complete anesthesia of the extremity, with the exception of a small area in size about as wide as the hand on the posterior portion of the thigh, which is supplied by the small sciatic. He then performed the amputation and caused no pain whatever. As the pulse showed after the operation he had experienced no shock. The pulse before the amputation was 160; after the limb was removed it was 143. He thought that this method has a place, and it certainly is advantageous in those cases where we do not want to give a general anesthetic, and where it would be bad policy to add any shock to the case.--Brooklyn Medical Journal.

CONTRIBUTION TO THE STUDY OF SPINAL FRACTURE WITH SPECIAL REFERENCE TO THE QUESTION OF OPERATIVE INTERFERENCE.

BY G. L. WALTON.

Thorburn's prediction in 1890, that surgeons would "probably in the near future open the spinal canal with. as little danger and as little hesitation as they now operate upon the cavity of the cranium," has been already verified.

The spinal operation is comparatively free from the drawbacks and dangers attending intracranial surgery. This fact, together with the serious nature of the lesion under consideration, renders the question pertinent whether it is not wise to make early operation the common custom in the hope of relieving the average case, and even of saving an occasional patient from death.

It is important to determine whether we have reliable. symptoms establishing irremediable, crush of the cord; for if we have not, are we doing justice to the patient in following the expectant plan? We have no symptoms from which we can assert at the outset that the cord is crushed beyond at least a degree of repair, nor can we predict which cases may prove to be only incomplete crush. Therefore early operation in all cases will not only accomplish all that late operation will do for these cases, but it will be performed to better advantage before reparative processes with adhesion and callus have appeared. The prognosis in cervical cases without operation is grave. Kocher's twelve cases lived on the average one week. Courtnay's average was five days, while Baldwin's thirty-six cases averaged five days, all fatal. In the dorsal and lumbar region, prognosis is better, but is still grave. The mortality was eighty per cent in a collection of some three hundred and fifty cases without operation, while following operation it ranges from forty to fiftyseven per cent.

What we need now is more facts. With regard to the author's personal experience, he says that the course of such operative cases as have come under his observation has been on the whole more favorable than his previous experience and study of the literature would have led him to expect without operation. As to the operation itself, it is generally wise to open the dura freely, thereby possibly relieving pressure by the escape of cerebrospinal fluid, and also relieving the edema of the arachnoid which is apt to appear. The suturing of the dura is not necessary, and drainage may better not be used. In most cases it will not be wise to operate within a few days of

the injury, but a delay of some hours is advisable, partly on account of shock and partly to eliminate the diagnosis of simple distortion.

We have no infallible guide to the extent of the lesion. The operation at the worst does not materially endanger life nor affect unfavorably the course of the case, and may at least reveal the lesion and lessen the pain; it may sometimes save a patient from death or from helpless invalidism of most distressing character. Instead of selecting the occasional case for operation, we should rather select the occasional case in which it is contra-indicated (the patient with great displacement of vertebræ, the patient with high and rising temperature, the patient plainly moribund, the patient still under profound shock.)-St. Paul Med. J.

FINGER TIPS TOTALLY LOST; THEIR RECONSTRUCTION BY SPONGE EDUCTION.

G. E. ABBOTT, PASADENA, CAL.

Reports two interesting cases of finger injuries. where regrowth of the destroyed tissue was stimulated by sponge grafts. The technique was as follows:

The patient was anesthetized and a straight incision made from side to side through the stump, just as one would pass a knife under the matrix and root of the nail, had it been in place. This gave one straight flap on the back of the finger, in which the nail was to develop, should any part of the matrix prove to be still in a living condition.

The end of the stump was then incised into four triangular-shaped flaps, having their apices at the center of the nail-flap and their bases at the circumference of the stump. These were then dissected up, so that when the finger was held upright they formed a crown around the stump, except at the back, which was occupied by the matrix flap above referred to.

Into this crown, in close contact with the denuded end of the finger, was placed the sponge graft into which the granulations were to grow. The sponge was held in place by Z. O. adhesive plaster, bandaged with gauze, and the sponge kept constantly wet with warm normal salt solution. The sponge (in place) was syringed out every day with pyrozone and boric acid solution, using an ordinary glass dropper as a syringe. Every three days the adhesive strips and old sponge were removed and replaced by new.

