While on the Board of Health twelve years ago he had opposed a measure to sprinkle the streets, because he thought that street sprinkling conduced to the growth and multiplication of these micro-organisms and by vaporization of the water favored their dissemination, and he now disapproved it on the same grounds. At that time it was proposed to flush the city with sea water, and the city engineer suggested a plan of pipes and mains which cut the city into two sections. The estimated cost of construction then was $4,000,000, the cost of maintenance $130,000 annually. This plan proposed to supply water with a pressure high enough for fire service, and to do away with the old system of fire engines. I think Dr. Smith's scheme is an excellent one and its cost small in proportion to the great benefit it would be, not alone to the health of the city, but to the comfort of its citizens and the appearance of the streets. I was prepared to find New York dirty, but my mind had not preconceived an idea of the great amount of filth I find here. At the same meeting Dr. D. B. St. John Roosa opened the "discussion upon a bill regulating the removal of manure from New York City." It seems that a Mr. Kane has a contract for removing the manure from East Side. Finding it convenient and profitable to himself to establish dumps on certain piers on East River, he ignored the Board of Health and City Council, went to the Legislature and succeeded in getting a bill passed granting him this perIt would be useless to add that the sanitarians of East Side are wrathy. Dr. Roosa, in a melo-sarcastic, yet logical manner, completely annihilated Mr. Kane, the Legislature and the sanitary officers.

mission

At the German Hospital a few evenings since, I witnessed Dr. A. G. Gerster, Professor of Surgery at the Polyclinie, do an operation for the removal of villosities from the knee joint, which, as an exhibition of diagnostic acumen and operative skill, was astonishing. The patient was a man æt. 40, well developed and muscular. For two years he had been suffering with pain in the knee joint without any inflammatory evidences. Dr. Gerster diagnosed the condition by etherizing the patient and feeling the villous growths He operated by making two incisions three inches long, on either side of the

patella, opening the synovial sac, exposing the villosities and removing them, some half dozen, with a Pacquelin cautery. He then carefully brought the edges of the synovial sac to-, gether with catgut and brought the external wounds in close apposition with deep sutures, after adjusting four drainage tubes, two on either side, one above and one below. He told us that he expected union by first intention, without the slightest loss of function in the joint; that this was his fourth case of the same kind, and that he had obtained this result in the previous three. Dr. Gerster operates under strict antiseptic rules. He employs for ordinary purposes of cleansing and irrigation a solution of the bi-chloride 1 to 2000. All of his dressings (he uses wood cotton) are previously soaked in a solution 1 to 500, while his own and the hands of his assistants have been previously rendered aseptic. The same afternoon he operated for hydrarthrosis of the knee joint. He introduced a trocar and canula, one on either side of the patella, withdrew the trocars and thoroughly cleansed the joint with the bi-chloride solution. He then introduced two small drainage tubes, dressed the wound antiseptically, and placed the limb on a long posterior splint.

A competitive lecturing contest is in progress at the College of Physicians and Surgeons for the chair of Surgery, made vacant by the resignation of Dr. T. M. Markoe, on account of old age. The contestants are Drs. W. T. Bull, W. S. Halstead and Hall. Dr. Bull is quite well known to the profession from his contributions to the literature of abdominal surgery, and is recognized here and abroad as a very able man. I am told that he is the favorite of the class. Drs. Hall and Halstead stand very high here, both occupying hospital positions. All three are alumni of the college. Selecting its teachers from its alumni is, I think, a wise and magnanimous step on the part of the college

New York offers many advantages to the student of clinical medicine in any department, especially since the establishment of two post graduate schools. That the physicians of the country appreciate these advantages is evidenced by the phenomenal success of the Polyclinic, of which Dr. J. A. Wyeth, a Southerner by the way, is secretary, which was

organized about five years since. Its system of clinical teaching attracts physicians from the Pacific Slope to the Atlantic, and from the Gulf to the Esquimaux region. Its teachers are all connected with the various hospitals in the city, and its students are thereby enabled to witness operations at some one of the hospitals every evening, frequently having the option of several. I find a good many Southerners here, among them our friends, Drs. L. L. Saunders and D. T. Johnson, of Fort Smith, Ark, and Dr. Nolan Stewart, of Jackson, Miss.

At the Roosevelt Hospital yesterday I saw Dr. Sands make an excision of the knee joint, an excision at the elbow, and a perineal lithotomy. Dr. Sands is an expert and skillful operator. He, as indeed all the surgeons here, practices the antiseptic method strictly. Carbolic acid, however, seems to have been banished from the realm of antisepsis, every one using the bi-chloride.

