by silk Lembert sutures.

without interruption.

The speaker supposed it to be a parovarian cyst. After the specimen was removed, it was thrown upon the floor. When the patient was put to bed, the sac was slit open and out came the foetus. When the abdomen was opened in this case, the head of the cæcum was found in front and adherent to the anterior abdominal wall. It was found necessary to remove the appendix.

Colloid Carcinoma of the Rectum with Excision by the Combined Vaginal and Inguinal Routes.-Dr. J. HORACE WHITACRE of Cincinnati, Ohio, reported a case of colloid carcinoma of the rectum which presented unusual pathological and clinical features. After detailing a complete history of the case and describing the operation, the author stated that his chief reason for presenting the case was the unusual nature of the primary tumor. He had never before seen a carcinomatous tumor of the bowel which had developed as a hard, uniform thickening of the entire circumference of the tube. The tumor involved the wall of the rectum to almost a uniform degree for six inches of its length, and the organ was transformed into a tube that might very well be compared to a flattened lead pipe with very thick walls. The tube was very rigid and non-collapsible when in a fresh state. The lumen of the tube was unfortunately firmly packed with gauze before it was placed in Kaiserling's preservative fluid, and had been thereby dilated to almost twice its actual size during life. A second point of interest was the strong naked eye resemblance to tuberculosis. The minute bodies which were scattered over the pelvic peritoneum could not be differentiated from miliary tubercles. Large caseous lymph nodes were found in the hollow of the sacrum. The great predominance of fibrous tissue, the uniform involvement of a long segment of the bowel, and the appearance of minute nodules resembling miliary tubercles in the primary tumor of the rectum all spoke for hyperplastic tuberculosis of the bowel. A third point worthy of mention was the exceedingly rapid development of the solidly carcinomatous ovarian tumors from half a dozen minute miliary metastases on the peritoneal surfaces of each. These tumors were friable and almost jellylike, as were all of the metastases, whereas the original tumor was as hard as cartilage.

Free Growths in the Tunica Vaginalis.-Dr. EDWARD A. BALLOCH of Washington, D. C., reported the case of a colored boy, sixteen years of age, who came under his care in December, 1902. Family and personal history threw no light on the case. There was no history of injury. Present trouble began eight years before, as an enlargement in the upper part of the right of the scrotum, which continued to grow painlessly from that time onward. Examination showed a scrotum reaching nearly to the knees and measuring twenty-one inches in circumference at its largest point. Both testicles and both cords could be made out and felt normal as to size, shape, and consistence. There was no fluid in the scrotum, but a peculiar gelatinous, flabby feeling of the scrotal tissue. Three separate tumors were felt in the right side of the scrotum. The growths were freely movable in relation to cord, testis, and scrotal tissue. The diagnosis of fibroid growths in the tunica vaginalis was based partly on the history of a slow, painless growth, and absence of ulceration and fistulæ, excluding cancer, syphilis, and tuberculosis, and partly on the physical characteristics of the growths, together with a cheloid behind the right ear which was interpreted as indicating a tendency to fibromatosis in the patient. Operation, December 15, 1902, showed the tunica greatly enlarged and thickened, and converted into a gelatinous mass. inguinal canal and The upper tumor ran into the was attached there by a pedicle. The other two showed no distinct points of attachment. All the tumors were enucleated and the thickened tunic removed. The testicle was removed accidentally in dissecting out the tunica. The tumors weighed thirtyeight ounces, and specimens the tunica twenty ounces. The shown. The report of the pathologist showed that the growths were soft fibromata, with areas of fatty and myxomatous degenerations. The testicle also showed areas of beginning myxomatous degeneration. The pathology of the condition was considered briefly, the conclusion being reached that the growths had their

were

origin in the subserous connective tissue.

Examination

of the literature showed but one case at all resembling the one reported, although there were several reports of minute fibrous growths on the tunic following hydrocele treated by the injection of iodine.

Extrauterine Pregnancy. Dr. T. J. CROFFORD of Memphis, Tenn., reported in which the gestation sac was so thoroughly developed a case and exhibited a specimen and so strong, that it was enucleated without the loss of any blood. The sac was completely intact all around the

foetus. The operation

was performed before the class.

