ounce, given four, six, or eight times a day, each dose representing one drachm of the saline. No dose was repeated on the following day until the stools had been inspected. The treatment was continued until every trace of blood and mucus had disappeared, which was generally the case in two or three days. In some cases they returned in three or four days, necessitating repetition of the treatment. He advocates this method for acute cases only, and does not deem it safe with chronic or relapsing cases with ulceration of the colon. Considering the fact that the death-rate among the natives, from dysentery, is usually given as from 30 to 37 per cent, its reduction to about 1 per cent is certainly a favorable showing.-Journal American Medical Association.

FORMALDEHYDE IN SUPPURATIVE OTITIS MEDIA.-Dr. H. O. Reik (Maryland Medical Monthly) cites thirty-one cases of chronic otorrhea to show that formaldehyde will cure those cases which are susceptible of cure by syringing with an antiseptic solution in a much shorter time and with more certainty than the solutions usually employed. He says that the advantages which formaldehyde has over boracic acid and bichloride are (a) its bacterial power compares favorably with that of bichloride or any other agent; (b) it can be entrusted to any patient with safety; (c) it has great rapidity of action, and also a stimulating effect upon the local tissues.

As to the manner of using formaldehyde, it is most satisfactory to use one drachm of the commercial solution of formaldehyde (40 per cent) in one pint of boiled water, and to direct that the ear be syringed twice daily, using at least a pint of the mixture at each sitting. This is equivalent to a 1:300 solution of the formaldehyde gas. Stinging sensations usually follow its use, but the amount of discomfort is slight and lasts only a few moments. In sensitive ears a weaker solution can be used.-Medical Review of Reviews.

Results of OPERATION For Varicose VEINS.-Dr. Blake (Medical and Surgical Reports of the Boston City Hospital) comes to the following conclusions:

1. Operation for radical cure of varicose veins by dissection is not suc cessful in every case.

2. To obtain successful results cases must be selected, and certain conditions avoided and recommended to palliative treatment.

3. The conditions which will probably militate fatally against satisfactory results are: (a) Old age, or an extremely debilitated condition; (b) excessive and very extensive varicosity; (c) occupations which to an extraordinary degree favor the development of varicose veins.

4. Cases which may be cured by a thorough and careful operation are: (a) Local varix, even of marked prominence, particularly if thrombosis has occurred either in thigh or lower leg; (b) extensive varix, limited to a single venous stem; (c) varicosities which are a bar to passing civil service, military, or naval examinations; (d) cases in youth and middle life; (e) cases

in which the development of permanent varicosity was at least partially due to more or less removable conditions (flatfoot, garters, etc.).

5. Operation, even if not entirely successful, will usually relieve such complications as thrombosis, hemorrhage, and ulceration.

6. The usual conditions which follow unsuccessful operation are: (a) Pain in and around the scar; (b) general swelling and tenderness of the leg; (c) development of varicosities above or below the operation scar, but not at the site of the operation itself.

7. In all operated cases general systemic treatment as well as local treatment should be prescribed, together with exercise and the avoidance of a continued upright position whenever possible.

8. Cure of symptoms does not necessarily mean the removal of all visible varicosities.

Comparison of relative methods of multiple ligation and continuous dissection must be based upon a larger number of cases than are here recorded. Ibid.

RESULTS OBTAINABLE IN The Treatment of Dense, Tight, DeepLYING STRICTUres of the UreTHRA.-L. S. Pilcher (Annals of Surgery). In cases of retention due to a deep stricture, prolonged efforts are not made to secure the passage of instruments. If a No. 2 or No. 3 French olive-pointed bougie does not pass readily, the bladder is aspirated and preparation made for urethrotomy, usually without a guide. A free incision is made in the perineum, and if the urethra is found to be a distorted, hardened mass of cicatricial tissue, from one half to three quarters of an inch may be excised and the divided ends brought together. In the majority of the cases the urethra is split along its floor and a gorget introduced into the bladder, followed by the introduction of the finger. The first joint of the index finger corresponds to about a No. 60 sound of the French scale, and dilatation short of this is not advisable. The meatus and penile urethra is cut until it admits a No. 40 sound, and a sound of that size is passed through the entire urethra into the bladder. A rubber tube of about the same size is passed through the perineal wound into the bladder and held in place by sutures passed through the sides of the wound. A packing of iodoform gauze is placed around the tube. After four days the tube is removed; sounds Nos. 36, 38, and 40 are passed in succession. The tube is not replaced, and the sounds are passed every third day for two weeks, then once a week, then at rapidly-increasing intervals-once a month, once in six months, once in twelve months. There is no theoretical reason why these old strictures should not be cured permanently, as overstretched scar tissue, as seen in ventral hernia, has no tendency to contract. Some cases which have been followed for several years show that the cure has been perfect.

