separation of the muscles. He has found that better results are secured from the treatment of this class of hernia by overlapping the tissues from above downward, than by the lateral lapping, the method so much in vogue. He has employed this method twenty-five times without a death, and with but one relapse. His method of procedure is to make a transverse elliptical incision around the umbilicus and hernia, clearing the aponeurotic structures for at least three inches from the neck of the sac. The coverings of the hernia are divided at the neck, exposing the contents. All adhesions are separated, and if the sac contains omentum it is ligated and removed with the sac. The peritoneal structures are closed with running sutures of catgut. An incision is then made through the abdominal structures one inch or less, transversely, and the aponeurotic structures separated from the entire surface to form two flaps. Mattress sutures of silk or some other firm material grasp the border of the lower flap, making the upper flap cover the lower until the hernial opening is entirely obliterated. The margin of the upper flap is then sutured to the structures below with catgut; the overlying tissues are then closed in the usual manner.

This method of operation has not only found success at the hands of the writer, but the paper was discussed by such men as Ochsner, Murphy, and Ferguson, all of Chicago.

Doctor Ochsner stated that the modern text-books on surgery claim for the radical cure of umbilical hernia a large mortality, and a large proportion of recurrences. The large mortality, he believes, was due to the unnecessary traumatism caused by the operation, failure sometimes due to the fact that the principles underlying the operation were not understood. The advantage of the method used by Doctor Mayo, and followed by others, is not only due to the doubling of the fascia layers, but by taking advantage of the deformity which exists in the lengthening of the distance from the sternum to the pubes.

Doctor Murphy lost a patient from pulmonary edema, following the lateral operation. He believes that the method of operating was largely responsible for this cause of death, as a latteral operation interferes with diaphragmatic breathing if there is sufficient irritation. The operation described does not interfere with breathing in the least.

Doctor Ferguson believed that the operation is a good one, but that it was not applicable in all cases. The surgeon should perform the operation which permits the best use of material at hand for preventing the return of hernia. He believes that the bringing together of the recti muscles is of immense advantage when they are not too far separated; that the fat in the abdominal wall when excessive, should always be removed. This point, however, may apply to Mayo's operation as well as others.

Eastern surgeons do not appear to have taken part in this discussion. Doctor Mayo disclaims all credit for the devising of this operation, and states that he believes that the principles may have been known to surgeons from the time of Hippocrates.

C. C. D.

OPHTHALMOLOGY.

BY WALTER ROBERT PARKER, B. S., M. D., DETROIT, MICHIGAN.

CLINICAL ASSISTANT IN OPHTHALMOLOGY IN THE DETROIT COLLEGE OF MEDICINE.

PARALYSIS OF CONVERGENCE AND DIVERGENCE WITH PARALYSIS OF THE SUPERIOR RECTUS.

DOCTOR DUANE (Archives of Ophthalmology, May, 1903) reports a case with the following history:

"Patient, two years old, was suddenly attacked, while walking on the street, with diplopia, both vertical and lateral. She was examined. then and righ hyperphoria 9° was found. One year later tenotomy of right superior rectus, reducing hyperphoria to 4°, then tenotomy of the left inferior rectus, producing marked overcorrection. This it was attempted to remedy by tenotomy of the left superior rectus, and subsequently a number of operations were done. She was also exercised with prisms and has worn, prisms and various glasses designed to correct the refraction."

When he first saw the case, ten months ago, she had diplopia in every direction of the field of fixation and marked vertigo, with the objective evidences of marked but not complete paralysis of the left superior rectus and a less marked paresis (evidently postoperative) of the right superior and the left inferior recti, and nearly complete paralysis of convergence and divergence, as shown by the following signs. Approximate balance for distance; insuperable crossed diplopia, beginning at six feet from the eyes, and increasing steadily in amount as the object of fixation was carried nearer the eyes; inability to overcome prisms of even one degree either base in or base out; inability to converge even to the slightest degree on a test object carried toward the eyes; absence of pupillary convergence-reaction with retained lightreaction; all this being combined with a perfectly normal excursion of either eye, inward or outward, in performing associated parallel

movements.

"To relieve the vertical diplopia a graduated tenotomy of the right inferior rectus was done, and later an advancement of the inferior As a result of these operations the point of equilibrium was shifted from far distance to sixteen inches with temporary relief of the vertical diplopia. Two months later the right hyperphoria amounted to fifteen or sixteen degrees, due to increase in the paralysis of the left superior rectus. There were no evidences or organic nervous disease. Doctor Duane thinks the original lesion was a paralysis of the left superior rectus, the insufficiencies found in the other vertical muscles being due to operations. Ten years after it first developed, this primary paresis suddenly and without cause increased and became total."

In conclusion he states the facts illustrated by this case as follows: "(1) The unwisdom of attempting to correct a deviation (especially a hyperphoria) due to a paresis of one muscle by a tenotomy of its

antagonist. The result is nearly always disastrous. Here an initial tenotomy of the left superior rectus was proper under the circumstances, but to supplement this by a tenotomy of the left inferior rectus was a serious error.

"(2) The care that has to be exercised in handling these paretic affections which after remaining stationary, it may be for years, suddenly and without cause increase or diminish.

"(3) In paralysis of an elevator, the increase of a diplopia in looking to the right or left is fully as great as the increase in looking straight up, and is of more significance for the diagnosis.

"(4) The contraction of the pupil taking place when the attention is directed to a near object is a convergence-reaction and not an accommodative-reaction. In this, as in similar cases, it was only when the patient converged, not simply when she accommodated, that the pupil contracted.

"(5) The correction of a complete convergence-paralysis by operation is unsatisfactory, about as much so, indeed, as the correction of a complete paralysis of a muscle by advancement of it."

