cardiac contractions, and motion of the blood. The Reaction, or the backward swing of the pendulum of paralysis soon spreads from one system to the other, and life, consumes the vitality that the disease has left, and the brain ceases to act. After death the blood coagu-hastens a fatal termination. That reaction is an effort of lates with difficulty, and the right side of the heart is filled, the left side remaining quite empty. Shock therefore, is a disease, arising as all disease must arise, in derangement between means and their uses, but it is to be noted that an injury is not a disease of the spirit, the body by external causes is rendered unfit for a medium, but the spirit of the man is not affected, save in so far, as it cannot act harmoniously in every part of the body. III. The indications for the treatment of shock, are, o restore equilibrium to the nervous system, and to prevent reaction. That the stimulating treatment of shock does not fulfill these requirements, may be known from the following considerations: 1.-To restore nervous tone, and maintain an equilibrium between waste and repair, food, or that which can be converted into motion, is required; alcohol furnishes no such materials. 2.-Healthy nutrition is accomplished only when the blood is normal and circulates freely through the body; alcohol kills the white blood corpuscles, coagulates albumen, and thus retards the flow of blood. nature to establish harmony, seems an unwarranted conclusion, because, First, before reaction is established, only the primary disease has been expended; Second, reaction is a feeble activity of the nervous system. first attacked, and occurs because of exhaustion of its. antagonistic system. To guard against reaction, it is necessary that the assisting force should act in the direction of the force assisted, this will be the similar remedy, and it is also necessary that the waste incident upon shock should be repaired; this is accomplished by administering easily assimilated food. IV. A comparison between alcohol and shock, will show that because of the similarity existing between. them, alcohol is curative to some forms of this disease, not in stimulating, toxicological doses, but in the minimum dose, in a state of division that liberates the spirit of the drug sufficiently to meet upon its own plane, the spirit of the disease. The pathological similarity between alcohol and shock, is that both paralyze the sympathetic nerve; from this action results the symptoms of morbid circulation and nervous depletion that have been mentioned. In reviewing the symptomatology of alcohol, it will be unnecessary to institute more than a mental comparison with shock. 3.-Alcohol paralyzes the sympathetic nerve, and for a brief time allows the remaining vitality to be expended through undue activity of the cerebro-spinal system; when this vitality has been consumed, death must en-sciousness. The heart's action becomes feeble, respiration sue. 4. Any medicinal substance that takes possession of the system to such an extent as to destroy natural physiology, or pathology, and substitute for these its own action, cannot but injure the organism, and render it more difficult of future treatment; that alcohol is such a substance, cannot be doubted. followed almost immediately by paralysis and unconThe introduction of raw spirits into the stomach is embarrassed, and the temperature reduced, while a cold perspiration covers the body. The face becomes pale, the eyes glassy, and pupils inactive. Feces and urine are discharged involuntarily, and death occurs from paralysis of the lungs and heart. These are the secondary symptoms of alcohol, induced rapidly by the size of the dose, but they are as truly curative as the primary symptoms, because they mark the deep action of the drug, the exponent of which is the minimum dose, and that action which corresponds to the waning strength of the organism, while at the same time the primary symptoms are similar to the initial stages, not always perceived, of the disease. 44 LEUKO-SCLEROSIS. Nervous harmony is best restored by that agent which attacks the essence of the disease. Let it be premised, that a medicine can affect the body, only by first acting upon the spirit, for the body without its life, which called it into existence, is dead, and cannot be acted upon. Moreover all disease being primarily a mental disorder, arising, either in the individual or remotely, from our faculty of rationality, is a separation in uses of the two forces which as one constitute health, and is not physical but spiritual. Therefore, disease can be removed in two ways, by introspection and a voluntary opening BY J. A. CARMICHAEL, M. D., NEW YORK. of the spiritual man, and by drugs, (the most frequent The following case of a rather unusual form of method,) the vital principles of which originate in uterine disease may be found of some interest. Before some violation of law, and