culty in urination, and only small flexible instruments can be passed, the fact is often overlooked that while there is obstruction in the deeper urethra, this may be due to spasmodic contractions of the membranous portion brought about by the presence of organic stricture nearer the meatus. If these anterior strictures are diseased and removed, a full sized sound may be made to pass with ease into the bladder.

SCROFULOUS GLANDS.

The treatment of scrofulous glands is often unsatisfactory. The children who are most commonly subject to the disease are too timid and feeble to undergo the operation of having them carefully dissected out, as some authorities advise. The plan of teasing out the sinus is likewise painful and not likely to meet with favor. M. VERNEUIL has proposed to inject the scrofulous glands with an ethereal solution of iodoform. He draws the pus off with a trocar and then injects fifteen or twenty minims of a 5-per-cent. solution. Another writer has injected non-purulent glands the same way, and has been highly pleased with the result. The constitutional treatment by means of cod-liver oil, etc., should be rigidly maintained while the local means are being carried out. Some weeks have elapsed in all the cases described before a complete disappearance of the enlarged gland has occurred.

D. B. ST. JOHN ROOSA thinks that in a large percentage of cases acute inflammation of the middle ear is a self-limited affection. He tries to secure cleanliness, and then dries the parts. He does not use dryness as a means of destroying the germs or preventing them from acting, for he does not believe in the germ theory of dis ease. He thinks that germs are the products and not the causes of disease and that they retard recovery and therefore should be removed. In a large proportion of the acute cases the only treatment required is irrigation with warm water, pro re nata, and drying afterwards. He believes that the pus has a chemical quality apart from the presence of the germs, which renders it corrosive. He there. fore tries to keep the parts as free from pus as possible.

TREATMENT OF CORDEE.

Strapping the penis, or the mechanical treatment of painful erections, has received some attention from French surgeons. The plan is to fasten a belt around the waist, then arrange a sort of a T bandage by fastening to the belt a

broad band in front. The free extremity of this band is split so that each strap can run in the gluteo-femoral folds on its way to be fastened to the back of the belt. When it is adjusted the penis is pulled down between the testicles, upon the perineum, the broad band covers it in and holds it down by means of the straps running through the gluteal folds to the back of the belt. The pain of chordee is greatly mitigated by the use of this contrivance. There being no tension upon the urethra the desire to urinate is much less frequent.

DISEASED FALLOPIAN TUBES.

The frequency of pathological conditions of the fallopian tubes, was the subject of a paper by DR. GARDNER, of Montreal, recently. His facts were taken from one hundred necropsies lately performed in the London Hospital. All of them were cases of death from pelvic disease; and seventeen were found to have distended fallopian tubes either hdro-, pyo- or hematosalpinx. It has been claimed that actual disease of the tubes was much less frequent than is commonly supposed, but 17 per cent. as shown by the above figures is certainly often enough to find these organs distended in the course of 100 general pelvic cases. In 302 necropsies of women above the age of puberty only 12 cases of diseased tubes were found.

DEATH OF DR. N. A. RANDOLPH.

A sad accident occurred on August 21st. on the New Jersey coast. NATHANIEL ARCHER RANDOLPH, M. D., one of the editors of the Medical and Surgical Reporter was bathing, when he was carried off his feet by the under current and disappeared beneath the waves DR. RANDOLPH was Professor of Hygiene at the University of Pennsylvania and was wellknown as a hard worker. He was about 30 years of age.

Notes.

A correspondent contributes a note from his practice which tends to show that grief may be very poignant and yet not obliterate the sense of the beautiful. In the case of a patient suffering from meningitis, the head was ordered shaved. In a few days the man died, and his brother, on reporting the demise to the doctor, said: "It may be all right, doctor, to shave a man's head for that disease, but poor George makes a h- of a looking corpse."

The State Medical Society of California at the recent session in San Francisco, April 20th, unanimously adopted resolutions heartily ap

proving the project of erecting a statue of "the immortal BENJAMIN RUSH," in the city of Washington, and requesting the various medical journals to call upon every physician in the State to contribute the very modest sum of one dollar each, to which the subscription has been limited.

La Tribune Méd., July 3, 1887, says that TEISSIER believes diphtheria to be an infectious disease whose germ is disseminated by means of atmospheric dust. He considers manure, rags and straw excellent media for the culture of these germs which are frequently disseminated by chickens and pigeons. A moist atmosphere is propitious to the development of the germs, and a chill renders the subject more likely to contract the disease.

