

VEGETABLE DIET.-The very strict ascetic sect of vegetarians who only live. upon seeds and uncooked food look down upon their weaker brethren who eat eggs and milk and butter, in fact, everything which does not necessitate the taking of life; which appears to me to be the only reasonable stand-point. It is certain that the giving up of animal food cures many illnesses which no medicine

can reach.

Everybody knows the bad effects of butcher's meat in gout and rheumatism. In affections of the heart it is often the only remedy, and the wonderful results are not difficult to explain in a case where rest often means cure, if one reflects that while the meat eater's heart has seventy-two beats in the minute, the vegetarian's only has fifty-eight beats, therefore twenty thousand beats less in the course of the twenty-four hours. Insomnia and nervousness are affected in the same way; there is less wear and more repose in the constitution. I could enumerate many other illnesses in which vegetable diet does marvels, but will only mention those of the skin. Most vegetarians have unusually clear and often beautiful complexions. I need only remind those who know them of the old Carthusian and Trappist monks, who all have smooth white and pink Fra Beato Angelico kind of faces, which are not found among the orders that do not habitually live on Lenten fare. The splendid teeth of the Italian peasantry, who never touch meat, speak for themselves, and it is the same in other countries where the people live under similar conditions. It is foolish to associate vegetable diet with temperance, as so many do; they are quite astonished to see a vegetable eater drinking wine or beer. One thing, however, is true, namely: that it is far easier to cure a drunkard if you deprive him of meat, because, as Dr. Jackson, head doctor of the asylum for dipsomaniacs, Danville, New York, says, "It is clear that meat contains some not nutritious particles, which excite the nervous system so much that it at last becomes exhausted and unstrung. In this state of exhaustion unhealthy reaction follows, which brings on a paroxysm and violent desire for spirits and the excitement which they create." G. Bünge, professor of physiological chemistry at the university of Bâle, writes, in his book on vegetarianism: "The appetite of the drunkard is directed almost exclusively to animal food, and vegetarians are quite right when they teach that spirit drinking and excessive use of animal food are in connection with each other." Vegetarianism is often called a fad, but it is a healthy and innocent one and the natural reaction against the present state of things. It imparts lightness and elasticity to the body, brightness and clearness to the mind. The vegetarians I know are all unusually strong, active and young looking people for their age; one of them walked without stopping for thirty-four, and another time twenty-seven hours, without a rest, while on an excursion in Norway, feats not easily equaled by the most inveterate beef eater. Traveling, mountain climbing, all seems easier and less fatiguing on this light and soothing diet; and why should it not give strength to the limbs and sinews if one reflects that all the strongest animals who do the heaviest work in the world, like horses, oxen and elephants, are entirely herbivorous? It is not my intention to be understood to say that I look upon vegetable diet, even with its necessary accompaniments of fresh air, frequent ablutions, gymnastics and exercise as a panacea for everything, and that medicines become useless. We are mortal, and there is no perfection in this imperfect world. Nobody has a greater belief than I have in remedies judiciously given during illness, but it is the many who are out of health and below par, without hardly knowing what is the matter with them, who would be all the better for trying whether their discomforts spring from too high and rich a diet or from the inability to procure any but inferior meat or fish.-Lady Paget in the Nineteenth Century for April.

The Physician and Surgeon

A JOURNAL OF THE MEDICAL SCIENCES.

BY EUGENE BOISE, M. D., GRAND RAPIDS, MICHIGAN.

DURING no period has surgery made more rapid or more notable advance than in the past ten or fifteen years. In every department the best and most earnest efforts of the brightest minds have been put forth. Operations undreamed of a few years ago are every day performed, and pathological conditions, universally considered incurable, are daily yielding to the surgeon's skill. In no department of surgery has there been greater advance than in gynecology. So rapid has it been that the attention of the professional world is turned toward it. And those voices which are not heard in admiration and encouragement are loud in condemnation.

In the treatment of many of the diseases of the pelvic viscera there has been a complete revolution. Not many years ago uterine fibroids were almost universally let alone or treated palliatively. Some, not satisfied with this, hoped much from the administration of muriate of ammonia or ergot. A few attempted the removal by morcellation of those which were intra-uterine. Occasionally, when the extremity of the case demanded it, one, bolder than the others, removed the entire uterus as early as 1825. Electricity was tried as early as 1871, but fitfully and uncertainly, till Apostoli finally in the last six or eight years established it firmly as a rational and valuable mode of treatment. His teaching has been followed by a large army of pupils whose enthusiasm almost leads them to claim that it should supersede the knife. The laparotomist, on the other hand, is unable to see the benefits claimed, and pronounces it even more harmful than useful.

Vaginal hysterectomy for fibroids was performed by Kottman and by Pean in 1882. Now the technique has been so perfected that in proper cases, no one whose knowledge keeps pace with the times, hesitates to recommend it. Abdomi

nal hysterectomy for fibroids was performed as early as 1825, and from that time at intervals, rare because of the extreme danger of the operation, till Koeberle's operation, December 19, 1863. He so perfected the technique and his published report was so complete, that the operation was established as fully justifiable from that time. Various modifications in the several details of the operation have been made from time to time. The elastic ligature was first employed by Kleiberg in 1876, modified by Martin in 1878, and is now used practically as then. Schroeder announced his intra-peritoneal method of treating the pedicle in 1878, and his method, unmodified in any important particular, is used by many operators to-day. In 1889 Martin advocated total extirpation of the uterus, and now this method is finding many enthusiastic advocates, the technique being gradually perfected till in ordinary cases it is comparatively free from danger. In 1876, Trenholme and Hegar each advocated castration for the cure of fibroids, and to-day, this is, in proper cases, the established method. Pozzi says it should be employed in every case where its performance is less grave than hysterectomy, and where the latter is not especially indicated by compression phenomena.

In the treatment of cancer of the cervix uteri, amputation of the cervix has been performed for more than twenty years, and now is being urged by many warm advocates as against total extirpation. It is not in order in this article to give even a résumé of the various arguments urged, but it sms that the majority is in favor of entire removal of the diseased organ. As summed up by Pozzi: "For my part, I think that total hysterectomy is preferable to removal of the cervix, even when the disease is circumscribed, for it alone gives security that the whole of the affected part has been removed, and the mortality of the operation has been so far reduced that it does not materially exceed that of cervical amputation." In cancer of the cervix and body, total extirpation of the organ, by the vagina, is the only procedure advocated in suitable cases. Freund's description of his abdominal method in 1878 caused it to be very generally tried, but the technique was so faulty that it fell into disfavor. Czerny, searching for a better way, advocated the vaginal operation in 1879. Since this time it has made very rapid strides in favor, the debatable ground now being whether to use clamps or ligatures to secure the broad ligaments. Cancer of the cervix, extending to the vagina, was, till very recently, treated only palliatively. Pozzi, even, saying "this invasion is an absolute contra-indication to any radical operation." But within a very short time successful cases have been reported where the entire uterus with the upper third of the vagina was removed, the cases not only making good recoveries, but showing no tendency to a return of the disease. This, then, is taking its place among the curative possibilities.

In the treatment of retro-displacements the pessary has been the sole reliance of physicians for many years, and even now has its strenuous advocates, as against recourse to any surgical procedure. But conscientious gynecologists have never been satisfied. In December, 1881, Alexander made his first successful operation for restoration by shortening the round ligaments, not describing the operation till 1883. Adams made the same operation at about the same time. Their success caused a wave of excitement among those who were dissatisfied with the then prevailing incompleteness of all methods of dealing with