PENETRATING WOUNDS OF THE ABDOMEN. The question of operation in penetrating wounds of the abdomen is one that can no longer be lightly passed over by surgeons. The excellent articles by Prof. Senn, of St. Louis, which have appeared within the last two or three years, have given a new impetus to this field of surgery, and now American surgeons, especially, are almost unanimous in favor of operating immediately instead of waiting until peritonitis has set in as has been the custom heretofore. The diagnosis of perforation of the intestines is invariably difficult, often impossible. Senn's method of inflating the intestines with hydrogen gas has not given as good results as were at first hoped for, and is rarely resorted to. An accurate diagnosis can only be made by an exploratory laparotomy— with our improved surgical methods a comparatively safe procedure -to which recourse, should be had immediately when there is evidence of the abdominal cavity having been penetrated. Not infrequently the shock is slight, even where the intestines, or other vis cera, have sustained serious injury. The patient should always be given the benefit of the doubt. The very improbable occurrence of recovery without operation-about one chance in a hundred-should not stay the hand of the surgeon. Nor is extreme shock, which is generally prolonged and increased by internal hemorrhage, a contraindication to an operation.

In by far the larger proportion of fatal cases death is the consequence of either hemorrhage, or septic peritonitis due to the escape of the intestinal contents into the peritoneal cavity. Hemorrhage can only be safely dealt with by ligating the bleeding vessels, and the surgeon or physician who expects to control dangerous internal hemorrhage by the administration of opium or the application of ice is certainly leaning on a broken reed. Septic peritonitis can be prevented only by opening the abdomen, suturing rents in the viscera and thoroughly flushing the peritoneal cavity.

With the decalcified bone plates of Senn, the segmented rubber rings of Brokaw or the cat-gut mats of Davis, resection of the intestines and intestinal anastomotic operations are very much simplified, and the length of time required for their performance decidedly shortened.

While the results thus far obtained are not brilliant, still they are encouraging, and lead us to hope for much better success, when the technique of the operations is more thoroughly mastered and the operations more promptly done.-Atlanta Med. and Surg. Jour.

RESULTS OF EXCISION OF VARICES ON LOWER EXTREMITIES.Bennecken reviews Madelung's report of Rostock clinic in 1884, and other literature, from which it appears opinions are divided on the subject of recurrence. At Madelung's clinic 32 cases have been treated in 7 years, and in the worst of these radical operation was done; not a single recurrence to date. Operation: Patient is anesthetized, limb allowed to depend from table until varices swell up. At the upper third of thigh a rubber tube is loosely tied, to stop venous, but not arterial, circulation. Extremity replaced on table, any ulcers scraped or circumcised, and after longitudinal incision. veins are peeled out (for 4 inches on each side of incision if necessary), veins removed with blunt instrument (partly torn out), artery forceps applied, and at close of operation torniquet removed and larger central ends tied. Pockets are drained by small button-holes in skin, larger ones by drainage tubes. Continuous suture, iodoform gauze, aseptic moss pillow, compression, light splint and vertical suspension. Change of dressing in 10 days. Thiersch's transplan- · tation when necessary. The least rise of temperature calls for change of dressing; small abscesses may thus be nipped in the bud. No untoward symptoms observed. Necessarily not always primary union.

Report of 15 cases. Duration of disease, from 1 to 24 years; of treatment from time of operation, 10 to 70 days, average 40; time elapsed since cure, 6 months to 7 years. One recurrence in another part of leg; operation and permanent cure. Usually massage of scar before dismissal.—Berlin Klin. Woch.-Memphis Jour. Med. Sci.

THE TECHNIQUE OF INTUBATION.—In a paper read at the recent meeting of the Amer. Pediatric Society (Med. Record) Dr. Dillon Brown said he had seen a great many cases of intubation, and he desired to present some of the practical points derived from his experience, and especially to call attention to the many badly made tubes and the many dangerous modifications of the O'Dwyer tube, which were sure to bring disrepute upon one of the most brilliant and important operations of modern times. The difficulties of the operation had been greatly underrated. While it required but a few seconds to insert the O'Dwyer tube, and the immediate results were most brilliant and gratifying, yet he knew of no operation in surgery

which was more brutal and shocking than the efforts of an unskillful man to intubate the larnyx. He ventured the opinion that the great majority of deaths reported as due to the pushing down of membrane were really due to apnea from unskillful and prolonged attempts, or to asphyxia from forcing the tube through a false passage. Neither Dr. O'Dwyer nor himself had ever had death on the table due to pushing down the membrane, although they had operated on nearly seven hundred cases.