PROF. GROSS says: To properly examine a woman's breast, she should be lying on her back. If examined in any other position, it can be so manipulated as to convert it into any tumor. When on her back, examine by pressing the tips of the fingers back through the chest against the breast's walls, and not by pinching the structures up between the fingers.

Apropos of young mothers, DR. N. L. FOLSOM, of Portsmouth, N. H., writes that he attended in her confinement a girl so much short of thirteen years of age that she must have conceived before her twelfth birthday. She was, moreover, very small in stature.

Sick man.-Am I to take all that medicine? Wife. Yes, all of it. Sick man. - There's enough in that bottle to kill a mule Wife. No, there is'nt, John, or the doctor would'nt have prescribed it.—Puck.

A CORRECTION -In DR. WYMAN'S article, on page 341, Enterotomy" for gunshot and bayonet wounds, should read Laparotomy,"

etc.

The cow is afflicted by a mild kind of scarlatina-so mild that it hardly causes her inconvenience, but this produces scarlatina among those who drink her milk.

Merited Honors to PROFESSOR ESMARCH.Letters of nobility have been given by the Emperor of Germany to F. ESMARCH, Professor of surgery of the Faculty of Medicine at Kiel.

The Chief of Police of Chicago has issued an order giving the vehicles of physicians precedence at bridges, along with the mail and patrol wagons, ambulances and fire apparatus.

DR. LIEBERKUHN, Professor of anatomy at Marburg, died recently at the age of seventyfive.

DR. JOSEPH D. BRYANT, the eminent surgeon of New-York City, has been appointed Health Commissioner.

Salol, introduced by MENCKE, of Berne, is stated to be poisonous as it contains 38 per cent of phenol.

Resection of the pylorus has been performed by BILLROTH fifteen times for carcinoma, with success in seven cases.

PROF. BARTHOLOW states that he believes nicotine, if rightly used, will prove to be our best remedy for hodrophobia.

PROF. PARVIN, for all plastic operations on the female genitals, uses silver wire in preference to either silk or cat gut.

Book Notices.

STUDENTS' GUIDE TO DISEASES OF THE EYE. By EDWARD NETTLESHIP, F. R. C. S., Ophthalmic Surgeon to St. Thomas' Hospital; Assistant Surgeon to the Royal London Moorfield's) Ophthalmic Hospital; late Ophthalmic Surgeon to Hospital for Sick Children. With a Chapter on Examination for Color Perception, by Wм. THOMPSON, M. D., Professor of Ophthalmology in the Jefferson Medical College of Philadelphia.

Philadelphia: Lea Brothers & Co.

This is the third American from the fourth English edition of a popular student's work, which is too well known and too extensively used in this country to call for much comment. The edition is a trifle larger than the previous issues, and, in addition to the old matter, embraces all inatters of value that more recent workers in this branch of surgery have contributed to eye disorders and their cure. The chapter on Examination for Color Perception, by DR. THOMPSON, has been inserted from the previous edition, and is a valuable feature of the volume.

SYPHILIS. BY JONATHAN HUTCHINSON, F. R. S., LL. D., Consulting Surgeon to the London Hospital and to the Royal London Ophthalmic Hospital; Vice-President of the Royal College of Surgeons.

Philadelphia: Lea Brothers & Co., Publishers.

In this admirable little work DR. HUTCHINSON has clearly and concisely grouped together all that is actually known of syphilis, and succeeded in laying down the general principles on which our knowledge of the disease and its treatment is based. His object has been to avoid hasty generalizations with nothing but an isolated case or two to sustain them and to give the surgeon the benefit of practical data gathered in the treatment of numerous cases. His conclusions are stated with candor, and his observations so fairly presented that the student can do his own thinking independently of

what the author says. The work is adorned with several excellent colored illustrations. It is dedicated to DR. FOURNIER, in recognition of the eminent Parisian's researches in the field in which the author is a worker.

SEXUAL IMPOTENCE IN THE MALE AND FEMALE. By Wм. A. HAMMOND, M. D., Surgeon-General U. S. A. (retired list); Professor of Diseases of the Mind and Nervous System at the New York Post-Graduate Medical School, etc. Detroit: George S. Davis.

