is frozen as hard as ice, but, strange to say, in a few minutes circulation returns without any injury to the tissue, provided the part is not in the end of some extremity. There is no pain in the application excepting at the very beginning, but there is a slight burning or tingling. It also completely anesthetizes the part to which it is applied without freezing it solid. Dr. White has tried liquid air as a local anesthetic in a number of cases with invariable success. It has one important advantage; that is the absence of hemorrhages during the operation, enabling the operator to apply the dressing before any hemorrhage sets in, the dressing then being sufficient to stop any oozing. Dr. White has found the use of liquid air beneficial in the local treatment of ulcers, etc. He states that an abscess, boil or carbuncle in the early stages is aborted absolutely with one thoro treatment. If it is more advanced, several applications at intervals of twenty-four hours are necessary. Liquid air has also been used with advantage in cases of sciatica, neuralgia, etc.

An interesting experiment was tried in a case of ivy poisoning, involving the entire left forearm and hand. A band around the forearm about three inches wide was slightly frozen by the spray, and then the usual treatment was applied to the entire poisoned area, including the part which had been treated with the liquid air. At the next dressing the part which had been treated with the air was very distinct, and this portion was greatly improved, the inflammatory process having subsided. A number of other diseases have also been treated with liquid air with markt success. Where no loss of tissue is desirable, liquid air should be applied by the spray and not by the swab. Dr. White takes issue with Mr. Hampson. Dr. White is undoubtedly correct in advising the greatest possible care in using the new substance which science has placed at the disposal of the surgeon. Even such cooling agents as the ether-spray should be used with great caution, and liquid air should be applied only by those who have had some experience in its use.

In conclusion, Dr. White considers that we have reason to hope that we have in liquid air a therapeutic agent which will remove many otherwise obstinate superficial lesions of the body and cure some lesions which have hitherto resisted all treatment at our disposal, including the

Surgery.

By William V. Morgan, M.D., Department Editor of the Med. and Surg. Monitor, of Indianapolis.

In true ankylosis, when an attempt is made to flex the limb, pain will only be experienced at the points where pressure is made, but in false ankylosis the pain will be in the joint.

Ammoniacal urine gives olfactory evidence of infection cystitis. Ammoniacal decomposition in the bladder can only take place as the result of the presence of pyogenic micro-organisms and should always be the signal for cystic lavage and the administration of diluents.

A differential diagnosis between a femoral and an inguinal hernia may usually be made by observing the relation that the protrusion bears to the tendon of the adductor longus muscle. By abducting the leg this tendon stands out more prominently than any other tendon inserted into the pubes. Hernias lying to the inner (median) side of the tendon are of the inguinal variety, and those to the outer side are femoral.

The

The surgical principles for the treatment of a nevus (mother's mark) should be based upon the truth so plainly and tersely enunciated by J. Bland Sutton: "A nevus should be cut out, not into." The lesson taught by the hemorrhage which results from disobeying this rule would surely not require repetition. It is never safe to inform a patient that a nevus will not grow larger. On the exposed surface of the body (and especially upon the face) what is at first but a slight blemish may become a most repulsive disfigurement, smallest nevoid fleck of infancy, requiring only the simplest measures for its effacement, may become of such size in later life as to require a serious surgical operation and be followed by an unsightly scar. The simplest and the safest method for the cure of small nevi upon portions of the body where scarring is to be avoided, is by the use of the galvanic current. A large sponge electrode, thoroly moistened, is placed upon some indifferent portion of the body and connected with the negative conducting cord, and a properly insulated needle introduced beneath the skin (near the vessels which feed the nevus), and connected with the positive pole. A current of from fifteen to thirty milliamperes

is allowed to flow for from fifteen to thirty minutes, according to the size of the growth and the effect produced. On account of the coagulating effect of the positive pole, the needle will be difficult to withdraw unless the current be reversed for a short time. A repetition of this treatment once or twice a week, according to indication, can be depended upon to give excellent results. The bunglesome mistakes so frequently coming under the observation of the writer justify the somewhat elementary injunction, "Do not use a Faradic battery to secure electrolytic effects." The enlarged nevi (angiomata) of the lips can be attackt by the sharp point of a Paquelin cautery heated to a cherry color. Such tumors are better treated from the mucous surface, in order that no visible scars may result. This method is much superior to excision, and on account of its simplicity, effectiveness and freedom from mutilation, merits entire confidence.