The essentials of a sponge graft are a fine-grained, stiff sponge; a coarse, soft, open sponge being of no use. Second, the sections must be cut transversely and not longitudinally to the pores of the sponge. A carving knife or sharp case-knife will cut sections and scissors snip off mastoid portions of sponge, quite as well as the best microtome.

These sections should be one-eighth, one-sixteenth or one thirty-second inch thick; they should, of course, be thoroughly sterilized and after being applied be kept wet with sterilized normal salt solution (a teaspoons ful of common table salt to a pint of water answers every purpose).

Eduction sponges, or mastoid portions of sponges for filling cavities, must likewise be cut transversely to the

fluctuation present from crest of ilium to within four inches of the knee. The thigh was fixed to a right angle with the body, the leg at a right angle with the thigh and the foot inverted. The knee of the left leg laid against the thigh of the right-the left knee four inches above the right and the abductor muscles firmly contracted. Although there was no possibility (on account of the pain and swelling) of finding the head of the femur or the trochanter by manipulation, from the deformity alone, I made a diagnosis of dislocation of the hip.

With everything apparently against success, I yet determined to save her if possible, and to that end made the sanitary conditions as good as possible in the way of cleanness, antiseptics, disinfectants, etc., and put her on tonics, stimulants and nutrients. In course of time her general condition improved and the abscess healed.

March 17, with the help of Drs. Skinner of Hoosick Falls, N. Y., and A. S. Chisholm and E. B. Daly of Bennington, Vt., the dislocation of the head of the femur was reduced, when the knee and foot assumed their natural position and the leg its proper length. In the manipulation necessary to accomplish this the cicatrix of the old abscess was torn open and the muscles and ligaments ruptured more or less; so, soon after this adjustment of the limb, pus again accumulated in the tissues of the thightreated by free incision and drainage. Shortly after this

healed an abscess formed at the knee; it was promptly opened, about two ounces of pus evacuated; and quickly

healed.

July 1, she was discharged, well, but with one and a half inches shortening of the affected leg. Motion at knee and hip fairly good.

How was this dislocation produced? And when did it occur? An extended search through obstetric literature shows no similar case recorded, so these questions must be answered purely from the history of the case as presented. It is probable that this woman has a shallow acetabulum and that in the handling of the woman at delivery the head was pushed out of its socket, and the condition not noticed; subsequently the injured soft parts became infected and suppurated because of the puerperal sepsis which followed the instrumental delivery.-American Journal of Surgery and Gynecology. FRACTURE INVOLVING THE FRONTAL SINUS.

Dr. R. S. Fowler presented a patient 69 years of age, who fell while crossing the street, striking his forehead against the sharp corner of the curbstone. The result was a compound fracture involving the frontal sinus. Several days later at the German Hospital the speaker enlarged the wound to afford better drainage. This examination disclosed a fracture of both orbital plates. There was considerable loose bone in the sinus itself. This was removed. It had been interesting to watch the progress of this case, as the healing process of infections of the frontal sinus was well demonstrated. At the present time by looking through the external wound the thickened and rolled-up mucuous membrane lining the sinus can be plainly seen. At one time this swollen mucous membrane almost filled the cavity. It is his intention to perform a plastic operation in the near future with the object of overcoming the deformity. Dr. W. C. Wood said it Dr. W. C. Wood said it

would be interesting to know if there is a communication now between the sinus and the nose. If there is, the outlook for healing is excellent; if there is not such an opening, the outlook for recovery is not good, but is easily accomplished by securing drainage through the nose by the methods well known for suppurative sinuses. The swelling of the mucous membrane is characteristic of all inflammations of the frontal sinus, and it is this inflammation which prevents drainage of the frontal sinus in the normal way.-Brooklyn Medical Journal.

LYSOL.

Tavel protests against assuming that elaborate operating rooms are necessary for aseptic operations. A small valise for the instruments, dressings, etc., and an hour to transform any room into a suitable operating room, and the surgeon is ready. He boils the tampons, compresses and threads in the salt-soda solution, the instruments in a 2 per cent solution of borax, and uses a tepid salt-soda solution for irrigating the wound. He lays cloths wrung out of lysol or sublimat solution around the field of operation, with dishes of 1 per 1,000 sublimat, or 2.5 per cent lysol, for disinfecting the hands, rinsing them afterward in the salt-soda solution. With these simple precautions he has operated on numbers of patients at their homes, doing laparotomies, resection of the knee, herniotomies,

etc., and has never had an infection.

dents should be especially trained to dispense with costly He urges that stuappliances and learn to "think bacteriologically as well as surgically." Journal of the American Medical Association.