DR. HAMMOND explains that this book was written in the hopes of aiding his professional brethren in treating a disease that probably causes more unhappiness than any other disease with which mankind is afflicted. The book is made up almost entirely of cases which have occurred in the author's practice, and every form of impotance, both congenital and acquired, is dwelt upon and the proper treatment pointed out. The work is written in the vigorous, clear and entertaining style for which all of DR. HAMMOND'S literary efforts are noted, and is as entertaing in the manner as it is instructive in the matter with which it deals. A subject of vital importance to material and moral happiness is cleverly handled. The volume is neatly printed and bound.

ELEMENTS OF BOTANY. By EDSON S. BASTIN, A. M., F. R. M. S., Professor of Botany, Materia Medica and Microscopy in the Chicago College of Pharmacy. 8 vo., 282 pages. Price $2.50: G. P. Englehard & Company, Chicago. 1887.

This work is very nicely written, the style being concise, and the cuts, of which there are 450, are well executed from drawings by the author. There are too many books of to-day on botany that are designed for students who have already made much advancement in this study; but few of these works are well adapted to beginners. To the latter class this book is well suited, as it is easy of comprehension, and each chapter is taken up in such a progressive way that it at once awakens in the reader an interest to know more as he advances in this beautiful science.

per cent. of solids, chiefly chloride of sodium. The addition of two and a half grains of this salt to the ounce of distilled water renders any lotion for the eye more soothing.—Druggists' Circular.

TREATMENT OF BURNS.-For burns of the first degree a dressing of cotton batting dipped in acetate of alumina is advised; for burns of the second or third degree, iodoform is preferred over all other topical applications. The iodoform is best used as a paste:

B White earth, 30 grammes.

Linseed or olive oil, 30 grammes.
Subacetate of lead, 02 grammes.
Iodoform, 8 to 16 grammes.

Mix first the earth and the oil, apply the paste with a spatula and cover with gutta percha tissue and absorbent cotton, retaining with a muslin bandage.-Journal de Méd. de Paris.

SALICYLATE OF SODA IN ORCHITIS.-The Bulletin General de Therap. says that in gonorrhœal orchitis salicylate of soda causes in a few hours at first diminution and finally complete cessation of pain. Its action is especially constant in acute cases of epididymitis, with vaginalite. When inflammation of the cord predominates the medication is often without effect. In cases thus treated resolution of the swelling begins sooner than in cases treated antiphlogistically. It follows a regular course and it may be completed in less than eight to ten days, leaving only slight induration of the epididymis.

Medical Progress.

MACCORMAC ON ABDOMINAL SECTION FOR THE TREATMENT OF INTRA-PERITONEAL INJURY.-SIR WM. MACCORMAC, whose personal experience of military surgery in the great Franco-Prussian war of 1870, whose sound and detailed knowledge of antiseptic practice, and whose recent brilliant successes in two cases of intra-peritoneal rupture of the urinary bladder, mark him out as peculiarly well qualified to deal with the subject, has recently delivered an oration before the Medical Society of London, with the title at the head of this article.

In his introductory observation he quotes the words of HELMHOLTZ that "medicine indeed has become young again, and endowed with fresh and greatly enhanced powers of doing good by dipping in the youth springs of the natural sciences." He then goes on to pay to LISTER that tribute which no true apostle or modern surgery withholds from the man who has shown us the key to it.

After mentioning that MR. WALSHAM has recently had a successful case of suture of an intra-peritoneal rent in the urinary bladder, SIR WM. MACCORMAC describes a case of suture of the intestine by his colleague, MR. CROFT.

A man, aet. 34, jumped upon in a public house row; great pain; sickness. Hospital after seventeen hours. Operation in eighteen and a half hours. Temperature previously 130°. Median laparotomy. Ileum discovered ruptured transversely in two-thirds of its circumference. Lacerations of mesentery and omentum. Fæcal extravasation. Septic peritonitis. Irrigation with warm 15 to 20 per cent. solution of boracic acid. Edges of intestinal rupture suture to margin of parietal wound. Operation lasted one and a half hours. Collapsed state. Ultimate recovery, but no strength or flesh regained. Irrepressible escape of intestinal contents at the artificial anus.'