Pneumatic Rubber Suit.-Dr. GEORGE W. CRILE of Cleveland, Ohio, said that the pneumatic rubber suit was constructed of a double layer of specially made rubber, which, when inflated, exerted a uniform pressure upon the surface, constituting an artificial peripheral resistance. It was so constructed that one or more limbs or the abdomen might separately or in combination be subjected to pressure by inflation by means of a bicycle pump. The air valves were so adjusted that the rate of decompression might be completely controlled. The effect of the suit upon the blood-pressure might be checked by means of a sphygnomonometer. The general bloodpressure might be varied at will within a range of 25 to 75 mm. of mercury. The rise had been sustained as long as twelve hours. In operations upon the head and neck, which were likely to be attended by dangerous shock and collapse, the pneumatic suit was put on the patient prior to operation. By inflation and deflation the blood-pressure might, within certain limits, in the heaviest operations, be maintained at a given level. In a laryngectomy, with extensive resection of lymphaticbearing tissue of the neck, moderate shock developed. The blood-pressure was raised by means of the rubber suit, which soon sprung a leak; a marked fall in the blood-pressure following. During the experimental stage, the influence of the pneumatic suit upon the bloodpressure was strikingly demonstrated in a pulseless case in which the blood-pressure was raised to 110 mm. Other cases were reported, showing the value of the pneumatic rubber suit in cases of shock and collapse.

Resuscitation of Animals Apparently Dead.-Dr. CRILE also read a short paper on this subject, giving a summary of experimental data. When asphyxia caused failure of

the heart and respiration, vigorous artificial respiration usually restored their function when administered within a few seconds. It was effective in an inverse ratio to the time that had elapsed; it was rarely effective after forty seconds. By the addition of saline infusion a larger proportion of animals could be resuscitated after the lapse of a little longer time. Rhythmic pressure upon the heart, either through the thorax by pressure upon the ribs over the heart or direct pressure within the thorax was also an aid. The effect of the traumatism to the heart by the direct method partially counterbalanced the benefit from this measure. Nitroglycerin, alcohol, and digitalis were useless; rapidly alternating the posture, head up, then head down, was not effective. Suspending the animal head down and making rhythmic pressure upon the heart was an effective method. This method gave the brain the advantage of gravity; it provided a moderate artificial circulation as well as respiration. It could be promptly applied. The addition of this saline infusion increased the effectiveness of the method. Animals apparently dead for periods up to fifteen minutes were resuscitated by the combined effect of artificial respiration, rhythmic pressure upon the heart, and the infusion of adrenalin. When the blood-pressure had risen to 30 or more mm. Hg., the heart began to beat and the blood-pressure was rapidly restored. The return of respiration was signaled by a short, almost imperceptible movement of the diaphragm, the respiratory action becoming gradually stronger and more frequent. The conjunctival reflex returned early. Some of the experiments failed on account of too great elevation of the adrenalin bottle; some on account of an overdose of adrenalin; several were only partially successful, owing to the great dilution of the adrenalin. Adrenalin, when injected directly into the chamber or into the wall of the heart, caused fibrillar contractions, after which the heart could not be resuscitated. After final cessation of the heart, by employing manual compression of the heart and infusing adrenalin, the blood-pressure could be raised even higher than the normal. Respiration in some instances was partially restored. Experiments in which saline infusion was substituted for adrenalin, and which were unsuccessful, were promptly successful on adding adrenalin. In a patient with crushed skull, and whose heart had ceased beating for nine minutes, resuscitation of the heart for thirty-one minutes was made by this method. During the operation for the elevation of the depressed bone, the patient moved his head. Another patient apparently dead from a severe crushing of the base of the skull was partially resuscitated twenty-four minutes after the apparent death. The proofs of the apparent death were absence of respiration, absence of heart sound on a stethoscopic auscultation, and, as a final proof, on opening the jugular vein there was absolutely no circulation. In this case the blood-pressure rose to 80 mm. at one time; voluntary respiration appeared. These evidences

of vital action continued for thirty-four minutes.

Officers for the Ensuing Year.-The following officers were elected: President, Dr. Floyd W. McRae, Atlanta,

thereof two thousand dollars be appropriated to the erection of a monument to the memory of Dr. W. E. B. Davis in Birmingham.

The report of the Council was adopted.

THE PRACTITIONERS' SOCIETY OF
NEW YORK.

One Hundred and Eighty-third Regular Meeting, Held on
November 6, 1903.

