have would convey more current than the brass and nickel-plated one made by the surgical instrument makers.

To use it: Simply run the ends of the conductors into the large ends, crowding them in so as to hold. Before this application, a fine platinum wire 12 or 16 inches long is run through the large end of one tube, out of the small end, then through the small end of the other tube and out of the large end. This wire can be fixed by simply bending the free end outward sharply over the tube.

found the iodide of potash to promote in an astonishing manner the cicatrization of extensive wounds. He used a 5:200 solution in adults and a 3:200 in children. Unhealthy wounds would assume a healthy appearance, and, in general, the time required for healing was greatly reduced.

Some principles about the wire:

a. It must be small.

b. It is not an écraseur.

enough to cut tissues, and iron wire does.

C. Simply draw it in contact with the tissue, then pass the current by a switch; or better, by nipping the plates of the battery in the solution.

d. Stop the current when things are getting too hot. There is no need of the adjacent parts being burnt. Besides, slow and broken applications allow of the sealing of the blood-vessels, so as to avoid hæmorrhage. Rarely do I have a hæmorrhage.

e. After things have cooled, draw gently one end of the platinum wire and take up the slack, and fix by a sharp turn over end of tube. You are then ready for another application of the current. This letting the wire cut its way by burning is much different from cutting as an écraseur. In the method here used there is no disturbance of the adjoining parts. With the écraseur, all the surrounding tissues are drawn in more or less, so that more tissue is taken in than needed. In the method here used there is no indrawing of tissue, and no taking more than is required. Important repetition.

f. Another thing, the wire must be hot. A white incandescent is the best.

The connections of the battery are so arranged that they cannot come in contact with the fluid. This is done by the battery being shorter than the plates.

It is a good plan, after use, to wash cell and battery thoroughly in water and then to dry, before restoring plates to cell.

The fluid best for battery is saturated solution of bichromate of soda with sulphuric acid, 1 oz. to 11 ozs. of solution. It should be cold. Battery works best while cold.

The potash salt is used the most, as it is the cheapest, but it does not dissolve so well as the soda salt.

Anaesthesia. This is not always needed, as, if the wire is properly heated it destroys the nerves as it burns, with little pain.

THE DROP BY DROP METHOD OF GIVING CHLOROFORM.-Brook. Med. Journal.-Brandt (Centralblatt f. Chirurgie, No. 47, 1891). Two communications appear in which especial stress is laid upon this method of administering chloroform. Zuckerhandl claims that the method has been extensively employed in Dillel's clinic at the Vienna General Hospital with excellent results. Brandt states that Lauenstein, in the Sailors' Hospital at Hamburg, has used the same method for six years without a single accident occurring in consequence of the use of this anæsthetic agent. Only in rare cases is morphia used in connection with chloroform anesthesia.

IODIDE OF POTASH AS A CICATRIZANT.-Lancet Clinic. -Dr. Schleich (Le Bulletin medical, No. 8, 1892) has

plaster, the whole being secured by a spica bandage. After removal of the dressing a little accumulation of pus was found, and removed by antiseptic washing as before and dressed in the same way. The dressing was renewed a third time, the opening was quite filled up, and the wound healed after six days. He has come across many cases of buboes which took some weeks to cure, but this treatment has been found the most effectual and satisfactory in its results.

LAPAROTOMY UNDER COCAINE.-Dr. Emory Lanphear; Kansas City Med. Jour., reports the following interesting case:

Mr. W- , age fifty-two, patient of Dr. F. B. Wheeler, of Sawyer, Kansas, was admitted to the All Saints' Hospital suffering from a cancerous tumor of left side of neck, of very rapid development. Patient began to experience difficulty in swallowing about nine weeks ago, when his weight was 165 pounds. The dysphagia increased at an alarming rate and two weeks before admission to the hospital it became a matter of impossibility to swallow at all. Partial removal of the tumor was done by Drs. Wheeler and McCoy (of Pratt, Kans.), under local anesthesia, it being deemed inadvisable even at that date to use chloroform or ether. There was very little improvement, so patient was brought to Kansas City to the hospital for further treatment.