cease when that law is ful- describing the pathological condition as revealed by filled, meanwhile existing in form as means for remov-autopsy, I will give a few incidents connected with the ing similar disorders. To cure, the drug must be similar life of the patient, as furnished me by one of her intito the disease, for if it could be identical, which from mate friends. the nature of the case is an impossibility, it would be Miss Elizabeth R. Branson, forty-nine years of age unable to affect the disease, save to augment its severity; at the time of her death, was born in South Eastern. if the drug is contrary to the disease, it cannot touch the Ohio. Her parents were orthodox friends, her father seat of the disorder, but if it is similar, it acts upon the from Virginia and her mother from Rhode Island. From same sphere with the disease, but from without inwards, infancy she was of a highly nervous organization, which and being similar, it is also correspondent. Therefore, increased with her growth and affected her health unas the external which is correspondent to the internal, favorably. While a student at the Eclectic Medical Colexists only so long as the internal remains, and as the in-lege of Cincinnati, Ohio, she contracted small-pox from ternal or disease, is a negation, being the absence of nursing a friend, from which she recovered bearing no health, and as the good which is the spirit seeking to re- marks of the disease. At the age of twenty-three, while cover, and the bad which is the drug as an emanation dining at a hotel, she was poisoned by arsenic which, as from discord, cannot exist together, for a thing must supposed, had been introduced into the coffee by the be wholly good or wholly bad, the disease is removed servants of the hotel, and from which several of the when the meeting of the external and the internal is ac- guests died. For some time thereafter she experienced complished, for this meeting is with an attractive force attacks of severe illness. About 1865, she received sufficient to destroy the form of these two factors, and treatment by the Swedish movement cure from Dr. Dio substitute in their place a third, which is health. Lewis, Lexington, Mass., and electric treatment from Dr. Garside, now of Brooklyn. For a few years her health was better, but in 1870 she became again very feeble, and while trying the lifting cure in Boston, small swellings came that could be felt by digital examination per vaginam, pronounced by some vaginal, by others. intestinal, as she gained strength, these swellings in It has already been observed that shock is not a disease of the spirit, but as the body can be affected curatively only through the spirit, the symptoms will indicate the remedy, without regard to the cause of the disease, for the spirit acts as a mouth-piece of the derangments of the body. creased in size and became more painful. At length one broke and discharged half a wine glass full of pus through the anus, others followed, though not as large and all discharging through the anus. Her health now rapidly improved, and from weighing 85 pounds she increased to 130 pounds. In July, 1876, she had a severe uterine hemorrhage, and though under various and skillful treatment, the hemorrhages returned from time to time at various intervals, hopes were entertained that at the menopause, she might regain her health, which, however, proved fallacious. During the autumn of 1877 she steadily grew weaker, with more frequent hemorrhages, the blood coagulating more and more, and the pain increasing. All the spring and winter of 1878, her sufferings were intense, the body, hips and thighs cold, and required much artificial heat. Hot sitz baths afforded more relief than anything else that was tried. The appetite was generally good, but from the time of the poisoning, the intestines, and especially the colon, were sluggish and inactive, requiring enemata to relieve. The mind was clear, and her diagnosis of her own case singularly correct. There had been cancer in her family. Leuko-sclerosis of the uterus with cancerous degene ration of the Bas. fond of the bladder. An autopsy of the above interesting case held at the Women's Medical College, revealed the following morbid conditions. The uterus had undergone the degeneration known as sclerosis, so called because of its hard, tough nature, so much so, as to creak under the knife and feel as though leather was being cut. The interior of the organ presented a white, shining or nacreous appearance, to which I venture to prefix the term leuko, as indicating this peculiar form of sclerosis, and which has been described by Klob thus: "The Parenchyma, on section, appears white, or of a whitish red color, deficient in blood vessels, from compression of the capillaries by the newly formed connective tissue, or from partial distruction or obliteration of the vessels during the growth of tissue, the firmness of the uterine