110° F. At 60°, with 95-per-cent. alcohol, ignition is slow, but becomes more rapid if the temperature of the bottle is raised, until at 110° it takes place as a hoarse cough, necessitating quick corking. Below 60° the alcohol will not ignite. Above 110° it ignites so rapidly as to introduce possibly, with a weak bottle or narrow neck, an element of danger. With 50-per-cent. alcohol, or whiskey, the temperature of the bottle must be at least 85°F. for combustion to take place. Ether and other volatile substances should be avoided. The bottle in the illustration has been used over a thousand times. No accidents have ever happened.

If the vacuum should be lost through clumsy corking or leaky connections the vitiated air must be displaced by water before ignition is again. attempted.

The great economy of time and labor has resulted in this device supplanting since its origin eight months ago all the expensive and rapidly deteriorating Dieulafoy, Potain, and other mechanical aspirators, and the less powerful syphon methods hitherto employed at the New York Hospital. The method has recently been introduced into Roosevelt Hospital, with satisfaction, by Dr. Geo. L. Peabody, and demonstrated by Dr. Henry P. Loomis before the Clinical Society.

The monetary feature commends the instrument to the average practitioner. It can be obtained, exclusive of clamp, at any village drug store, for less than fifty cents.

The instrument is satisfactory as an aspirator for exploring or evacuating liver abscess or empyema, or for suprapubic aspiration of the bladder. A larger bottle would provide ample suction for rapidly. drying the pelvis or aspirating a cyst at the operative field. When relief from massive oedema of the legs or scrotum is sought by direct puncture, this vacuum bottle is useful to secure more rapid drainage without liability of infection. For such a purpose, a medium-sized needle is inserted deeply into the oedematous tissue, and attached to the bottle which rests clear of the bed. Twenty ounces of serum can be obtained from a single puncture of an oedematous scrotum in several hours, with relief of symptoms, in a cleanly manner, and without subsequent oozing.

Gersuny's Operation for Saddle-back Nose.-Joseph Rilus Eastman reports a case successfully treated by paraffin injections. Two cubic centimeters of molten paraffin were injected into the skin over the site of the bridge of the nose. Directions are given for the preparation of the paraffin and the method of conducting the operation. There is nothing of interest, the author says, in connection with the history of the case cited since the operation, except that the patient has suffered three or four attacks of pronounced syncope. The patient was not seen by him during any one of these attacks, therefore he has no knowledge of their character, but he suspects slight embolism. -The Medical and Surgical Monitor.

Microbes at the Pole.-Dr. J. Charcot is heading a very unusual expedition to the polar regions. On May 15 he sailed from St. Malo, France, under the auspices of the Pasteur Institute and the Museum of Natural History of Paris, to study bacteriology in the polar regions. A number of prominent investigators deny the existence of microbe life in the polar regions, and Dr. Charcot, by making repeated analyses of air and water in these regions, as well as by careful examining the intestinal tracts of polar animals for the primary microbes which are found so abundantly in warm or temperate latitudes, will undoubtedly make many interesting discoveries and definitely settle the dispute.-Albany Medical Annals.

CASES. DEATHS

June 13-20.

3

June 7-14.

May 23-June

June 3-17..

3

June 13-20.

3

June 6-20.

June 6-13

June

6-20.

3

June 13-20.

I

I

2

June 13-20. June 13-20. June 18 .May 1-31. June

6-20.

24

7

June 15-22.

7

June 13-20.

I

June 13-20.

2

June 13-20.

ADJUNCT PROFESSOR OF DISEASES OF WOMEN, AND GYNECOLOGIST TO THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL; INSTRUCTOR IN OBSTETRICS AND GYNECOLOGY, CORNELL UNIVERSITY MEDICAL COLLEGE; ASSISTANT GYNECOLOGIST TO ST. FRANCIS' HOSPITAL; FELLOW OF THE NEW YORK OBSTETRICAL SOCIETY AND ACADEMY OF MEDICINE.

INTESTINAL surgery is a subject which should be of interest to all who make any pretense to surgical work. The general surgeon must, of course, be qualified to deal with any of the complications necessitating operations upon the intestines whenever he invades the abdominal cavity. Likewise the gynecologist, equally with the general surgeon, would be incompetent to attempt any abdominal section for pelvic disease were he not thoroughly conversant with the methods and technique of this branch of surgery. The gynecologist, more frequently than not, expects to find intestinal complications in the way of adhesions when he opens the abdominal cavity; in fact, I think we may state that he has to deal with dense intestinal adhesions more frequently in his allotted field than does the general surgeon in his work in other parts of the abdomen. The obstetrician occasionally must open the abdomen, and

b

$5.00 Per Annum. Single Copies, 10c.

Only a few years ago Senn wrote: "We have reason to believe that the technique of intestinal surgery remains an unfinished chapter, and that the ideal method of uniting intestinal wounds has not yet been devised." This statement holds true tuday, but since that time great progress has undoubtedly been made.

