SURGERY.

SOME APHORISMS IN OPHTHALMOLOGY.-(M. F. COOMES, M. D.) 1. As a local anesthetic to mucous surfaces and open wounds, the muriate of cocaine is one of the most certain and effective agents that is known.

2. All surgical operations on the eye, except enucleation of the globe, may be performed under the influence of cocaine with as much or more safety than under other anesthetics.

3. In all forms of iritis keep the pupil dilated.

4. In acute retinitis unaccompanied by iritis, keep the pupil contracted, in order to keep out as much light as possible.

5. The only relief for senile cataract is surgical interference.

6. The rule is that all acute purulent discharges from the conjunctiva are contagious.

7. The only proper method of testing the vision in persons possessing the power of accommodation, is to suspend that power by paralyzing it, and then pursue the usual method with the trial lenses.

8. Jequirity is a dangerous remedy as well as an unreliable one, and should not be used by unskilled persons.

9. All kinds of strong caustic applications are contraindicated in the treatment of acute purulent inflammations of the conjunctiva.

The best results are obtained by frequent cleansing with mild saline solutions, and the use of weak solutions of the vegetable or mineral astringents (excluding nitrate of silver), a solution containing five grains of tannic acid and three grains of carbolic acid to the ounce of water, or from one half to one grain of the sulphate of copper to the ounce of water will be found among the most efficient agents.

10. It is always good surgery to remove a foreign body from the eye, provided it is not entirely within the globe behind the iris. If a foreign body is between the iris and the cornea, prompt removal is urgently demanded.

Great care must be taken in order to avoid wounding the lens, as such an accident would be certain to result in the production of cataract. If the foreign body should be entirely within the globe behind the iris, or if it should be large and partially within the globe, the question to be settled is, whether it will be best to remove the eye or the foreign body. If the laceration of the globe is not too great it will probably be best to remove the foreign body, and then if the globe becomes violently in

flamed, or if sympathetic inflammation of the other eye should occur, remove the diseased member without delay.

II. An eye-ball that is destroyed for visual purposes, and is painful, should be removed without delay, as it may induce inflammation in the good eye, and result in its destruction.

12. Whenever there is one or more small nodules about the margin of the pupil or in the iris in case of iritis, it is almost absolute evidence that the disease is syphilitic.

13. The operation of strabotomy should be performed, if possible, without general anesthesia, because its influence so thoroughly relaxes the muscular system that it is impossible to determine when the operation is completed

14. When the iris is wounded and is protruding, it should be cut off, and the eye kept under the influence of a mydriatic until the inflammation has subsided.

15. An unskilled person should never attempt to replace a protruding iris, as such a procedure is difficult, and there is great danger of injuring the lens and inducing cataract

16. Surgical interference is the only means of giving permanent relief to glaucoma. Eserine will give temporary relief, and cocaine relieves the pain for a short time.

17. One of the most efficient agents in tenia-tarsi is an ointment composed of ten or fifteen grains of the yellow oxide of mercury to one half ounce of simple cerate, or some other suitable vehicle. This is to be applied to the lids night and morning after thorough cleansing.

18. Poultices of every description are to be avoided in diseases of the eye, unless ordered by some one who is specially skilled in this line of practice.

19. Whenever there is great edema of the conjunctiva, and particularly when this is associated with excessive purulent discharge, the membrane should be snipped in numerous places so as to permit the pent up fluid to escape, and thus prevent destruction of the cornea, which is always in danger in such cases. Remember that there can be no harm done by this cutting, and if it does not give the desired relief, a tarsarophy should be done.

20. In the majority of cases of strabismus, glasses are necessary as well as tenotomy, inasmuch as the strabismus in most instances is dependent on an optical defect which, if uncorrected, would cause a return of the squint.

21. It is always better to correct squint by means of properly adjusted lens than by tenotomy:-Med. Herald.

PROPOSED MODIFICATION OF PIROGOFF'S OPERATION. At the recent congress of Russian practitioners, Professor Tauber described and demonstrated on the dead subject an operation for removal of the foot, which he believes has several advantages over Pirogoff's amputation. Standing on the outer side of the limb, he commences an incision at the insertion of the tendo Achillis, and carries it forward just below the external malleolus to the dorsum of the foot, and then vertically downwards on the inner side in front of the heel. When the middle line of the sole is reached, the incision is carried along it backwards and prolonged upwards to the starting point at the insertion of the tendo Achillis, a flap having thus been cut, consisting of the inner side and half the sole of the heel. The joint is then opened, the external ligament being first divided and then the internal. The astragalus is seized with the bone forceps and removed, nothing being left but the os calcis, the soft covering of which on the inner aspect is untouched. The os calcis is seized with the