substance is also increased, simulating the hardness of cartilage, and creaking under the knife." or why it should not, like others of its kindred attack persons in every stage of life, old age as well as childhood and youth, Just why dame nature should plant in the human system, at birth, the seeds of such a disease; or why she should deem it necessary to entail upon her offspring so loathsome and terrible an affliction, I shall not now stop to enquire. Enough for me to know that it is so, and that "what ever is, is right." One reason, why it does not, as a rule, attack persons later in life may be owing to the fact, that, during the process of evolution, the germ thereof may have been eliminated from the system. There being no tinder, the sparks engendered by the concussion of flint and steel fall harmless to the ground. I advance the doctrine that, in every human organism there is a latent diathesis, ready to be fanned into a flame. Whether this will be small-pox, chicken-pox, measles or scarlet fever, depends alone on the peculiarity of the contagium with which the system is brought in con tact. I said that every human organism is subject to these at. tacks; I will modify this by saying that that is the rule. Every physician knows of cases where repeated vaccinations have been of no avail. They know also of repeated instances where the system has been exposed to the scarlet fever contagium without the disease having been contracted, and so some persons go on through a lifetime unscathed by any of these exanthematous fevers. And why this exception? Simply because, in these exceptional cases, none of the germ was present in the system of this or that particular dyscrasy. Or if it was imminent, at the first, before contact with the external conditions, necessary to its development, the processf evolution had eradicated it (the germ) from the organism. Hence, there being no fuel, there could be no fire or fever. Mumps sometimes only appear on one side, the other parotid remaining intact. Only a part of the dyscrasy being exhausted, the system is not proof against further attacks, and will not be until the remaining gland has been subjected to the same process. Scarlet fever has been divided into three varieties, viz. : Simplex, anginosa and maligna. When a person is attacked with a case of scarlet fever it is only a question of how much of this inborn dyscrasy the system contains, and how much of constitution there is to withstand the explosion, to determine the quantity of scarlet fever the subject will have; if the quantity be small, the heat, or fever, will be commensurately so, and this is called scarletina simplex. Superadded to this uterine degeneracy, (in which I should mention the ovaries were not involved in any appreciable degree, indeed they seemed to have undergone a marked atrophic transformation, the result perhaps of the absence of the stimulus of impregnation, the patient having been unmarried and virginal,) there was a close adhesion of the antero-posterior walls of the vagina and bladder, and here the cancerous transformation was plainly observable, no doubt, the source of the re peated hemorrhages occurring so frequently during the life of the patient, as also the cause of the great suffering she endured. There was more than the usual exsangueous appearance of the small intestines, with marked contraction of the colon, particularly of its de-yond directions to the nurse. When the throat is predisscending portion. SCARLET FEVER. BY C. T. CORLISS, M. D., INDIANAPOLIS. (Read before the Indiana Institute of Homœopathy, May 1, 1879, Indianapolis.) Scarlet fever is a disease that belongs, almost exclusively, to childhood and youth. Unlike other fevers belonging to the group exanthemata, it rarely ever attacks persons in middle age, and seldom, or never, those far advanced in years. As a rule it occurs but once in a lifetime. This rule applies also to variola, rubeola and varicella. Instances are, however, on record, where persons have been attacked the third time, and, in some cases, they have succumbed to the disease during the third attack. Just why this fever should attack persons but once in a lifetime, I have never yet seen a reason, or an apology; Under favorable circumstances it runs a mild and rapid course, requiring but little of the physician's services be posed, in consequence of a scrofulous taint, having an affinity for those parts, to glandular enlargements, &c., it is then that this scarlet fever diathesis, when aroused into action, concentrates all of its morbid force upon this one point, and the mingling of these two morbific tent, of wall-structure of the glands of the throat, &c.