the median line of the abdomen. The peritoneum must be divided over the kidney before the extirpation can be accomplished.

LAPARO-ELETROTOMY.

Laparo-eletrotomy is a term used to designate an operation for the removal of the child from the uterus without cutting the uterus. It is intended to take the place of cæsarian section and it is done by making an incision from the spine of the pubis to the anterior spine of the ilium, then cutting through the peritoneum or pushing it up, the vagina is reached and opened and the child if presenting by the head is turned and delivered through the os uteri. It may be practised upon sheep or dogs, the incision being made from the pubis to the anterior spine of the ilium of these animals will enable the operator to introduce his hand into the pelvis to search for the vagina and incise it. He will in doing this observe how easily the bladder may be wounded in the removal of a child, through the operation of laparo-eletrotomy. Many of the successful cases of this operation have required subsequent operation for vesico-vaginal fistula and no doubt many of the fatal cases have followed extravasation of urine.

Good surgery would require one making this operation to inject the bladder with warm water or to use other means to find a rent or cut in the bladder, and when found close it with suture passed through its peritoneal coat.

It is difficult after comparing this operation with the cæsarian section to see where the advantage over the latter is. There might be a fancied advantage if the peritoneum were not wounded but such a result is quite improbable. The absence of sutures and a large wound of the uterus and the avoidance of the copious hemorrhage which follows the division of the large uterine sinuses in the laparo-hysterotomy operation, one can easily see would be very favorable for recovery. On the other hand, an extensive, incised, lacerated and contused wound of the deep pelvic connective tissue as required in the operation of laparo-eletrotomy would be very likely to set up a very grave cellulitis.

THE UNION OF INTESTINAL WOUNDS.

The union of intestinal wounds by suture was practised by the early masters of surgery, and it is impossible to give a fair conception of the different methods of employing intestinal sutures without referring to them. JEROME, of Bruynswyke, in his work entitled "The Noble Experyence of the Verteous Handy Werke of Sergeri" (London, 1525), says: "If that the wound of the belly is not grate inowgh, then shall ye make it greater, as I shall shew you hereafter, then shall you take out properly the guttes and sow it thereafter as it is nede

ful with a skymers nedyll. Jamericus, Theodoricus, Rogerius lay elder pypes in the guttes, under the seme, that the seme rotte not. WILHELMES and some other, lay therin a part of a cryer of a throte gall of a beest, as the IV masters sayeth. But ZANFRANCUS and GUIDE they think it not be profytable, for nature is inclyned to outdrawynge straunge thyngys and thus igt helpe not therefore it was layd, and it is better that the guttes be sowed, as afore is sayd, and that it be clensyed of the unclenes." The four masters mentioned here, practised in Paris, from 1235 to 1280, many years before JEROME wrote his terse work. They tried to unite wounded intestines by bringing the cut surfaces together over cylinders of dried intestine, bone, tallow, wax and almost anything that could be made to fill the lumen of the bowel and hold the cut edges in apposition. These various articles were expected to pass away by stool. Other French surgeons devised certain rings and ferrules of metal to be used in accordance with the principles laid down by the four masters, but no one now-a-days thinks of resorting to such cumbrous methods. It requires just as much skill in the use of the needle to sew the wounded bowel over any of those things as it does to make the suture of LEMBERT.

GLOREI'S suture is formed by passing the needle obliquely through the sides of the wounds when held together by an assistant.

loop on its inside, the ends were left out of the external wound, so as to draw the serous coat

of the intestine up to the peritoneum lining of the abdomen, after which the abdominal wound was closed and the threads fastened upon the skin by adhesive strips.

SUTURE OF HEYWARD.

A small, thin, and oiled piece of light wood, twelve to fifteen lines long, and four to six broad, being first introduced into the intestine at the wound with a piece of thread attached to it, each end of the thread was armed with a needle. After passing each needle from one side to the other, from the inside outward through the thickness of the intestine, and also of the abdominal parietes, the wooden plate was drawn upon so as to compress the peritoneal coat of the intestine against the serous lining of the abdomen, and close the wound hermetically. When the adhesions thus excited seemed to be sufficiently strong, that is, in about three days, the thread was withdrawn, and the little plate of wood left to be discharged by stool.