OPERATION FOR THE DEFORMITY OF PROMINENT EARS.-In the Annals of Surgery, Prof. W. W. Keen describes a new operation for the deformity of prominent ears. The operation consists in removing from the long axis of the posterior aspect of the auricle a long oval piece of skin, the cartilage being laid bare by the dissection. A strip of cartilage of the same length, but narrower and V-shaped on cross section, is then removed, taking great care not to cut through the skin on the opposite side. Cat-gut sutures may be introduced through the cartilage in addition to those in the skin. The operation is attended with very free bleeding, which, however, is easily controlled. The stitches are not removed until the tenth day.

THE TIME FOR SURGICAL INTERFERENCE IN ACUTE INTESTINAL OBSTRUCTION..—ı. In all cases the use of milder measures, such as purgatives, enemata, and massage, may be safely carried out until the supervention of fecal vomiting. 2. As soon as this is established, an exploratory incision into the abdomen should be made without delay. 3. Obscurity of diagnosis in presence of this symptom, ought not to stand in the way of an operation. 4. Clinical experience has taught that there is very little chance of recovery when once stercoraceous vomiting has begun, unless an operation be performed. 5. Symptoms of collapse are not a contra-indication to operative interference.-Canada Lancet.

RESORCIN FOR RODENT ULCER.-Dr. Chas. Szadek (Satellite) recommends resorcin for various forms of skin diseases, particularly condyloma and verrucæ, in the form of ointment and powder. He reports a case of cure of rodent ulcer by using an ointment of resorcin and vaseline (25 per cent).

NEPHRO-LITHOTOMY.-Dr. Keyes (Med. Record) says:

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1. The posterior exploratory incision upon a kidney suspected to contain stone, is devoid of any serious danger when performed with proper care, and should be resorted to more often than is at this date sanctioned by general surgical opinion.

2. The best incision is the transverse, below the twelfth rib, with as much of a liberating incision downward along the line of the edge of the quadratus as may be required to gain ample room.

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3. The kidney may be freely cut into and rudely lacerated with the finger, when the stone calls for it, without producing any hemorrhage which hot irrigation will not control.

4. It is better, in the case of a large, branching calculus, to break it up, and extract it in fragments, rather than to remove it entire.

5. So little danger attaches to the posterior incision, that it seems wiser always to make it the first step, reserving peritoneal exploration for a later recourse in cases where the posterior exploration miscarries.

RESORCIN IN SIMPLE CHANCRE.-Dr. Leblond (British Jour. of Derm.) causes the ulcer to be sprinkled each day with resorcin powder, and the following morning gently cleaned, as long as the base of the sore is of a greyish color. In five or six days the whole surface of the wound is generally of a rosy hue, and shows healthy granulations. Then a five per cent. resorcin solution dressing is applied, and cicatrization quickly follows. Resorcin will cure a recent chancroid in a couple of weeks, and adenitis rarely develops.-St. Louis M. & S. Jour.

MEDICINE.

MEDICAL HEROISM.-There are two armies. The one in splendid trappings, with gorgeous banners flaunting in the van, with golddecked officers who cheer or threaten, with men whose faces gleam with the fierce delight of victory, or darken with defeat, sweeps over the earth with horrid noise of shouting men, and rattling musketry, and thunder-rolling guns. The air is darkened by its dust, and the earth shakes beneath its rushing squadrons. It passes, and the peaceful fields are blackened in its track; the clear streams are stained with long, dark streaks of blood, and all of nature's thousand happy voices are drowned in awful groans, wrung from the parched lips of mangled things that once were men.

The other host comes with so still a thread you hardly note the Its men are sober suited, and the faces steadiness of its advance. of them grave and set. Here and there upon some brow the deeper lines, the whiter hair, in some calm countenance the sadder eyes, mark alone the presence of a leader, whose daily foe for many years, perhaps in many lands, is death. For, though no mortal ear may catch the sound of conflict, each man of this devoted band is target for a myriad poisoned darts that fall more gently than the silent snow; and many, ah! how many, as the great host keeps its unfaltering way, drop stricken from its ranks and yield the ghost, not leaving even one dark stain on God's green grass to mark the spot they fell. But they fall not in vain. Ever before them flee the fell sisters, pain and death. Ever behind them rise the deep sigh of relief, the murmured prayer of gratitude, the glad cry of Rachael, weeping no longer, but comforted, for her children are restored unto her.

The one is the army of death, the militant hosts of the world. Nations are proud to honor its heroes, and their monuments of brass or marble are lifted to every sky. The other is the army of life, the host Esculapian, and with the exception of a few, a very few, we may look, and we shall look in vain, for their memorials.

The roll of this honorable company is forever lengthening. The journals tell us of the death of Lawson of scarlet fever, “contracted from a patient;" of McCaughin of typhus, taken while attending the