comes from the external plantar branch of that artery and from the posterior tibial at the bifurcation; and that it is important, therefore, to leave at least a half or three-quarters of an inch of the external plantar artery intact. The pocketing of the flap is not objectionable, and can be in great part remedied by making a much shorter anterior flap, the lines of the incision being well above the level of the ankle joint. I have discarded, in general amputations of the leg or arm, any method looking to obtain a long posterior and short anterior flap (Teale), with the idea of bringing the cicatrix away from the end of the stump. I have always held that a circular skin flap, with or without a lateral incision, as the emergency may demand, is the ideal flap, the muscles being divided an inch or more above the level of the circular incision through the skin, and the bone sawed on a level with the muscle. Dissection of the periosteum from the end of the bone, in order to secure a periosteal flap, is entirely unnecessary and should not be done.

In certain cases of amputation, when osteomyelitis has prevailed, it was thought that the surgeon might be called upon to carry his amputation high up, close to the shoulder or hip joint, in order to get above the disease in the bone. This is not good surgery, for the longer the limb the more useful to the patient, and bones that are the seat of osteomyelitis can be readily cured provided the canal is opened even near the knee or elbow joint and the bone carefully curetted up to the end of the canal. The insertion of a drainage tube through which aseptic irrigation is made every day or two, and the gradual withdrawal of the tube, will cure the disease in the bone and leave the stump long and useful. I have, in several instances, carried out this plan with invariable success.

One other point has been of great service to me in effecting rapid amputation. When making a hip-joint amputation or an amputation through large masses of muscular tissue after tieing large arteries, such as the two femorals and the circumflex branches, in order not to lose time that is usually spent in applying forceps to oozing surfaces, I pass deep catgut sutures through great masses of muscle all the way across the whole cut surface and tie these firmly. In this way the muscles are brought together and compression exercised which prevents bleeding. Ten or fifteen minutes can be saved by this practice in an ordinary amputation. In the last hip-joint amputation I did by the bloodless method, although I made no effort at haste, the operation was done, the vessels were tied, and the disarticulation was completed in twenty-five minutes, the tourniquet still remaining on until the wound was ready to be closed by sutures. In this amputation I now apply the tourniquet higher than at first advised. Experience has taught me that complete control of hemorrhage can be obtained by carrying the strong white rubber tubing close in the crotch, where it is held by the inner pin, while the other pin is so inserted that the tube passes in the notch just

below the the anterior superior spine of the ilium, from which the sartorious muscle originates. In this way the pressure is entirely above the level of the hip joint, the capsule can be opened, and disarticulation rapidly affected without any attention to the tourniquet. If the tourniquet is not tightly applied, when the bone is removed and the rubber tubing is slackened by diminished resistance, there may be some slight dripping from the vessels in the posterior part of the flap; but this is immaterial and can be immediately controlled by pressure with the fingers and the application of artery forceps.

It is not necessary to emphasize to this Society the point that in amputating for malignant disease it is the better surgery to get just as far from the lesion as possible, shaping the flap to meet this object.New York Medical Journal.

A CASE IN PRACTICE.

BY DR. J. C. ANDREWS, 528 E. 6th St., Los Angeles, Cal.

In March last Mrs. H., mother of five children, the youngest but thirteen or fourteen months old, was again confined. She recovered rather poorly; the secretion of the mammary gland was so small in amount, and so poor in quality, that she was compelled to wean her child. In resorting to the various artificial foods, with impaired digestion, the child was poorly nourished. So that when dentition began, the child was in an exceedingly poor.condition to weather the impending storm. When in the course of teething, bowel difficulties intervened, and finally convulsions were ushered in, I was summoned and was soon at the bedside of the little sufferer. The first spasm had been relieved by the use of the usual domestic remedies, when I learned the above history of the case. Its present condition was that of cerebral irritation, caused by the long continued looseness of the bowels. The evacuations were now very frequent, thin and watery, and exceedingly fetid, and cadaverous in odor; the face was flushed; the eyes were bright and staring; the nervous system was suffering severely; the parents were excited and wringing their hands, when the child was seized with another convulsion, which seemingly could not be controlled. It lasted for six or seven hours, though liberal doses of specific gelsemium with bromide of potassium were administered, after which it was in a semi-conscious state with sighing respiration, and it was with difficulty that anything could be gotten into the stomach. The case now presented a serious aspect. After twelve to fifteen hours of unceasing toil and care, the parents gave up all hope of seeing their child recover, and became reconciled to its fate. I also thought the

child would die, as the sclerotic became congested, and the bowels continued to run off. But we were unceasing in our labor with it, giving it water frequently, besides the medical treatment which was now radically changed. Besides getting into it all the water we could, with a small quantity of food, it was now taking hourly teaspoonful doses of the following: R. Specific aconite gtt., ij., specific passiflora 3ij., specific matricaria gtt. x., specific echinecea 3j., water ounces four, under which, with quinine inunction morning and evening the child in due time, entirely recovered, and is now three months after, a fat, healthy boy.

There is nothing specially new or stunning in this case, except that of the specific action of the three last named remedies. The last one corrected the condition of the intestinal canal and its secretions, removing the fetor of the alvine evacuations, thus overcoming one of the prime factors of the trouble. The other two in relieving the severe tension of the nervous system, permitted the child, under careful and judicious nursing and feeding, to get well. I am strongly of the opinion that in too many cases these little sufferers fail to recover from the want of pure, fresh water; and I attribute not a little to its free use in this case, as it was sponged and fed with it every few moments. As of necessity the system under the strain of a burning fever, and frequent watery evacuations, the vascular system is drained to its utmost. It must be supplied or the child will die.

