veals the fact that the uterus is at least one inch too long. Eccentric hypertrophy is a sign of metritis, the cavity is large, and there is actual thickening of the walls. We usually have leucorrhoea, and in most cases menorrhagia. If you could remove such a uterus you would find engorgement in some places and anæmia in others. In the early stages the organ is universally congested, but later it becomes stenosed in parts. Menorrhagia is most common when the mucus membrane is involved. We will order for this woman hot water injections, and give her ergot and nux vomica, but the greatest relief will be derived from electricity. We hear a great deal about ulcerations of the cervix, and we do find them sometimes, but the majority of the lesions that have for centuries been taken for ulcers are nothing more than hypertrophies of the mucus membrane.

THE KIDNEYS.

BY

W. F. GLENN, M.D.,

Professor of Genito-Urinary Diseases in the Medical Department of the University of Tennessse.

No practitioner passes many days, or seldom many hours, without being called upon to prescribe for some real or imaginary disease of the kidneys. While such serious disorders as diabetes and Brights' disease, in which these organs are fatally involved. are occasionally met with, they are few as compared with the many minor affections, not only of the kidneys themselves, but of all parts of the genito-urinary tract. Catarrh of the kidney, ureter, bladder or urethra, irritations and congestions of the various parts of the urinary apparatus, are as common as bad colds. What is more frequent than patients complaining of pain in the back, in the region of the kidneys, with or without a scant flow of urine, or a burning sensation in the neck of the bladder

or urethra on voiding urine, and numbers of other similar ailments. In all forms of functional derangement of these important excretory organs the administration of a gentle but effective diuretic generally affords relief. Where an analysis of urine proves the absence of elements that would indicate serious organic lesions it is a safe, and in fact a proper course, to use a remedy that will stimulate to gentle action the cells of the kidneys, thereby increasing the watery portions of the urine. Such a course will rarely fail to affect a cure.

For this purpose there is nothing superior to buchu, juniper, acetate of potash, corn silk and digitalis. The action of many of this class of remedies, such as corn silk, juniper, encalyptus, etc., have a more or less specific influence on bladder and urethral irritations and inflammations.

Some years since my attention was attracted to a remedy styled Wayne's Diuretic Elixir, which, upon examination, I found to be a combination of acetate of potash, juniper and buchu, prepared in such a manner as not to be unpleasant, but rather agreeable to the taste and accurate in its proportions. Being easier to prescribe and by far more pleasant to the patient than the same remedies freshly mixed in the drug-store, I began to use it in all irritations of the kidneys, bladder, urethra and prostate gland, and have found it to meet every indication. Now, when I desire a mild diruetic effect continued for some time, I rarely depart from this mixture. Prof. Deering J. Roberts, Surgeon to the State Prison, has been using it largely of late at the hospital of that institution, and reports it perfectly satisfactory. Numbers of others of my medical brethren, to whom I have suggested its use, have reported it thoroughly satisfactory. Case after case taken from my own and from others record books, could be cited to show its satisfactory effects, but that is hardly necessary. While Wayne's Elixir is a proprietary medicine, and while I am not an advocate of the wholesale use of all the various preparations that are now crowded upon us, at the same time, after thoroughly testing this one for some years, I feel that it will not be amiss to present its virtues to the profession. Not for any new virtues that its ingredients may possess, for they

have been understood for many years, but because of its careful preparation and pleasant taste, and thereby ready utility. From the very highly satisfactory results obtained by me for the past five years, I am sure its use will be attended with no disappointment or regret.

Selections.

AMPUTATION OF THE KNEE-JOINT BY DISARTICULATON;· WITH REMARKS ON AMPUTATION OF THE LEG BY LATERAL FLAPS. At the meeting of the Royal Medical and Chirurgical Society, December 8, Mr. Thomas Bryant read a paper on this subject, which he commenced by saying that the operation of removal of the leg by disarticulation at the knee-joint was first practised in England by Mr. S. Lane, and had been advocated by Messrs. G. D. Pollock, Pick, Stephen Smith, Markoe, Brinton, Staples, and himself. It was still regarded with some suspicion and not frequently resorted to, amputation through (or just above) the condyles being generally preferred. The operation by disarticulation required for its success the disease or injury should be confined to the leg, the condyles of the femur uninvolved or very slightly affected, and sufficiency of healthy soft parts below the knee for the formation of a good flap. If these conditions were not present some other method of amputation would have to be adopted. The author gave tables of his thirty cases, with the results. Where there was no sloughing, no trouble was experienced with the articular cartilage on the condyles of the femur, and after healing the soft parts moved freely over the end of the femur. The cicatrix was always placed well behind the femur. The patella was preserved, its removal being found to be quite unnecessary. The steps of the operation, after three different methods, were then described, viz.: that of Pollock by the long