At end of a month a second operation. Bowel separated from abdominal parietes, and opening in it closed with LEMBERT'S suture. Operation lasted two and a quarter hours. Death thirteen hours after operation. "The suturing had been perfect and the peritoneum was entirely free of any recent exudation or inflammatory products."

Another case is mentioned in which MR. MACKELLAR, for a gunshot injury of the sig moid flexure, recently opened the abdominal cavity, but found it impraticable to apply LEMBERT'S suture to the intestinal perforations caused by the bullet. "The patient was in a state of impending collapse at the time of the operation, and died twelve hours afterwards."

Still a recent case is given in which a young man never rallied after his ruptured spleen had been excised (by MR. CROFT).

Though MACCORMAC writes of these as cases in which success was nearly achieved," less sanguine and more cynical persons may regard them as instances of failure completely achieved," as regards the radical measures of enterorraphy and splenectomy.

The first two cases, indeed, seem at first sight to lend countenance to JOHN BELL'S strong words concerning BENJAMIN BELL's recommendation of suture of wounded intestine.

This is quoted (later on in the oration) by MACCORMAC, and runs as follow: "I have ventured to say that if there be in all surgery a work of supererogation it is this operation of sewing up a wounded gut. It is a dangerous and puerile conceit."

But reflection and careful study of the facts put forward by our author point to a different conclusion. So minute a percentage of cases of wounded intestine recover when left to nature that such treatment or want of it offers practically no hope. And though the cases operated on die, it seems almost always, on reading their hissory, that the operation is done too late. Perhaps this argument scarcely applies to MR. CROFT's first case, in which the enterorraphy was performed at the surgeon's leisure one month after the accident, but it does apply to his second, which was not brought to the hospital until twelve hours after the spleen had been ruptured.

The history of the subject is touched upon, and ST. CROIX, of Pennsylvania, BENJAMIN TRAVERS, JOBERT, LEMBERT, GELY, AMUSSAT, GROSS, PARKES, of Chicago, SENN, of Milwaukee, DENNIS, of New York, and other operators, experimenters and other writers are duly referred to. The great rarity of penetrating wound of the abdomen without injury to the viscera is emphasized and various facts given in proof. LARREY in his long career only observed one instance in which a ball penetrated the abdominal cavity without producing immediately serious results. and in this case the intestine was afterwards found to have been contused."

The most fatal complication of penetrating wounds of the abdomen is injury to the small intestine. Sword and bayonet wounds of the bowels are rarely met with even in time of war, but knife and dagger wounds are common in time of peace, especially it might be added, in certain localities. Their diagnosis is of prime importance, and, in the early stage, often a mere matter of conjecture. Tympanites, discharge of blood per anum, are valuable symptoms when present, but neither may appear directly after the injury. If the blood passed from the bowel be abundant, and show itself soon after the injury, it is a very valuable symptom. Emphysema, when it occurs in the wound-neighborhood, is said to be pathognomonic. Shock and pain vary so much in degree as to afford no useful guidance.

With regard to the advisability of probing, if precautions be taken to exclude septic influences, the thorough examination of the wound by the probe may determine its direction and extent, and if this fails to clearly establish the fact or otherwise of penetration, the wound should be enlarged and explored to its termination either in the parietes or more deeply. The important point to speedily determine is, whether the wound penetrates the abdominal cavity, and this is perhaps the most effective manner of ascertaining it.

To wait for peritonitis, etc., to confirm the diagnosis is a fatal mistake..

With regard to treatment, the choice lies between enterorraphy and the formation of an artificial anus by suturing the margins of the wound in the bowel to the skin. The latter course should always be avoided when possible. It is in the highest degree undesirable, and cer

tainly in those case where the injury does not extend more than half way around the calibre of the tube, or where the convexity of the bowel is wounded, and probably in all cases where the mesenteric attachment is intact; and the same may be said where the bowel is ruptured by external violence. This practice gives the surgeon a false sense of security; he thinks if his sutures give way the patient may still recover, but the evidence is very strong that the risk of focal extravasation is less when the wound in the bowel is completely closed, and the gut at once returned to the abdominal cavity. The indications in those cases are not identical with those in strangulated hernia with gangrenous bowel.

Other objections to forming an artificial anus in cases of wounded intestine are: (1) That even if the operation succeed the surgeon's work will be only half done, and the artificial anus will have to be closed at a future time by separate operation. (2) Should the original injury be done to the upper part of the small intestine the patient may be starved or fatally weakened by the escape of nutriment.