Specific medication based on specific diagnosis, gets there every time. If this hurried article helps any one out in these cases, it will have served its purpose.

THUJA IN HYDROCELE.-Mr. M

age 56 years, came to my office for consultation. Diagnosed the case as hydrocele. Patient told me that he had been operated upon five times previously, and that the scrotum refilled in three months after each operation.

First I put the patient half under anæsthesia. Then I took a small trocar and pushed it into the sac; then withdrew the point and left the canula in. Evacuated the fluid. After evacuation I injected two drams of the following solution,-one part "Lloyd's Thuja" and three parts

warm water.

Waiting an hour no pain occurred. I instructed my patient to go home, and in case pain occurred, to report. Six days after the operation the man reported that he had very much pain and that the scrotum was swollen as before. I instructed him not to do anything, that the swelling would subside eventually.

The patient reported after three months, and upon examination, I found no infiltration. He was permanently cured.-DR. E. Schneller, Ackley, Iowa.

DELAYED UNION IN FRACTURES.-(Journal of Materia Medica.)— Mr. George A. Peters, M. B., F. R. C. S., recently addressed the Ontario Medical Association on this topic. After referring to the value of anæsthesia in diagnosis, he says:

Having set the fracture and applied retentive apparatus, we must inquire how in any given case the surgeon in charge can ascertain whether the normal processes which result in the welding together of the fragments are going on or not. All are agreed that meddlesome surgery, like meddlesome midwifery, is bad. It certainly is injudicious and unjustifiable to remove the splints at frequent intervals, and test by flexions and rotations the degree of union that has taken place. Undoubtedly great harm may result from such interference. In fact, such meddlesome curiosity has, in itself, frequently been a cause of nonunion. On the contrary, it is unwise to set fracture once for all the time of injury, and then never remove the splints until it is expected they may be left off permanently. It is difficult to state in a general way what rule should be tollowed in regard to this matter. Much will depend on the nature and seat of the injury. To be as definite as the general character of the question will allow, I consider that it is good treatment to loosen the splints and examine the seat of the fracture within the first forty-eight hours. (If there is burning pain in the skin under the splint, over bony prominences, or elsewhere, this should he looked to as soon as complained of, otherwise a slough may occur.) It is true that there will not be much diminution of the initial swelling, and the tenderness will be great at this examination, but muscular spasm will have passed off. Any gross deviation from the normal length or continuity of the bone may be detected, and the necessary readjustment made more easy than at a later period. Throughout the whole course of the treatment thereafter, it appears to me a wise measure to remove the splints every four, five, or six days, according to circumstances, so as to expose the seat of the fracture for a few moments at least, to the sunlight and air, and to subject the skin and muscles to a light friction and massage in order to prevent what has been very aptly called "local scurvy." Now I wish particularly to state that this must be done without permitting any movement whatever of the fragments upon one another, and I would most strongly deprecate any idea of "testing the degree of union by bending or rotating the limb." Such testing can do no good whatever; it rarely gives any reliable information to the surgeon, and it may be productive of very great harm.-Am. Med. Review.

HYSTERIA. It is said that one-tenth grain of apomorphine, given hypodermatically, will break up and thereafter prevent any attack of hysterics. Med. Age.

THUJA IN HYDROCELE.-I have used thuja in this disease with the grandest success, and consider it "the specific," either in chronic cases, or in those of recent date. I will cite a chronic case cured by one injection to prove to you its value. Last September Mr. Jacob S―, of this town, presented himself at my office for relief from this disease. He stated that he had been "tapped seven times" during the past three years with only temporary relief-the last physician telling him there was no permanent cure for him.

After examining him thoroughly, I told him I could cure him, my confidence being so great in thuja. I stated though, that it would probably require more than one operation.

On September 4th, 1895, I called at his home and operated, selecting a medium sized trocar. I made a quick firm plunge through the integument into the tunica vaginalis and through the canula, drew off over two quarts-by measure-of clear fluid. Then injected spec. thuja, water, aa 3 ss and manipulated the scrotum for a few minutes, then allowed the medicine to escape. No bad symptoms followed the operation; patient recovered rapidly, and to-day, nearly five months after the operation there has been no return of the disease, and Mr. S― says he is feeling better than he has done for years. I consider this a severe test case for thuja and its success strengthens my faith in its efficiency.-Edwin Scott, 2118 La Grange St., Toledo, O.

RHUS TOX.-We have been having an epidemic of measles here, and one of its worst complications has been sore eyes. There have been great redness of conjunctiva, swelling of palpebræ, photophobia, and extreme lachrymation. Specific rhus tox. in from two to five drops according to age of child in four ounces of water, a teaspoonful every hour has proved a true specific.

In any case of sore eyes, marked by redness and inflammation of conjunctiva, you will find it truly a specific. At least this has been my experience, and I feel quite sure that it has a curative affinity for this portion of the anatomy.

Again, I have had most excellent results from it in controlling the extreme nervousness and jactitation accompanying typhoid fever in children. It has proved of much more benefit than passiflora for me: but as yet I have not had experience enough with it in these cases to be sure of its specific action. Try it and report.-G. W. Harvey, M. D., Kanab, Utah.

WATER. When judiciously taken in half-pint doses as a laxative in the morning, as a sedative in the evening, as a diuretic when the skin is cool, as a diaphoretic when the skin is warm, as an expectorant, or a refrigerant, its value is remarkable.-Pye Smith.