Sup

If a physician is cool-headed and has a reasonable degree of ingenuity, he will seldom be caught in an emergency from which he cannot extricate himself. pose you have a patient suffering from retention of urine and you are several miles from a catheter. If nothing better is at hand, take some wire from a broom, sterilize it, bend it double and pass the blunt end into the bladder. The groove on each side of the doubled wire will allow the urine to slowly dribble away, and you can have time to meditate upon the esthetic side of life. The writer once saw a patient of Dr. Wm. B. Fletcher who was suddenly stricken with paralysis of the vocal chords. The doctor quickly stabbed the cricoand inserted a goose-quill thru the openthyroid membrane with his pocket-kuife ing. This allowed the patient sufficient air to keep him alive until a deliberate tracheotomy could be done. A hairpin bent at right angles one-half inch from the free ends is a useful instrument with which to keep the lips of a tracheotomy wound apart, and two of them bent as retractors at the blunt ends may be attached to tapes, past around the neck, and made to serve the purpose of a tracheotomy tube for many hours.

The tyro often manifests his sappy juvenility by the assurances of perfect success which he lavishes upon his patients.

Fortunate the doctor who is an expert in parrying the "leading question" when prudence demands. Suppose a patient suffering from Colles' fracture should hook this kind of an interrogation point around your neck: "Doctor, will I have a perfect arm?" Instead of indulging in monosyllabic fatuity, one would better say, "If proper apposition of the fragments is maintained, and nature is successful in her reparative efforts, you will have a useful limb." This will indicate that you are trying to establish an equal and perpetual partnership between yourself and nature, and if the patient is willing to contribute his legitimate share towards the effort made to benefit him, then the tripartite surgical agreement between himself, nature and yourself will probably prove satisfactory.

An injury to the lower end of the radius in a person under twenty years of age may be a diastasis instead of a Colles' fracture. In such a case there is a possibility of great retardation in the growth of the bone in its length, from injury to the epiphyseal cartilage, as the upper extremity grows in length mostly from the upper epiphysis of the humerus and the lower epiphysis of the radius and ulna.

To secure success in the use of coaptation sutures it must be remembered that their function is simply retentive. If any strain is placed upon them relaxation sutures should be so placed that all tension is relieved.

Bleeding from the nose may usually be readily controlled by placing a tampon of iodoformed, or sterilized, gauze in the anterior nares. If the bleeding be from the posterior nares a double thread is easily carried thru the nose into the throat by attaching it to a soft rubber catheter. The thread is now drawn out thru the mouth and the distal end tied to a tampon, when the catheter is withdrawn from the nose and the proximal end of the thread tied around a tampon at the anterior nares. In case no catheter is to be obtained, a probe, piece of wire or a hairpin can be made to serve its purpose. In no case should cauterizing injections be used to stop hemorrhage from the nose.

The advice to avoid abdominal section in all gun-shot wounds of the abdomen above the level of the umbilicus, seems to be discredited by accumulating experi

The

ence. The conditions obtaining in military and in civil life are so different that rules formulated for the one condition will not hold good for the other. soldier seldom suffers from an overloaded stomach, and the civilian seldom allows that viscus to become empty. In the one case there would likely be no leakage from the injured stomach, while in the other it would certainly occur. The condition of the patient, his surroundings and the ability of surgeon to do clean work will always count for more than any hard and fast anatomical rules.

A most excellent filiform bougie is made by taking a piece of silver wire of proper length and holding the end in the flame of an alcohol lamp until a small bead is melted upon it.

The chief symptoms to be relied upon in dislocation of the humerus are the squareness of the shoulder, caused by the prominence of the acromion process; the angle formed at the insertion of the deltoid; the prolongation of the axis of the humerus leading away from, instead of toward, the glenoid cavity; feeling the head of the bone in its abnormal situation, and the inability to place the elbow against the chest when the hand of the injured side is upon the opposite shoulder.

One of the most markt advances recently made in orthopedic surgery is that of tendon implantation. By this operation a part of the tendon of a healthy muscle is implanted into the tendon of a paralyzed muscle in such a way as to restore the function of the disabled part. In such case we have muscular action by proxy. The happiest effects of this newer surgery have been noted in cases of infantile spinal paralysis. Of all the muscles in the body, the one most frequently par alyzed are those supplied by the peroneal

nerve and its branches. Most of the tendons of these muscles are readily aecessible to operation. In paralytic talipes equino-varus the method of tendon implantation has been particularly efficacious. and the benefits derived from restoring the functions of a paralyzed hand have seemed little less than marvelous.

