in the United States, 672. outlook, the, 95. prevention of, 368. Sobriety a great recommendation, 20. Some interesting cases taken from record-book things not learned on the benches, 181. Springtime medical rhymes and jingles, 551. State and Local Boards of Health of Ohio, 96. Stomach, influence of spices on the, 54. in the child, the, 239. the examination of the functions of by means "Story of Luke," the, 49. Strained relations at Ithaca, the, 418. Subjective sensations and their objective causes Striæ atrophicæ, 413, 512. Subscription problems, 561. rates, 154. Suprarenal gland as a hemostatic, the, 444. 13, 44, 58, 86, 116, 149, 166, 195, 218, 246, Surgical instruments, 417. Swamped by physicians' bills, 540. the Justus test for, 20. and gonorrhea, instructions to patients af- TABES associated with anterior poliomyelitis Temperatures taken in the mouth, the trust- worthiness of, 577. Tennessee State Medical Association, 437. Tetanus and vaccination, 208. contaminated serum, 218. three cases of, 227. treated with veratrum viride, recovery; re- Therapeutical iconoclasts, 446. Time, 436. Tobacco deafness, 523. To drink or not to drink, 237. Tracheotomy tube retained three years and four months, 59. Transylvania University, the old, 545. Trunk sewer for Mill Creek Valley, a, 187. Tubercular glands of the neck, treatment of, 259. the essentials for successfully treating, 174. Tuberculous working women, the necessity and Typhoid bacillus and lemon juice,.51. fever, treatment of with castor oil, 608. fatal throat complication in the convales- treatment of hemorrhage in, 125. perforation, its surgical treatment, 492. ULCERS in the stomach of a child, a case of Union District Medical Association, 417. Ups and downs of a physician's life, 10. Urinary secretion, the; its obstetrical and gyne- VACCINATION law sustained, the, 51. COMPARATIVE ANATOMY. A knowledge of comparative anatomy is essential, especially for experimental work. In reptiles only one surface of the capillaries is exposed to the air, while in men all sides are exposed to air. The lung of the water-dog (necturus lateralis) consists of two elongated cylindrical bodies. Both the outer and inner surfaces are smooth. There is both an arterial and venous system. These are so arranged that each vein is at right angles to the corresponding artery. Snakes have only one lung (the right). It is an elongated cylindrical body, and smooth two-thirds of its length. The posterior third is divided into numerous air cells, which communicate with a central cavity without any apparent communication between the air cells. In birds the bronchus, after penetrating into the lungs, breaks up into numerous tubular passages. These passages are not true bronchia, since the alveoli or true lung structures arise directly from them. The principal bronchia communicate by large rounded openings with large air-bags situated in the abdomen and in the hollow bones. These air-bags should be considered as part of the lungs, as they are directly connected with the bronchi. The air-sacs do not communicate with one another. LUNG OF MAN-BLOOD SUPPLY. In the first, the venous radicles from the bronchioles empty into the vena pulmonalis, and the arterial branches into the vena azygos. Hence in all operations involving the bronchus the latter should be ligated transversely, whether it be transverse to the lung or not. The larger pulmonary arteries and vein... are situated in the intra-lobular connective tissue. They subdivide into minute vessels, each encircling an alveolus, and then split up into a very fine capillary network, only separated from the air by the exceedingly thin alveolar membrane. Only a single mesh of capillaries exists in an interalveolar septum. Malpighi, 1661 A.D., was the first to discover them. He first found them and the lung cells in the mesentery and lungs of frogs. Lymphatics rise from the alveolar septa and communicate directly with the alveolar cavity by stomata in the alveolar walls. The lymphatics form a plexus in the submucous tissue accompanying the branches of the bronchia, as well as the pulmonary veins and arteries, emptying finally into the bronchial glands at the roots of the lung. Nerves. The pulmonary plexi are formed from branches of the vagus and sympatheticus. The filaments of these plexi follow the ramifications of the bronchia, and finally become lost on them in the parenchyma of the lungs. Monkeys have an accessory lobe called the azygos lobe. This is supplied by an The lung receives its blood from two accessory bronchus, which arises from the systems, the bronchial and the pulmonary. right bronchial trunk near the point where * Read before the Western Surgical and Gynecological Association, at St. Joseph, Mo., December 29 and 30, 1902. the first branch is given off. The bron. chus of the sheep grows from the trachea direct. Man's septum bronchiole is placed to the left of the longitudinal axis of the trachea. For this reason foreign bodies lodge more frequently in the right bronchus, which is shorter than the left. This is also why the right lung respires before the left at birth. There are, sometimes, three branches of the bronchus. The sensibility of the bronchia is thought to be slight. Lobes.-Some animals have one or more lobes, having as many as five on one side. Some have fissures while others have not. Man.-The normal number of lobes on the left is two, while three are upon the right. The fissures are many times so high porsteriorly that the middle lobes will prevent palpitation and auscultation of the posterior surface of the upper lobes. EXPERIMENTAL (HISTORICAL). Davidson's (1795) observations on the anatomy and pathology of the pulmonary system is one of the first contributions to this subject. Harlan, 1819, showed by experiments upon living animals that the circulation of the blood through the lungs is immediately and entirely suppressed during expiration. Cauman, 1848, said that the capillaries of the lungs do not anastomose. Bert, 1869, contributed his research on the elasticity and contractility of the lungs, and the connection of these properties of the lungs with the pneumogastric nerves. Brown, 1884, showed the alveoli of the lungs to contain squamous epithelium, and in 1885 that the bronchia contract under certain conditions. Crevilheir, by dissection of a