SUTURE OF GELY.

After cleansing the edges of the wound this surgeon turned in the serous surface on each side with the needle, and passed the threads tranversely through them, at sufficient distances to keep the serous membrane of each side in contact. Then the ends, being knotted and tied as in the interrupted suture, were left to come away by stool, or they were twisted and brought out of the wound, as in the suture of LEDRAU.

BERTRANDI'S SUTURE.

The lips of the wound being approximated, pierce them both rather obliquely about two lines from their edges, and one from their extremity. Then repassing the needle in the same way on, the opposite side, two lines further on, continue them in the same direction to the other end by a series of equal stitches. The intestines being reduced, fasten the end upon the abdomen, and three days subsequently cut off one end of the thread near the wound and draw out the other.

SUTURE OF LONGITUDINAL WOUNDS.

Suture of RAMSDOHR-Invagination of the two ends of the intestine being accomplished, this surgeon stitched them together by two or three points of the interrupted suture, reduced the intestine and left the suture to the efforts of nature If the mesentary interfered with the invagination he excised it to a sufficient extent.

Suture of JOBERT-With a piece of silk passed at each end into a needle, JOBERT operated as follows: After traversing the anterior part of the upper end frem without inward with one needle he then passed both needles from within outward through the lower end of the intestine, and after placing as many threads in this manner as were sufficient to unite the wound, invaginated the intestine by gentle traction upon the thread, and either knotted them on the outside of the inferior end, or brought them out of the wound and the abdo

as many of these loops as the size of the wound may require are placed, and the opposite ends of the ligatures are tied together. EMMET claims that it obviates some of the weightier objections to the methods of LEMBERT.

TREATMENT OF WOUNDED INTESTINE ACCORDTO JOHN BELL.

EMMET'S SUTURE.

BALDNESS-WHAT SHALL WE DO WITH IT? BY E. B. WARD, M. D., LAINGSBURG, MICH. In the issue of June 25th last your very excellent periodical contained an editorial on "Baldness-What shall we do with it?" This was supplemented by an extract from an article by DR. GEORGE T. JACKSON in the Medical Record, wherein the doctor proceeded to show the cause, and, so far as known, the prevention and cure of alopecia.

The article interested me much, not because I am bald, for fifty years of age finds my head far from lacking in capillary covering, notwithstanding the fact (as I have been told) that I was born bald, or nearly so. It interested me by the various reasons given as a cause of baldness, and also by the plan of treatment suggested, simply because experience does not bear out the conclusions arrived at.

With threads each armed with two needles;

Now, as I am not one of those literary doctors so feelingly and frequently referred to by the medical press of the land, my ideas may be presented in crude form and seem somewhat clotted with ignorance; still, in my child-like innocence and simplicity, I would like to have certain questions respecting the disease-if it is a disease-answered, and doubts removed, so that we shall all, through the medium of THE AGE, know how it is ourselves. That baldness is fearfully on the increase, especially among young men, cannot be denied. The back hair of an auditorium filled with men of any ordinary sort always reminds me of a pool table after the first shot, and that the recent meeting of the American Medical Society presented the same appearance proves little towards intellectuality being one of the causes of it, especially when we remember that doctors are particularly subjected to the "hot-hat" theory of its cause. Again, we must remember that the rear view of an audience at the "can-can" show presents the same wonderful phenomenon-down towards the foot-lights. Further, we know that intellectual women are no more prone to baldness than their ignorant sisters. In regard to churches and theatres being better supplied with bald heads than low places of amusement and prize fights, cannot this be accounted for on the same principle as the vices of the latter class, viz.: the force of early training?

This brings us to these several questions which everybody would like to have satisfactorily answered. Why are not women bald? If heredity, as DR. JACKSON thinks is a cause, why are not the sisters of a family of baldhead

ed boys bald? If lack of care and filth is a cause, why are not the western savages-who never pay any attention to their own dirty scalps, but direct their attention entirely to the scalps of others,-why are they not bald? One can go up through the Sioux nation away into Montana, as I have been, and the oldest buck he can find will have more hair on his ugly pate than a whole roomful of average Detroit · clerks who have their hair clipped every week and shampood Sundays,-to make it grow.