A high tribute is paid to the late Fessenden N. Otis, who, without question, has pointed out the way whereby in the management of the worst forms of urethral strictures a full restitutio ad integrum may be secured in many instances.—Georgia Journal of Medicine and Surgery.

TENDON TRANSPLANTATION IN MUSCULO-SPIRAL PARALYSIS.-Von Biste records the case of a youth, aged twenty, who was stabbed in the left forearm, the extensor muscles and the posterior interosseous nerve being divided. He was unable to dorsiflex or supinate the hand, or to extend the fingers or thumb. An attempt was made to find the divided ends of the nerve, but it was not successful. All the muscles supplied by the posterior interosseous nerve were paralyzed, and did not react to faradic or galvanic stimulation. The following operation was performed: An incision was made above the ulnar styloid process, the flexor carpi ulnaris was exposed and divided close to its insertion. An oblique incision was made at the junction of the middle and lower thirds of the forearm, exposing the extensor communis digitorum. The flexor carpi ulnaris was then drawn underneath the extensor of the same name, and stitched to the extensor digitorum in the angle between the tendons of the third and fourth fingers. The wound suppurated and healed by second intention, but after the use of the battery and massage the movements of the fingers improved very considerably. At a second operation, the tendon of the flexor carpi radialis was drawn beneath the tendons of the extensor ossis metacarpi and primi internodii pollicis, and stitched to the tendon of the secundi internodii. The wound again suppurated, but in spite of this he recovered the power of extending the thumb, and six weeks later he was able to perform all the manipulations required in his occupation of engine fitter.-Centralbl. f. Chir., Leipzig.

Abscess of the Liver in ChiLDREN.-The following are the conclu sions arrived at by Oddo, writing on the subject of abscess of the liver in children: (1) Abscess of the liver is a rare condition in children, except as the result of injury, but traumatic abscess is relatively more common in. them than in adults. (2) This relative frequency is probably due to the occurrence of blows or injuries on the abdomen, to which children are more subject than adults. (3) Sometimes the abscess developes immediately after the injury, while at other times a latent period intervenes, during which time the symptoms are in abeyance. (4) Generally the injury has been applied directly over the hepatic region, in which case the abscess is primary. Occasionally an abscess of the liver results from an injury to some other part of the abdomen, when the resulting abscess is secondary or indirect. (5) The symptoms of a traumatic abscess of the liver are local pain, swelling, and fluctuation; at the same time there is fever, either remittent or continuous, and rapid and profound cachexia in every case. (6) The natural tendency of the liver abscess is to rupture, either through the skin or through the respiratory passages. In the latter case the abscess discharges either through the bronchi or into the pleura, setting up a purulent pleurisy or a pyopneumothorax. (7) The evacuation is followed generally by a rapid amelioration of the symptoms, but in every case surgical intervention brings about a more certain and rapid cure of the condition.-Rev. mens. d. mal. de l'Enf., Paris.

THE TREATMENT OF INOPERABLE SARCOMA.-The results so far achieved by Dr. Coley and others in the treatment of inoperable sarcoma with the mixed toxines of erysipelas and bacillus prodigiosus might nearly have been deemed unimportant were it not for the fact that they deal with cases previously so utterly hopeless that every brand snatched from the burning constitutes here nothing less than a triumph. Dr. Coley has again taken up the subject in an essay read before the American Surgical Association, at Baltimore, last May. He is unable to suggest any improvements in the methods advised seven or eight years ago, but neither have his conclusions changed. The important fact remains that about fifty per cent of cases of inoperable spindle-celled sarcomas can be thus cured, while the proportion is considerably less in the other varieties of this form of neoplasm, and in carcinoma the results are practically nil, only a few cases having shown temporary improvement. The duration of the cures obtained is certainiy most encouraging. In a certain proportion of the cases the tumor dwindled to so small a size as to readily allow a complete excision. One case only recurred after eight years, another after more than three, while a boy was living and in good health after seven and a half years, and a woman is now well after nearly eight years. In all he is able to report sixteen cases that have remained well from three to eight and a half years. In eight cases the tumor disappeared entirely.