Under the heading "Methods of Suture " three conditions are laid down as necessary to success: (1) Two adequately broad and sufficiently wide surfaces must be brought into contact. (2) The mucus membrane must be excluded, for when the needle passess through the whole thickness of the gut peritonitis generally ensues from leakage along the line of the thread. (3) Rapidity of execution is of extreme importance, and that form of suture is best which can be effectively applied in the shortest time. LEMBERT'S suture is recommended, with the warning not to draw the thread too tightly for fear of gangrene, and consequent failure to procure union. Experimentally, this has been found to be the most frequent cause of nonunion. For cleansing the abdominal cavity MACCORMAC recommends irrigation with a 3per-cent. solution of boracic acid at a temperature of 100, with water previously boiled. Drainage tubes may be dispensed with when the operation is performed soon after an accident.

Gunshot wounds.-These, we are told, are far from being rare in civil practice, especially in America, where everyone carries a revolver, and often uses it on small provocation. It is rare for more than two convolutions to be wounded by one bullet, or for the intestine to be wounded in more than four places. It is also rare for fæces to appear in the external wound. The mucous membrane seldom or never blocks the perforation caused by the smallest bullet to an extent to prevent extravasation. Bloody stools is usually a late symptom, without practical importance in reference to operation.

Air in the abdominal cavity, emphysema around the wound, a larger escape of blood than the injury to the parietes would account for, are among the symptoms which will help to indicate intestinal injury. Hemorrhage is apt to be severe even when only small vessels are injured. The admission of air by abdominal section has a salutary effect, in tending to check the bleeding. Hemorrhage is the most frequent cause of death after gunshot wound of the abdomen. In the treatment of gunshot perforation of the intestines an exploratory abdominal section is strongly recommended, as

soon as possible after the infliction of the injury. Every antiseptic precaution should be exercised. No hand but the operator's should ever be allowed to enter the abdominal cavity. The entire intestinal tract, as well as the stomache and other viscera, should be examined. When several openings exist close together resection of the portion involved is recommended. The fingers are considered better than the ingenious clamps which have been invented.

When a large piece of intestine requires removal, a triangular_piece of mesentery may have to be excised. The mucous coat becomes everted. It should not be excised, as it gives support and supplies blood to the edges of the gut.

There is a triangular interval, filled with connective tissue and blood vessels, between the layers of the peritoneal coat, as it leaves the bowel to form the mesentery. At this place the needle must be passed deeply enough to include the mucous coat as well as the serous. Otherwise extravasation will result.

Abdominal injury without external wound.The fatality of concealed lesions of the intestine is so great that the idea of intervention has occurred to many surgeons, and has several times been put in practice, but with invariably fatal results. The symptoms and indications for an operation are the profound shock, with persistent and intense pain, increased on pressure. The jijunum and ileum are the portions of the intestine most frequently ruptured, and the rent will generally be found just behind the part of the abdomen which has been struck.

The French troops in the Crimea lost one in every three. Of 95,615 Frenchmen who lost their lives only 10,240 perished at the hands of the enemy. As many more died in hospital from the effects of their wounds, so that the remainder, amounting to 75,000 men or more, were sacrificed to diseases for the most part, preventable. During the American war 97,000 men died from wounds, just double the number, 184,000 perished from disease. During the Franco-German war the losses on the German side exceeded, for the first time in military history, those sacrificed by disease. In the older campaigns blood-poisoning caused the most fatal consequences to the wounded. In the last Egyptian campaign not a single man died from pyemia, septicæmia, erysipelas or hospital gangrene, a result unparalleled in the annals of war.-C. B. KEETLEY, M.D., London, Eng., in Annals of Surgery.

THE PROPHYLACTIC TREATMENT OF THE TEETH.-PROF. DR. MILLER, in the Pharmaceutische Central Halle. states the care of the teeth should not be deferred until the permanent teeth have appeared; it should rather be begun in earliest childhood.

The prophylactic treatment of the teeth has the object of preventing the appearance of caries and the further affections resulting therefrom.

Normal teeth, of all animal textures, show the greatest power of resisting decay, and it never occurs that teeth, removed from the oral cavity, are destroyed by decay, corruption or mould. Deprive the teeth, however, of the