fetus, showed that one or both apices may extend along the cervical spine. Here it may be remarked that the fact that the pericardium has never been found absent should be remembered in eliminating its absence in herniated lung of the left side. It should also not be forgotten that the lower costal cartilages on the left side in women are rare, and that the cervical ribs are also rare, there being but two cases of the latter reported. LIGATURES (HISTORICAL). Susrutus, 1500 B.C., applied ligature to the umbilical cord of new-born babies before severing it. Hippocrates was familiar with ligatures. Archigenes, 100 B.C., was probably the first to use ligatures in amputations. Celsus, 30 B.C., used linen thread. Galen, 131-211 A.D., was partial to silk or fine catgut for ligating the proximal ends of injured vessels. Alphonso Ferri, fifteenth century, preferred a needle three inches long, curved only at the point, with the eye at the opposite end. Fabricius the Elder, 1537-1619, mentions the use of animal sutures for intestinal wounds. Fabricius von Hilden, 1560-1634 A. D., was first to introduce hemp for ligatures into Germany. Fabricius of Aquapendente, 1647, recommended metallic sutures. Animal sutures were introduced into America by Dr. Physick, in 1814. Wardorp used silkworm-gut for ligatures as early as 1796, and McSweeney in 1818. Dr. Ishigaro, a Japanese surgeon, used a ligature made from the tendon of a whale. Marcy, 1871, and Croft, 1880, employed kangaroo tendons. Silk cat-gut and animal tendons are preferable for sutures and ligatures in the lung. PNEUMONOTOMY, PNEUMONECTOMY, PNEUMONOPEXY. In this chapter are included all cutting operations, such as amputations, incisions, removal of foreign bodies, opening of abscesses, gangrene, cysts, etc. In each of these chapters, however, have been placed their respective cases. Fabricius, 1646, records cases in which large portions of the lungs were excised, with recovery of the patients. Baglion, 1714, advocated operations on the lungs, and Barry, twelve years later, advised operations on the lungs for consumption. A fellow-officer wounded with General Wolfe at Quebec, 1759, is said to have recovered after the removal of a large portion of the injured lung. Hale, 1851, referred to a case of pene trating wound of the chest in which he removed a piece of the protruding lung. Little was said concerning operations on the lung for more than a century later, when Richard, 1880, reported a case of penetrating wound of the thorax with. immediate pneumocele. Excision of the lung was employed, and the patient recovered. Thomas, 1885, suggested and treated cysts of the lung by opening and drainage. Bull, 1891, treated two cases of gangrene by operation. Tuffier, in his Moscow address, analyze 306 pneumonotomies, as follows: Metapneumonic gangrene, different causes, 55 operations, 10 recoveries; 49 operations for abscess, 23 per cent. succumbed; 3 operations for incipient tuberculous foci cured; 26 operations for cavities, 13 recoveries; 29 operations for aseptic lesions, 22 recoveries (75.8 per cent.); 61 operations for hydatids, 55 recoveries; 215 operations for septic lesions, 140 recoveries (64.8 per cent.); tubercular cavities, 36 operations, 36 deaths; abscess, 49 operations, 12 deaths; bronchiectasis, 45 operations, 13 deaths; foreign bodies, I operations, 4 deaths; gangrene, 74 operations, with 30 deaths; actinomycosis, I operation, recovery; total 306, cured 217, died SS. B. Bell advises and opens abscess in any locality of the lung with more or less success. ABNORMALITIES. There are many types of abnormalities of the lungs, any one of which might greatly influence surgical intervention. There may be one, two, three, four, five, or even more lobes, or there may be the entire absence of lung tissue on either side. The blood-vessels, nerves and bronchi vary greatly in number and position, so that there is no way of determining their presence or absence without opening the chest before or after death. General body deformity is also many times a cause for variations from the normal type. The diaphragm is ofttimes entirely absent in man. Hoffman, 1783, reported a case of diaphragmatic junction with the lung, and Broca, 1852, reported one with complete separation of the two lobes of the lung. There have been about fifty interesting papers contributed to hereditary defects of the lung. Atelectasis-Apneumatosis.— Atelectasis is collapse of the lung before birth, and due to many causes, such as continued compression of the lung by fluid, new growth, or deformity. Apneumatosis is collapse of the lung after birth, due to the same causes. Joerg, 1832, Barlow, 1841, and Spangenberg, 1844, each record such cases. More than thirty observers have reported upon this subject in the various journals. Hernia or pneumocele is of many varieties and degrees. Lung tissue may protrude from an opening in any portion of the chest. It may be congenital or acquired-congenital when there is defective development of the chest wall, acquired when due to injury. Sudden hernia have no pleural sac, while those which come gradually do have a sac. If left alone the first always have adhesions, while the latter may or may not have adhesions if let alone. Rolandus, 1499, removed a portion of a herniated lung with recovery, and he took the patient to Bologna for inspection by his colleagues. Tulpius, 1674, ligated and cut off three ounces of the lung which protruded. Knox reports two cases of hernia of the lung in the neck. Couvey reports fourteen such operations, with two deaths. Morell - Lavaliè, 1824, reported eight with one death. Of twenty thousand wounds of the chest during the rebellion there were only seven herniæ of the lung. Abscess is the most frequent surgical lesion of the lung, and recovery more certain in the acute form, when operated upon. Balgious, 1710, was one of the first to treat tubercular abscess of the lung. Bligny, 1720, Berry and Boerhave, 1726, each advocated opening tubercular abscesses of the lung. Campradon, 1769, treated a case of abscess of the lung, and cured it by surgical intervention. Gumprecht, 1793, treated an abscess of the lung surgically. Richard, 1812, successfully incised an abscess of the lung, with recovery. There are many other cases of abscess of the lung, tubercular and otherwise, |