wrist, compression being sufficient to entirely arrest or very much retard the return of blood to the heart until the operation is over; then, in the line of the proposed incision, the cocaine may be used a little more recklessly than is advised in operating upon the body. So painful, however, is a phlegmon of the finger that I have made it a rule never to carry the needle through the inflamed integument, but to introduce it preferably upon the back of the finger where the tactile sense is less, and carry it beneath the skin to some point near the proposed line of incision and inject the cocaine from the under surface. In this way complete anæsthesia may be obtained, and these painful swellings incised, evacuated and dressed before the tourniquet is removed and sensation restored. It is important in loosening the tourniquet not to remove it entirely at once, but to allow the circulation to be restored only for a few seconds, then to tighten the tubing for four or five seconds, and repeat this until several minutes have elapsed before the constriction is finally removed. This precaution is taken to prevent the sudden passage of any excess of cocaine into the circulation. operations upon the leg, the thigh, the forearm or the arm, the same control of the circulation may be exercised by constriction of the limb between the wound of operation and the heart. So safe and satisfactory, however, is the employment of cocaine by the method described in operating on the trunk, that I now

In

rarely use the tourniquet, or when employed, the constriction is just sufficient to retard the venous flow.

In operations upon bones cocaine anæsthesia is not always satisfactory, and general narcosis is preferable; but for the removal of many superficial tumors, covering an area of from one to three inches in diameter, incising infected wounds (phlegmons), removal of ingrowing toe nails, amputations of the fingers, incising or clipping off external hemorrhoids, excision of limited portions of the lips, and similar minor procedures, this agent is safe and satisfactory. In the urethra its employment gives the greatest satisfaction. As far down as the cut-off muscle a complete anesthesia may be obtained by using a 2- to 4-per-cent. solution. The quantity should be graduated to the case under consideration, and when using cocaine for the first time in any subject and for any purpose, it should be borne in mind that it is important to learn the dose the patient will require or tolerate, since in very exceptional instances an individual may be met with in whom cocaine cannot be used. Again, in urethral surgery it has frequently been noticed that patients who exhibited no constitutional symptoms after the injection of cocaine prior to or during an internal urethrotomy will absorb a dangerous quantity when an injection of the same amount of the same strength solution is made for the introduction of the sound on the third or fourth day after the

first operation. This increased susceptibility is accounted for by the fact that the solution is not so readily absorbed from an unbroken. surface, as when brought into contact with the rich net-work of vessels and embryonic tissue, as a consequence of the incision into the walls of the urethra. For a second operation, a weaker solution or a smaller quantity should be employed, gradually increasing the amount as the case will permit.

Recently Schleich, of Germany, has introduced the method of "infiltration anæsthesia," in which a very weak solution of cocaine hydrochlorate is employed in connection with a solution of common salt, and a small quantity of morphine. He recommends three formulæ; the first for operations on highly sensitive areas where there is inflammation or neuralgia; the second for operating on moderately sensitive areas; and the third, the weakest possible solution for extensive operations, to be used alone, or with the strongest solutions. These solutions should be kept in a cool room, the temperature in which should not be higher than 66 degrees Fahrenheit. A convenient tablet containing the proper proportions for ready use is as follows:

Sterilized dist. aq., q. s. to 100 cc. fl 33%

Of the No. 1 solution as much as six and one-half fluid drachms (25) cc.) may be used; of the No. 2, three and one-half fluid ounces (100 cc.); and of the No. 3, as much as one pint (500 cc.) may be employed at a single operation. No. 2 should be preferred in most cases; No. 1 is only to be employed in tissues that are excessively painful, where the No. 2 solution will not secure satisfactory anæsthesia. The No. 3 solution is employed when necessary in the deeper tissues, as in the fat and muscles. A large sized syringe holding two or three drachms should be preferred, and the very finest needle. The barrel of the syringe should be carefully graduated and a check placed on the thread of the piston to prevent the accidental discharge of a greater quantity than is required.