Dr. Louis Pilcher and many other surgeons here use sawdust as a surgical dressing. They claim that it is a good absorbent, that it is cleanly, cheap and always obtainable. They prepare it by soaking it in a bi-chloride solution 1 to 500 for a short time, dry it and sew it in thin muslin bags of any convenient size or shape, to be used as wanted.

Dr. Cauldwell in one of his recent clinics gave the class his treatment of styes and furnucles with camphor, which is original with himself and according to his experience is quite successful, certainly very simple and cheap. On styes he uses ordinary camphorated oil applied as often as convenient and before the formation of pus. He has a record of seventyfive cases, all successful. For furnucles he uses the ordinary tincture, rubbed on well six or eight times a day. He has a record of fifty-one cases thus treated with only two failures, and in these two the treatment was begun too late. He said also that he had been remarkably successful in treating felons with a saturated solution of bi-carbonate of soda. He directs the patient to keep the felon surrounded with cotton batting, kept constantly wet with the solution.

Dr. Janeway has been selected to fill the Chair of Princi

ples and Practice of Medicine at Bellevue, made vacant by the death of Dr. Flint. I do not think a successor has been appointed to Dr. Janeway's old chair.

FRACTURE OF THE RIBS, WITH HEMATHORAX. EDITORS MONTHLY-S. K., a stout, plethoric laboring man, aged forty-two, on the 4th of June last, while lifting some heavy irons, fell backward, receiving their full weight across his chest. The seventh and eighth ribs of the left side were fractured about one inch from their cartilaginous extremity. Violent dyspnoea supervened, with the expectoration of large quantities of frothy blood, proving that the lung had also suffered from the violence of the blow.

I administered a hypoderm of morphia and atropia (Wyth's), and covered the whole side from beyond the sternum in front and the spine behind, with a roll of adhesive plaster. The next day I found a temperature of 101°, but little blood in the sputa, restlessness, and unable to lie only on the affected side. The third day I was called hurriedly, as my patient was thought to be dying. The dyspnoea was alarming, and in his frenzy he had torn the plaster from his side. The intercostal spaces were bulging freely. Morphia and atropia again relieved him.

Satisfied that there was an accumulation of blood in the pleural cavity, I chose the quickest and safest means of giving relief, i. e, "aspiration." Introducing the needle at the most dependent portion of the morbid space, I succeeded in withdrawing a quantity of "bloody serum," nothing more. Removing the needle, its point was occluded with a small coagula. I again introduced it, with negative result. The blood had evidently been poured out the first day, and could then have been easily removed. Now it was coagulated, and must be liquefied before it could possibly be made to flow through the small opening of the aspirating needle; but would this be wise? Some surgeons have advised to reverse the current, and inject tepid water, and even solutions of pepsine. The pleural cavity being already distended to its full capacity, injections of fluids for this purpose would certainly be haz

ardous.

Abnormal fluids in the chest cavity are most often absorbed, though they frequently break down and suppurate, and sometimes become organized. In this case I decided to leave the removal to nature. A portion of the material being removed, it was logical to suppose that nature would endeavor to take up the work and complete it. My confidence was not misplaced. With a little assistance the duty was performed to the full satisfaction of both physician and patient.

The patient was directed to take the following prescription: R Potassii iodidi, 5jss; ammon. carb., 3ijss; elixir simplicis, q.8., 3iv. M. Sig.-Teaspoonful every three hours. This, with quinia, brandy, and a nutritious diet, constituted the after treatment. He gradually but surely improved from day to day, until the cure was permanent. His lungs are as sound to-day as they were before the accident.

ALMA, ARKANSAS.

Respectfully,

GEO. O. ALVIS, M.D.

EDITORS MONTHLY-February 9th Edgar J., aged five years, while playing with some shelled corn, had a grain drawn into the trachea, and was almost strangled. His little sister brought him at once to my office. I tried the usual methods, and failed to get the corn. I repeated these methods; tried to dilate the larynx and pharynx with my finger; stood the little fellow on his head and introduced my finger; could feel the corn, but when the finger was withdrawn it remained behind, for several succeeding days. Finally I urged tracheotomy as the only hope of saving the child. This was about the 18th, or say ten days after the accident. There were at this time painful and unmistakable evidences of pneumonia of the right lung They hesitated to consent to the operation for some five days more.

I secured the assistance of Drs. McCluneg, Jeter, Harp, and my brother of this place. We put the little fellow partially under the influence of chloroform, and I proceeded to operate. The pneumonia was well marked in right lung, with bronchitis in the left. The face and nails were blue, indicating deficient oxygenation, but as the corn was still loose in the trachea, I was hopeful of success. The operation was conducted very