Higgins, of Chicago; Mrs. Louis Remelin, of Cincinnati; Mrs. H. McLenore, of Chicago, and Mrs. E. B. Carrick, of New York.

Dr. Carrick was a Mason and member of the Loyal Legion.

The Clinical Value of Cryoscopy. Dr. Gaetanoflorio (Gazz. Degli Ospedali E Delle Clinche, July 6, 1902) concludes as follows as regards the clinical significance of cryoscopic examinations: The cryoscopic examination of urine gives very important clues as to the functional state of the kidneys. The urine of twentyfour hours should be collected for the freezing test, but it is not nccessary to obtain the urine from each kidney by ureteral catheterization. The freezing point of urine taken from the bladder in a case of unilateral renal disease is different from that of a case in which the lesion is bilateral. When one kidney is diseased the freezing point does not reach below 0.95, while, when both are diseased, it is nearer to 0.45 or 0.30. The proteid substances, such as albumin, pus, etc., do not take part like the crystalline substances in influencing the freezing point in the urine, and therefore cryoscopy offers a means of differentiating most readily cystitis from pyelitis and pyelonephritis. This fact also explains the independence of the freezing point from the specific gravity, which may be increased by the proteid substances. The freezing point of blood is not proportional in any way to that of urine, as the toxic substances in the blood are not wholly excreted by the kidneys alone. The loss of renal permeability through disease would influence the freezing point of blood only if the other emunctories were also impaired. The formula of Claude and Balthazar, whereby the relation between the chlorides of the urine and the organic substances excreted by the kidneys can be established, have no application in surgery, as the chlorides vary with the amount of chlorides taken in, and with the intensity of intestinal fermentation. Cryoscopy has no application in surgical conditions which do not involve the kidneys directly or indirectly.-N. Y. Med. Times.

IN lumbago, macrotys in combination with hydrangea and potassium acetate cannot be excelled.-Med. Summary.

Current Literature.

Suture of the Liver.

After we pass Glisson's capsule, according to Dr. R. C. Coffey (Med. News, August 30), the softer structures of the liver have no more power to retain sutures to control and counteract blood pressure than so much mush. He thinks it of no use to apply sutures directly to the liver tissue for this purpose, and employs a mattress suture where all the pressure comes on Glisson's capsule at three or four points. The pressure is all the time toward the center of the incision, and obliterates all the space at the bottom. Two sutures are used, one being applicable to an incision which does not penetrate the liver entirely, and the other is applicable to wounds in which the liver is severed through and through. One he calls the Y-suture, the other the X-suture. The Ysuture is placed as follows: "A round curved needle, at least four inches long, armed with catgut or silk, is passed through the catgut support to the bottom of the incision, comes out on the other side, passes through another catgut support, re-enters through the support of the same side, goes back parallel to the other stitch and comes out through the support from which we started, making a quilt suture. A suture is then passed from the opposite side of the liver, either straight through or indirectly, as may be convenient, includes the two threads at the bottom of the cut in its loop, comes out on the bottom of the liver and again both ends passing through a single catgut weave are tied in the form of a quilt suture, thus drawing the other suture well into the bottom of the cut. The first suture is now tied, and any amount of pressure can be used, for the line of pressure is not against the suture, but is on the catgut supports. Thus the bottom of the wound is brought in absolute apposition, and any amount of pressure desired may be used. This may not bring the surface of the liver in as close contact as is desired; therefore a second quilt suture is passed through the edges of the support, nearest the wound, simply taking in the capsule. In this way the tissues are abso

the

lutely brought into contact, and as much pressure can be brought to bear in closing a wound of the liver as in any other part of the body. In closing a wound of the liver which extends entirely through its substance, a modification must be used. Instead of the single suture which goes into the bottom of the liver, a second quilt stitch is passed through both sides on the bottom, the same as the Y-suture above, interlocking the two sutures to the center of the wound. In this way the pressure is brought to bear in a very effectual manner." The cuts which illustrate article give a better idea of the suture than the description, and the reader is referred to the original. Coffey says, as far as he knows, this method is entirely new, but he is conducting experiments on living animals to find the amount of catgut that will be absorbed. The points which are original are the use of the catgut weave for a support and the indirect or angular pressure made by a counter-traction suture. The needle should be round, full-curved and fully four inches long. The one with which the counter-stitch is made may be a simple darning needle, or any kind of a long straight needle.-Boston Med. and Surg. Journal.