When admitted he was in extremis-cadaverous, weight less than 80 pounds and at the gate of death from starvation. Upon the evening of admission the abdomen was carefully scrubbed and shaved and a pad of moist bichloride gauze applied. At 9 A. M. on the following day, assisted by Drs. J. F. Binnie and T. B. Thrush (Dr. Sawyer standing ready to administer ether if it should be required), I made a gastrostomy under local anesthesia from cocaine. Onehalf dram of a 4% solution was injected in eight places into the subcutaneous areolar tissue along the proposed line of incision. As soon as the analgesic effect was established the usual operation was made, and without any pain or even sense of discomfort on the part of the patient. The only disagreeable symptom was a slight nausea when the left lobe of the liver was turned up to allow the stomach to be drawn up into the wound. The operation lasted twenty-two minutes.

How much longer the operation might have been prolonged without discomfort to the patient is a question of interest. But as a large number of the abdominal operations can be made within twenty minutes it is not so important as might at first be supposed. Besides the fact that the primary depressant effect of a general anæsthetic was avoided by the use of cocaine, there were two other points of much importance in this case, viz.: the absence of the vom

iting that nearly always follows chloroform or ether and especially the absence of shock. There was a total absence of anything like shock, and if this be found to be a general rule an immense gain may be made in sewing up stab or even gunshot wounds of the intestine (as well as in other numerous abdominal operations), by the use of local instead of general anæsthesia.

FRACTURE OF THE PENIS.-On February 1st, about midnight, I was called to see A. B.- a Hebrew, about thirty years of age. I found him greatly agitated, and sitting up in bed and holding his penis. As soon as he saw me he called out several times in great distress, "Oh, doctor, I have broken my penis!" On examination I found blood escaping from the urethra, the sheets and patient's hands soiled with blood, and the penis arched toward the left with a distinct sulcus midway between the symphysis pubes and the glans, the whole organ very much engorged, more especially the right corpus cavernosum, and the skin of a darkish blue color. The patient gave the history of an old stricture, which he had been treating with Ag. No. 3 bougies, under medical advice.

History of Accident.-About half an hour before, on getting warm in bed, the organ being in an extreme condition of engorgement, he had forcibly tried to turn it down under the left thigh.

Treatment.-A number of English gum elastic catheters was passed without much difficulty into the bladder, and a small quantity of normal urine drawn off. On withdrawing the instrument a small clot was entangled in its eye. Fearing sloughing, which must have inevitably taken place, fourteen small incisions were made, mostly on the right side, and toward the distal end of the organ. Considerable blood and serum were allowed to escape, the part was freely dusted with iodoform, and enveloped in a linseed poultice, the glans being left uncovered. After the incisions patient expressed himself as much relieved, but the part was still very swollen, blackish, and bent over to the left; the privates were raised on a soft pillow. The poultices were renewed every two hours during the night. At my morning visit the parts looked better, and were not quite so much swollen.

Much the same treatment was continued for six or seven days, the poultices every three hours, and a soft rubber catheter left with the patient. All the incisions at the end of a week were healed, except one just behind the glans, on the right side, and the penis had almost recovered its normal size and color. On the eighth day the poultices were discontinued, and a dressing of iodoform 3 j. in lanoline 3 j. used, being spread on lint and changed twice a day.

On the eve of the ninth day patient had difficulty in passing the catheter, and found the urine ran along its side and escaped from the unclosed incision on the right side; with considerable force, however, this was avoided in the future by using a full-sized rubber catheter, and emptying the bladder three times in the day. The patient left his bed on the fifteenth day, the iodoform ointment being still used, When I saw him last on February 19, the wounds were all healed and the penis looked normal, the catheter being discontinued.

LIGATION OF ARTERIES.-Med. and Surg. Reporter. -In an excellent lecture by Prof. Ashhurst, reported

in Gaillard's Medical Journal, the following practical conclusions are formulated:

1. The best material for ligatures, as far as my experience enables me to judge, is catgut, prepared with alcohol and oil of juniper for ordinary operations, but with chromic acid for ligations of vessels in their continuity. For the lateral closure of veins I am disposed to recommend fine carbolized silk.