The initial point of puncture may be anaesthetized by using a minim of a 4-per-cent. solution; through this the needle which is to convey the weaker solution may be carried. When the needle has been conveyed just beneath the skin, a certain quantity (five to ten minims) of the solution is forced out until a pale wheal is noticed about half an

inch in diameter. The needle is withdrawn and inserted in the anæsthetized zone of the first wheal, and this is continued indefinitely until the entire surface is ready for incision. The tissues may be at once divided and the dissection continued until sensation is felt, when additional solution may be employed. In prolonged operations

the anesthesia may disappear in from ten to twenty minutes, requiring a repetition of the injections.

The distension of the tissues in cocaine anæsthesia interferes to some extent with the rapid repair and union of wounds, but not sufficiently to contra-indicate its general use.-New York Polyclinic.

The personnel of this year's students is very far above the ordinary. All of them appear to have a prosperous look-a sort of

"Let the wide world wag as it will,
We'll be gay and happy still."

But there is also a very decided improvement in the mental and social culture of the present class, which augurs well for the future of American medicine. We also are gratified to see that there is such a general acquiescence in the stringent laws that have been enacted to control medical education in the State of Missouri, which have raised the hand of everyone interested in the present jack-pot of medical teaching. (We do not know whether this metaphor is exactly "according to Hoyle," but we venture it at any rate.)

We also remark a great increase of enthusiasm-a real earnest desire for knowledge-independent of the sheepskin. This means progressit means education in the full sense of the word—the leading out of the faculties. According to Matthew Arnold's quaint method of putting it, which we never tire of repeating,

"try to see how much you can get out of a man, not how much you can get into him.".

It is a very favorable outlook for the future of American medicine when we see, instead of a falling off of students under the new ironclad laws which now equal those across the pond, a great numerical increase of the better sort financially, socially and intellectually. Let the fittest survive! So mote it be. Amen.

THE BACTERIOLOGICAL LABOR

ATORY.

A large amount of money has been expended this summer upon the latest and most approved apparatus for bacteriological and histological work. Magnificent microscopes, new equipments entire for culture work and all pathogenic germinal investigation have come in in such glittering profusion as to make glad the heart and soul and mind of the laboratory worker. The gleam of the copper, the sheen of the brass and the glister of the glass make the Biological Laboratory "a thing of beauty and a joy forever.”

or contumely. We do not parade in the daily press our immaculate devotion to the higher standards, as is the Pharisaic custom of some who spread their phylacteries before the public and proclaim with Bombastes Furioso effusiveness that "we thank God we are not as other men," but we silently accept the situation, act up to it and without public selfaggrandizement try to hold up the hands of the State Board in all their measures to elevate the standard of medical education. We are glad to note that among those who have been "interviewed" ("God save the mark") by the secular press, the name of not one of the Professors in the College of Physi

cians and Surgeons appears. Somehow we cannot help believing, as did our noble medical fathers before us, that, in the language of the venerable Bowling, "to medical men belong medical matters," and this puffing and blowing and bombastic declaration of peculiar excellence and supreme medical purity, dignity and glory, under the color of protecting "the dear people," with personal names affixed thereof, is but a low sort of advertisement which subverts the very purpose of advancing the principle of medical culture. Turn on the screws, gentlemen; we can stand the pressure, and we wave you the

signal of success.

Among the list of interesting papers to be read before the meeting of the Tri-State Society (Alabama, Georgia and Tennessee), to be held at Chattanooga, October 13, 14 and 15, we notice one by the erudite editor of the Alabama Surgical Age, Dr. Davis, with the title as written above "Puss in the Pelvis." We should be most delighted to hear this paper. We have heard of pussy in the moonlight on roof and gable, in wood-shed and in stable, on fence, piazza, tree and plaza, but never before have we heard of pussy entering the sacred precincts of the pelvis. How got the pussy