In the present state of science we must agree with Dr. Coley in the statement that the action of the toxines can be explained only upon the theory that malignant tumors are the result of some infectious microorganism, and we venture to add that the results obtained by him give support to the idea that more efficient means of cure will in time be discovered.-International Journal of Surgery.

THE CYSTOSCOPE IN THE DIAGNOSIS OF DISEASES of the GENITOURINARY TRACT.-The introduction of the cystoscope has been quite an advancement and help in the diagnosis of bladder and kidney diseases. J. W. Handly, according to the Southern Practitioner, says:

Since its introduction by Nitze in 1887, this delicate little instrument, by its kindly light, has aided in opening dark avenues and obscure recesses hitherto impossible to the genito-urinary surgeon, for lack of a clear insight into the affected parts; and so cleared and illuminated the way that where we formerly dwelt in doubt now we can feel the strong arm of certainty; where our treatment was once expectant and often inappropriately applied, now the most radical measures can be adopted with a feeling of security that we are treating the exact organs affected, and not erroneously the one or the other, as heretofore our custom.

Some of the essentials necessary for intelligently using this instrument are: First, that the urethral caliber be of sufficient size to admit it without injury to the urethra so as to cause bleeding. The caliber must be from twenty-two to twenty-four millimeters in size, and its course must be

straight.

Second, the bladder must have the capacity of four to five ounces. Third, the fluid contained must be transparent, and remain so during the examination. Any deviation from the above essentials will obscure our examination, and necessitate bringing into requisition sounds and solutions to aid in obtaining the above.

Now as to some of the diseases of the bladder, ureters and kidneys, the diagnosis of which may be cleared by the aid of the cystoscope, we find central prostatic hypertrophy, carcinoma of prostate and bladder, vesical ulceration, vesical tumor, vesical calculus, free or encysted-cystitis, gonorrheal, tubercular or prostatic; inflammation around the ureteral orifices, ureteral calculi, sequel to nephrolithiasis, pyelitis or pyelonephritis.-The Charlotte Medical Journal.

THE RESULTS OF PRIMARY VERSUS SECONDARY Nerve Suture.-At a recent discussion on this subject before the Surgical Society of Paris, Reynier maintained that the regeneration of a divided nerve and the restoration of sensory and motor functions is greatly influenced by the length of time which intervenes between the division of the nerve and the suture of the cut ends. When there is an interval of several hours or days, the restoration of motor functions does not take place until six months or a year have elapsed, but when the suture follows immediately on the division of the nerve there may be an absence of any trophic, sensory, or motor paralysis. In two cases in which he divided the external popliteal nerve in the course of excising the head of the fibula, the immediate suture of the cut ends was followed by complete restoration of function. The abstractor had a similar experience; the ulnar nerve was accidentally divided in performing an excision of the elbow-joint for advanced tuberculous disease; the cut ends of the nerve were brought into apposition with catgut sutures, and when the dressings were removed a fortnight later there was no indication of any paralysis. Reynier's observations were not supported by the other surgeons who took part in the discussion, nor have they been confirmed by experiments on animals.—Rev. de Chir., Paris.

RENAL TUBERCULOSIS.-H. M. Kinghorn (Montreal Medical Journal) finds that the general symptoms are often lacking at the onset, but later there may be loss of appetite and weight, perhaps some night-sweats, and especially fever, with evening rise. Polyuria is one of the first indications, and frequency of micturition, equally marked at night, is suspicious. At any time there may be a brisk emission of considerable pus, or blood in clots or streaks may appear. Blood not clotted is intimately mixed with the urine, and the hematuris may be intermittent, lasting for a few days at a time. The bacilli are differentiated with such difficulty from the smegma bacillus, even with acid alcohol, that guinea-pig inoculation is the method of choice for diagnosis. The stain used in Trudeau's laboratory is carbolfuchsin, which when washed and dried is decolorized with twenty-five-per