2. In dealing with arteries, the ligature should be tightly tied so as to divide the inner and middle coats of the vessel. In cases of hæmorrhage in continuity, double ligatures should be used, and the artery may properly be divided between them. In cases of aneurism, a single ligature applied through a very small opening in the sheath is safer. In dealing with the trunk veins of the extremities, the dangers attending complete occlusion are so grave that it is worthy of consideration whether, in cases of punctured or longitudinal wound, lateral closure in some form might not be advantageously substituted for the ordinary double ligature.

3. In the treatment of hæmorrhage in the continuity of an artery, the vessel should be tied where it bleeds, and on both sides of the bleeding orifice. In the treatment of aneurism, on the other hand, the ligature is best applied at a distance, as in the Hunterian method.

4. In cases in which the great veins are wounded, the vein only should be tied. Simultaneous ligation of the artery increases the risk of gangrene by cutting off the visa tergo, which is needed to maintain the circulation.

5. In the surgical treatment of aneurism, digital compression on the cardiac side of the tumor may be considered the "ideal" method. When it is not applicable, or if it has failed, the Hunterian mode of ligation is the best substitute, and Anel's method, the "old operation," and the various plans of distal ligature, should be reserved for cases to which Hunter's method is not applicable. For aneurism of the innominate or thoracic aorta, simultaneous ligation of the carotid and subclavian of the affected side is preferable to the ligation of either artery separately. For subclavian aneurism, shoulder joint amputation is to be recommended as a modified distal operation.

CASE OF DOUBLE DISLOCATION FORWARD OF THE THIRD CERVICAL VERTEBRA. A. Stout, M. D. University Med. Maz. A young boy 14 years while playing foot-ball stumbled and fell, three or four of his companions falling upon him and throwing most of the weight upon his neck. He suffered great pain; head extended and thrown back and marked protrusion of the thyroid cartilage. A careful examination revealed a deep depression in back of neck into which the finger could be placed to the depth of half an inch and counting up from below, this depression was found to be over the seat of the third cervical vertebra. The head and neck could not be moved in any direction, but there was no evidence of paralysis or anæsthesia in any part; could detect no crepitus and the rigidity excluding the idea of fracture, it was decided as the head was square to the front, that both condyles must be dislocated, the nature of the deformity showing that the third veretbra was dislocated anteriorly on the fourth.

There being necessity for immediate action, the boy was put on a low stool, the hands placed on each side of his head, with the fingers on the occiput, extension

made, pulling first in the line of dislocation at the same time making slight rotatory movement, later pulling in the direction of the axis of the cervical vertebra. This overcame the deformity somewhat, but not entirely, so an assistant applying extension in above manner, the index and second fingers of second person were forced through mouth against the projection of the body of the vertebra in the pharynx, this overcoming still more of the deformity.

The following day the patient was able to move his head a little from side to side and extension was was again applied as at first. Three days after accident he was able to move head still a little but forward and backward caused him considerable pain. Extension being daily applied, he continued to move head more and more, but always causing pain if bent back. Otherwise functions were all normal and he was able to take exercise in open air. He continued to improve and six week after accident was running about with playfellows, apparently well, but with slight prominence in the region of the thyroid gland.

Ophthalmology.

POISONING FROM HOMATROPINE USED IN THE EXAMINATION OF REFRACTION.-Pooley, in Med. News.—No instance of poisoning by homatropine has previously been recorded, though many from the use of atrophine. The following is therefore of interest:

A girl seven years old was examined for refractive condition. Homatropine, two per cent solution, was ordered to be instilled every fifteen minutes for an hour, and the following day the second examination made. Four days later her family reported that on returning home from the second examination the child became very much flushed in the face, very restless, and both mind and senses very much dis turbed. Her ideas came very rapidly, at first coherent, but later quite incoherent and extravagant, and she saw imaginary objects. By the time home was reached the gait was staggering and the other symptoms more constant and marked. Her family physician put her under opium probably which ameliorated the condition, and the following morning she was much better, though still nervous and tending toward the hallucinations. It was several days before she had regained her usual health.

the blood in a peculiar manner, giving rise to numerous thromboses, especially in the intestinal vessels; they also effect very similarly the mucous membrane of the eye, and they are both converted into nonpoisonous substances by digestive ferments. Ehrlich's experiments, however, show that they are perfectly distinct alkaloids. One peculiar action of abrin is to cause the loss of hair speading round the point of injection. In its toxic properties ricin is found to be nearly twice as powerful as abrin, but when applied to the eye their action is reversed. Moreover, it is possible by special treatment to render an animal immune against both. The practical inference to be drawn from the results obtained by Ehrlich is that by the use at first of dilute solutions of either abrin or ricin, and then carefully and slowly increasing the strength, all danger to the eye in using these solutions may be avoided, without at all diminishing their therapeutic effect.