There are numerous anatomical protes's against the amputation of the leg for in

In

jury to the popliteal artery or vein. The older surgeon lost sleep because he feared secondary hemorrhage; but the newer surgeon knows that secondary hemorrhage rarely happens in clean wounds. wounds of either of the vessels mentioned, ligatures should be placed upon both sides of the wound and within half an inch of the lesion. This more surely conserves the channels thru which the redeeming collateral circulation is to be establisht, and adds nothing to the dangers of the case, provided the treatment is proper in other respects.

Prominent among the measures to be carried out must be placed the postural treatment. If the artery is injured, the limb should be lowered and artificial heat applied to the leg. If the vein is injured, the limb is to be elevated and gentle upward-friction massage applied to the thigh. A moment's study will reveal the reasons why by these means the forces of the blood stream will be best conserved for the restoration and preservation of the parts. Do not think of amputation until the evidences of gangrene evidence the folly of further delay.

A ganglion was formerly supposed to be a sequestration from the synovial membrane of a joint or tendon sheath. Later investigations seem to prove that it is a cystoma, arising from gelatinoid degeneration of tendon sheath or the para-articular tissues. The benign form of ganglion is single, usually of globular form, and rarely exceeds an inch in diameter.

The older method of treatment by subcutaneous rupture was generally successful, but the most approved treatment is extirpation. As a rule, such an enlargement is simply an inconvenience, and is seldom painful unless the contents become infected.

In markt contradistinction to this innocent growth is the condition known as compound ganglion. Compound ganglions are fusiform in shape, and are often multiple. Both growths have their usual habitat in the region of the superficial tendons of the wrist or ankle.

Compound ganglion is a tubercular tenosynovitis and requires early and thoro eradication. The injection of irritating solutions is timerous folly. Those cases which are not subjected to radical treatment frequently extend their infection to the contiguous joints or to the lungs, so that the more common causes of death in

such cases are exhaustion from prolonged suppuration, and pulmonary tuberculosis.

On account of their giving little pain, and being so innocent in appearance, both the patient and the inexperienced physician are likely to be deceived into a fatal delay. Thoro extirpation of the growth before dissemination of the bacilli has taken place gives the only hope of recovery.

Surgical Hints.

In all amputations, remember that the loose muscles retract more than those which are attacht to the bone. Hence it is better to sever the loose muscles first, and the attacht ones next, so that the ends may be of equal length.

If you believe that your operation has been a clean one, leave the wound alone, if not an infected one. The best surgeons usually apply but one dressing, the first. When this is removed the stitches are taken out, and the wound only needs a clean covering for a few days.

Before giving ether to patients suffering from catarrh of the nasal passages, wash these out with an alkaline solution. This will, by cleaning out the secretions, allow much easier breathing, and hence increase the facility with which anesthesia can be induced.

Scalp wounds should always be stitcht, if of any size. But always remove the stitches very early; otherwise they may act as setons, and lead to suppuration, which if it reaches the loose layer under the aponeurosis, is likely to be serious. These wounds only gape if the scalp or muscle or its aponeurosis is incised, and very few stitches are needed.

In cases of felon, find out as soon as possible whether the bone is attackt. Should the terminal phalanx become loose, amputation will nearly always give the most useful finger, especially to workmen. The amputation, however, is best delayed until the septic process is overcome, or else the flaps will probably die, and the time needed for healing by granulation will be greater than that taken up in previous antiseptic treatment.

In bad cases of frost-bite of the hands or feet, do not be in a hurry to amputate. Rest in bed and the most careful asepsis will often allow you to save fingers and toes that would be sacrificed otherwise. The asepsis must be thoro; shreds of necrosing tissue must be duly removed,

and the patient's strength be upheld by careful nutrition. Under such conditions, if gangrene becomes establisht, it is usually found that the line of demarcation is much farther towards the extremity than was anticipated.-International Jour. of Surg.

Peanuts as Absorbents.

Peanuts have a faculty for absorbing alcohol and preventing it from demoralizing the nerves and upsetting the thinking machine. It is estimated, for example, that if a man drinks a quart of champagne and eats a pint of peanuts, the peanuts will overcome the inebriating quality of the wine without entirely curtailing its exhilarating effects. The large proportion of oil in the peanuts accounts for this result. A good wineglassful of olive oil has the same effect.-Prac. Rev.

WORLD one year and Dr. Waugh's book, $5. You need them both.

Book Reviews.