The Food Factor in Education. "Overpressure" in education has now for some time been made the theme of endless discussion. This crusade against modern methods of training the rising generation has not been undertaken with out valid cause. The youth of great cities throughout the world are crammed with knowledge-much of which is more or less useless-while their physical condition is neglected. The consequence is that the urban population is degenerating in physique and constitution, and is becoming every year less fitted to fight successfully the battle of life. In the British Medical Fournal, April 4, is an article which, although allowing that the present tendency to overload the minds of the young produces many evil effects, yet contends. that insufficient food is a factor of much

importance in the production of ill-health, and that the diet of growing children is generally inadequate. both as regards quantity and quality. Dr. Clement Dukes, a distinguished authority on school hygiene, states that the average schoolboy

requires meat twice a day, and suggests that the innumerable petty misdemeanors of boys may be due to insufficient nourishment. Underfeeding is especially noticeable in the case of girls. Dr. Newsholme points out that girls thus underfed often get into the habit of relying on bread and butter and puddings to the almost complete exclusion of meats and other nitrogenous food. The conclusion arrived at from a consideration and comparison of diets in various schools in England and France, is that, as a rule, not enough nitrogenous food is given, and that girls are generally underfed. In these days, when examinations are harder and competion more acute than ever before, the strain upon the mental faculties and upon the nervous system of those at school and college, is exceptionally severe, and in order to preserve good health, the necessities of the body must be carefully looked after. The young, then, when studying hard should not only be given sufficient food, but suitable food.-Med. Record.

Leprosy.

The former fear of of the contagion of leprosy is shown to be much overrated and the dread of the spread of the disease very much diminished as its history and progress have been more carefully studied. As regards the cause of the disease we are still in a great measure in ignorance. Mr. Jonathan Huchinson, the distinguished scientist in England, has recently made careful inquiries at home and abroad, more especially in Africa, as regards the cause and communication of leprosy, and has reached the conclusion that notwithstanding the isolation of these cases, shutting them out from all contact with the outer world, there is no authenticated instance of the disease being communicated to the families of the sufferers, except by the contamination of the food prepared by leprous hands and eaten by the members of the family who are themselves uncleanly. Dr. Huchinson thinks that the great cause of the disease is the consumption of badly cured fish, which he thinks the natural home of the leproses bacillus and which is taken into the system not by the touch or the air, but through the mucous membrane of the mouth and the intestinal canal. In his investigations in Africa and in the leper

institutions in India he found it was among the fish consumers that this disease was most prevalent. This was particularly noted among the so called Salsette Christians, numbering about 50,000, whose diet consisted to a large extent of fish. In one asylum there were 369 lepers, and but 324 cases in the whole population of the Bombay presidency. These facts contributed by so authentic an authority as Dr. Huchinson are of the utmost importance in considering the entire isolation of leprous cases. In this city there are not more than a half dozen cases and these are located in a small building on the grounds of the Metropolitan Hospital. The treatment recommended in an institution in Ceylon, where marked beneficial results have been obtained, has been followed here with a certain amount of success, not in curing, but in preventing the spreading of the disease.-Med. Times.

The Importance of an Early Diagnosis of Cancer of the Stomach, with a View to Radical Treatment, with Remarks on Operative Results, Immediate and Remote.

A. W. M. Robson (British Med. Fournal, April 25) advances evidence to prove : 1. How desirable it is to make an early diagnosis of cancer of the stomach in order that a radical operation may be performed at the earliest possible moment.

2. That it may be needful to perform an exploratory operation, in order to complete or confirm the diagnosis.

3. That such an exploration may be done with little or no risk in the early stages of the disease.

4. That even where the disease is more advanced and a tumor perceptible, an exploratory operation is, as a rule, still advisable in order to carry out radical or palliative treatment.

5. That where the disease is too extensive for any radical operation, the palliative operation of gastro-enterostomy, which can be done with very small risk, may considerably prolong life and make the remainder of it much more comfortable and happy.

6. That some cases, thought at the time to be cancer too extensive for removal, may after gastro-enterostomy clear up. completely and get quite well.

7. That in cases of disease of the cardiac end of the stomach too extensive for

removal, the operation of gastro-enterostomy may considerably prolong life and prove of great comfort to the patient by preventing death from starvation.

8. That even where the disease is too extensive either for removal or for gastroenterostomy with a fair chance of success, the operation of jejunostomy may occasionally prove of service to the patient.

9. That where a radical operation can be performed the thorough removal of the disease may bring about as much relief to the patient as does the operation for cancer in the breast, uterus, and other organs of the body, and that in some cases a complete cure may follow.-N. Y. Med. Fournal.