— forces results in the destruction, to a greater or less exthis is called scarletina anginosa. I undertake to say, that no child inheriting a scrofulous taint, ever contracts this disease without having the anginosa variety. And the severity of the case will be in proportion to the extent of the scrofulous dyscrasy. When we are called to the treatment of a case of scarletina, our first care should be to ascertain the habits of the parents, as far back in the generation as possible, and if there be a scrofulous taint to know it, for as the old adage has it, to be fore-warned is to be fore-armed; and the physician will find his labor lightened, and his chances of success greatly increased by thus taking time by the forelock. During the practice of nearly quarter of a century this has been my rule, and, without boasting, I am proud, as well as happy, to say that I have never in that time lost a case of scarletina, in any of its varieties, nor has there ever a case passed from my hands to another as incurable or otherwise. The third variety-Scarletina Maligna-is the most formidable of them all. As its name would imply, it is the most malignant in its character. Although the " refrain" is the same as the two preceding varieties, it is the fearful "variation" which is the cause of so much alarm and solicitude during its progress This form frequently assumes many of the features of the most malignant typhus, with an eruption strongly resembling that of variola-vesicles becoming confluent, eyes swollen to a close, deafness, sanious discharges from ears, nose and mouth, tongue swollen, black and crusted sordes on the teeth, carpologia, low mutterings, delirium, discharges of fœtid blood and mucus per anum, &c. Such are the faint outlines of the picture of a disease which we have all had more or less to deal with. In the February of 1871 an epidemic of scarlet fever prevailed in this city and vicinity. I retain a vivid recollection, among others, of one family of childrensix in number-whom I treated all at the same time. Three had scarletina simplex: the other three the malignant variety. All of the symptoms related above were present in these last three cases in the most virulent form, and they all made a good recovery-I say good, because none of them had any of the sequelæ so frequently entailed upon this class of patients. And right here I hold that when these fearful complications are present in any given case, and the legitimate treatment is directed to the eliminating of this scrofulous dyscrasy from the system during the progress of the disease, no such sequelæ need be entailed upon the system. The discharges from the ears, the enlargement of the parotid or other glands, the weak and inflamed eyes, &c., do not constitute part of the scarlet fever per se; on the contrary, it is a latent scrofulous diathesis that has slumbered in the organism until aroused into activity by coming in contact with that innate principle which underlies the scarlet fever, and by which it is set free to enact its peculiar role among eruptive diseases. In treating scarletina simplex I would, in the main, use the same remedies as in the treatment of catarrhal fever or common cold. In prescribing for the anginosa variety I would give the same treatment as in tonsilitis with catarrhal complication. In meeting the disease in its third and most dangerous form I have always, as before intimated, been successful in the use of those remedies prescribed in cases of malignant typhus. The types are so nearly alike that by instinct alone almost the physician would be led into that form of treatment. In the cases referred to above, by recurring to my case-book, I find the remedies used were Bry. Bell, Hyoscyamus nig., Verat. vir., Arsenicum, Phos, and Sulphur-as in the progress of the disease each was indicated by the symptoms and the pathological anatomy. In my treatment of scarlet fever I have always used the two potencies, ranging from the mother tinctures to the third decimal dilution, or the first, second or third triturations, and until some one cures a larger than one hundred per cent.; and I am officially informed of that fact, I shall continue to do so. "Speak well of a bridge that carries you safely over is an old adage. Others may be equally successful with the higher potencies; with them I can have no controversy. The grand, cen tral idea is the law upon which the remedies are administered. It is this that makes us a people distinguished from all others. No matter if it be high church or low church, whether the dose be finitesimal or infinitesimal, if so be it is founded on the corner-stone "similia similibus," it is well; for however we may differ in the minor details, in this every true homoeopath is united, and against that union the portals of Hades cannot prevail. RIP VAN WINKLE "HOMOEOPATHICIAN." I presume that all persons have heard, or have read, Of the Doctor, that Holmes in a poem, described; Rip Van Winkle, M.D., son of Old Rip, since dead, Good for naught, as a medical course was prescribed. How he studied, and worked, went to sleep, and awoke; How disgusted he was, when he found that the world Viewed his practice, and life, in the light of a joke; Then