The history of intestinal surgery dates from ancient times, but two landmarks stand forth, from each of which great advances in the problem were made. Lembert in 1826 proved that the healing of

Fig. 1.

even an ophthalmologist may be called upon in an emergency to do likewise, as was the case with one of the members of this club. Suffice it to say, that the recent advances and the present status of this interesting subject, and a practical knowledge of the technique of the different methods, should be familiar to all who do abdominal work. Those who are not especially interested in this subject, may be under the impression that the problem of uniting the severed ends of the intestine has been solved of late

years by the Murphy button, which is so generally

used. The fact that new ideas and methods are being constantly presented in great variety goes to prove that the end is not yet and that we are still searching for an ideal.

*Read before the Hospital Graduates' Club.

Fig. 2.

intestinal wounds takes place most constantly and speedily if serous surfaces are brought into contact, and the law of "serosa to serosa" has stood the test of time and holds good to-day.

Lister by his discoveries in antisepsis made possible the invasion of the abdominal cavity with impunity, and thereby opened up the field for the attainment of the hitherto impossible. It is only in the past twenty-five years that the abdomen has been opened so that intentional operative procedures upon the intestines might be performed. Before that time operations upon the bowels were only done in emergencies as the result of accidents, and as a forlorn hope. Less than fifty years ago, the rule was to do nothing, as nature was considered the better surgeon.

The mind of man has been ever active in the

devising of ingenious devices whereby a fellow-being might be saved from the consequences of grave intestinal wounds, as is shown by the precursor of the Murphy button, when four monks of the thirteenth century first snatched from death a case of intestinal injury by inserting the trachea of a goose into the open lumen of the bowel. This was the

first authenticated instance of a foreign substance being placed in the interior of the gut for purposes of anastomosis. Since that time every conceivable substance of metal, bone, rubber, and vegetable matter has been employed to take the place of the goose trachea, known in history as the "Method of the Four Masters."

In 1730 we find recorded the first case of recovery following circular enterorrhaphy for complete transverse division of the bowel, when a surgeon by the name of Ramdohr inserted one cut end into the other and retained the parts by a single suture placed

the method of the "Four Masters" previously referred to. Senn, by his masterly investigations upon the healing of intestinal wounds, stimulated the work in this country, and in 1887 he presented his method of using decalcified bone plates to hold the cut ends of the bowel together. These had the advantage of being softened and gotten rid of by the action of the intestinal juices, so that they were eliminated after their usefulness as splints was over.

This method is not popular to-day, because of the trouble in preparing the plates, and the introduction of more handy substitutes. Different investigators have presented the same idea, using rings of catgut and rubber, plates and cylinders of cartilage, turnip, potato, chromicized gelatin, tallow, raw

Fig. 3.

in the convex border of the intestine; truly a remarkable recovery.

Since that time the development of the subject has been upon three lines, and we may divide the methods into three classes of operation: First class, methods where foreign bodies are employed in the lumen of the bowel to hold the ends together, and to act as splints to favor accurate approximation. Second class, by suture alone. Third class, by mechanical devices which hold the parts in apposition while the sutures are being placed, but which can afterward be withdrawn.

All three classes as perfected to-day are successful, but each has its disadvantages as well as its advantages, so therein lies the reason for the constant

Fig. 5.

hide, rubber, cardboard and cork. The same objections that apply to Senn's original bone plates apply to all of these methods, chiefly that they are never ready, are difficult to prepare, and require unusual skill to apply them speedily and accurately.

It was not until Murphy of Chicago invented the button which bears his name, in 1892, that a means was found whereby the ends of the intestines could be accurately approximated, serosa to serosa, with great speed, and without the employment of unusual skill, that the whole problem was simplified and a

Fig. 6.

great advance in results was attained. The Murphy button is to-day the most used of all methods, which means that it has proved generally satisfactory. It owes its popularity mainly to its simplicity of application, and to the rapidity with which the anastomosis can be made by its use; two most important requisites to the success of any method. When it is used without reinforcing sutures, much time is saved, but of late years I think the majority of surgeons prefer not to trust to the button alone, but insert a row of sutures to insure the strength of

improvement upon the rings employed by Denan, more than half a century ago. Any instrument, suture, or ligature used in effecting the continuity of a wounded or a divided bowel that produces gangrene must be looked upon as a source of danger. As a means of end-to-end union of the intestine, the Murphy button is certainly inferior to Denan's procedure, because the lumen of the connecting part is not large enough as a temporary outlet for the intestinal contents." He quotes Keen, in the Annals of Surgery for June, 1893, as saying, "The button should be abandoned for intestinal anastomosis," and concludes, "If this warning of so eminent a surgeon foreshadows the final verdict of the pro

fession in regard to the use of the button for anastomotic purposes, it will never come into use in endto-end approximation."

That Senn has been compelled to change this early opinion of the merits of the button is shown, if we refer to his recent work on "Practical Surgery" just issued, in which he says of it, "Of all the appliances as a substitute for suturing of intes

Fig. 10.

test of experience. The law of "serosa to serosa," as first demonstrated by Lembert, marked a change in the technique of suturing, and all methods to-day have the approximation of serous surfaces as their object.

The continuous overhand suture, applied after the principle of Lembert, is rapid but has marked disadvantages; namely, if one part becomes loose the whole is liable to become insecure; in tightening it, it is difficult to secure even tension all along the line; should the bowel contract, the whole suture may become loosened and the wound gape. Therefore it is not