excision of the larynx. There were 26 fatal cases in 102 operations. The excessive mortality was due to the special causes of death associated with these operations, namely, affections of the lungs and septic poisoning. The two main obstacles to contend with in the management of patients having undergone these radical operations are:

1. The difficulty of keeping the wound aseptic.

2. The difficulty of preventing the entrance of fluids into the airpassages.

The latter is the greater danger. The author treats the majority of his patients without tracheotomy-tube or tampon, after removal of first tampon-tube within twenty-four hours of the operation, by dusting the wound with iodoform and borax and placing over the wound iodoform gauze; patient to be placed upon side, the head on one small pillow, thus allowing wound in a measure to be dependent.

Of the 102 cases, 15 patients were alive and free from disease, or dead of some other malady than cancer, at periods extending from three to twenty years after the last operation.

In choosing the operation upon individual cases, the author urges the smallest operation consistent with the widest excision of the disease and a considerable area of surrounding tissue.

The larynx should be widely opened and thoroughly examined. The disease generally occupies a larger area than is apparent in laryngoscopic examination. The removal of the cartilages, forming the framework of the larynx in most cases of intrinsic carcinoma, is not necessary; if the disease has penetrated and laid bare these structures, it is sufficient to expose them and to cut away or scrape with a Volkmann's spoon all of the softened parts.

Carcinoma with great difficulty make their way into cartilage, and the chances of recurrence in these hard parts are infinitely less than in the soft tissues.

NOTE ON THE PROCESSES TAKING PLACE IN DIPHTHERITIC MEMBRANE.

M. Armand Ruffer (Brit. Med. Jour., July 26, 1890). The bacillus of diphtheria, first investigated by Klebs in 1883, is found in the false membranes only, and not in the organs or blood of persons who die from the disease. After introducing a pure culture of diphtheritic bacillus into the veins of a rabbit, it was impossible to find the specific organisms in the blood or organs.

After inoculating guinea-pigs subcutaneously, a marked dema was found at point of introduction, and the number of bacilli increased up to eighth hour after inoculation; they then gradually decreased in number until the animal died.

The blood and organs of these animals were found to be sterile.

It is probable, therefore, that the microbes, in the effort to penetrate the living tissues, are killed if forcibly introduced into the system. There is evidence that such a result takes place in the diphtheritic membrane of man. The pharynx and larynx of patients dead from diphtheria were perfectly hardened in alcohol, embedded in paraffin, cut, and stained with alum-carmine, and after ward with gentian-violet. In these specimens it was possible to study the position of the bacilli with relation to the surrounding structures.

A section of bronchus, where the disease had passed into the lungs, • showed, in the free surface of the membrane, next the lumen of the tube, an enormous number of specific bacilli, lying mostly in the exudation. In the deeper layers of the false membrane the number of micro-organisms is exceedingly small, and not a single bacillus can be found in the mucous or sub-mucous tissues.

Conclusions from observations:

1. The diphtheritic bacilli are present in most superficial part of membrane only, well within reach of medicinal agents.

2. In the diphtheritic membrane there is an active contest between the amoeboid cells in the membrane and the micro-organisms.

3. The reason why the bacilli do not penetrate the living tissues is that they are arrested and antagonized by the amoeboid cells lying in the network of fibrin that constitutes the diphtheritic membrane.

MEDICAL JURISPRUDENCE.

THE LAW AND THE DOCTORS.-AND NOW THE DRUGGISTS.

BY SIDNEY V. LOWELL.

The last volume of the Law Reports of the State of Tennessee contains a report of the case of Demoville & Co. against Davidson County. It seems that at the session of the Legislature of that State in 1887, a very curiously worded Act was passed, in relation to druggists who had sold liquor which was not used medicinally, and to relieve those who had honestly sold, as for such use, from liability for tax as liquor dealers. We give the first section entire :

SECTION 1.-Be it enacted by the General Assembly of the State of Tennessee, that all druggists in this State who have made themselves liable for taxes as liquor dealers under the Revenue laws, * * making them liquor dealers, and who were not in fact using the drug

gist's license as a blind, but were in good faith only selling the prohibited articles as medicine, be and they are hereby relieved of all liability. * * *

The plaintiffs, it seems, being druggists, had been mulcted in damages for selling liquor-as being liquor-dealers, the alcoholic fluid sold by them having been used as a beverage. To obtain relief from the judgments obtained by the Government of the County where they resided they had, perhaps with the aid of others similarly situated, obtained the passage of the Act cited.

The Attorney-General of the State, Mr. "Attorney-General Pickle," refused to accept the statute as being "law," and took high constitutional ground against it. He claimed especially that it was "class legislation;" that is, legislation in aid of particular individuals, rather than for the benefit of the community, and as such obnoxious to a provision of the Constitution of Tennessee, directly negativing legislation, granting to any individuals especial rights or exemptions.

He claimed that all liquor dealers constitute a class, and that the Act singled out one portion of that class, and extended relief to them alone.