he, into his annual slumber, was curled. He sleeps soundly till spring, then awakes with a growl; Shakes the "kinks" from his muscles, the leaves from his hair, And comes out to the medical meetings to howl: "All progress is humbug!" and goes back to his lair. I have lately been somewhat inclined to believe, run, Till we come to be fossils, or fogies, or both. And so Rip the Second, just like the wise fox, Who was tailless, proclaims in his autocrat way: "You must all put yourselves in the same kind of box, That holds me, or else with Eclectics you'll stray !" Thus he turns to those masterly doctrines of yore, And accepting the old, while rejecting the new ; Says that "true Homœopathy and nothing more, Was by Hahnemann taught-all else is untrue." He defines Homœopathy thusly," 'tis true, As the deacon his faith or religion defined; "To be Orthodox is, to believe as I do, 66 While to Heterodoxy all else is confined!" Homopathy is that, which Hahnemann taught, That which I, his disciple, accept without change; Nothing else can be classed with us, though it be fraught With true knowledge, and science and facts that are strange. Rip looks back to our Father, and thinks as he did, The remainder he intimates, should be this way: That the teachings of age, bound the progress youth, And beyond them it would be a great sin to stray.” Rip will find that the life of our Founder, so great, of Was as far in advance of the times that are flown, As the times of to-day, or the thoughts of this date, Will be found, without doubt, in advance of his own. We are sorry, indeed, that a doctor like Rip, Looking backward, with eyes all discolored with gall, Should endeavor to show all the world, what a grip He would take (if he had but a chance), on us all. But this comfort we have, that in numbers he's slim, And his influence less,-almost gone, if not quite. He will serve to hold back,-our position to trim, Like the weight, that is put on the tail of a kite. -ANONYMOUS, GYNECOLOGICAL RETROSPECT. BY MRS. J. G. BRINKMAN, M.D. (Read before the Hom. Med. Society of the County of N. Y. Mr. President and members of the Association:-To present upon this occasion a complete resumé of all that has been done in the department of Gynecology during the past year, would tax your time and patience too severely. I have therefore brought forward for your consideration, such matter only as I trust may prove of general interest. Thomas Kieth, (Edinburgh) in writing of ovarian cysts, (Lancet, 1877), claims that, however hopeless the circumstances, operation should be the rule of practice. He has performed ovariotomy fifteen times in cases of acute suppurating or putrid cysts, every one of which at the time of the operation looked hopelessly bad, yet of these cases twelve recovered. He further states that if so large a proportion of bad cases do well, the mortality under ordinary conditions should be less. The Eden. Med. Jour. for 1875 has a report of some of his operations on suppurating cysts. The July number of the Pacific Med. and Surg. Jour. has a report of a case of ovariotomy performed in San Francisco by Mrs. Charlotte B. Brown, M.D. It has proved an eminent success, and the patient has entirely ecovered. in Six cases of death, following the use of the aspirator cysts, supposed to be ovarian, have been noted. This fact was brought out in a discussion of the Am. Gyn. Soc., published in Trans., vol. II. M.de Sinety has described before the Société de Biologie, the anatomical characters of the uterus and ovaries of a woman who had never menstruated. She was thirtyeight years of age and with the exception of the menstrual flow, had presented from her tenth year all the symptoms of puberty. The uterus was externally of normal volume, but the cavity was formed almost entirely by that of the neck. The cavity of the body was like that of a foetal organ, and the mucous membrane presented the character of the infantile condition. Ovu lation had been very active, for the ovaries presented many false corpora lutea.-Hospital Gazette, Nov. 28, 1878. In the Annales de Gynécologie, June, 1878, Dr. Ch. Talamon relates the following rare case: Marie T., aged 6, was admitted to the Sainte Eugenie Hospital, with symptoms of tubercular meningitis. There was found, also, consolidation of the lungs at both apices. No symptoms drew attention to the abdomen, which was flat, excavated, and flaccid. At the end of six days the child was seized with convulsions and died. At the necropsy the usual appearances were found in the brain, and tubercular consolidation of both apices of the lungs. In the intestine all the Peyer's patches were the seat of irregular ulcerations. The uterus was three times its normal size and contained a clear green viscid fluid, like muco-pus.; its cervical orifice was closed by tubercular ulceration. The Fallopian tubes were obliterated; the ovaries were surrounded by thick caseous exudation. On removing these exudations, the ovaries appeared, indurated, irregular, and enlarged to the size of the ovaries of a young adult. On section, they were found to be entirely changed into yellow cheesy matter. The miscroscopic examination revealed miliary nodules on tubes adjacent to the ovaries presented tubercular degenthe external surface of the ovaries. The portions of the eration of the mucous membrane, whilst the uterine ends of the tubes remained normal.