EUROPHEN AND ARISTOL FOR WOUNDS.

In a discussion on the treatment of wounds, before the Orleans Parish Medical Society, Dr. Mainegra stated that the solutions employed were sometimes too strong; sometimes too weak. We should not discard measures which experience has taught us to be of value, but should continue the use of antiseptic solutions and of dry absorbent powders. He was in the habit of employing with entirely satisfactory results bichlorid for irrigating wounds and after checking all bleeding and suturing, application of a dry absorbent powder, such as aristol or europhen.-New Orleans Medical and Surgical Journal.

TO PROTECT SHARP INSTRUMENTS.

Whenever a cutting instrument must be used in a deep cavity in which the incision is to be limited and the operator must be guided nearly entirely by the sense of touch, as, for instance, in excavating certain tonsillar, palatine or retropharyngeal abscesses, it may be necessary to so protect the blade of the knife that only the point will be free, in order to avoid inflicting damage upon surrounding parts. A strip of adhesive plaster wound around the blade of the instrument and only allowing as much as is needed of the point to protrude, is far more efficient than wrapping with bandage or cotton.-Red Cross Notes.

Dirty hands have destroyed more lives than all the implements of warfare.-Senn.

Notices and Reviews.

"Saunder's Medical Hand-Atlases." Atlas and Epitome of Traumatic Fractures and Dislocations. By Professor Dr. H. Helferich, Professor of Surgery at the Royal University, Greifswald, Prussia. Edited, with additions, by Joseph C. Bloodgood, M. D., Associate in Surgery, Johns Hopkins' University, Baltimore. From the fifth revised and enlarged German edition. With 216 colored illustrations on 64 lithographic plates and 190 text-cuts. Philadelphia and London: W. B. Saunders & Co.; Chicago: W. T. Keener & Co., 1902. Cloth, $3.00 net.

This very valuable contribution to the subject of Fractures and Dislocations consists of 353 pages and is divided into: Frist, General Consideration of Fractures and Dislocations, 84 pages. Second, Fractures of the Skull and Facial Bones, 25 pages. Fractures of the Vertebral Column, 4 pages. Third, Fractures of the Thorax, 13 pages. Fourth, Fractures and Dislocations of the Upper Extremities, 99 pages. Fifth, Fractures and Dislocations of the Lower Extremities, 106 pages.

The general consideration of fractures is fully and concisely stated and in the main conforms to what is found in the best books on this subject. One point, however, may be particularly noticed. On page 51, reference is made to injuries to blood vessels and tight bandaging; the editor notes what has occurred to us often. He says that "gangrene of the limb more often follows this complication (injury to blood vessels) than tight bandaging, although in many instances the bandage and the surgeon have borne the odium of the result." The railway surgeon will find interesting and valuable information as to "reasonable probabilities" under the head of Prognosis of Fractures on page 59.

Under the general consideration of the treatment of fractures, many valuable suggestions are offered, and the dangers of the inconsiderate application of the most useful means of support are pointed out. Particular attenParticular attention is called to the advisability of frequent inspection and dressing of a fractured limb. It is our opinion that if this advice was followed more frequently, fewer bad results would be obtained. The application of plaster of Paris as a primary dressing in fractures, is, in our opinion, too unqualifiedly condemned. When the soft parts are much injured, or the fracture has been caused by direct violence, plaster-of-Paris should not be employed as a primary dressing, but may with advantage be applied later when the swelling has subsided. But when the soft parts have not been much injured, as is often the case when the cause is in direct violence, we think the primary plaster dressing is an admirable one. The editor makes the following observation in this connection: "As we become more experienced we use the plaster-of-Paris more. frequently as a primary dressing."

The author's conservative views on the treatment of slight depressions of the skull are not wholly in accord with American surgery, but fortunately the notes of the editor will set the practitioner right on the subject. The chapter on fractures of the base of the skull is very interesting and instructive reading.

The treatment advised in fractures of the vertebral column is not full or satisfactory. The reduction by extension is not without danger, and if employed, great care

should be observed, otherwise serious additional injury may be inflicted upon the cord. Operative treatment, which is so much resorted to in certain cases in this country, is not mentioned.