The Court held, however, that druggists are not liquor dealers in any true sense, and that they constituted a natural and not an arbitrary class of the community, and legislation of which all of them might have the benefit, was not obnoxious to the Constitution.

General Pickle also urged that the statute was invalid as being retrospective, and that the Legislature could not give away the taxes earned by the State. The Court made a rather fine distinction as to this, and decided that these taxes were "privilege taxes," (an expression not common in New York), as distinguished from "property taxation," and held that the Legislature could waive them. Likewise overruling the objection that the Legislature could not interfere with the course of justice as to judgments already inflicted.

Our friends, the druggists, went free, but it was a close call, and must have cost them in various ways a pretty penny.

There was once great abuse by certain druggists of their privileges in the same way in this city. This was reprobated by all good physicians, and their establishments shunned. While a few made money,

others were ruined.

It may be that our Tennessee friends will be yet called to account as to whether in the racy language of the Act, they were not using their license as a blind!" It would be safe advice, perhaps, to all in the business, to make no sales of intoxicating liquors except on a physician's prescription. There is no other safe course.

CORRESPONDENCE.

FOR THE RELIEF OF THE POOR CRIPPLES OF

BROOKLYN.

To the Editors of the Brooklyn Medical Journal.

As shown by the annual reports, hundreds of the poor crippled children of Brooklyn are every year taken to the out-door departments of the orthopedic institutions of New York. These cases, under the most favorable circumstances, require for a term of years detail treatment only possible at an especially equipped establishment. The parents, at first faithful in attendance, in many cases soon become careless, or find themselves unable to lose the frequent day's work for the purpose of taking the journey and awaiting their turns at the crowded clinics. Others cannot leave their families. Some of the patients cannot endure the trip. Thus a large proportion fail to receive the treatment which would restore them to health, and much suffering and deformity and not a few deaths result. This might have been prevented had the means of relief been more available. In view of these facts, the trustees of the Dispensary of St. Mary's Hospital have established a Department of Orthopaedic Surgery and Diseases of the Bones and Joints. It has now been in successful operation for more than a year. Facilities have been provided for the careful examination and record of cases and for the application of the necessary apparatus. The patient is not turned over to the tender mercies of an instrument maker, but the instruments are made according to measures, patterns, sketches, and directions furnished by the surgeons who personally adjust the appliances and regulate their action. The fundamental working principle is that a brace is simply a tool, and that it is the skill with which it is used that determines the result. Shop facilities are at hand for the immediate repair of apparatus. The greater number of the patients are children, but aid is extended to those of any age. Those who cannot be properly treated as out-patients are cared for in their homes. For those who cannot there secure the necessary local conditions, or who require operation or more constant supervision, beds are provided in the hospital. When a patient fails to report after some time, a visit is made to ascertain the cause of the neglect.

The Department is for the exclusive benefit of the poor, and the case of any patient apparently able to pay for treatment is investigated. The work is under the charge of an orthopedic surgeon who has for several years served on the staffs of the New York Orthopedic Dispen

sary and Hospital, and the Hospital for the Relief of the Ruptured and Crippled, in New York. New patients, and applications for those unable to come, will be received at the Dispensary, 1205 St. Mark's Avenue, on Tuesdays, between two and three o'clock.

JAMES CLYNE,

Sec. of Board of Trustees of St. Mary's Hospital.

TREATMENT OF DYSENTERY.

To the Editors of the Brooklyn Medical Journal.

If I had been present at the April meeting of the Medical Society of the County of Kings-whose proceedings are reported in the October number of your Journal-I should have taken part in the discussion of Dr. Fairbairn's paper on the Treatment of Dysentery, and advocated a reliance upon the sulphate of magnesia, in small repeated doses, as the best method of treatment, giving better and prompter results than any other.

Of course, there are complications of dysentery which may require a modification of this course; and it would not meet all the indications presented by a case seen first at an advanced stage. But this is also true of irrigation. I am speaking of dysentery seen at the outset. A long experience has satisfied me that simple acute dysentery yields surely and promptly to the treatment by sulphate of magnesia, unaided by any other medicine. The characteristic symptoms are more speedily relieved, and convalescence is more rapid.

In a case quoted by Dr. Fairbairn, his patient was "convalescent in four days, and well in a week." If by this is meant that the bloody mucus had disappeared in four days, and no earlier, the result is not nearly as good as is obtained by the saline treatment. I give one drachm of sulphate of magnesia every four hours. If the treatment is begun on the first day of the disease, within the next twenty-four hours the pain and tenesmus have ceased, the blood and mucus have disappeared, the dejections have become watery and less frequent; and in another twenty-four hours the passages have ceased entirely. The success depends on the continued use of the salts-given at longer intervals after the change in the character of the evacuations-until the discharges cease altogether. There is occasionally a patient whose watery passages continue, and it becomes necessary to suspend the salts and give a sedative and astringent dose. But such a necessity is rare.

Absolute rest in bed, warm clothing of the bowels, and a bland diet, such as starch, are indispensable, whatever medicinal treatment is used. With the saline method, opiates are unnecessary; pain and tenderness are relieved in the first day.