Dr. CHARLES STEDMAN BULL, PRESIDENT, IN THE CHAIR. Neural Injection of Osmic Acid for Facial Tic.—Dr. ROBERT ABBE presented a young man who had first come under his observation two years ago. The patient was then suffering from a severe form of facial neuralgia which involved the middle branch of the fifth nerve on the left side. As a radical operation was refused by the patient, an inch and one-half of the nerve was resected by raising the cheek after a free incision of the lip. This operation gave immediate and permanent relief; but a few weeks ago the patient began to suffer from similar pain affecting the supraorbital branch of the nerve. The pain was shooting in character, like an electric shock, recurring about once every ten minutes during the day, and occasionally it awoke him at night. It radiated upward from the left eye and there was marked tenderness of the entire scalp. As the patient still objected to an intracranial neurectomy. Dr. Abbe said he intended to resort to the neural injection of osmic acid, as had been successfully practised by Bennett. The nerve was exposed through a small incision along the upper margin of the eyebrow, and perhaps five drops of a 1 per cent. solution of osmic acid was injected into the substance of the nerve. Dr. Abbe said he would report subsequently as to the result of the procedure.

Dr. CHARLES STEDMAN BULL called attention to the fact that the destruction of the supraorbital branch of the fifth nerve rendered the cornea non-sensitive and very liable to injury from the effects of dust or cold air. After the radical operation for facial neuralgia (removal of the Gasserian ganglion), superficial ulceration of the cornea was not an infrequent occurrence. It could be obviated by temporarily stitching together the edges of the lids.

Dr. Abbe said he understood that if the cornea was properly protected from dust and injury for a few days after these operations, it would be able to take care of itself.

The Value of the Thomas Sling in the Treatment of Fractures at the Elbow-joint.-Dr. VIRGIL P. GIBNEY presented a boy who had sustained a fracture of the internal condyle of the right elbow. When he entered the Hospital for the Ruptured and Crippled, three weeks later, motion at the joint was much limited. Massage was first ordered, and then the arm was put up in a Thomas sling and kept in that position for several weeks. Over four months had elapsed since the receipt of the injury, and the boy now had practically a perfect elbow. Flexion, extension, pronation, and supination were normal, and the condyle seemed to be in fairly good

ham, Ala.; Second Vice-President, Dr. J. Shelton Horsley, Richmond, Va.; Treasurer, Dr. Chas. M. Rosser, Dallas, Tex.; Secretary, Dr. W. D. Haggard, Nashville, Tenn.

Birmingham, Ala., was selected as the place for holding the next annual meeting; time, December 13, 14, and 15, 1904.

Dr. John D. S. Davis of Birmingham was selected as the Chairman of the Committee of Arrangements.

The Council made a report to the effect, that the former action of the association in appropriating two thousand dollars, to a memorial in Birmingham, consisting of a ward bearing the name of the association in the City Hospital of Birmingham, be rescinded, and that in lien

of the Thomas sling in the treatment of these cases

A Case for Diagnosis.-Dr. GIBNEY showed a boy of eight years, who first came under his observation three years ago. No history was obtainable. Examination revealed an ossification of all the tissues of the right leg underneath the skin, extending from the pelvis to the internal malleolus. The condition was apparently congenital. All the joints of the leg were involved in the process and were immovable. Dr. Gibney said the condition did not correspond in all respects to a myositis ossificans, and he was inclined to attribute it to a congenital defect of the lymphatic system of the leg. The boy was otherwise in good health.

A Case of Walrus Fin.-Dr. GIBNEY presented a boy with that peculiar condition of the extremities which has

been designated as "walrus fin." Both feet were inverted, and the hands were pronated and could not be brought into a position of supination. There was also a congenital dislocation of one hip. The condition was attributed to a failure of development of the joints.

A Case of Extreme Rickets.-Dr. GIBNEY also showed a female child, four and one-half years old, with marked deformity of the joints (especially of the wrists), pot belly, curvature of the femora, and other evidences of extreme rickets. The bones, however, were apparently firm and did not fracture easily, as in some of these cases. In one instance coming under his observation the bones of the extremities had suffered such numerous fractures from very slight injuries that the resulting shortening made the patient's body appear preternaturally long and his limbs preternaturally short.

The Management of Fractures Involving Joints.-Dr. VIRGIL P. GIBNEY read this paper (see page 43).