-Lond. Med. Record, Oct., 1878. Dr. Herring, of Leipsic, communicated to the Ninth Waturforscher-versammlung, a remarkably successful case of excision of the uterus for cancer of the neck. The disease had not returned at the time of the report, (eight months subsequent to the operation). In the performance of the operation the uterus was first separated from the anterior wall of the vagina by the knife and scissors, then from the anterior fold of the peritoneum with the fingers. The broad ligament bled very little; the fundus was drawn forward with the combined aid of the fingers and a tenaculum and its posterior connections with the vagina divided without difficulty. The tubercle had invaded the rectum. In the removal of this disease involved the posterior vaginal wall, and one latter tissue an opening was made into the rectum. The left ovary and tube, and one-half of the right tube adherent to the uterus were removed with it. The opening into the rectum was sewed up. There was hemorrhage. The wound was cleaned by injections of salicylic acid used twice a day. Peritonitis supervened, reached its climax on the first day; then gradually subsided.-Hosp. Gazette, Nov. 14, 1878. Amputation of the Uterus and Ovaries as a safeguard against hæmorrhage and other accidents after Casarian section, has been successfully performed by Prof. Ed. Porro, of Paria, (Am. Obst. Jour., 1878). Contrasting the unfavorable results of the Cæsaran operation with those following laparo, hystero, and ovariotomy, which he attributes to the want of closure of the uterine wound, with extravasation of blood, etc., he conceived the idea of removing the uterus and ovaries, and performed the operation successfully in one case, both mother and child being saved. The paper concludes with indications for resorting to this procedure. Freund, of Breslau, (Am. Obst. Jour., 1878,) has extirpated the entire uterus by a new method, applicable in cases of cancer limited to the uterus and to sarcoma of the body of the uterus. A paper giving minutiæ of the technics of the operation and after treatment, has been published by Freund, in the Centralblat für Gynä kologie, Vol. II, No. 12, June 8th. He mentions having performed the operation five times, three of which were entirely successful. In a paper on the Relations of Laceration of the Cervix to Carcinoma Uteri, by Prof. Briesky, (Prague), Trans. of the Soc. of German Physicians, April 27, 1876, the writer calls attention to the possibility of the everted cervical membrane becoming through constant irritation the seat of cancerous degeneration. This supposition was based on two cases, in which, notwithstanding the cancerous disease of the cervix, both lips still plainly showed their bilateral laceration and eversion. Briesky reports two further cases of this kind, in both of which the laceration extended to the vaginal insertion and only one lip was affected, and thinks himself justified in considering the cervical laceration and eversion the primary cause of the carcinoma. B considers Emmet's operation called for, as soon as laceration is recognized, as a prophylactic against possible subsequent malignant disease. In a report to the Ger. Gyn, Soc., (Cong. of Phy., Sept., 1877, Am. Jour. Obst., April, 1878.) Viet, of Berlin, having made careful examinations of specimens freshly taken from the living body, states that the prognosis should be guarded in cases of erosions of the cervix uteri, as they are often the commencing stage of carcinoma, which condition is apt to be set up in the diseased glands of the eroded patch. The beneficial effects of the action of Ergot in Uterine Fibroids is still claiming attention. H. A. Dean reports a case of fibro-cystic tumor cured by this drug.-Med. and Surg. Jour., 1878. Dr. O. R. Mason, exhibited before the New York Path. Soc. a specimen of fibrous tumor, which was expelled spontaneously, after the use of Ergot in large doses.