Notes on the Topographical Anatomy of the Anastomosis between the Portal Vein

and the Ascending Vena Cava. Dr. Giovanni Russo-Travali (Riforma medica, April 15) gives the following data concerning the surgical anatomy of the region concerned in the operation of portal anastomosis proposed by Tansini. This operation, through the splendid results attained experimentally in animals. and through its simplicity, promises to become available for man. The incision should be made along the border of the ribs in the right hypochondrium. The abdomen having been opened, the lower edge of the liver is lifted and the colon pushed down, slightly lacerating the hepato-colic ligament. The cystico-duodenal ligament is then exposed, and the part of the duodenum looked for which embraces the head of the pancreas. The hepatoduodenal ligament is next sought. It is the right margin of the lesser omentum, including the cystic duct, the hepatic duct, the common bile duct, the hepatic artery, and the portal vein between its folds, limiting the foramen of Winslow. The anterior layer of this peritoneal structure is then divided and the ducts and hepatic artery are then pushed aside to expose the portal vein, which is carefully freed for as long a distance as possible from the surrounding structures, i.e., from the margin of the pancreas to the hepatic sulcus. The vena cava is situated at a deeper plane. It is exposed by pushing aside the hepato-duodenal ligament and the duodenum, and is found covered by the posterior layer of the peritoneum. The vena cava ascends almost vertically in front of

the spine at the right margin of the aorta. In the region considered, i.e., at the level of the insertion of the renal veins, the vena cava is very close to the aorta. A few centimetres below the insertion of the renal veins, the right spermatic (or ovarian) vein is inserted into the anterior surface of the vena cava. The sympathetic plexus sends branches parallel to this vein and crossing the vena cava.

The tract of the vena cava embraced between the renal veins and the spermatic or ovarian vein is the best for the portal anastomosis under consideration. On the right and externally, this tract is in relation with the right kidney and ureter, internally with the aorta, in front with the third portion of the duodenum, and behind with the lumbar vertebræ. The lumbar veins enter into the vena cava at right angles from behind, and this is important to remember when applying forceps to the wounded vena cava in order to arrest the bleeding. It is also useful to remember the occasional anomaly of the renal vein on the right side, which may be inserted in front of the vena cava, instead of at the side. With these anatomical data, the author believes that the anastomosis of the portal vein and the vena cava may be executed without great diffi culty in spite of the deep situation of the parts.-N. Y. Med. Journal.

A Case of Painless Amputation of the Leg after the Intraneural Injection of Cocaine.

John H. Gibbon, M.D. (Philadelphia Med. Journal, May 2), is an enthusiastic believer in this method of local anesthesia, in properly selected cases, although he is not an extremist in his advocacy of its use. If the technique of infiltration, as described by Matas, is carefully carried out failures should be few. At the present time, local anesthesia, of the kind referred to in this paper, should be limited to those cases in which a general anesthetic is contraindicated. The method is specially adapted to emergency hernia operations. The work of Crile in this field has been of great importance. A warning is needed for those unfamiliar with the method. Before trying the method in the more extensive operations one must have learnt to use the method successfully in the smaller The solutions of cocaine employed

ones.

must be freshly prepared and sterile, and the technique must be perfect. The case the author reports follows. A man, aged fifty years, with extensive tuberculous disease of the ankle joint and bones of the tarsus, presented himself for treatment. His general condition made amputation desirable, but contraindicated the use of a general anesthetic. Fifteen minutes before operation he received one quarter of a grain of morphine and a one hundred and fiftieth of a grain of atropine hypodermically. The sciatic and anterior crural nerves were then exposed by infiltration anesthesia (Schleich's fluid), and injected with a 1 per cent. solution of cocaine. Anesthesia was complete in about eight minutes. Amputation was performed at the middle third of the leg and absolutely no pain was experienced by the patient. He did not even know that an amputation had been performed. Examination of the patient, about one year after operation, failed to reveal any secondary nerve changes in the injected nerves.N. Y. Med. Journal.

Piano Playing.

In the course of a lecture to the Conference of Musicians in Dublin, Ireland, some interesting particulars and some astonishing statistics were given relative to the amount of work accomplished by the brain and nerves in piano playing, says the Scientific American. A pianist, in view of the present state of piano-forte playing, has to cultivate the eye to see about 1,500 signs in one minute, the fingers to make about 2,000 movements, and the brain to receive and understand separately the 1,500 signs while it issues 2,000 orders. In playing Weber's "Moto perpetuoso, a pianist has to read 4,541 notes in a little under forty minutes. This is about nineteen per second; but the eye can receive only about ten consecutive impressions per second, so that it is evident that in very rapid music a player does not see every note singly, but in groups, probably a bar or more at one vision. In Chopin's "Etude in E Minor" (in the second set) the speed of reading is still greater, since it is necessary to read 3,950 signs in two minutes and a half, which is equivalent to about twenty-six notes per second.-Atlanta JournalRecord of Medicine.