have been looked upon as one of the subjects forever settled. For, as far back as the works of surgery of the eighteenth century, I find the same old plates, the same old positions for the removal of the limbwhere it is a matter of selection with the surgeon-as I find in use to-day. Sometimes the accident comes to the patient's rescue and removes sufficient of the limb to compel the surgeon to give the patient a good stump. In an amputation to-day in the foremost hospital of the world-the Pennsylvania-if the location of the injury left a choice as to where the limb should be removed, it would be done through the ankle or at the lower third of the leg. I suppose you ask "Why not?" I would answer that question by asking the question: Why do we amputate at all? The answer would be: first, to save life; and second, to make a useful limb. Now, we can save life as easily by one method as by the other. Why not, then, operate solely for the best interest of the patient? In an amputation of the leg, all that is left below the middle of the middle third of the leg is useless and in the way, and gives that much more room for ulceration and friction sores. Let me tell you, gentlemen, these are weighty considerations in an amputation, for they compel the wearer of an artificial limb either to endure great suffering or to leave the artificial limb off, as I can abundantly testify from personal experience.

Nearly three-quarters of a century ago, Gibson used the following language: "As much as possible of the thigh should in all cases be saved. But the rule does not always hold good in amputations of the leg. If, for example, the leg be amputated just above the ankle, the bone, from the deficiency of surrounding muscle, cannot be well covered, and is, therefore, not calculated to bear the pressure of an artificial leg. On this account, the patient is obliged to have an instrument of the kind adapted to the knee, and the leg, therefore, is carried out behind at right angles with the thigh, and by its weight greatly incommodes the patient; so much so, indeed, that I have known two or three to submit to a second operation, for no other reason than to get rid of the incumbrance." This Dr. Gibson gives as his professional experience. I personally know of a number of reamputations for no other reason than the suffering, discomfort, or absolute impossibility of wearing an artificial limb upon a long stump. After the application of an artificial limb, there is a constant diminution of the size of the stump. Its nutrition being continually interfered with, and the parts being of low vitality, consequently, when we have ulcer

1

ation or friction sores of any kind, it is with great difficulty that they are induced to heal.

There is another element to be taken into consideration: As soon as the artificial limb is left off, and the patient assumes an upright position, the limb is greatly enlarged by a species of edema which takes place immediately, leaving the parts in no condition to heal. The limb has the feeling of being cold and almost lifeless; and if exposed to cold, it would be the first to freeze. It is almost impossible to keep the amputated limb warm.

When the artificial one is left off, amputations through the kneejoint give in many cases a very bad surface to bear the weight of the body, and a leg is rarely worn with comfort. Such an amputation absolutely prevents the application of a full-lengthed limb, as the kneejoint would have to be lowered some three inches for want of room, making at best a useless appliance. Amputate, therefore-if it is a matter of selection-through the lower third of the thigh. An amputation below the middle of the leg is objectionable on account of the length of the stump, which presents occasion for ulceration and is difficult to dress properly so that the limb may be worn with comfort. Every inch of stump over five or six inches below the knee involves that many hundreds of hours of suffering and distress to the patient. The additional chance of life does not add one feather's weight in favor of the long amputation. Amputation at the lower third does not give sufficient room for a strong ankle-joint, and, therefore, adds greatly to the wear and tear of the limb, thus adding largely to the expense. Amputations through the ankle may give the patient something to walk on, but this is oftentimes accompanied with great pain. It often gives him a poor excuse for a limb, and completely prevents any mechanical appliance from aiding him in the least, and forever prevents him from hiding his terrible deformity. If ever there was an appliance to which the term "slip-shod" could be appropriately applied, it is to those intended to imitate nature in these cases. The usefulness of an artificial limb is in proportion to the simplicity and completeness of its mechanical construction. The nearer it resembles the human limb in all its parts, the more perfectly it fills its office. There is one fact associated with these cases to which but few of you, perhaps, have given a thought; that is the ever-present and painful consciousness of physical deformity which the patient has, and the fact that his maimed condition closes to him many avenues of honorable, useful,

and lucrative employment. This applies especially to the case of civilians; to the soldier it is different; to him the loss of part of a limb is unchallenged testimony of gallant and heroic sacrifice.-Maryland Medical Journal.

THE WHITE THROMBUS A NOVEL PRIMARY AFFECTION.-In a lecture before the Verein fuer innere Medicin, in Berlin, Prof. Litten related, December 3, 1888, the case of a young man who died with an uncontrollable bloody diarrhea in the short space of three days. The intestinal canal was in a state of bloody infiltration, the cause of which was found in a thrombus of perfectly white appearance, ten cm. from the aorta in the arteria mesaraica superior. Peripherally of this thrombus was a red one. The white thrombus was evidently primarily white, altogether formed from the third blood element (Bizzozeros plates) in a state of disintegration. The endothelium of the artery was lost, and the thrombus quite solidly attached. Of course, the location caused the issue. Seemingly the loss of the endothelium was primary, but why? No atheromatous changes elsewhere; valves of the heart normal.-Vide Berlin. klin. Wochenschr., No. 1, page 15. 1889.