AFTER TREATMENT OF CATARACT OPERATION.- Dr.W. H. Baker, Vir. Med. Monthly, has discarded compresses, bandages and restraint in the after treatment of cataract operation, using the adhesive strips suggested by Michel and allowing the patient liberty after the manner of Chisholm. He sums up the adwith which it can be applied; its diaphonous nature, vantages of the new method as follows: The facility allowing the eye to be examined, and drops applied while the eye secretion can escape without disturbing the eye; the regular and continuous pressure of the lid, preserving the contour of the globe; the freedom from restraint, which is hazardous to the health of old people, and the absence of lachrymation, photophobia and congestion after removing the dressing.

CALCIFICATION of Entire CAPSULE, EMPTIED OF ITS LENS AND HELD IN POSITION. RESULT OF SEVERE INJURY. M. Michel, M. D.--Annals of Ophthalmology and Otology.--The patient in moving around suddenly struck the right eye against a post projecting beneath a piazza, crushing the spectacles which he was wearing for defective vision, and driving a fragment of glass into the eye. A year after a cataractous formation was discovered and when the patient was examined for its removal the eye presented a puckered and withered appearance and through the pupil a pearly white nacreous product was discernible pressing upon the iris to which it seemed attached. There were indications of destructive changes apparent in this physical eye, inflammatory action having left little if any light perception. At the patient's request the cataractous product was removed.

The linear incision with a free iridectomy discovered a firm concretion of the capsule; the cretaceous formation gritted perceptibly against the cystotome and was of such hardness that it was severed with difficulty from its zonular attachment; the wound was enlarged with the probe-pointed secondary knife, the product seized with forceps and extracted finally with some loss of vitreous. The specimen was at first supposed to be an ossification of the lens, but proved to be a complete calcification of the entire capsule, free from any trace of lenticular substance. It maintained its capsular shape with a cavity widely opened with its anterior and posterior halves rigidly held apart by a very thick cretaceous deposit on all sides. There was no perception of light following the operation, it having been performed principally to improve the appearance of the eye.

Toxicology.

POISONING BY GELSEMIUM SEMPERVIRENS.- The Practitioner. Dr. Jepson was called upon to treat a lady, aged forty, who was suffering from neuralgia in both temples. He gave her tincture of gelsemium in ten minim doses every two or three hours; and as no relief had been obtained after one day, he ordered double doses in a quinine mixture. She took three or four doses during the night. Next morning at eight o'clock she seemed better, but an hour later she was found in a very peculiar state. Though perfectly conscious, she had lost power over her tongue; could not protrude it, could not articulate, and could only swallow with very great difficulty. Her pupils were widely dilated, and she could not see clearly. She could not write, but nodded in reply to questions. A hypodermic injection of strychnine (gr. 10) was given with excellent results. Ten minutes after it there was a return of power in the tongue and hands, and an improvement in the vision. After a second injection there was still further improvement; she took food and stimulants; and all paralysis disappeared. She had some return of the neuralgia and was very weak for a few days, but eventually quite recovered and enjoyed better health than for some time previously. (Brit. Med. Journ., September 19, 1891.

OBSTETRICS AND PREGNANCY WITH OVARIAN TUMOR. -Dr. William Gardner, Montreal, Medical Journal, writes of four cases of pregnancy with ovarian tumor and draws the following conclusions:

1. The association of pregnancy and ovarian tumor, if left to nature, is fraught with danger to the woman, whether the termination be premature or at full term.

2.

When left to nature, abortion or premature labor may occur, in either case with frequently fatal results to the mother.

3. When the case proceeds to labor at full term, the result to the mother may be rupture or such other injury to the tumor that fatal peritonitis carries her off.

