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coveries, wrote as follows: "For years past I have seldom been obliged to use the knife, even when strangulation had existed for several days. Generally, easily and promptly effected reduction, followed in most cases by rapid recovery." Referring to the use of the knife within five or six hours after the commencement of the strangulation, he remarks: "Such

a procedure as this is certainly not justifiable when carried to such an extent, any more than too great a procrastination with the taxis.”

Spence said in 1871: "After operating we find that the taxis has done harm. There is no risk, I hold, in the operation itself, whether extra-peritoneal or by opening the peritoneum, if done early and before changes have taken place. The causes of death after operation are invariably due to changes taking place in the sac, or hernial protrusion prior to the operation."

In the presence of a strangulated hernia it will be always safe, when in doubt, to operate. If a swelling is discovered, even if unlike a hernial tumor, cut down; if it be an inflamed gland, or abscess, no harm has been done.

A case came under my observation not long ago. There was a slight enlargement in the groin. For three days the attending physicians disputed. The one claimed that it was an inflamed gland, the other that it was intestine. The symptoms pointed clearly to obstruction. By incision I exposed a knuckle of intestine deeply placed and discolored. The strangulation had lasted nearly six days. Relieving the stricture and replacing the intestine within the peritoneal cavity, a slow recovery took place, for there was present at the time peritonitis. This was treated with opium in heroic doses. I give these ardent disciples of Clark all credit, both for wisdom and candor, while I am happy to state I do not share his views.

Called to treat a case of strangulated hernia inguinal or femoral, several hours or two days may have passed by, unrelieved; now, the treatment must be prompt and definite and with no delay; recumbency enjoined, in bed, thighs flexed by means of pillows under the knees; the taxis may be cautiously employed, if not considered dangerous, with or without anesthesia. If, with the administration of the anesthetic, the skin about the hernia may be shaved and thoroughly cleansed, and the operation begun. We may wash the part with mercuric solution or with boracic acid. Towels saturated with either placed about the field of operation. The incision should extend well above the inguinal or femoral ring, so that we can expose the point of stricture and effect the division, guided

by the eye instead of the director, probe-pointed bistoury, or finger, and thus liberate the imprisoned intestine with greater security. The sac is opened while being caught up between two catch forceps, and the incision extended with scissors bent upon the flat. The edges of the peritoneal sac are now caught up by a number of forceps and held by assistants; thus will be exposed the strictured part. No traction must be made upon the intestine until the stricture is relieved entirely. If the intestine be not necrosed it is immediately placed within the abdominal cavity, in an aseptic condition. The sac ought to be retrenched and occluded by purse-string suture in the absence of peritonitis. But if it be present, drainage. The radical operation of hernia completes the procedure. Iodoform, dusted over the line of incision, over this dry dressing, cotton being preferable (carbolized), kept in situ by a light elastic bandage. Overcome constipation in forty-eight hours by enema. If peritonitis is threatened, rely upon a saturated solution of salines. Remove drainage tube on the sixth day if the case progresses favorably. It will be sometimes extremely difficult to decide if intestinal necrosis is present, and still more difficult to decide what to do if it has occurred. Would you excise the dead portion, or allow it to slough away?

PRACTICAL POINTS ABOUT SURGICAL DRESSINGS.-In a report of four months' service in the Albany Hospital (Albany Medical Annals) Dr. A. Vander Veer says that in all 133 operations were done. In 168 cases of surgical lesions treated, there were seven deaths: two due to peritonitis, two to uremia, two to exhaustion of the disease, and two to shock. The death rate was four and one-sixth per cent.

With regard to the dressings used in these cases, he says that the methods have been very simple, and the antiseptic agents used neither new nor novel. To begin with: all the gauze used was of home manufacture; that is, plain gauze medicated chiefly with bichloride of mercury. Plain absorbent gauze can be bought, he says, in two hundred yard lots at four and a half cents per yard. This can be cut conveniently and folded in five yard pieces and treated as follows: It is immersed in a solution consisting of one part of bichloride of mercury, fifteen of tartaric acid, 150 of glycerin, and sufficient water for 1,000 parts; enough eosin is added to give a faint tint. After remaining in the solution for twelve hours the gauze is wrung dry and packed in stoneware jars ready for use. The addition of tartaric acid and glycerin he regards as very advantageous, increasing both the antiseptic and absorbent power of the gauze.

The bichloride gauze was used for making "Gamgee" pads for bandages, and for iodoform gauze, by rubbing iodoform in its mesh. Iodoform and boric acid were used in dressing ulcers both in powder and in ointment. Boric acid solutions were used in washing the bladder and urethra before and after operations. A one-half per cent. solution of hydrogen peroxide he says was very satisfactorily used about the mouth and nose. It acts also as a powerful deodorant. For flushing wounds, 1-2000 or 1-3000 bichloride of mercury solutions were used. In Dr. Vander Veer's abdominal work hot water took the place of all anti septics, except in dressing. The spray was used in the room for three hours before opening the abdomen. No poisonous effects were observed during the four months from the use of antiseptics except in one case in which a slight iodoform erythema appeared upon the abdomen after an abdominal section.