A NEW COLOR-REACTION (ROSSBACH'S) OF THE URINE.-Some urines will, upon the addition of nitric acid to the boiling urine, change their color to a red, burgundy-red and bluish-red with bluish-red foam. Further addition of nitric acid, drop by drop, will suddenly change the color into reddish-yellow and yellow, the foam being likewise yellow. Neutralizing slowly with ammonia, after each drop bluish-red deposits occur, which dissolve again till finally a reddishbrown color remains constant. The clinical importance of the reaction, which seems to depend upon the indolphenol components in the urine, is decided, inasmuch it always appears in earnest intestinal derangements-occlusion, or cancer of the intestine, extensive ulcerations, and severe diarrheas. Peritonitis and diseases of the stomach, paratyphlitis, do not cause the reaction to appear. The longer persistence of the reaction has always a grave outlook.Berlin. klin. Wochenschr, Jan. 7, 1889; page 5.

THE CONSTRUCTION OF A NEW BLADDER from a part of the intestinal canal, is the latest achievement of operative surgery, although so far only successfully executed by G. Tizzoni and A. Foggi on a female dog.

The operation was performed en deux temps. First, laparatomy and exsection of a piece of ileum, which was antisepticised and closed on both ends, while the continuity of the intestine was restored in the usual manner. One month later, the second operation took place, the ureters were isolated from the bladder, implanted into the piece of gut, the bladder extirpated and the urethra attached to an incision into the isolated loop of intestine, which had contracted considerably. Incontinence for fifteen days; later continence followed, so that the dog voided the urine voluntarily about every hour. Evidently a loop of seven cm. was not long enough. For further detail, see original article in the Centralblatt für Chirurgie, No. 50. 1888. M. H.

PURIFIED WATER.-The boiling of water to "kill the microbes " (Arch. de Phar., October 5, 1888,) has sometimes been recommended by physicians. M. Tellier has shown that this cannot be effected by a temperature of 212° F. He also observed that boiled water, being deprived of its air, is heavy and indigestible, and that, through loss of its calcareous salts, it becomes insipid, and is disagreeable to drink. He prepares water in a closed vessel, placed in a salt and water bath, by which he gets a temperature of 300° F. In using, the water is drawn from a filter-faucet near the bottom of the vessel. A small faucet at the top, to admit air, is kept covered with cotton.-Amer. Jour. of Pharm.

USE OF ANTIPYRINE WITH QUININE.-Derlon says (Revue Gen. de Clin. et de Therap., July 15, 1888,) that if antipyrine is added to the prescription containing quinine, in cases in which large doses of quinine are necessary (as much as fifteen grains or more), the unpleasant effects of the quinine are obviated. He adds three grains of antipyrine to each five grains of quinine. This, he says, also increases the antipyretic effect of the quinine, and prevents quinism. The mixture is better tolerated by the stomach than the quinine alone. Chicago Med. Jour. and Ex.

A NEW DIAGNOSTIC SIGN IN SHOULDER PRESENTATION.-Quiz Master" How do you diagnosticate a shoulder presentation?" dent-"By feeling for the hair in the axilla.”—Medical Record.

Stu

BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

THOS. LOTHROP, M. D.,

EDITORS:

W. W. POTTER, M. D.

All communications, whether of a literary or business character, should be addressed to the editors: 284 FRANKLIN STREET, BUFFALO, N. Y.

Editorial.

ECTOPIC GESTATION, AND PELVIC HEMATOCELE, CONSIDERED IN THE LIGHT OF MR. TAIT'S VIEWS-BEING PKINCIPALLY A DISCUSSION OF THESE AS ENUNCIATED IN

HIS LECTURES ON THIS SUBJECT.'

In the light of his achievements in the surgery of ectopic gestation, no future consideration of this subject can be approached without due acknowledgment of the value of Mr. Tait's contributions toward the clearing up of doubtful questions of this hitherto much discussed, but little understood, bête noir of abdominal surgery.

The lectures, which are taken as the text of these remarkschiefly in the sense of a review-are the most important addition to the literature of the subject since the appearance of Bernutz and Goupil's Memoirs. This book, as Mr. Tait most justly remarks, has received by far too little notice, containing, as it does, a basis scientifically correct for the pathological study of aberrant gestation; while, on the other hand, from the point of treatment, it is absolutely of no value whatever, barely suggesting, as it will be found, the possibility of the success of surgical interference. In this connection, it is interesting to note that the passage of the electric current through the fetal sac is suggested by these authors as a vague possibility of benefit. The use of this

1. Lectures on Ectopic Pregnancy and Pelvic Hematocele. By Lawson Tait, F. R. C. S. Edin. and Eng., LL. D., Prof. Gynecology in Queen's College in Birmingham, etc., etc., etc.