Fig. 1 shows the instrument complete, and is two-thirds the full size. The inhaler consists of a metallic frame, sufficiently large to cover the lower part of the face. The bars are nearly a quarter of an inch broad, leaving a quarter of an inch between each and its fellow. The spaces are made by a punch. which removes a section from a solid sheet of metal. It will thus be seen that there can be no danger of the bars giving way, as they would were they soldered upon a band.

Fig. II. shows this frame with a bandage partly laced between the bars. It has been passed from side to side, dividing the instrument into parallel sections. On the right, a part of the bandage may be seen rolled up. When the bandage has been passed between all the bars, and the hood or cover put on, (Figs. I and III, one can look through the instrument from end to end, as there is a space of nearly a quarter of an inch between the several sections of the bandage.

The advantages of this mode of construction, are:

Ist. It gives the patient the freest access of air. It is a mistake to think that air must be excluded. All that is necessary is that the air should be saturated with the vapor of ether.

2d. It affords a series of thin surfaces upon which the ether can be poured, and from which it will almost instantly evaporate. In this respect it differs from the sponge, which retains the ether in a fluid state much longer. Should the bandage become soiled a new one can be inserted in a few minutes.*

3d. By leaving the instrument open at the top, the supply can be kept up constantly, if desired; and as ether vapor is heavier than air, there is no loss by not covering it. The top should never be covered.

MODE OF USING THE INHALER.—IST. Place a towel beneath the chin of the patient, as experience has taught that a towel should always be within reach in administering anesthetics.

2d. Place the instrument over the face, covering the nose and chin, and let the patient breathe through it before any ether is applied. This will convince him that he is not to be deprived of air.

3d. Begin with, literally, a few drops of ether; this will not irritate the larynx. Add, in a few seconds, a few drops more, and as soon as the patient is tolerant of the vapor increase it gradually to its fullest effect,

*A draw slip is furnished with each instrument-the suggestion of Dr. W. W. Keen, Surgeon to St. Mary's Hospital; this prevents the bandage from being soiled, and can itself be changed in a few seconds.

4th. When the patient is fully influenced it is well to add a few drops at short intervals, and thus keep up a gradual anesthetic effect.

ADVANTAGES OF THE INHALER.-Ist. It presents a large surface for the liberation of ether vapor. The partitions are made of thin bandage, and the air coming to both sides of each layer, sets the ether vapor free more rapidly than is possible in the use of a towel or sponge.

2d. It is open at the top, and the ether can be added constantly, if desired, and in small quantities, without removing from the face. The sponge and towel both require removal, and the ether is usually poured on them in quantities.

3d. The ether falls by its weight, as it is heavier than the air; and as the instrument fits the face the patient gets the full advantage of it.

4th. It does not cover the patient's eye-does not terrify him, and he often passes under its influence without a struggle.

5th. By its proper use the laryngeal irritation may be wholly avoided, the anesthetic effect as easily gained as is possible with the use of ether, a great economy of ether, and great comfort to the patient. The instrument is manufactured by William Snowden, No. 7, South Eleventh Street, Philadelphia.

SURGERY.

TREATMENT OF ACUTE ABSCESS.-Stephen Smith, M. D., Surgeon to Bellevue Hospital, etc., says: In many instances of the ordinary acute abscess, I have recently had excellent results in treating them for immediate cure. The following example illustrates the course pursued:

A man had an abscess on the external part of the thigh, resulting from a severe fall. There had been a high grade of inflammation, much suffering, and a temperature of 103°. At the time of the operation the temperature was 101°. There was fluctuation, but the pus was not very near the surface. The treatment was as follows: When the patient was fully under the influence of the anesthetic, the parts were thoroughly washed with soap and water and a flesh-brush, and then with a douche of corrosive-sublimate solution, I to 500. Then the abscess was opened with a knife, treated with a carbolic solution, I to 30, the opening being of a size to admit the nozzle of a Davidson syringe. The depth of the abscess cavity was two inches. The pus was forced out by pressure, and when it ceased to flow the nozzle of the syringe, well disinfected, was introduced and the edges of the wound held firmly around it. The cavity was then distended to its fullest capacity, with corrosive-sublimate solution, 1 to 5,000, the amount of water injected being one pint. Withdrawing the syringe-tube, the solution was forced out, with strong and gentle pressure. This injection and hyperdistension were repeated three times, when the water flowed away quite undiscolored. An incision was then made down to the cavity of the abscess, its full length, the incision being six inches long. With tenacula the edges of the wound were held apart, and the entire cavity exposed. During this part of the operation the irrigation with the corrosive-sublimate solution, I to 2,000, was continued. The internal surface of the abscess was covered with large granulations and shreds of broken-down connective tissue. The process

of cleansing the wound was next begun, with disinfected hands and instruments. All the shreds of tissue were carefully dissected away, and then the granulations were gently scraped off with the curette, until a perfectly clean surface was everywhere apparent. Several small vessels were ligated with carbolized ligatures, and the whole surface of the cavity thoroughly irrigated. The wound was closed with the uninterrupted suture, except at the lower extremity, where a small opening was left for drainage, over which was placed a disinfected sponge to absorb the dis

charge. The external wound and adjacent skin were sprinkled with iodoform; folds of gauze, between which iodoform was sprinkled, were applied around the limb from below the knee to the hip, over these layers a dressing of borated cotton was wrapped about the leg and thigh; and over this was applied a light plaster-of-Paris dressing, which completed the operation. On the following day the temperature had fallen to normal, and did not rise again to rooo. The pain entirely ceased; the appetite returned; sleep was sound and undisturbed. The patient stated that from his recovery from the anesthetic he had felt entirely well. The dressing was removed on the eighth day. The wound was entirely closed, and though there was some thickening of the tissues involved in the injury, there was no tenderness. He could walk without pain or inconvenience, and there was a rapid subsidence of the swelling of the part. It is safe to estimate that this man saved at least a month in time by the operation. What was saved in pain, impaired health, and possible dangerous sequelæ, cannot be estimated. I have operated for acute abscesses of the neck, back, groin, etc., in a similar manner, and have not failed of rapid and complete recovery without further symptoms.-Esculapian, Analectic.

GASTROSTOMY.-After reporting a successful case in the American Practitioner for May, 1884, Dr. S. W. Gross says: A personal experience with two cases and a thorough knowledge of the subject have convinced me that gastrostomy is not only easy of performance, but that it should be resorted to in all cases of carcinoma of the esophagus as soon as dysphagia has set in, for the double object of alleviating suffering and prolonging life. The best incision to reach the organ is that of Bryant, which commences at the outer border of the rectus at the level of the eighth costal cartilage, and is carried for three inches below the borders of the ribs toward the apex of the tenth cartilage, the movable tip of the latter on the ninth cartilage being a capital guide for the termination of the incision. Unless there is imperative need for opening the stomach at once, it will be wise to divide the operation into two stages, so as to insure perfect union of the peritoneal surfaces, and thereby prevent peritonitis from effusion. To effect this object the stomach should be stitched to the wall of the abdomen by an outer row of pure silk sutures, as recommended by Howse, in addition to the sutures inserted through the viscus and the edges of the wound, care being taken not to penetrate the cavity of the stomach, lest its contents may pass through the punctures and light