bone forceps and turned so that the articular surface is towards the operator. The forceps are now taken by an assistant, who holds them tightly; the operator then saws the bone longitudinally in two, the outer half, which is free, is removed, the inner half remaining attached to the flap. The ends of the tibia and fibula are then sawn off just above the malleoli. The cut surfaces of these will be found to correspond almost exactly with that of the os calcis, which is now brought into apposition with them. The advantages claimed for this operation are: 1. The posterior tibial artery itself is untouched, only its branches being divided. 2. The insertion of the tendo Achillis, as well as its bursa, are not injured. 3. The surface of the os calcis and of the leg bone correspond very nearly to one another.—Lancet.—Maryland Medical Journal.

[The operation of Professor Jarvis S. Wight, of Brooklyn, has all the above advantages, besides being simpler and not necessitating the opening of the ankle joint. Two incisions are made from one malleolus to the other, one incision extending in front of the ankle joint and the other under the heel. The os calcis is sawn through from below upwards, and then the tibia and fibula just above the articular cartilage. This operation is simple, efficient and quickly done. The originator calls it the lowest possible amputation of the leg with a piece of bone in the posterior flap. A. H. P. L.-Amer. Digest.

OBSTETRICS.

STATISTICS OF THE LYING IN CLINIC.-Dr Emil Ehrendorfer, writing of the statistics of the Lying-in Clinic here, for the year 1882, 1883 and 1884, has furnished us with some very interesting data. In 1882 the puerperal mortality was 0.51 per cent; in 1883 0.33 per cent; and in 1884 it was 0.32 per cent.-this including three cases of Cesarean section. Puerperal fever in 1882 occurred in 4.31 per cent., in 1883, in 3.59 per cent.; and in 1884, in 3.08 per cent., while other pathological diseases resultant upon labor fell from 6.17 per cent. in 1882 to 4.87 per cent. in 1884; and all this from a strict attention to antiseptics and cleanliness in every possible detail. In these matters few people have a riper experience than Dr. Ehrendorfer. As first assistant to Prof. Spaeth he is responsible every year for about 3000 labors.

One is very much struck here with the rarity of perineal lacerations. The matter becomes plain, however, when one sees with what tact the perineum is handled during labor. The woman rests on her back until the head presses upon the vulva, then she is turned upon her left side, with the buttocks resting upon the edge of the bed, the legs well drawn up and kept apart either with a pillow or by an assistant. The nurse

sits on the right side of the bed, with her back to the face of the patient ; the left hand is passed over the right thigh of the patient, and manipulates the child's head; the free right hand of the nurse keeps the perineum moist with carbolized water, and assists the left hand. The patient is enjoined not to bear down, and the head is kept back forcibly, so as to prevent a too sudden birth. The fingers of the left hand are occasionally run around the presenting part of the fetal head, just inside the labia, or the head is gently moved toward the symphysis by a well directed action of the left hand. The main thing is to keep the perineum moist and to keep the head back. If there is thinning of the perineum, and a danger of laceration either lateral or bilateral, episiotomy is resorted to. If there be immediate danger of a central rupture, an incision is made from the posterior labial commissure, creating a laceration of the second degree, which is operated on immediately after labor. Lacerations of the first and second degree, and even sometimes of the third degree, are operated on immediately after the birth of the child, except when the woman's condition contra-indicates such a procedure. For all minor lacerations serres-fines are used. I have seen several cases of hydramnios lately, and apart from other methods, the curves made with the women in different positions are quite sufficient to distinguish this condition from others which may simulate it.-Am. Med. Digest.

COLUMBUS MEDICAL JOURNAL.

EDITORIAL.

Heating and Ventilating.

The connection of the heating of a house with its ventilation is, of course, inseparable. Many persons will cheerfully expend ten or fifteen thousand dollars in building a house, putting from two to three thousand on outside ornaments, who would not dream of spending five hundred or one thousand dollars for the necessary Hot Water Apparatus to keep this same house thoroughly and comfortably warmed and well ventilated.

In reading the reports from the various Boards of Health, one can not fail to notice the startling increase in the death rate from Scarlet Fever, Diphtheria, and allied diseases. It might safely be said that this condition of affairs is due to the fact that the tightly closed doors and windows, which cold weather makes necessary, prevents the ventilation of houses, which is essential to the maintenance of health.

To those who intend erecting a dwelling, we would advise that the matter of heating and ventilating be given much consideration; and before deciding how it shall be done, consult the A. A. Griffing Iron Co., Manufacturers of the Tompkins Hot Water Indirect Radiator, 518 Communipaw Ave., Jersey City, N. J.