some hours have elapsed does an appreciable | pulpy granulations, and the débris of longdischarge appear. The explanation of this continued suppuration. phenomenon is that the Eustachian tube being closed, swelling of the mucous membrane of the tympanum and antrum, and more especially of the somewhat complicated folds and reduplications of mucous membrane existing at the upper part of the tympanum and antrum, occurs so suddenly as actually to compress the air contained in these cavities, producing pain and interfering with the transudation of serum from the distended capillaries. Under such circumstances, the instillation of a drop or two of a 4-per-cent. solution of cocaine into the mouth of the Eustachian tube by means of an Eustachian catheter and Politzer's air-bag will sometimes secure patency of the tube and afford marked relief from pain. Often the use of the air-bag alone is sufficient. The treatment of cases of commencing mastoiditis will some times tax the ingenuity of the surgeon in order to successfully abort threatened suppuration, and, for this purpose, the use of cold over the mastoid by means of Leiter's coil, the application of leeches, paracentesis of the upper posterior part of the drum-head, and the administration of frequently-repeated small doses of calomel or the sulphide of calcium, is of decided value.

The treatment pursued in the case of chronic abscess of the mastoid, detailed above, is that which I generally carry out, aside from the fact that the operative procedures in this case were done without the aid of general anæsthesia. This innovation, apparently unavoidable under the conditions that existed, is not to be recommended, because, where caries of the mastoid bone is at all extensive, the utmost care on the part of the surgeon must be exercised to avoid wounding the lateral sinus, the facial nerve, or labyrinth, or opening the middle cerebral fossa; and complete control of the patient during the operation, such as can only be secured by his complete anesthesia, is more than desirable. I have, however, already operated three times in cases of chronic suppuration of the mastoid cells similar to the one I have detailed above, and in each case secured a creditable result. The pain of the operation cannot be very great. It is a well-known fact that the skin over an abscess can be incised without causing great pain, and curetting the sinus cannot be very painful if the sharp curette be used with only sufficient force to remove

The prognosis, as far as the more or less complete restoration of the hearing is concerned, is good in most cases of suppurative mastoiditis. Of the eight cases in which I have trephined the mastoid, all but one ultimately attained very satisfactory hearing in the affected ear. The remaining case is still under treatment. An injudicious operator can, however, do much at the time of operation to impair his patient's chances of satisfactorily recovering his acuteness of hearing by continuing the use of the curette or chisel until the wound involves the important structures of the middle or internal ear. Practically, the attic, or recessus epitympanicus, and the mastoid antrum are one cavity, with only a thin layer of bone, the tegmen, between it and the dura mater of the brain. A ridge of bone containing the facial canal and the external semicircular canal projects outward in such a manner as to narrow somewhat the communication between the attic and antrum. Frequently these im portant structures are encased by only a very thin, bony covering, and, lying almost in a direct line of operation, it is entirely possible to wound the facial nerve or the external semicircular canal by injudicious curetting at the bottom of a deep wound in the mastoid process. It should also be borne in mind that cutting into healthy bone and unaffected mastoid cells opens a way for the rapid absorption of morbid material and septic infection, some of the fatal results that have followed mastoid operations being attributable to no other cause than sepsis. It would seem the part of wisdom, therefore, not to insist upon the removal of all bone that is inflamed and somewhat softened, because the mastoid bone differs from most others in the fact that it contains large and numerous cavities lined with mucous membrane, the secretion from which will interfere with the maintenance of strict antisepsis. The mastoid bone is also covered both within and without by periosteum, so that its vitality is great, and, provided a condition approaching asepsis is maintained, small amounts of greatlyinflamed bone quickly return to a condition of health, and do not much retard the healing of the wound.

No. 41 SOUTH NINETEENTH Street.

DR. EDWARD C. MANN has located at for Madison Avenue, New York City.