ANCHYLOSIS OF THE KNEE-Joint as a REMEDY FOR THE "DANGLELEG," DUE TO INFANTILE PARALYSIS AFFECTING THE ENTIRE LIMB.-The author has done this operation of anchylosing the knee-joint in several cases, and always with success; he, therefore, advocates this treatment in preference to apparatus or amputation, with the attendant discomforts of an artificial limb.

He quotes his first case in detail. The patient was ten years of age, and had walked with a crutch since three years old. At first a tenotomy was done upon the flexor muscles with the view of straightening the knee, and then applying apparatus to fix the knee joint. After division of the tendons the leg could not be straightened, owing to the tension of the soft structures in the popliteal region. Failing in this, the author decided to excise the joint. The joint was opened by dividing the patella. Then four thin sections were taken from the femur, which allowed of the tibia being brought into proper position. Two wire sutures were inserted to keep the femur and tibia in apposition; the two halves of the patella were held with one suture. The wound healed without suppuration, and in four weeks the patient was moving around on crutches; at this time there was considerable movement at the knee. In eight weeks he could bear some weight on the limb, and, though consolidation was more firm, it was not complete. In twelve weeks he was walking without cane or crutch; there was still slight motion at the knee. In four months the union, though fibrous, was firm, and no motion could be detected.

Similar results have attended his other cases.

The patients soon ac

quire a gait that hides the stiffness of the joint, so that it is almost impossible to detect the infirmity. The author thinks the best cases for operation are those in which the atrophied limb is only slightly shorter than the sound member. In some cases he excised both the femur and tibia; here union was more rapid than where only the femur was excised, but the leg was much shorter. He, therefore, gives a preference to the slower process of repair, since the results are better.-Prof. Smith in Med. Rec.-Arch. of Ped.

EFFECT OF THE Entrance of AIR INTO THE CIRCULATION. (H. A. Hare, M. D., in Therap. Gazette.)- From experiments on seventy dogs the author concludes:

I. Death never occurs from the entrance of air into the ordinary veins of the body unless the quantity be enormous-from one to several pints, a quantity which cannot enter unless deliberately sent in by

the surgeon.

2.

The cases on record have been due to other causes than air and have not been proved.

3. The tendency of the vessel to collapse and the leakage of blood prevent any entrance of air, and it would seem probable that a clot has generally caused death, not the air itself.

The dogs were of all ages, breeds and states of health. The amount of air injected into the jugular vein varied from a minute bubble to forty c. c.

Injection of a small amount of air into the carotid artery almost invariably caused speedy death with convulsions and paralysis.

NEW METHOD OF EXCISING THE WRIST.-Mr. Edward Thompson, Surgeon to the Tyrone Infirmary, has lately described (British Medical Journal) a method of excising the wrist joint which he believes has not hitherto been recommended. In a case of caries of the carpal bones, in which the disease appeared to be limited to the first row of carpal bones and to the lower extremity of the radius and ulna, he determined to try to save the hand, although the patient, whose sufferings were acute, was anxious for amputation. On the back of the hand, and within half an inch of its ulnar border, there was a large shallow ulcer. The outer edge of this sore was selected as the site of incision, which ran between the tendons of the extensor communis and minimi digiti, and was about four inches in length. The joint was freely opened, so that its interior could

be thoroughly examined. A gouge was then introduced, and the semilunar bone gouged completely away; then each of the neighboring bones was firmly caught with strong forceps, slowly twisted from its connections and removed. The diseased ends of the radius and ulna were gouged away, and afterwards both bones were sawn across immediately above the seat of disease. A small incision was made on each side of the joint as close as possible to the level of the floor of the joint, and a drainage tube was inserted. The wound was stuffed with iodoform gauze and dressed antiseptically. A straight splint was placed under the forearm and hand, the palm being supported on a roller bandage. Recovery was uninterrupted and speedy, and the patient has now a useful hand. Mr. Thompson claims for the method that "it is easy of performance and free from danger, and that it does not tear or injure any of the tendons, vessels, nerves or deeper structures. It is quite bloodless, and does not require removal of any portion of bone which is sound and healthy."— London Medical Record.

CURE OF ABSCESSES ABOUT THE NECK WITHOUT CICATRIX OR OTHER DEFORMITY.- Dr. Quinlan, of Dublin, some years ago, recommended the introduction of a silver wire through the abscess, the ends being tied together outside the skin, and through these small openings the pus was drained. At end of twelve days the wire was removed, and the little wounds would pucker up and heal with two cicatrices, each the sizs of the head of a large pin. The redness left, and after a while would gradually turn white. This method has seldom failed in my hands, and would therefore recommend it.-Summary.

A VEHICLE FOR IODIDE OF POTASSIUM.-Milk as a vehicle for iodide of potassium completely masks the taste, and does not apparently interfere with the therapeutic qualities. Patients who could not tolerate ten grains when administered in water could soon take forty grains in milk with no symptoms of nausea.