-Lancet, 1877. He Prof. A. R. Simpson, (Edin. Med. Jour, 1878), states that, while he knows of no drug, which on being introduced into the system, finds its way to a uterine fibroid and acts in the way of a solvent on its structure, the Ergot of Rye most powerfully affects their growth. makes use of the hyperdermic injection, and directs that care should be taken that the fluid carry with it no small globules of air. The injections are best borne in the gluteal region. He remarks having observed that students err in pushing the point of the needle obliquely through and to some distance into the cellular tissue. The point of the syringe should be carried right into the muscular strata. J. T. Everett, (Am. Obst. Jour.), cites a number of cases of uterine fibroids removed or benefitted by the use of the faradic current. He prefers it to Ergot, as its action can be more easily controlled. It does not disturb nutrition, nor interfere with digestion. It never produces pain in distant organs, it is not followed by cephalic disturbance or nervous shock, and it does not produce inflammation or other local injury. The marked influence of gestation on the growth of fibroid tumors has been demonstrated in three cases reported by Dr. S. Playfair, to the Lond. Obst. Soc., Lancet, April, 1877. The tumors filled the pelvis, labor progressed naturally with no post partem hæmorrhage. Six months after delivery they could scarcely be detected in either of the three cases. (To be Continued.) HELMUTH'S ELASTIC LIGATURE CARRIER, SUITABLE FOR COMPLETE OR INCOMPLETE FISTULA. The use of the elastic ligature in the treatment of fistulæ, especially those of the anus, has not, I think, been properly appreciated by the majority of the profession. I have employed it between twenty and thirty times with absolute success, in a few cases only the operation having to be repeated, and in two instances the track made by the ligature not healing. In these, the fault was more with the operator than with the ligatures. After having tried various contrivances for the passage of the thread, I finally came back to the directer and probe. The difficulties I found with Allingham's needles were: first, the liability of the ligature to slip out of the eye of the instrument unless the thumb was pressed tightly on the shank and the pressure continuously maintained; and second, that in incomplete fistulæ, a very sharp broad needle with cutting edges had to be passed through the fistula, which was liable to cut into tissues and make false passages, besides giving trouble of a similar kind in the rectum. G. TIEMANN & CUL The ligature carrier which I have devised, and which was manufactured for me byGeo. Tiemann & Co., can be used for complete or incomplete fistulæ, and may be explained thus: An examination of the wood cut shows two buttons (A and B) close up to the handle of the instrument. By pushing forward the button A, the blunt end of the instrument, as seen at E, opens. The elastic ligature is then put upon the stretch, and while thus drawn out, is slipped into the notch, and the button A drawn back to its place, and the needle (if the case is one of complete fistula) is ready for use. One great advantage claimed for the instrument is, that in its passage through the fistulous track, the more pressure that is made upon its end, the tighter is the ligature held in the notch, and the operator may change the position of his thumbs and fingers without in any way loosening the thread. If the fistula be incomplete, the blunt end is passed firmly up to the end of the sinus, the button B is pushed forward, which protrudes the sharp point D; in other words, transforms the blunt into a sharp point. The fistula is then made complete by piercing the tissues; so soon as this is done, the point is retracted again within its sheath, thus leaving a rounded extremity in the rectum. By elevating the handle with the left hand, and drawing the blunt end down by means of the index finger inserted within the rectum, the ligature is brought out at the anus, taken hold of and held, while the button A is pushed up, which entirely liberates the thread. The instrument is then withdrawn, thus leaving the elastic ligature traversing the fistual, one end being at the entrance of the sinus, the other hanging out at the anus. Taking these two ends, they are passed through a small leaden ring, and then drawn out, until their calibre is about half that of the unstretched ligature, and while a sufficient amount of tension is maintained to keep them this size, the leaden ring is seized with the jaws of a forceps, slid close up to the anus, and there compressed by forcibly closing the handles of the forceps. Any one who may try this method I think will be satisfied with it. The patients are confined but a few hours, and indeed, in some instances, not at all. There is not a drop of blood lost, and the tedious and painful process of packing the cuts or tightening the ordinary ligature is entirely obviated. WM. TOD HELMUTH. 299 MADISON-AV. April 25th, 1879. STRANGULATED INDIRECT INGUINAL HERNIA-HERNIOTOMY-A CASE FROM PRAC TICE. BY E. CARLETON, JR., M.D., NEW YORK. Mr. J. B., German, æt. 36 years, had for several years a reducible indirect inguinal hernia on the left side, about the size of a robin's egg, which he kept reduced by constant use of a truss. On the 23d of last April, while on a spree, the truss became misplaced, the hernia assumed enormous proportions and strangulated. At 3 P. M. of the 24th, he was |