A CASE OF ABDOMINAL HYS

I

of the wall of the divided ureter. Traction on these sutures dragged the ureter into the

terectomy, IN WHICH THE bladder, and, when tied, they held it in this

URETER WAS RESECTED AND
IMPLANTED INTO THE BLAD-

DER.*

BY CHARLES B. PENROSE, M.D., Professor of Gynecology in the University of Pennsylvania. REPORT this case because the immediate implantation into the bladder of a ureter, which has been divided during a cœliotomy, is a rare proceeding.

The patient was a white woman, 40 years old, who had a scirrhous cancer of the cervix uteri. The growth extended as high as the internal os, and infiltrated the left broad ligament, in a dense, hard mass, to a distance of about one inch from the cervix. There was no involvement of the vagina. There were no symptoms of obstruction of the ureter.

position.

The loose peritoneum, which formed a partial investment to the ureter, was drawn down and sutured to the peritoneum of the bladder by a continuous silk suture around the line of union of ureter with bladder. The abdomen was closed without drain. A soft-rubber catheter was introduced through the urethra and was retained for three days. The patient made an unusually easy recovery.

There were no symptoms of bladder or renal disturbance. The quantity of urine passed was as follows: 10 ounces in the first twentyfour hours; 26 ounces in the second twentyfour hours; 22 ounces in the third twenty-four hours; and 38 ounces in the fourth twenty-four hours.

She left the hospital twenty days after operation. Her physician wrote me in December that she was perfectly well and doing her own housework. He wrote again in Februaryover six months after the operation-that she was suffering with pain in the right iliac region,

Cœliotomy was performed at the Gynæcean Hospital in July, 1893. It was found that the left ureter passed directly through the hard mass in the left broad ligament; and in order to remove completely all diseased tissue, it was necessary to excise about one inch of the ureter, -the portion involved in the broad ligament.perhaps a recurrence of the disease. After the uterus had been cut away at the vaginal junction, the distal end of the ureter was ligated with silk, the vagina was closed, the peritoneum was sutured over the seat of operation as much as possible, and the proximal portion of the ureter was then implanted into the body of the bladder. The operation was similar to, and was derived from, that used by Dr. Van Hook for uniting a ureter after complete transverse division, by lateral implantation of the proximal into the distal portion (Journ. Amer. Med. Assoc., March 4, 1893). An incision was made antero-posteriorly in the body of the bladder somewhat less than one-half inch in length. A needle, armed with fine silk, was passed through the bladder wall from without in, at a point about one-third inch from the edge of the incision on the right, and brought out through the incision. It was then passed through the right wall of the ureter close to the extremity, carried back through the incision in the bladder and passed through the bladder-wall from within out, close to its point of entrance. A similar suture was passed on the left side of the incision in the bladder and through the left side

She has at no time presented any symptoms whatever of disease of the urinary organs.

Our text-books on surgery advise that, in case the ureter be torn or cut across during the removal of an abdominal tumor, the renal end must be brought out through an opening made for this purpose in the loin. And in some instances nephrectomy has been performed for the relief of such an accident.

* Read before the Philadelphia Academy of Surgery.

The clinical and experimental researches of Dr. Van Hook, of Chicago (paper read at the Forty-fourth Annual Meeting of the American Medical Association, June, 1893), a recentlyreported case of Dr. H. A. Kelly, when a divided ureter was immediately united by lateral implantation of the proximal into the distal portion, and the case just reported go to show that the advice of our surgical text-books should be modified; and that, if the patient is able to endure a slightly-prolonged operation, and the anatomical conditions are suitable, it is better immediately to implant the proximal portion of the ureter into the distal portion or into the bladder.

It is announced that the Atlanta Polyclinic has disbanded.

by the idea to see how milk would act under the same conditions. He takes fresh milk and incloses it in a tight vessel, where it is compressed with oxygen to kill the germs, and finally he puts it in cans of 100 litres, under pressure of two atmospheres.