Dr. ABBE said it had not been his experience that it was easier to correct faulty flexion than extension after fracture at the elbow-joint. He was in favor of putting up these cases in a flexed position, no matter what the character of the fracture might be, and keeping the limb at a somewhat acute angle. It was to this principle that he attributed the value of the Thomas bandage. Extension would usually be fully restored in the course of time. He did not favor passive motion after fractures. In the treatment of fractures involving the neck of the femur he considered the application of plaster-of-Paris the most comfortable and serviceable method; it rendered the patient more manageable in bed and obviated the bed sores which were so common in that class of cases, especially in old people who were treated with Buck's exten

sion

Dr. ROBERT F. WEIR said he regarded extreme flexion as the important point in the treatment of most of the fractures involving the elbow. We should try to get the arm up as far as possible in order to hold fragments in the best possible position and avoid future disablement. In the treatment of fractures of the leg, on the contrary, flexion should be avoided: the limb should be kept as straight as possible. In the upper extremity retention of motion less than a right angle was to be kept in mind. If a fracture of the elbow-joint was attended by considerable displacement of the fragments, as disclosed by the x-rays or otherwise, and efforts to replace them by manipulation proved unsuccessful, Dr. Weir, said he did not hesitate, after a week or ten days, to open the joint and replace and suture the fragments in their proper position, with chromicized catgut. The arm should then be strongly flexed and held in that position. The speaker said he fully appreciated the value of plaster-of-Paris in the treatment of fractures: it could be employed in the treatment of all fractures, with the exception, perhaps, of those involving the femur in its shaft.

Dr. Gibney, in closing, said he agreed with Drs Abbe and Weir that the treatment of fractures of the elbowjoint by flexion had many points in its favor. He recently saw several cases, however, in which that method had resulted in considerable interference with subsequent extension of the limb. In a paper published by Gillette and Brimhall (St. Paul Medical Journal, August, 1902), the authors had brought up this point and had mentioned as one of the advantages of the extended position that it preserved intact the fossa of the elbow, serving also as a splint for the condyles. Dr. Gibney said he was thoroughly in favor of the open method of treatment in certain cases of fracture at the elbow-joint.

re

Result of a New Method of Creating a Vagina in a Case of Congenital Absence.-Dr. ROBERT ABBE ported on this case, which was first presented to the society in 1898, and a complete report of the operation was published in the MEDICAL RECORD in the issue of December 10 of that year. The patient was a young woman of twenty-one years, who, after becoming

engaged to be married, confided to her sister that she had never menstruated. An examination showed that the external genitalia were perfect, excepting that from the meatus urinarius to the perineum was a blank wall. A rectal examination revealed an entire absence of uterus and ovaries. The following operation was carefully planned and carried out: For several days the alimentary canal was made as empty as possible.

A crescentic cut was made across the interlabial space, with concavity upward, thus getting a little shelf of mucous membrane below the urethra to divert escaping urine. By blunt dissection a free cellular space was readily created between the bladder and the rectum, to the depth of five inches. This was temporarily packed with sterile gauze to check oozing. Thiersch skin grafts were then cut from the thigh, sufficient to cover an ample plug made thus: A thin French rubber pouch, such as can be obtained at drug stores, was sterilized by boiling and stuffing with long strips of iodoform gauze to its full capacity. Upon this the skin grafts were spread with their wet sides outward and edges freely overlapping. (The method of transferring the grafts after floating them on rubber tissue immersed in salt solution was devised by me, and has been continually used for the past eight years.) Numerous small punctures had been previously made in the rubber bag after stuffing, so that the gauze contents would receive any discharge lurking about. A piece of rubber tubing, the size of one's little finger, wrapped loosely about with iodoform gauze, was now inserted into the rectum, with a view of permitting free exit of gas during the subsequent days of enforced constipation. Finally the graft-covered form was carefully passed into the new vaginal space, the walls of which were held apart by three deep retractors, which, on removal, allowed the fresh surfaces to come into closest contact with the wet surface of the grafts. To prevent the plug from being in the slightest displaced, two silkworm-gut stitches were passed across the vulva, transfixing the gauze-packed tampon, and tied over iodoform plugs at either side, as seen in the illustration. The urine was drawn every eight hours for a week with such precaution that no cystitis resulted. The bowels were confined for ten days, without the slightest discomfort to the patient. Light diet was given. No febrile reaction whatever followed.