anterior flap, Pick's plan by lateral flaps, and Stephen Smith's method by lateral hooded flaps; and illustrations of the steps of the latter operation were shown. The author endorsed completely the remarks of the American surgeon upon the value of this method of procedure, and strongly urged its application to cases of amputation in the leg also. The muscle substance was generally included in the flap in thin subjects, but not in others. The resulting stumps in the leg thereby obtained were excellent. The method of Stephen Smith for amputation at the knee-joint was to be preferred to either of the two other plans already mentioned, as it gave a better covering to the condyles of the femur, and the flaps were less prone to slough than in the long anterior flap of Pollock. One case in five of the former sloughed, and rather more than half of the latter class of cases. Smith's method also placed the the cicatrix entirely behind the condyles and out of harm's way, whereas by Pick's method the cicatrix came to lie in the inter-condyloid notch. Moreover, Smith's plan permitted no bagging of fluids, the stump being in the position for drainage. The author advocated the leaving of the semilunar cartilages in situ, as of great advantage to the case, the soft parts being thereby all held well in place and the fascial relation preserved. Dr. Brinton, as early as 1872, had advised this point of practice. Finally, the author summarized the advantages of this form of operation over amputation through the thigh in the following words: (1) The lessened shock of operation. (2) The lessened section of tissues and the non-exposure of the muscular interspaces of the thigh. (3) The escape from the necessity of sawing the femur, with its attendant risks. (4) The preservation of the attachments of the thigh muscles, and consequently the greater mobility of the stump. (5) The useful character of the resulting stump.

Mr. Pick was glad that the subject had been brought forward, for he felt that the operation was still unpopular, and that preference was given to cutting through the femur, with its attendant dangers. He preferred lateral flaps; in his earlier operations he had made long anterior flaps, and sloughing had frequently resulted; on one occassion he had practised a long posterior flap,

but had found that it dragged upon the incision during repair. The making of the lateral flaps was so, to speak, an accident, they were necessitated by the condition of the skin in a traumatic case. He rather disagreed as to leaving the patella; he thought that it was liable to be displaced, and that it might interfere with the fitting of an artificial limb.

Mr. Marsh commented on the leaving of the articular cartilage; it was not only not followed by any untoward results, but it seemed to act in some measure as a barrier against absorption of wound products. He did not think that any strong prejudice against this operation existed at St. Bartholomew's. It was very important to cut flaps long enough.

Dr. Hardie (Manchester) spoke in favor of the operation. He had read a paper at the Liverpool meeting of the British Medical Association, advocating its utility, but he preferred what he there called the "oblique circular" method. He said there was no other stump, except that of a Syme's operation, which could compare with it, the anatomical conditions being just those favorable for a good result. He thought the circular method lessened the chance of sloughing, as the skin flap remained a single piece. He left the patella, and had never seen harm follow. He was favorably struck with the idea of leaving the semilunar cartilage; it was of course a matter of great moment to secure, if possible, primary union.

Mr. Pollock referred to the question of leaving the patella; there were decided advantages, less dissection was needed, and few muscular insertions; he had never seen inconvenience result, not even as regarded the fixing of artificial limbs; on the contrary, the patients walked firmer, and with less throwing of the limb. He preferred Dr. Hardie's flaps to the lateral one advocated by Mr. Pick.

Mr. Timothy Holmes agreed that the results were very excellent when an operation was successfully carried out, but the method was more dangerous, and less often successful than amputations of the thigh done in any one way. Such flaps, wherever and however obtained, were chiefly skin, and there was danger of their sloughing. He approved of leaving the patella. The dan