4. Tapping of the tumor, while it may temporarily relieve tension, is by no means free from danger by injury to the uterus or otherwise, and it does not cure the case.

5. Ovariotomy with modern precautions is nearly as safe as in the nongravid condition of the uterus. while the woman is at once cured of a disease which must ultimately demand operation.

6. Serious complications such as torsion of the pedicle and consequent peritonitis with adhesions. necessitating the use of the drainage tube for so long a period as five days, do not necessarily lead to abortion.

Ovariotomy in the present status of surgery, in the great majority of cases, must be the only proper treatment, and is often urgently demanded to relieve tension.

8. The indication for the operation in the case of small abdominal tumors is even more urgent, because of their great liability to torsion of the pedicle; and in case of pelvic tumors, by reason of the almost certain rupture or necrosis from compression during

labor.

POISONING BY HYDROCYANIC ACID.-Dr. J. C. Ballard, Miss. Med. Monthly, reports the case of a child three years old which drank the greater portion of a mixture containing three minims of dilute hydrocyanic

and a half ounce of syrup of wild cherry. One hour afterward he found the child presenting the following symptoms: Face flushed, pupils dilated, eyes watery, and complaining of some dyspnœa, pulse quick and somewhat harder than normal. Later, the face assumed a dusky hue, the respiration much emoccasionally intermitting a stroke, eyes half closed, barrassed, pulse now became softer and very rapid, with head upon her father's shoulder, crying continually, with one hand clutching her chest. There was some twitching of hands and feet, also nervous movements of head.

These symptoms gradually became less alarming, and within three hours from ingestion of the poison, was sleeping quietly.

The only drug treatment was the inhalation of the aromatic spirit of ammonia, and 5 drop doses internally and one small dose of the tr. strophanthus. No emetic was used.

"From this very interesting case we may," says the author, "I think, learn several lessons." Among these are:

"(1) The truth of Mr. Lawson Tait's teaching regarding the starting point of menstruation—namely, that the ovaries are not causative of it. In fact, in this case, the presence of the diseased ovaries prevented it; normal menstruation was interrupted and the patient suffered from vicarious menstruation, as nose-bleeding, hæmoptysis, etc., and when they were. removed normal menstruation followed.

"(2) The possibility of vicarious menstruation. The woman had brought up blood daily for months, but this ceased after removal of the ovaries--that is, when normal menstruation became possible—and it has not recurred.

"(3) The proof that removal of both ovaries does not necessarily render a woman impotent. (An interesting medico-legal discussion might be raised on this point.) I was not aware of leaving any ovarian tissue. Indeed, my aim was to extirpate the ovaries thoroughly, and I thought I had done so. I suspect, however, that a small portion of healthy ovarian tissue had reached up to or beyond the hilus of the right ovary, and that this may have taken on regular ovarian functions. This, of course, is merely conjecture.

"(4) That in performing double oöphorectomy, ex

cepting in cases of uterine fibroid, any apparently healthy portion may, perhaps, be left. I shall, at all events, keep this in mind in future operations."

Otology.

THE EFFECTS OF INFLUENZA ON THE MIDDLE EAR.Dalby, in Lancet, Feb. 20, 1892.-Amongst the various ulterior effects which the influenza has left upon its subjects it might have been expected that the tract of the mucous membrane which lines the middle ear would have been included with tolerable frequency; and although this has in a measure proved to be true, it has occurred in a manner somewhat different from what might have been anticipated. It is true that a certain number of persons during the high temperature stage have for the first time in their lives been attacked with accute inflammation of the middle ear, ending in a few hours with perforation of the tympanic membrane, but these cases, so far as my experience goes, have been comparatively rare; equally rare, it seems to me, have been cases in which persons with ears that have always been healthy have become affected with nonpurulent catarrh of the middle ear, combined with obstruction of the Eustachian tubes. I have (in common no doubt with other surgeons) been called to some cases where rapid and acute inflammation of the middle ear has taken place, and to some in which septicemia has shortly followed, but such instances form a very small proportion to the considerable numbers whom I have observed to be affected in a different manner. These have been confined chiefly to those persons who are and have been for many years the subjects of perforations. There are a good many people who, having perforations, have learned under treatment so successfully to manage them by the use of an absorbent cotton pad that they hear fairly well, and have so minute a quantity of discharge as to be barely noticeable, and in this way continue for many years in a very comfortable condition in respect of hearing and local inconvenience. Many of this class, after an attack of influenza, come back again complaining of further loss in hearing power and greatly increased discharge, which has proved intractable to ordinary measures. The pads have ceased to have their accustomed effect on the hearing for the whole day, and now, in consequence partly of getting soaked with discharge, they are useless. But beyond this the congested condition of the tympanic cavity of itself dulls the hearing so much that the ordinary results of pressure on the stapes are gone for the time. Again, there are many subjects of perforations in whom the cavity of the tympanum has ceased to secrete purulent matter, a condition of a perforation which may be described as dry, and which often remains so for many years. I have observed many of these to resume their previous activity in regard to discharge after an attack of influenza, although for long periods, notwithstanding ordinary colds and exposure to all sorts of variations in climate, they have continued healthy. Thus a person with healthy ears has little to dread from infleunza so far as this mucous surface is concerned, but it may become a serious trouble to one whose ears have formerly been the seat of inflammation.