On the tenth day, when the packing was removed, it was seen that the grafts had taken universally, and that a newly-lined cavity had been created four and one-half inches in depth. Ten weeks after the operation the patient married. When she began to go about, the gravitation of the abdominal contents tended to shorten the vaginal canal, and it was found necessary for her to wear a vaginal plug, part of every day at least. Several varieties were tried, but nothing was so comfortable as a good-sized wax candle, smoothed and rounded, and kept in by a T-bandage. Omissions of one or two weeks allowed considerable shrinkage, but the renewal of the plug overcame it.

When the patient called on Dr. Abbe, a few days ago, she stated that during the four years of her married life the canal had remained competent. An examination showed that inevitable stenosis, by cicatricial contraction, had reduced the artificial vagina to two and one-half inches in depth, but as it was made more than ample in the original design, it remained to-day a practical and competent canal.

Dr. GEORGE L. PEABODY said that many years ago he had assisted a general surgeon in a similar case. As in Dr. Abbe's case, the external genitalia were perfect, but the vagina was entirely wanting. A good-sized opening was made between the bladder and the rectum, and into this a vaginal glass plug was inserted. No skin grafting was done, and the operation proved unsatisfactory, as the opening soon closed by cicatricial contraction, in spite of systematic attempts to keep it open.

Dr. CLEMENT CLEVELAND thought thes ecases of congenital absence of the vagina were very rare. He recalled one instance which was very similar to that mentioned by Dr. Peabody, but he was unable to say what the ultimate result of the operation had been.

Dr. WEIR said the method of skin-grafting described by Dr. Abbe might also prove serviceable in the treatment of cicatricial strictures of the rectum. The successful application of a skin-graft, after the division of such a stricture, would be a great help. The speaker said he had attempted this in three cases. In one, in which he took the skin from a distant part of the body, the result was a failure. In the other two cases he took a long strip of skin from the buttock and twisted it into the rectum without completely severing its external attachment. In one of these cases the procedure was a partial success: in the other, a complete failure.

Dr. Abbe, in reply to a question, said the dissection between the bladder and rectum was made with comparative ease. It was carried down to the subperitoneal layer

New Instruments.

TONGUE FORCEPS.

BY LUCIEN L. MINER,

NEW YORK.

MEDICAL STUDENT AT COLUMBIA UNIVERSITY.

Most tongue forceps in use to-day have serious disadvantages in that they bruise or puncture the tongue. An anesthetist is often bothered by a rebellious tongue that persistently falls back, blocking the larynx, yet he hesitates to apply tongue forceps, and relieves the condition as best he can by pushing the jaw forward. Sometimes he is forced to secure the tongue by forceps, spike, or needle and thread, none of which is a very refined method. This is my excuse for devising the instrument here described.

The cut explains itself. The forceps, by means of a central fenestrum and a side slot, secures two pieces of gauze which grasp the tongue gently but firmly. Clean gauze can be applied for each patient.

To prove that the tongue is not bruised, I have tried it on persons not under an anæsthetic and have found that the tongue can be securely held without exerting pressure enough to cause any pain whatever.

The forceps can be advantageously used in minor throat operations under cocaine, in a difficult case of intubation. It is especially useful in abdominal work for holding the intestines without danger of

trauma.

I am greatly indebted to Mr. Ford, the instrument maker, for valuable assistance in changing the original idea of a bulky double set of forceps to the present simple device.

Radiographing Criminals.-Röntgen rays will soon be made use of by the Paris police for the identification of criminals. Some 16,000 plates have already been collected, chiefly from the hospitals. Of course, all these do not represent portions of the internal anatomy of criminals. But the police go on the principal that people who have not broken the law yet may do so some day. These plates are, accordingly, being classified after the method invented by M. Bertillon. It is proposed that in future all convicted persons shall be radiographed as they are now "anthropometrized."-London Daily Telegraph.

Books Received.

While the MEDICAL RECORD is pleased to receive all new publications which may be sent to it, and an acknowledgment will be promptly made of their receipt under this heading, it must be with the distinct understanding that its necessities are such that it cannot be considered under obligation to notice or review any publication received by it which in the judgment of its editor will not be of interest to its readers.

