method by the patient's symptoms, while the innocent encysted foreign bodies might usually be best let alone. Attempts have been made to ascertain the existence of renal calculi by the new photography, but no successful cases are known to the writer. In an emaciated or very small subject, however, it is possible that the method may yet be shown to be of value.

Regarding the possibility of photographing the brain, it is, of course, to be remembered that we are dealing with a substance transparent to the ray energy, while its container, the skull, is more or less opaque. It is, however, not unlikely that the localization of certain foreign bodies in the cranial cavity, when not too far from its walls, may be accomplished, and the existence of bony tumors of the skull be discovered.

Where doubt exists as to the involvement of bone in joint disease, the skiagraph may throw light on the case, though it may be difficult by the use of a single picture to tell just where the trouble is. Pictures of exostoses, tooth-cysts, and rarefying tumors in the jaws may be obtained by having the plate held in the mouth, while the X-ray bulb throws the rays through from the outside. In such pictures the entire tooth with root, crown and canal is beautifully shown, so that in the case of dentigerous cysts there is no reason why the included teeth should not show as well as the dentine of the bone-covered, normal tooth-roots. A negative observation may here be of decided value, for if an abnormally situated tooth is not seen by this method it probably does not exist. The writer has operated in one case, not yet published, where absence of tooth in a tumor of the upper jaw was diagnosticated by the cathodal picture. The tumor proved to be a fibroma, but it had been pronounced by a dentist to be a dentigerous cyst.

Bone, as above stated, is more or less penetrated by X-rays according to its thickness and density. The skiagraph has been found useful in determining whether a fracture callus is soundly ossified. When a complete ossification has taken place, the position of the fracture shows distinctly darker than the uninjured parts of the bone.

Thinking that kataphoresis might be accomplished by cathodal ray action, the writer performed experiments in this direction, but in no case has been able to observe a specific action upon the skin.

In working with the X-ray apparatus for the purposes of diagnosis, it is necessary to note carefully the position of the photographic plate or the fluoroscopic screen in order to interpret correctly the results. Remember, too, that the farther an object is from the plate, the larger and more indistinct it will appear. In examining for foreign bodies of unknown shape, one should take pictures from three directions as widely divergent as possible.

HOWARD LILIENTHAL.

Surgical Hints.

When a patient comes to you complaining of symptoms in or about the rectum it is best not to give a final opinion until you have examined the empty bowel. If necessary, request him to take an enema and then return for further examination.

Never give an opinion based on appearences at the anus alone, but always explore with the well lubricated finger as high as you can reach, and also by conjoined touch with a finger of one hand in the rectum, the fingers of the other hand being on the abdomer. A man may have hemorrhoids or anal fissure and also a cancer or polypus high in the gut.

Digital rectal examination is easiest made with the patient lying upon his side with the knees and hips flexed. Tell him to make a mild expulsion effort during the manipulation, and he will experience

much less discomfort.

There is seldom any use in treating a fractured hip in an old and feeble person. It is the patient and not his disease which requires careful watching and nursing. Get him out of bed as soon as the local shock with the accompanying swelling and pain subsides, and do not invite pneumonia, bedsores, and a host of complications by confinement in one position. Above all, if any fixation apparatus be used, let it be as light and portable as possible, remembering that in the vast majority of cases good results will be as likely to follow treatment without splint or other appliance.

Fractures of the arm and fore-arm are often kept too long in splints, and the resulting atrophy from disuse may in the end be far more serious to the patient than a moderate degree of deformity with a sturdy and useful member.

A dislocation should be reduced as soon as possible, while a fracture may often be allowed to wait for a convenient time and place, the emergency dressing simply guarding against such accidents as perforation of the skin by subcutaneous fragments of bone, dangerous pressure upon important structures, or threatened laceration of nerves or vessels.

In purchasing surgical instruments select by preference those which are large enough and strong enough to be used with comfort. Toy instruments, such as may be found in many pocket cases, are often worse than useless. Let your instruments be few, simple and efficient.

Clinical Department.

HERMAPHRODISM SO-CALLED, WITH AN ILLUSTRATIVE CASE.*

BY J. W. LONG, M.D.,

Professor of Gynecology in the Medical College of Virginia, Richmond.

Gentlemen:-The name of this anomalous condition comes to us from mythology which gives us an inkling as to the entity of such a thing. Hermaphroditus was the fabled son of Hermes, the god of commerce, invention, patron of thieves, etc.; and Aphrodite the goddess of love. This young man being enamoured with one Salmacis, became so intimate with her that, like Keat's dewdrops, they "slipped into one," and ever afterwards Hermaphroditus was double-sexed.