In redution of the head of the humerus, the excellent method devised by Kocher is correctly described in the text, and illustrated by plates making the subject very clear. The discussion of this dislocation is very full and complete. The reduction and treatment of Colles' fracture could have been with advantage more fully considered. This fracture is so important on account of its frequence, and the unfortunate results which often attend it from stiffness of joints of the wrist and fingers, particularly in old people, as to entitle it to very careful consideration. In our opinion the patient should always be anestheized, unless there are special contraindications, that the bones may be carefully reduced. If this is thoroughly done, simple retention apparatus is generally sufficient. The dressing should not interfere with free movement of the fingers. The fracture should be frequently inspected, and massage and motion be early resorted to.

The description of the various fractures and dislocations together with the treatment recommended is very clearly set forth in the text, and a clear understanding is greatly facilitated by a reference to the excellent plates. The book will be of great service to the student.

D. S. F.

"Spectacles and Eyeglasses," their Forms, Mounting and Proper Adjustment, by R. J. Phillips, M. D. Ophthalmologist Presbyterian Orphanage; Late Adjunct Professor of Diseases of the Eye, Philadelphia Polyclinic and College for Graduates in Medicine, etc. Third edition, revised, with 52 illustrations. Philadelphia: P. Blakiston's Son & Co., 1902. $1.00. That this little book has supplied a need is evident from the fact that it has reached a third edition. Whether the oculist has the glasses made for the patient and personally superintends the adjustment of the frames, or sends his prescriptions to an optician who looks after this part of the work, it is very necessary for him to understand the importance and the means of securing perfect adjustment of the lenses before the eyes. Many a careful and painstaking examination of à patient's refraction has been without result because some careless optician has neglected to fill the prescription with accuracy or adjust the frame with sufficient care to make the lenses truly

serviceable in the correction of the error of refraction.

Dr. Phillips' little book supplies all the needed information in regard to the parts and construction of spectacles and eye glasses, the principles of frame fitting, centering of lenses, etc.; the methods of proving the strength of lenses, locating optical centers and axes, detecting imperfections in lenses, etc. The present edition has been thoroughly revised and some parts have been re-written, and an account has been added of such improvements in spectacles and methods as promise to be of permanent

value.

The book is well printed, the illustrations are clear and C. D. W. practical and the binding is good.

"The Public and the Doctor," by a Regular Physician. Published by Dr. B. E. Hadra, Dallas, Texas.

This is a little book of 150 pages, intended, the author says, "to enlighten the masses as to medical matters, to

help to subdue quackery and to assist the rational physician in his many troubles with the ignorant and uninformed." It is also intended that the book shall be given to patients by the doctor, and it is sold for 50 cents a copy. The different schools of medicine and the fads are discussed from the standpoint of the scientific physician, and osteopathy and Christian Science are exposed. The ideal family doctor is described and the true specialist defined. Patent medicines are properly condemned, and attention is called to the results of research and the benefits of preventive medicine.

Medical ethics and the business relations of doctor and patient are elucidated, and altogether it seems to be a very useful little volume. It is written in a simple, easy style and will supply a need. C. D. W.

"A Manual of Instruction in the Principles of Prompt Aid to the Injured," including a chapter on hygiene and the drill regulations for the Hospital Corps, U. S. A. Designed for military and civil use. By Alvah H. Doty, M. D., Health Officer of the Port of New York. Late Major and Surgeon, Ninth Regiment, N. G. S. N. Y. Late Attending Surgeon to Bellevue Hospital Dispensary, New York. Fourth edition, revised and enlarged. Pp., 302, 120 illustrations. New York: D. Appleton & Co. 1902. $1.50 net. Among the larger works on the subject of First Aid, Dr. Doty's Manual has held a high position for many years; the first preface bears the date of 1889.

While the size of the work precludes its general use by the railway employe in mastering the subject, it will be found of much value to those who are called upon to deliver lectures on First Aid.

The portions devoted to the consideration of anatomy and physiology are very clearly presented and the same comment applies to the illustrations. The important question of treatment is well handled, although more attention might have been devoted to "what not to do." A notable omission, particularly in view of the widespread use of electrical energy, is failure to mention electric "shocks" from live wires, etc. In the section on transportation of the wounded the "Halstead litter" is credited to the United States army and described at length, while a few pages farther on the regulation United States army litter is given a discrepancy which has evidently been overlooked. A referenec to some of the excellent contrivances used with advantage in mines for carrying the injured would prove a welcome addition to this useful book, as would also some variations from the standard drill of the hospital corps, which is designed chiefly for open spaces and is not always suited for cramped quarters and civil requirements. C. R. D.