THE HOSPITAL FORMULARY OF THE DEPARTMENT OF PUBLIC CHARITIES AND THE DEPARTMENT OF BELLEVUE AND ALLIED HOSPITALS OF THE CITY OF NEW YORK. W. E. DREYFUS, A.B., Ph.D., Editor. Sixth revised edition. 8vo, 160 pages. New York, 1903.

A NON-SURGICAL TREATISE OF DISEASES OF THE PROSTATE GLAND AND ADNEXA. BY GEORGE Whitfield OVERALL, A.B., M.D. 12mo, 217 pages. Rowe Publishing Company, 1312-34 E. Washington St., Chicago Ill. Illustrated.

HANDBOOK OF DISEASES OF THE EAR. By RICHARD LAKE, F.R.C.S. With three colored plates. 12mo, 232 pages. William Wood & Co., New York.

ESSENTIALS OF PELVIC DIAGNOSIS, WITH ILLUSTRATIVE CASES. By E. STANMORE BISHOP, F.R.C.S., Eng. 8vo, 297 pages. William Wood & Co., New York.

MEDICAL AND SURGICAL Reports of THE BOSTON CITY HOSPITAL. Fourteenth_series. Edited by HERBERT L. BURRELL, M.D., W. T. COUNCILMAN, M.D., and CHARLES F. WITHINGTON, M.D. 8vo, 178 pages. Published by Trustees, Boston, 1903.

THIRTY-THIRD ANNUAL Report of the Central STATE HOSPITAL OF VIRGINIA, Petersburg, Va., for the Fiscal Year Ending September, 1903. 8vo, 83 pages.

OSSERVAZIONI SU 203 CASI DI CROUP, E SU 80 INTUBAZIONI, ESEGUITE DAL PROF. ALFONSO MONTEFUSCO. 8vo, 117 pages. Detken & Rocholl, Napols, Italy. PRECIS D'ANATOMIE DEntaire. PAR J. CHOQUET 12mo, 496 pages, illustrated. F. R. de Reduval, Paris France.

TRANSACTIONS OF THE CLINICAL SOCIETY OF LONDON. Volume the Thirty-sixth, 8vo, 285 pages. Illustrated. Longmans, Green & Co., London, Eng.

TRANSACTIONS OF THE AMERICAN SURGICAL ASSOCIATION. Volume the Twenty-first. Edited by RICHARD H. HART, M.D. 8vo, 630 pages. Illustrated. Printed for the Association.

PHILADELPHIA HOSPITAL REPORTS. Vol. 5, 1902. Edited by HERMAN B. ALLYN, M.D. 8vo, 174 pages. Philadelphia, 1903.

QUIZ-COMPENDs, No. 19. Diseases of the Ear, Nose, AND THROAT. By JOHN JOHNSON KYLE, M.D. Illus trated. 12mo, 311 pages. P. Blakiston's Sons & Co., Philadelphia. Price, 80 cents net BLOOD-PRESSURE IN SURGERY. BY GEO. W. CRILE, M.D. Illustrated. 8vo, 422 pages. J. P. Lippincott Co., Philadelphia.

FOURTH ANNUAL REPORT of the Work of the Cancer LABORATORY of the New York State BOARD OF HEALTH, conducted at the Gratwick Research Laboratory, University of Buffalo, for the year 1902-3. Illustrated. Svo, 161 pages.

THE FIFTH ANNUAL REPORT OF THE INDIANA STATE BOARD OF MEDICAL REGISTRATION AND EXAMINATION FOR THE YEAR ENDING DECEMBER 31, 1902. 8vo, 268 pages.

A COMPEND OF PATHOLOGY, GENERAL AND SPECIAL. By ALFRED EDWARD THAYER, M.D. Second edition, containing 131 illustrations. 12mo, 711 pages. P. Blakiston's Son & Co., Philadelphia, Pa.

PROGRESSIVE MEDICINE. A QUARTERLY DIGEST OF ADVANCES, DISCOVERIES, AND IMPROVEMENTS. By Various Authors. Volume 4, December, 1903. Illustrated. 8vo, 444 pages. Lea Brothers & Co., Philadelphia and New York.

ATLAS OF THE EXTERNAL DISEASES OF THE EYE, AND TREATISE ON PATHOLOGY AND TREATMENT. BY PROF. Dr. O. HAAB. Second edition, 232 pages. Illustrated.