An Epitome of the History of Medicin. By Roswell Park, A.M., M.D., Professor of Surgery in the Medical Department of the University of Buffalo. Based upon a course of lectures delivered in the University of Buffalo. Second edition. Illustrated with portraits and other engravings. The F. A. Davis Company, Philadelphia, New York, Chicago. Price. $2 net.

This book past thru its first edition in less than a year. It is gotten up in the usual elegant Davis style-paper good, typographical work of a high degree of excellence. Beside correction of a few minor errors appearing in the first edition, a chapter on "Iatrotheurgic Symbolism," covering twenty-two pages, has been added. This chapter is a historico-critical supplement to the main body of the work. In his preface to this edition the author hopes "that a larger and more comprehensive work may be the outcome of interest in the History of Medicin." To this sentiment his readers will respond, "Amen, and let Park write it." The book contains 365 pages, in XXV chapters. There are fifty-six illustrations. The history of medicin has been divided into the Age of Foundation, the Age of Transition and the Age of Renovation, the balance of the work being devoted to separate chapters on History of Medicin in America, History of Anesthesia, History of Antisepsis, An Epitome of the History of Dentistry, and the chapter on Iatrotheurgic Symbolism. A critical review of a work of this character is impossible. Suffice it to say that no medical library will be complete without this work, and that a man will be a better doctor for knowing something of the history of the art he has espoused. Dr. Park has the faculty of adding zest to even the more interesting portions of medical history, and, at the same time, the ability to make even the dullest parts pleasingly readable.-A. L. R.

The American Pocket Medical Dictionary. Edited by W. A. Newman Dorland, A.M., M.D., Assistant Obstetrician to the Hospital of the University of Pennsylvania; Fellow of

the American Academy of Medicin. Containing the pronunciation and definition of over 26,000 of the terms used in medicin and the kindred sciences, along with over sixty extensive tables. Second edition, revised. Publisht by W. B. Saunders, 925 Walnut street, Philadelphia, Pa., 1899. Price, $1.25 net.

This little book is 3x6 inches, and inch thick. It weighs but 74 ounces, and will readily fit any coat or trouser pocket. The first edition only lasted six months, and in the preface to this edition the author says it is "his aim to make the book represent, as far as possible, the present state of medical lexicography by keeping it in all respects thoroly up to date." This he has done. His experience as a teacher has aided him in the selection of words and the elimination of useless padding found in many more pretentious works.

The book is bound in dark red Russia leather, with handsome gold title. The workmanship is good, and the book will bear usage. It will be used by the medical student most extensively; yet the most of us could drop it into our pockets occasionally, with benefit. It will not disappoint the most critical purchaser who buys it for what it claims to be an up-to-date pocket medical dictionary.-A. L. R.

Blake on the Hand, or the study of the hand for indiestions of local and general disease. By Edward Blake, M.D. Publisht by Henry J. Glaisher, 57 Wigmore street, Cavendish Square, W. London, England. Price, half-a-crown, net.

This little monograf is very readable, and furnishes many valuable hints; tho the subject is treated quite fully in this country, in our large text and reference works on diagnosis. The book contains thirty-seven pages, besides numerous bibliographical references and an index. It has four elegant plates and six cuts illustrating the text. It will furnish any practitioner a pleasant and profitable hour. The general getup of the monograf is good; it has been carefully edited, and the typography is perfection itself.A. L. R.

The Mechanics of Surgery; comprising detailed descriptions, illustrations and lists of the instruments, appliances and furniture necessary in modern surgical art. By Charles Truax, Chicago. Price, $4.50. From medical book sellers, or direct from the publisher.

The work is a large-sized quarto, containing 1,024 pages, and 2,381 illustrations. The paper is good, and every illustration distinct. While not by any means an encyclopedia attempting to illustrate and describe all the appliances used in surgery, it covers the field well. The hypocritical reader who searches for his favorite instru ment, or the enterprising surgeon who has made the attempt to foist some modification of a wellknown instrument (bearing his name, but without other perceivable advantages) upon the profession, and expects to find it exploited here. may very likely be disappointed. The work is up to date, and the typographical technic is excellent. The circumstances surrounding the authorship and publication are unique. It is seldom indeed that one outside the medical profession enters the field of medical or surgical authorship, and yet the particular field covered holds at this time no modern competitor. Instrument catalogs have appeared from time to time aiming somewhat along the same general lines, but they have either been so markedly commercial in instinct as to render them valueless as guides, or they have been made up with a context wholly in quotations. This work. on the contrary, seems free from commercial taint.