the other resource. Astringents may promote resolution in cases of temporary engorgement, but are totally powerless in true hypertrophy. Repeated cauterizations, destroying small portions in slow succession, is the only method that promises success. Applications of solid nitrate of silver, chloride of zinc (in stick), Vienna paste, London paste, or galvano-caustic, to a limited area, every two or three days are recommended. This process, as a rule, is so slow and tedious, that few persons persevere until positive results are obtained.

There is, however, another method of applying the common caustics to the tonsils. The gland is permeated by rather large channels, seven to fifteen in number, the orifices of which are sufficiently large to be plainly seen and counted in situ, whilst in the hypertrophied condition they greatly increase in size and are capable of admitting an ordinary size probe. These natural channels provide a way to attack the heart of the gland in a most efficacious manner. Thin pointed sticks of nitrate of silver or chloride of zinc can easily be pressed into the canals and worked around for a few seconds.

Small sloughs are formed, and soon discharged. The tonsils are hollowed out, and subsequently contracted by cicatrizations. Two or three lacunæ in each gland can be cauterized daily and thus act on comparatively large surfaces with but slight external soreness and little or no inconvenience to the patient.Lancet, November 11.

RADICAL CURE OF HERNIA.

In Mr. Bank's paper read in the Section of Surgery of British Medical association, he says: A hernia which cannot be kept up by a truss demands radical cure. Such operation restores the patient's tissues to their original state of integrity. That surgical bugbear, the peritoneum, has been exposed. Listerism has inspired confidence. Surgery of serous membranes has greatly changed. The removal of the sac, one of the oldest operations, has been revived. The neck is ligated, the sac excised, and the margins of the abdominal opening stretched together. In performing it, the writer has the parts most carefully shaved, and uses a thorough antiseptic treatment. In inguinal hernia the incision is begun an inch above the external ring. The sac is then freed from surrounding tissues. The sac must be fairly reached before any stripping of it is done. Care must be taken that, an old sac by being adherent to the tunica vaginalis, the testicle be not dragged out of the rectum. Adherent omentum carefully separated, is tied with cat gut and cut away. The stump must not be pushed into abdomen until every drop of bleeding has ceased. Being sure that the sac is completely emptied, it is pulled down, and then tied up as high as possible, using two ligatures of strong cat gut. The pillars of the

external ring are now pulled together with several stitches of silver wire which are cut short off and left in situ. A clean carbolized sponge put beneath antiseptic gause is best dressing for the first twenty-four hours.

The writer had performed the operation in thirty-two cases. His paper was accompanied with a table giving particulars of thirty. In twenty-one, it was done directly for curative purposes, and in eleven, as part of the operation for strangulated hernia. Not one death resulted from the operation. The introduction of the radical cure, as a part of the ordinary operation for strangulated hernía, he thinks, will mark an important epoch in the history of that operation.-British Medical Journal.

HEMORRHAGE AFTER EXCISION OF THE TONSIL,

The removal of an hypertrophied tonsil is a frequent and simple operation, in connection with which any complication is so infrequent as to be unheeded by many operators. Experience abundantly proves, however, that although it is attended with danger from primary hemorrhage, a more serious result is a profuse "secondary" hemorrhage. When the flow of blood is alarming, it is generally caused by a vessel in some neighboring tissue that has been wounded. The vessels of the tonsils are small and lie in soft tisues, which readily permits them to contract, but the palatine and pharyngeal arteries are much longer and lie in muscular tissue, where they are constantly exposed to disturbance from muscular movements.-Lancet.

TREATMENT OF SOME CHRONIC GASTRIC DISORDERS.

M. Broca, in a series of articles (Le Progrés Mèdical) strongly advocates, in ulcers of the stomach, and chronic gastritis from various causes, the systematic washing out of the stomach and artificial feeding. In washing out the stomach there are two indications to fulfill-one to empty it of its contents, whatever they may be; and the other, to treat the diseased mucous membrane with medicated solutions. He advocates the use of the siphon tube, on the ground that its manipulation is so easy that in a short time the patient can learn to wash his stomach out himself. The washing over, the patient should be fed before the tube is withdrawn, powdered meat, raw eggs, milk, broth being the most suitable food. He lays great stress on the advantages of over-feeding the patient, and mentions 600 grammes of meat, one dozen eggs and three litres of milk as a daily allowance that may easily be exceeded. It is always necessary to commence gradually, until it is ascertained that the patient can digest milk and eggs well. Should any pain come on some hours after the meal, it is advisable to empty

the stomach by means of the tube. The cure is permanent, if the patients only take proper care of themselves afterwards. He thinks this mode of treatment might with advantage be extended to other cases than purely stomachic disorders; he suggests it, for instance in advanced phthisis.-Medical Times and Gazette.

ANTISEPTICS IN PHTHISIS.

Dr. William Porter, Physician to Throat and Lung Department, Saint Luke's Hospital, Saint Louis, thus summarizes: Proven, it seems to me, are these two propositions:

(1) Phthisis is a specific disease from a specific cause. (2) Phthisis may be produced by absorption of tuberculous matter in contact with the mucous membrane of the air passages or intestinal tract.

There is also evidence that the energy of this tuberculous matter is due to germ development and progression.

Hence the value of antiseptic influence in the treatment of phthisis, not only in the later stages, during pus production and absorption, but also in the earlier process of infection.