M. Villon affirms that in this condition the milk will be in a state of perfect preservation after a voyage lasting for months. It supports

whereas, ordinarily, milk rapidly curdles if maintained at a temperature of from 50° to 75°. The author has sent milk from Lyons to London, and has had it returned. This milk, on its return, showed no sign of germ or ferment, and had the taste of fresh milk.

It has been observed in experiments made with formalin to determine its antiseptic powers on various pure cultivations of bacteria, that though formalin is intensely active against all kinds of disease germs, yet there are very appre-heats of 80° and 100° without coagulating, ciable degrees in its activity toward different organisms. In some cases this appears to be so great as to suggest its employment by Schild as an easy means of recognizing or distinguish ing one species of bacteria from the other, that are otherwise liable to confusion. Thus, for instance, Schild finds that the growth of the typhoid bacillus is checked by the action of formalin far more readily than that of bacterium coli. The growth of typhoid bacilli in broth is effectually prevented by the presence of 1 part formalin in 15,000, whilst bacterium coli continue to multiply in the same medium even when the proportion of formalin is increased to 1 in 3000. Consequently Schild advises the application of the following test to discriminate between the bacteria mentioned: Seven cubic centimetres neutralized broth is introduced into a test-tube and then sterilized; O.I cubic centimetre of 1-per-cent. formalin solution is then added by means of a sterilized pipette, giving a proportion of disinfectant of I in 7000. The tube is then inoculated with some of the culture under examination; in the case of typhoid bacillus the broth remains perfectly clear, whilst with bacterium coli it becomes turbid in twenty-four hours.- Centralblatt für Bakteriologie.

THE PRESERVATION OF MILK BY OXYGEN.

The problem of the preservation of milk in its fresh state has heretofore been considered to practically admit of no solution. Milk is the most variable of all liquids; and often, after a few hours, it is changed and has begun to sour. For its preservation a number of systems have been tried, sterilization at 100° C., pasteurization, condensation, by freezing, etc. It is evident that none of these methods gives fresh milk, the liquid when thus treated differing materially from milk fresh from the cow.

M. Villon, in pursuing his studies relative to the aging of brandies by the help of oxygen and carbonic acid under pressure, was inspired

If these experiments verify themselves in practice, it is clear that the method will be of great importance. Milk farms far from the centres of consumption would thus be able to send as the products of their dairies a milk at once fresh and natural to the markets of the large cities. But this procedure, though simple enough, and admitting that it is productive of results,-will it free us from the bacillus of tuberculosis? M. Villon says that all the germs are killed. We hope he is not mistaken in this respect. In any case it would be easy to prove the fact and to experiment with a method that presents itself, if proven, with so many evident advantages.

The milk question is a social one, and anything in regard to its preservation should not be treated with indifference.-(From the French-La Journal des Débats. By R. OLIVER KEVIN, M.D.)

FORMALIN AS A DISINFECTANT.

Dr. S. Rideal, lecturer at St. George's Hospital, London, writes as follows: Experiments that I have made with formalin as a disinfectant and preservative agent have yielded some very interesting results, and I am fully satisfied that in it we possess a bactericide and antiseptic of considerable value. When added in very minute proportions to substance capable of undergoing putrefactive change, it prevents such decomposition for a considerable time. This preservation may be effected in the case of liquids by adding a small amount of a diluted formalin solution to them, and in the case of solids either by spraying them from time to time with a weak solution, or by suspending them in an atmosphere impregnated

I have also had an opportunity of trying the effect of formalin as a preservative of specimens from the post-mortem room, and find that a 1 per-cent. solution is very effective for this purpose. The liquid does not become turbid nor dark-colored, and after three weeks' constant use and exposure to the air its strength had only fallen from 1.0 to 0.45 per cent.-London | mine. Corresponding experiments in regard Therapist.