Is not the "alopecia prematura" of to-day due to our higher civilization? To the "hot hat," and the barber?-principally the latter? I can remember when every man was his own shaver and some good handy neighbor did his hair cutting. The barber shops were dingy and frequently dirty places occupied only by gentlemen of the African persuasion. Now what are they? Gilded h-halls where tonsorial dudes gracefully toss scented foam on your face and rub rose-colored palms over your comparatively dusky cheeks and chin and inquire smilingly if you will have a sea foam shampoo and your hair shortened a trifle? when perhaps you had it clipped only the day previous.

The boy brought up in the average family of to-day has his hair cut early and often until he catches onto the close cut which he keeps up until about the time he reaches maturity he finds his hair coming out and growing thin on the top. Then he becomes alarmed and struggles to regain his covering and the barber helps him with hair tonics, shaving and shampooing, until the poor over-stimulated hair follicle gives up the ghost and dies from exhaustion. Did you ever notice, that a close shaven lawn will not survive the slightest drouth, while on a neglected one the same grass is hard to kill out, even when you try to do so. So with the constantly stimulated hair follicle. But right here some one asks, why does not the beard fall off? It does if kept shaven, but not perhaps to the same extent as the hair, because it is constantly exposed to the air, and further the beard differs from the hair in that it is coarser and dips deeper into the cutaneous tissues. It is so to speak the marsh grass of the hirsute headlands, while the hair is the cultivated portion.

The street gamin's and gutter snipe's hair goes uncultivated, and this being the source from whence spring the patrons of prize fights and low places of amusement, may account perhaps for their comparative exemptness from alopecia.

It must be admitted that the hot-hat has a deal to answer for in this matter, for it is not an uncommon thing to see the boundary line between the hat and the hair well marked. Still, the "greasers" in Mexico wear a leather sombrero with impunity, but they never cut their hair to any considerable extent, and they

are not bald. Again, visit any office in Detroit where clerks are employed who only wear a hat to and from their meals, and then go down and look at the street-car driver, who wears a hat continually but has no money to squander with the barber. Mark the difference.

Women are not bald because they wear nothing or next to nothing on their heads and do not cut their hair! They cultivate the growth of the hair, not by a shampoo or a close cut but by the old original “cultivator" of our boyhood days, which during our exposed condition at school used to bring in certain wonders of the animal creation in addition to the usual exfoliation. This is all the cultivator that is needed.

DR. JACKSON advises a shampoo of soap and water or borax and water to be practiced through life. I would like to see those Sioux Indians try that long enough to make them bald and then see them go off and hate themselves to death. The hair needs no soa por other alkali to go through it like a search warrant, destroying all the oleaginous matter which nature has supplied and which must be replenished by artificial means, or the hair seems dry-and it is dry and husky-and lacks lustre.

And now, my young professional friends-no use talking anything but " go up" to the old bald heads-if you have any hair left that you want to preserve, take my advice before it is everlastingly too late, and avoid the barber. The women do, the savages do, the gutter snipes have to and the "greasers" always do, and they are not bald.

If you have a wife, mother, sister or daughter, or even a barber who will carefully comb your hair and remove the dandruff once a week with a fine-tooth comb-spend half an hour at it if necessary-and then if you want to wash your scalp, do it with clean soft water, and never use on it any soap, oil, or pomade, and never allow your hair to be cut close enough to expose the scalp; and when it shows symptoms of dropping out let it grow, instead of cutting it off-three or four times a year is often enough to cut the hair. Never use any hair invigorator or other anti-mortem nostrum, and give your head as much air as possible. I say if you will do this you will carry as many grey hairs down to the grave as our present civilization will permit. I know whereof I speak in this matter from practical observation, as well as from personal experience, and if the conclusions at which I have arrived are not satisfactory to the average reader of the MEDICAL AGE I would like to have the question referred to DR. FOSTER PRATT of Kalamazoo, DR. T. A. MCGRAW, and DR. CONNOR, of Detroit-three of the brainiest of my many hirsute professional friends that I can think of just now.