One great demand is for that, which by local and internal use, may meet and destroy the septic agencies of disease. Such a remedy must be effective, unirritating and non-poisonous, susceptible of ready dilution and easy absorption, and withal inoffensive in odor and taste.

Carbolic acid and iodoform do not fully meet these requirements, and less harmful, yet no less potent, means of antagonizing contagion and putrefaction are finding favor.

The compound known as Listerine has for nearly two years served me better than any other remedy of its class, and, in the treatment of phthisis, has almost supplanted, in my practice, all other antiseptics. In treatment of diseases of the upper air passages it is pleasant and does not irritate; in the fermentative dyspepsia, so often accompanying phthisis, it is safe and efficient.

It is the most powerful non-toxic antiseptic I have yet found. -Lancet and Clinic.

PREVIOUS SYMPTOMS IN CASES OF PERFORATION OF THE BOWEL IN TYPHOID FEVER.

After giving the history of a girl aged thirteen, in which the perforation was verified at the postmortem examination, Dr. Byers states it was difficult to assign any cause for its occurrence. The patient was gaining ground, but on the sixty-fifth day, severe symptoms set in, after she had passed a solid motion. He thinks all careful clinical observers must admit that perforation of the bowel in enteric fever may occur in cases in which

the previous symptoms afford no clue as to the extent of the intestinal lesion. It is met in extremely mild cases; during convalesence; in patients who never took to bed until the fatal complication set in. However, certain symptoms have been met, and recorded as pointing to severe and deep ulceration of the bowel:-That perforation is met with most frequently in the more serious cases of the disease; that great tympanites is likely to produce it; that continued elevation of temperature after the third week points to severe intestinal lesion; that a deep ulcer will paralyze the bowel and produce constipation; that severe tremor is another symptom; that protracted headache in the early stages is believed to denote an unusually severe affection of Peyer's patches. When, from the presence of some of these symptoms, severe and deep ulceration is suspected, the treatment should aim at keeping the bowel quiet. The patient should be made to lie on his back, and not the slightest movement allowed. All nourishment snould be liquid. Purgatives should not be given, especially when there is constipation. Opium should be administered to paralyze the movements of the bowel.-Extract from paper read at annual meeting of the B. M. A., by John W. Byers, M. A., M. D.

RETENTION OF ONE HUNDRED AND SIXTY OUNCES OF

URINE.

A woman, aged thirty, was admitted into the North Straffordshire Infirmary for supposed abdominal tumor. She had been in usual good health, and believed herself to be about four months pregnant. For a fortnight before admission no urine had been passed. A catheter was introduced at once and one hundred and sixty ounces of urine drawn off. The next day seventy ounces more were taken away. An examination revealed retroversion of uterus. Chloroform was administered and the uterus replaced, which appeared to be literally "upside down." The patient gradually sank and died second day after operation. The case shows the danger of neglected retroversion during pregnancy, also, the enormous extent the bladder may be distended without actual rupture.-The Lancet.

REDUCTION OF DISLOCATION OF THE SHOULDER.

A valuable paper on this subject was read by M. Kocher at the meeting of the International Congress at London. In the subcoracoid form, the aim of the surgeon should be to open out the rent in the capsule, and to relax the untorn parts, which are rendered tense by the false position of the head of the bone. To accomplish this the patient should be seated, with the surgeon on the left side. The elbow-joint flexed to a right angle,

and firmly pressed against the side of the chest, the forearm is to be slowly, gently and steadily rotated out until firm resistance is encountered; then maintaining this rotation the arm is to be raised foreward and a little in, and lastly to be rotated in and the hand brought toward the opposite shoulder. This method has great advantages over those in common use and is especially valuable in old dislocations, enabling them to be reduced without any force and without anæsthetics.-Lancet, November 11.

DANGERS OF GROUND AIR.

As all the interstices of the ground are filled with air, the more porous the soil the greater the quantity of ground air. About one-third of the bulk of a gravelly soil is air. If a cesspool or leaky drain pipes are placed in this kind of soil offensive emanations will be given off. These may, especially under variations of temperature and pressure of the air, travel a rather considerable distance, and make their way into houses, especially when the air of a house is raised by fires to a much higher temperature than that of the ground. An instance is known where the foul air of a cesspool was drawn a distance of twenty-seven feet into a house.

Ground air consists of atmospheric air intermingled with carbonic acid, marsh gas, and occasionally with sulphurretted hydrogen. If there be any putrefying organic matter in the soil, the ground air will also be contaminated with injurious gases resembling sewer emanations. Movements are produced in the ground air by rains which raise the level of the ground water; by winds, from their drying actions on the surface of the soil. Fevers, cholera, diarrhoea and dysentery are the effect when this escape of ground air is carried into a house. From opening address on "Meteorological Phenomena" by J. W. Tripe, president of Society of Medical Officers of Health, (England).

ARTIFICIAL HUMAN MILK.

The method of preparation of artificial human milk as recommended and used by Professor Frankland is as follows: Let one-third of a pint of new cow's milk stand twelve hours, then remove the cream, and add to it two-thirds of a pint of new milk as fresh from the cow as possible. To that one-third of a pint of blue (or skim) milk left after taking away the cream, add a piece of rennet (about one square inch in size) which after it has served its purpose can be taken out and used daily for a month or two, and allow the vessel holding the skim milk to be placed in warm water and there remain for from five to fifteen minutes until curdling is effected. Break up the