The sensation vanished when the powder was | Ethylenediamine is not escharotic or corrosive, no longer given upon an empty stomach. but extremely mild, when it is as pure as Dornblüth can, therefore, recommend tolysal Schering's preparation. as an excellent antirheumatic remedy. An effect upon menstruation, which in most cases is lessened and shortened by salipyrin, he was not able to determine for tolysal.

This agent dissolves albumen very easily, even when boiled.

From this observation ethylenediamine would probably be suitable for dissolving membranes, such as are produced in diphtheria and similar diseases of the mucous membranes.

Etyhelenediamine, by dissolving this pseudomembrane, would therefore enable us to attack the real seat of this dread disease, the growth of the Loeffler bacillus on the mucous membrane. This must, of course, be done by the use of antiseptic solutions. Ethylenediamine may be mixed with trikesol, the new antiseptic now so much in vogue.

Dr. Zurhelle, of Burtscheid, also reports that tolysal is of especial benefit in acute and subacute articular rheumatism and in muscular rheumatism. He finds it of particular service in cases which had been treated by means of sodium salicylate, and which had relapsed when the remedy had been discontinued. Tolysal proved efficient, moreover, where the salicylate had failed or was not tolerated. In doses of 1.75 grammes (27 grains) thrice daily, or in certain cases five times daily, at intervals of two hours, the drug rapidly relieved pain and fever. No unpleasant effects, such as are often caused by sodium salicylate, were witnessed. Tolysal is much better borne by the stomach than so-erties of the nitrate, and yet not forming such dium salicylate. Occasionally it excites a coryza which, however, soon disappears. Deutsche Med. Zeitung.

NEURODINE.

This substance, which is chemically acetylparaoxyphenylurethane, is very slightly soluble in cold water, and, according to von Mering, is an anti-neuralgic, which, in the dose of 1 to 1.5 grammes (15 to 24 grains), is a succedaneum to phenacetine in the treatment of migraine and different forms of neuralgia. Pain ceases half an hour after absorption of the drug. It also has antipyretic power. A dose of 8 grains will lower the temperature 2° or 3° C. (32° to 5° F.). It sometimes, however, produces unpleasant effects, such as cyanosis, sweats, etc. The writer concludes that the drug should not be employed as an antipyretic, but only as an antineuralgic, in the dose of I gramme (15 grains) given in cachets. He thinks that the dose may, in certain cases, be increased to 4 or even 6 grammes (1 to 12 drachms). La Medicine Moderne.

ETHYLENEDIAMINE, AN ALBUMEN SOLVENT.

Though ethylenediamine is already a wellknown body, the therapeutical use of this chemically pure preparation is new. It is a clear, colorless liquid, of specific gravity 0.97. It is easily soluble in water, strongly alkaline in its reaction, and possesses an ammoniacal odor.

ETYHLENEDIAMINE SILVER PHOSPHATE

SOLUTION

A silver salt possessing the bactericide prop

insoluble sodium chloride and albumen combinations, has long been a desideratum.

This has at length been attained by E. Schering's chemical factory in the substance known as ethylenediamine phosphate of silver. The ethylenediamine itself has been proven to have but a very slight cauterizing action, and with fluids containing albumen and sodium chloride the alkaline silver solution causes only a turbidity, and no precipitation. The phosphate was chosen instead of the nitrate on account of the formation of ethylenediamine nitrate, a substance showing several undesirable by effects.

The solution of the ethylenediamine phosphate of silver is a colorless, clear fluid, containing twice as much ethylenediamine as phosphate of silver, and to the former its alkaline reaction is due. Like all the other silver salts, the preparation must be kept in the dark, as it decomposes when exposed to the light.

Dr. Jean Schäffer, Assistant Physician at the University Dermatological Clinic of Breslau, has lately published the results of an elaborate series of experiments with the new silver salt. They show very clearly that the ethylenediamine phosphate of silver solution possesses all the properties of the nitrate in much greater degree than does that salt itself. Parallel experiments were made in every case with argentic nitrate solutions, and the results compared.