"Woolsey's Surgical Anatomy." Applied Surgical Anatomy Regionally Presented, for the use of students and practitioners of medicine, by George Woolsey, A. B., M. D., Professor of Anatomy and Clinical Surgery in the Cornell University Medical College; Surgeon to Bellevue Hospital, etc. Octavo, 511 pages, with 125 illustrations, including 59 full-page inset plates in black and colors. Philadelphia and New York: Lea Brothers & Co. 1902. Cloth, $5.00 net. Leather, $6.00 In this portly volume the subject of topographic anatomy is very fully considered. The author tells us it is the outcome of his twelve years' experience in teaching, and expresses the fear that in parts it is more an anatomical surgery than a surgical anatomy. However, this does not detract any from the merits of the work,

either for the practical surgeon or for the advanced student desiring it as prefatory reading to surgery proper. The illustrations add materially to the value of the work, being from approved sources, and reproduced in colors. The Practical Medicine Series of Year Books. Edited by Eminent Specialists and Teachers, Under the General Editorship of Gustavus P. Head, M. D. June "Materia Medica and Therapeutics, Climatology, Preventive Medicine, Forensic Medicine." Materia Medica and Therapeutics, edited by G. F. Butler, M. D. Climatology, edited by Norman Bridge, A. M., M. D. Preventive Medicine, edited by Henry Baird Favill, A. B., M. D. Forensic Medicine, edited by Harold N. Moyer, M. D.; 270 pages. Cloth, $1.50.

July-"Pediatrices and Orthopedic Surgery." Pediatrices, edited by W. S. Christopher, M. D. Orthopedic Surgery, edited by John Ridlon, A. M., M. D.; 231 pages. Cloth, $1.25. August-"Physiology, Pathology and Bacteriology." Edited by W. A. Evans, M. D., and Adolph Gehrmann, M. D.; 212 pages. Cloth, $1.25. September-"Skin and Genito-urinary Diseases; Nervous and Mental Diseases." Skin and Genito-urinary Diseases, edited by W. L. Baum, M. D. Nervous and Mental Diseases, edited by Hugh T. Patrick, M. D.; 245 pages. Cloth, $1.25. Chicago: The Year Book Publishers, 40 Dearborn Street. These volumes complete the series for the first year of this admriable publication. They will be found of value both to the specialist and the general practitioner, though they are published primarily for the latter; the arrangement in several volumes being of special value to him. The low price at which they are published, and the high standing of the department editors render the series a desideratum in every medical library.

"A Textbook of Anatomy." By American Authors. Edited by Frederic Henry Gerrish, M. D., Professor of Anatomy in the Medical School of Maine, Bowdoin College. Second edition, thoroughly revised and enlarged. In one imperial octavo volume. Philadelphia and New York: Lea Brothers & Co. 1902. Cloth, $6.50 net; leather, $7.50 net; flexible waterproof binding, for use on the dissecting table, $7.00 net.

On the appearance of the first edition of this work, some two years ago, it sprang at once into popular esteem, owing to its intrinsic merits and the high standing of its authors. It meets the demand for a textbook between the small compends and the large, voluminous treatises. The various changes demanded by the progress of anatomic science have been made, and one of the principal is the substitution of a series of horizontal sections at different levels to show the relations of arteries, instead of schematic drawings, as in the former edition. The richness of the illustrations may be judged from the fact that there are 1,003 in the 943 pages. The claim that "Gerrish's Anatomy is the easiest book to teach from as well as the easiest to learn from" is well founded.

"The American Textbook of Obstetrics." In two volumes. Edited by Richard C. Norris, M. D.; art editor, Robert L. Dickinson, M. D. Second edition, thoroughly revised and enlarged. Two imperial octavo volumes; nearly 600 text illustrations, and 49 colored and half-tone plates. Philadelphia and London: W. B. Saunders & So. Chicago: W. T. Keener & Co. 1902. Per vol.: Cloth, $3.50 net; sheep or half morocco, $4.00 net.

This is a work for the student and practitioner alike. It makes clear those departments of obstetrics that are at once so important and usually so obscure to the medical student. The obstetric emergencies, the mechanics of