[This is a most instructive case, and we gladly add our plea for noninterference in cases of paralysis.-w. R. P.]

EDITORIAL COMMENT.

EFFECTS OF ELECTRIC CURRENTS AND SO-CALLED
LIGHT RAYS ON BACTERIA.

THE declaration made in a modern text-book that continuous electric currents are bactericidal is one that requires considerable modification inasmuch as it is capable of causing a vast deal of mischief. While the statement may be partially correct, various observers have demonstrated that degree or quantity is a factor which claims recognition in an estimate to determine the bactericidal power of the electric current.

In 1901 Zeit conducted some very thorough experiments by which he demonstrated that bacteria of low thermal death rate were killed by exposure to currents of from two hundred sixty to three hundred twenty milliamperes for ten minutes, but that a current of forty-eight milliamperes has no bactericidal effect, even if continued for two or three hours. On the other hand, currents of one hundred milliamperes will kill nonresisting bacteria "by the production of electrolytic germicida! products" if continued for seventy-five minutes.

Electrodes are rarely sterilized between employments in routine practice; indeed the construction of these appliances is usually such that the only reliable method of sterilization-boiling and steam under pressure—cannot be utilized. In genitourinary work the most essential precaution is to prevent the introduction of septic material into the

genitourinary tract. Currents of the strength mentioned are certainly seldom, if ever, applied to the region designated, as only a few milliamperes are required to disrupt a stricture. The irritation produced by electric currents constitutes a focus for infection, which is almost certain to occur if the electrode is not aseptic. Happily this method of treatment is fast being relegated to oblivion.

"The continuous current produced by polarizing electrodes and the exclusion of the effects of ions is neither bactericidal nor antiseptic." Tesla currents also prove negative as regards germicidal properties "when passed around a bacterial suspension within a solinoid." Ozone, when brought in contact in sufficient quantity, destroys bacterial life. The amount necessary to cause death may be obtained from high-frequency coils or from so-called brush discharges. The x-rays will kill many varieties of bacteria in plate cultures, providing the exposures are continued twenty to thirty minutes. Ultraviolet rays, as is now quite well known, are bactericidal. In the treatment of lupus vulgaris, according to the specifications of Finsen, the patient is subjected to ultraviolet rays for an hour and ten minutes, on successive days, until an apparent cure is effected. The patient is requested to report any manifestations of recurrence of the condition, and the claim is maintained that only one or two per cent of six hundred cases of lupus vulgaris treated at Copenhagen have resulted in failure, the greater number of which were attributable to faulty treatment.

CONTEMPORARY.

NONSECTARIAN MEDICINE.

[COLUMBUS MEDIcal Journal.]

SECTARIANISM in medicine is founded in selfishness and commercialism. It is sadly out of harmony with science and results in wasted. energy, dissociation and retarded progress in art. It is a stumbling block to the science and art of medicine.

The goal of medical science is truth, and the application of truth to the prevention and cure of disease. But truth is not divisible into schools, and its application to the cure of disease should not be made the basis of sects. To the physician all known truth should be available, all plausible theories should be his to prove. No dogma should fetter his choices, no school should select his remedies, no sect determine his methods.

It is this realization that sectarianism is restrictive rather than helpful, that it divides and weakens, where union and strength are needed, that has made the great majority of physicians in all ages. desire a united profession. They have sought to avoid the use of any term that would imply a school or sect. Allopathy is an erroneous designation given to the regular system of medicine and surgery, not by those to whom it is supposed to apply, but by others as an anonym to the term they selected for themselves.

The right to select remedies and methods with absolute freedom is so generally recognized by all the so-called schools that sects are sects now only in name. Surgery is alike in all; dietetics and nursing know no school. Homeopathy no longer pretends to administer infinitesimal doses of inversely potentialized medicines, expecting them to produce symptoms like those of the disease treated; eclectics no longer assume to have a monopoly of wisdom in the selection of therapeutic remedies, and physiomedicals can boast of no useful information that may not be known by all. Then why should we not have a united profession? Many believe that we may have an undivided profession and have declared in favor of union by the simple abandonment of sectarian names. These designations have lost their original meaning, and are retained presumably for some supposed advantage in the proclamation which they make to the public. The constitution of the reorganized state and county societies wisely provides that any reputable physician who will agree to practice nonsectarian medicine shall be eligible to membership in these societies and thereby in the American Medical Association. This has raised the question as to what is implied in the practice of nonsectarian medicine. It is the practice of medicine and surgery without proclaiming to the public that such practice is based upon any exclusive method or system. Truth as one sees it is to be the light, judgment as now to be the guide. The only restriction being that one is to refrain from using a sectarian designation which at best serves only to hold out a claim to the public that one has some remedy or method not possessed by our confreres. Not that we must change our methods of practice, but that we are to refrain from advertising them. The following statement expresses the meaning: "No physician who indicates to the public that his practice is based on a sectarian system of medicine shall be entitled to professional fellowship or recognition in medical bodies."

And what physician who has in that honored title a claim on ail medical knowledge, and freedom of all methods, could desire a circumscribing designation which would give him at best only an undue advantage over his professional brother?

If a physician is not to indicate to the public that his practice is based on a sectarian system, he should cancel sectarian names from his sign and from the title of his medical societies, for they can serve no good purpose there, and are certain to mislead the public.

MEDICAL NEWS.

OBITUARY.

DOCTOR DONALD MACLEAN relinquished temporal life at his home in Detroit July 24, 1903, in the sixty-fourth year of his age, after an illness of two weeks with gastroenteritis. The doctor was a native of Canada, having been born in Seymour, Ontario, December 4, 1839, of