In PROF. BARTHOLOW's Materia Medica, we find under the head of the "Physiological Actions of Alcohol", the following points of interrest, which I will endeavor to account for according to the "theory" I advanced in my last article.

The first of these is: that alcohol has been found, and is known to coagulate albumen and harden the animal textures. From chemical analysis we know that next to water, the greatest eonstituent of the gray and white substance of the brain is albuminous matter, which, according to LASSAIGNE amounts in the gray matter to 7.5 per cent., in the white 9.9 per cent. in every 100 parts. These substances we know are also found, more or less, in most of the animal tissues in combination with fats, gelatinous substances, etc., according to position and functions. Alcohol also has a remarkable affinity for water, which it abstracts from the tissues. What the final result is and must be, it will not be necessary for me to enter into.

2. PROF. BARTHOLOW further says: As alcohol is a very diffusible substance, it enters the blood with great facility, and is probably almost all taken into the stomach, passes into the blood from this organ, and does not reach the the small intestine. The liver is consequently the first organ, after the stomach, to be influenced by the ingested alcohol. The blood of the portal vein rendered more highly stimulating by the presence of alcohol, increases for the time being the functional activity of the liver-cells, and as is the case with the stomach, a more abundant flow of glandular secretion follows. Frequent stimulation and consequent overaction, result in impairment or loss of the proper function of the part, as is the universal law. The hepatic cells, overstimulated, produce an imperfect product; they are affected by fatty and atropic changes, and shrink in size; and the connective tissue of the liver undergoes hyperplasia. The first result of the structural alterations is an increase in the size of the organ; but with the shrinking of the hepatic cells and the contraction of the newly. formed connective tisue, the liver becomes sinaller, nodulated and hardened (Cirrhosis).

3. Further it has been found that within a certain limit alcohol may be disposed of by the organism by oxidation.

The treatment of acute alcoholism is the cautious use of ammoniacal gas, and faradization of the muscles of respiration.

I don't think that anyone will for a moment deny, or doubt, that the nervous system is the

direct source of all functional activity. Certainly the nerves themselves are merely conductors of "life-force," while the nerve centres are the seat from which all nerve force starts direct. Microscopical analysis of a nerve after death shows a change in its appearance; this is most likely due to a coagulation of its fluid composition. This, at any rate, is the final result, according to my knowledge of the subject, when an excess of a non-electrolyte, as alcohol, has entered into the system. Chemical action of the body will decompose and remove this poison from the system, quite rapidly for a time, and overcome almost completely its injurious effects on the nerve and tissue structure. I say almost, because I believe that just as in malaria, repeated engorgements of the spleen, more and more distend this organ beyond its limit of elasticity, so must it be with effects of alcohol. The strain on the system becomes so great, the chemical components, owing to the weakened condition of the organs whose office it is to purify and reconstruct, become altered, and therefore the counter-effects become weaker and weaker, the poisonous effects of alcohol more and more marked, and the brain substance is probably the first to become seriously impaired, not so much regarding its higher functions over the mind as those controlling the functional part of the organism. For instance, let the semi-fluid or gelatinous composition of the brain and nerve substance become altered in any way, and the absolute result must be a decrease in the conducting power; and decrease in the conducting power means nothing more or less than a diminished supply of life force. Diminished activity in any organ produces a greater or less change in the decomposition of its chemical composition, and finally structural changes are the result; naturally beginning in those parts, and in those organs whose affinity for this particular poison is greatest, and whose structure is the most delicate.

The second principal effects, as we have seen from the foregoing, are, the remarkable affinity of alcohol for water, and its power of coagulating albumen. As water is one of the chief constituents of brain and nerve substance, as well as of the remaining organs and structures of the body, it is perfectly natural that as soon as the water is abstracted from any structure, shrinkage of the part takes place, and as albumen is also a chief constituent of just those portions of the body which are most susceptible to the injurious influences of this slow, but deadly poison, a coagulation of this substance must produce, in time, serious results.

Probably the first effect of alcohol takes place in the nerve centres and nervous system generally, not however of sufficient power to produce any specific derangement of the higher functions of life, but the action of the ner