An hermaphrodite, then, may be defined as a person having the genital organs of both sexes. They are divisable into:

1. True hermaphrodites.

2. False hermaphrodites.

True hermaphrodites are subdivided into:

(a) Bilateral-where ovaries and testicles exist simultaneously on both sides.

(b) Unilateral-where an ovary and testicle exist on one side.

(c) Lateral-where an ovary is present on one side and a testicle on the other.

As a matter of fact, true hermaphrodism, while common in many of the lower animals, is so rare in the human species as to be almost a non-entity. Only two or three cases have been proven by autopsy. 2. False hermaphrodites are either:

(a) Males resembling females.

(b) Females resembling males.

It is easy to understand how a male with perineoscrotal fissure, infantile penis, hypospadias, and undescended testicles would simulate a female. Many such cases have been classed as females, dressed as women and married to men. This is, indeed, the preponderating type of so-called hermaphrodites.

On the other hand, it is just as easy for a woman with an hypertrophied clitoris, fusion of the labia, and hernia of the ovaries to be mistaken for a man.

The case which I have the pleasure of presenting to you, is that of a man resembling a woman. His history is very indefinite as regards many points, so you must take some things he says cum grano salis. Schmidt (which he admits is an assumed name) claims to hail from Vienna, Austria. He says there

A clinical lecture delivered before the graduating class and later before the Richmond Academy of Medicine. The excellent photographs illustrating this paper, were taken by Dr. William H. Taylor Professor of Chemistry in the Medical College of Virginia.

THE TREATMENT OF CARBUNOLES.

BY THOMAS PAGE GRANT, M.D., Louisville, Ky. Honorary Member American Association of Military Surgeons of the United States.

On Thursday afternoon Mr. L came to my office suffering with a carbuncle on his neck, which he said had been coming for three days and that he "waited for it to get ripe" before consulting me. Having suffered from this worst of all furunculous tumors, he was not a little anxious and somewhat depressed, as he had an important business trip arranged for the next week and he was especially anxious for a speedy recovery. On removing the dressings from his neck I found an induration about. two inches in diameter covered with pus; on cleaning it off there were brought to view six pustules in a space about three-quarters of an inch in diameter; these pustules were oozing a thick pus, and I was satisfied that my patient was in for a siege with one or more carbuncles, as there were a number of other pustules on his neck which looked bad, to say the least.

Taking a knife I made a free incision across the top of the carbuncle; after evacuating as well as I could, I washed it out with a solution of carbolic acid about three to five per cent. After this with a pair of dressing forceps I removed all the broken-down tissue I could, a plan which I have found to be of great service in many cases of carbuncles, as thereby whole colonies of micro-organisms are taken out that otherwise would increase and multiply until thrown off by suppuration. Having cleansed the wound thoroughly, I packed it with dry protonuclein special; after which I applied a poultice of flaxseed meal, on which was a teaspoonful of fluid extract of eucalyptus globulus.

wound was healed, and the induration was almost entirely gone, and I dismissed the case with directions that he keep a dressing of the ointment on the seat of the carbuncle for several days to protect the tender skin.

In an extensive and moderately successful experience-both personal and professional-with carbuncles, I have never seen a more threatening outlook for a serious carbuncle, nor one so quickly and satisfactorily cut short as in this case; and I am of the opinion that the results in this case are far ahead of the old-fashion treatment of poultices alone, or the more modern injection of methyl violet, or the treatment ting, which leaves a great gaping wound to be filled up much extolled of late, of total extirpation and curetby granulations and skin grafts, or to become an open ulcer followed by ugly scars. I am free to say that I am convinced that the success in this case is largely due the use of protonuclein, as with the same general line of treatment, which has been the very best I could find, I was never able to cure a carbuncle under two weeks, whereas in this case it was cured as quickly as a simple wound would have been. 815 Third Avenue.

REPORT OF TWO CASES OF GUN-SHOT WOUND OF SPINAL CORD.

BY WILLIAM CULLEN BRYANT, M.D, Finleyville, Pa..

Case 1. A young colored woman, aged twenty, was: shot in the left side of the neck, about midway be-tween the clavicle and inferior maxilla, and just posterior to the "trio" (carotid artery, internal jugular vein and pneumogastric nerve). There was immediate paralysis of both sensation and motion below the diaphragm. Patient did not complain of any pain, but. had slight stiffness of the arms which gradually deepened into paralysis. A diagnosis of injury to the spinal cord was made and a fatal prognosis given. Considering that my probes were better in their casethan in the wound, I simply applied an antiseptic dressing, and waited for the inevitable. The temperature rose gradually to 104° F., the pulse to 120.. Dyspnoea supervened and death occurred forty-two hours after the shooting. The mind was clear until the end.