OTACOUSTIC TREATMENT IN CHRONIC DEAFNESS. J. A Maloney, M. D.-Annals of Ophthalmology and

Otology.-A boy who had diphtheria at 6 years of age, and who was now 12, had been treated both in this country and abroad for deafness. In the right ear there was destruction of membrana tympani, save a portion of membrana flaccida. Left ear ostitis purulent, exacerbations frequent from exposure, pain relieved by discharge, membrana tympani perforated and sclerotic, inflammation with suppuration frequently recurring slight naso-pharnygeal catarrh, excessive hypertrophy of tonsils. Loud voice L. E. 2 inches, R. E. nothing.

Local applications were used upon ears, nasopharynx and tonsils and Otacoustic treatment faithfully carried out. Three months afterward the hearing power had been brought up to ordinary conversation at 12 feet and this remained fixed for three months, when he was lost sight of.

TRAUMATIC HÆMORRHAGE OF THE TYMPANUM CAUSING DEAFNESS WITH SUBSEQUENT RESTORATION OF HEARING. S. MacCuen Smith, M. D.-Annals of Ophthalmology and Otology.--A gentleman 44 years of age while driving along an embankment had his horse take fright, overturning the carriage throwing him to the ground and striking his left mastoid with sufficient force to render him unconscious, remaining in the condition for eleven hours, his recovery being looked upon as doubtful. There were neither symptoms of fracture or a diastasis in the temporal bone such as water discharge or hæmorrhage from the meatus.

After regaining consciousness he complained much. of intense tinnitus, vertigo and vomiting, with severe pain directed to the external auditory canal and Eustachian tube, all these symptoms continuing for two years at which time he came under observation. Sudden movements of the head in any direction intensified these symptoms. One year previous the mastoid cells were opened in the hopes of relieving if possible the pain by lessening the pressure, but this operation did not prove to be of any benefit. Objective examination showed the osseous meatus to be much inflamed and very sensitive, with little oedema, membrana tympani inflamed and thickened, bulging in the posterior segment of drum, quite close and parallel to the handle of the malleus--the Eustachian tube and adjacent parts were much swollen, which completely occluded the tube. completely occluded the tube. Aerial conduction of sound entirely lost; osseous conduction quite good over mastoid.

The membrana tympani was punctured at the point of bulging, by making a free incision parallel to the handle of the malleus, from the floor of the meatus to the extreme end of the malleus. Some half solid substance, dark red in color escaped, immediately relieving the patient's pain and vertigo, as well as the accentuated tinnitus, rotatory sensations and staggering movements. Hearing was not improved and two days after finding the Eustachian tube closed, the Eustachian catheter was introduced and a warm five per cent solution of biborate of sodium gently forced through the tube into the middle ear, which found its way through the incised membrana tympani and escaped by the external auditory canal. After the ear and tube had been thoroughly cleaned of all obstruction, the middle ear was inflated by Politzer's method and for the first time since accident, the gentleman was able to hear loud noises. In one week, after the inflation had been continued daily, hearing distance was 2-50 and in three weeks had increased to 7-50.