W. B. Saunders & Co.

Therapeutic Hints,

The Relations between Peritoneal Adhesions and the Functionating Uterus.-Ch. B. Reed finds that many adhesions are undoubtedly destroyed by the growth of uterus in pregnancy, but the rupture of the same may be attended with fatal hemorrhage.

Adhesions between the movable organs of the abdomen and the functionating uterus are only rarely a source of danger or cause of death. Where adhesions are protecting the peritoneal cavity from pus pockets, either appendicular or tubal, and pregnancy supervenes, a condition of extreme danger is present. The pus should be evacuated as soon as possible after the diagnosis is made without reference to the pregnancy.-The Chicago Medical Recorder.

Methylene Blue in Diarrhoea.-Combemale of Lille strongly recommends the use of this drug in all forms of rebellious diarrhoea. He thinks it is particularly indicated in infectious cases, such as those due to typhoid fever, etc. The dose is one grain three times a day.

-Medical Press.

Opacity of the Cornea.-Mazel of Marseilles recom mends a solution of benzoate of lithium (5 to 15 gr. in 3ii. p. aqua) to be instilled into the eye t. i. d.—He reports several patients successfully treated with this solution. -Medical Press.

The Extraction of Foreign Bodies from the Ear.-Use a soft rubber tube, about the length of a cigarette, and of the proper size to be introduced into the ear. The end of the tube is dipped in paraffin, and pushed into the canal until it comes in contact with the foreign body, whereupon the operator, applying his mouth to the free end aspirates forcibly, at the same time throwing back his head. Except in cases of angular bodies of irregular contour, this method is usually attended by success, the body coming away with the tube.—Medical Press.

Carcinoma of the Bile-ducts.-On account of the deep situation of the bile ducts and the great difficulty in making an early diagnosis, surgery will probably never accomplish very much. If an operation is carried out sufficiently early, while the process is confined to the duct, it may be successful. If the disease be in the cystic duct, this duct, with the gall-bladder, should be removed. If the adjacent portion of the liver is implicated, a V-shaped piece of the liver may be excised. If the common bile duct is implicated a portion may be excised, the ends united with sutures, and the fundus of the gall-bladder attached to the wound or to the intestine. If the common bile duct be implicated and the growth cannot be removed, an anastomosis may be made between the fundus of the gall-bladder and the duodenum-cholecystenterostomy. If the growth is situated in the head of the pancreas and involves the common bile duct, ex

cision is impracticable and a cholecystenterostomy should be done.-A. HAMILTON LEVINGS in the Clinical Review.

Physostigma.-Hare thinks that physostigma is a valuable drug in atony of the bladder or intestines, and in catarrh of the bowels; also, when combined with nux vomica, in gastric and intestinal dilation.

Fetid Breath.

R Inf. sage.
Glycerin, pure

Tinct. myrrh

Tinct. lavender..

Laborraque's solution

250.0 30.0

.ǎă 12.0 30.0

M. et S. Mouth wash, as required.
When due to gastric fermentation, wood charcoal in dose

of ten grains every three hours.

-CAMPBELL.

To remove vegetations from the external genitals salicylic acid is an excellent remedy. Dissolve half a

drachm in an ounce of acetic acid, and apply to parts with a camel's hair brush.-The Southern Clinic.

In Acute Laryngitis.-Full doses of sodium bromide should be given, and an embrocation of oil of amber, one part, to olive oil, three parts, should be rubbed in thoroughly over the larynx.-The Southern Clinic.

Epilepsy. Dr. James Taylor does not believe that belladonna is of much effect in the treatment of epilepsy. He has found digitalis of much use, especially in those cases showing nocturnal attacks and in instances in which the patients have cold and cyanosed extremities. -Clinical Journal.

Acute Bronchitis in Infants.-J. B. Norman speaks very highly of apomorphine as an expectorant in these cases. He gives grain every two hours. He has observed great benefit from combining strychnine with the apomorphine. -Kansas City Medical Index-Lancet. Pruritus.

R Chloral hydrate..
Camphorated oil (1 in 10).
Lanolin.....

I part. 10 parts.

90 parts.

M. Sig: Apply at bedtime and before stools.

Squibbs' Cholera Mixture.

R Tinct. opii....
Tinct. capsici.
Spts. camphora.
Chloroformi...
Alcoholis...

M. Dose, 20 to 40 minims.

Ji. 3iii.

q. s. ad.