Case 2. A young colored man, aged twenty-four, got into a row at a dance, and was shot in precisely the same location and presented the same symptoms as the preceeding case. The temperature rose in twenfour hours to 103°, then dropped to 101° twelve hours later, and again rose to 104° just before death, which occurred fifty-eight hours after the accident. His mind also remained perfectly clear until the end.

Death occurred from failure of respiration, the heart continuing to beat for three minutes after all respiratory movements had ceased.

Post mortem in the first case revealed the fact that the bullet had passed through the body of the second dorsal vertebra, penetrated the substance of the cord, and was found under the right scapula.

In the second case the bullet was found imbedded in the substance between the second and third dorsal vertebræ, having carried with it a piece of the victim's shirt collar. The bullets in both cases were 38 calibre. Death in both cases undoubtedly resulted from paralysis of the diaphragm when the inflammatory process reached the origin of the phrenic nerves. The question arises: "Was an operation indicated or justi"Supposing the ball had been removed, would the function of the cord ever have been restored below the point of injury?"

fiable ?"

Both cases were shot at very close range, and I considered the bullets as bearers of septic germs. Considering carefully all the pros and cons, I decided that to operate would simply hasten the end that seemed inevitable. The question of gunshot wounds of the cord, is rather sparingly discoursed upon by modern writers. I would like to see an article from some one

on the subject. Another point regarding the above cases was that they were both murder cases, and the defendants lawyers asked the following all-important question: "Was this injury in and of itself absolutely and necessarily fatal ?" It was answered in the affirmative.

A New Method of Cauterization.-Dr. Laubenberg describes the following method which he has employed with success in cases of angioma in infants, papillomatous growths in the skin and mucous membranes, obstinate ulcers, cancerous ulcerations : The part to be cauterized is first carefully washed with a tepid antiseptic solution, after which fuming nitric acid is applied with a cotton-swab wound round the end of a stick, and soaked in the acid. Before the local action of the acid has been exhausted, pure liquid carbolic acid is applied to the same surface by means of a small staff, dipped in the acid. Care should be taken that only very small quantities of each acid are thus brought into immediate contact, if one wishes to avoid the slight explosion which necessarily would follow the mixture of somewhat large drops of nitric and carbolic acid. It is needless to state that one must never mix in the same bottle these two acids, which form a very explosive substance. After the cauterization the surface is dressed with a mixture of iodoform and tannic acid, or of tannic and boracic acids.-Medical Week.

Surgical Memoranda.

Hypertrophy of the Prostate.-Dr. A. T. Cabot, in a paper read before the American Surgical Associations May, 1896 (Jour. Am. Med. Assoc.) discussed the question whether additional experience shows that castration is a curative remedy in the treatment of hypertrophied prostate. His conclusions were as follows:

1. In the matter of mortality the operation of pros. tatectomy has a slight advantage over castration. It last improvements in the technique of prostatectomy, seems probable that with later statistics, reflecting the this advantage would be further increased.

2. Prostatectomy has the further advantage that it allows of a thorough examination of the bladder and of the discovery and correction of other conditions not before suspected. Stones are frequently removed in this way without adding to the gravity of the operation. In several reported cases of castrations the absence of improvement has led to the subsequent discovery of stones which have required other operations for their removal.

3. Prostatectomy has, on the other hand, the disadvantages that it confines the patient for a longer time, and that it is sometimes followed by a fistula. This occurred in one of the forty-two cases cited in this paper.

4. It is too early to know whether any permanent loss of vigor follows castration when done on old men. The nervous effects which sometimes immediately follow the operation, suggest a suspicion that with the testes the system may lose some tonic effect exerted by those organs.

5. The functional results of the two operations seem at present to be as nearly equal as possible, and the tendency to relapse shows itself in about the same proportion of cases after either operation.

6. The reduction in the size of prostate after castration, is largely due to a diminution of congestion. Later a degeneration and absorption of considerable portions of the gland may occur. The glandular elements are particularly affected by this atrophy.

7. Castration would seem to be especially efficacious in cases of large tense prostates when the obstruction is due to pressure of the lateral lobes upon the urethra. 8. Castration is of but little use in myomatous and fibrous prostates.

9. Prostatectomy has its especial field in the treatment of obstructing projections which act in a valvular way to close the urethra. There is, however, no form of prostatic obstruction which a skilful operator may not correct by prostatectomy.

10. Prostatectomy is then applicable to more cases