up are easily frustrated by having a nurse place her hands under the patient's heels and keep them continually elevated one or two inches above the surface. As long as the heels are raised it is impossible for any one to sit up; it requires no muscular strength to effect this. The simplicity of Gersuny's plan to prevent struggling will commend itself to operating surgeons as worthy of being followed.-Medical Age.

Thymol Iodide in Hay Fever.

Fink (Therapie der Gegenwart) believes that the mucous membrane of the antrum of Highmore is the point of departure of the reflex irritation which produces hay fever. In order to overcome this he insufflates thymol iodide through the orifice of the maxillary sinus situated in the middle meatus of the nasal chambers. He uses a powder insufflator with a curved cannula to apply the powder. The relief is marked and permanent. In some cases one treatment is sufficient, in others it is necessary to repeat.

Observations on an Ideal Local Anesthesia for Submucous Resection.

F. E. Miller (Medical Record, February 23, 1907) describes a method that he has found ideal in his practice. The mixture used consists of about twenty to twenty-five grains of cocaine crystals placed in a shallow dish, to which sufficient adrenalin chloride solution, I to 1000, is added to dissolve the crystals. The solution is applied as follows: The cotton on the applicator is wet so that there is no excess of solution. In this way the constrictors of the pharynx are not paralyzed by the treatment. The entire field of operation is swabbed over. The writer has been able to operate for three quarters of an hour without the slightest discomfort to the patient.

The Danger of Repeating Prescriptions.

Dr. Ignatz Weiss reported to the Clinical Society of Vienna (Lancet) the case of a man who complained of cardiac uneasiness, and presented the typical grayishblue line on his gums so generally seen in cases of lead-poisoning. The man had never worked with lead, but six weeks previously he had had an attack of pulmonary hemorrhage. The doctor prescribed acetate of lead in doses of one-half grain

three times a day. The hemorrhage had soon stopped, but the man kept on taking the medicine continuously all the time (refilling through an accommodating

druggist) simply as a prophylactic. He had taken in all sixty-two grains of the acetate of lead, and this quantity was sufficient to produce the symptoms of lead poisoning. The treatment of the case consisted in the immediate discontinuance of the lead acetate, of course, and in the administration of sulphur and iodine internally to aid in the elimination of the lead from the system.

Drugging a Druggist.

Tschepke (Deutsche Klinik, Maschka Handbuch) relates the case of a pharmacist who took from 0.48 to 0.72 (8 to 12 gr.) of strychnine nitrate dissolved in about 30.00 (oz. i) of bitter almond water, and after half an hour, having experienced no symptoms, o.60 (gr. ix) of morphia acetate also dissolved in bitter almond water. Subsequently, being still capable of locomotion, he poured chloroform on his pillow and lay with his face upon it. An hour and a quarter after taking the first dose he suffered severe symptoms of strychnine poisoning, from which he, however, recovered under treatment by emetics and tannin.

Injections of Hydrogen Peroxide and
Colloidal Silver of Permanganate
of Potash.

H. Futh (Zent. f. Gyn.) says that colloidal silver acts as a katalysator and in contact with hydrogen peroxide causes the evolution of much free oxygen, without itself being changed. Permanganate of potash with hydrogen peroxide has the same effect. The author recommends the use of injections of the two solutions from different vessels with a double catheter, so that they become mixed when they reach the diseased area, and a large amount of free oxygen is evolved. Such treatment results in immediate deodorization of the foulest surface or cavity.

M. Brocq (Bulletin génerale de therapeutique) as a local treatment for pruritus employs preferably the "pomade of the three acids," of which the following is the formulary:

M.-Fiat suppositoræ, No. xii. S.-Insert one each evening. In three or four days the hemorrhage disappears and recovery soon occurs.

Extirpation of Bartholin's Cysts by a
New Process.

Pozzi (Annales de Gynecol. d'Obstet.) says all operators who are in the habit of removing cysts of Bartholin's gland are aware of the difficulties met with in getting such tumors out whole, and that it is not easy to remove every portion of the lining membrane when once such cysts are opened or burst during dissection. In order to facilitate their complete removal, Pozzi injects spermaceti into the cavity the evening before the operation. This solidifies after injection, and the tumor can then be removed as a solid mass.

colon, diagnosis was that of intestinal obstruction. I advised immediate operation, which, after preparation, was done at 4 P. M. An incision was made in median line below the umbilicus. Intestine was greatly distended and the peritoneal luster absent. As we approached the point of obstruction numerous dark purple spots were apparent, gangrenous in character. It was evidently a hernia in the fossa duodeno-jejunalis. There was considerable amount of damson plum-colored fluid in the cavity. After liberating the hernia it was apparent that gangrene had gone on so far that the only hope was a resection of intestine (thirty-two inches in length), which was done, making an endto-end approximation with a Connell suture. The patient never rallied, dying about 9 o'clock in the evening.

CASE II.-Chronic Obstruction; Double Resection of Intestine.

S. C., aged fifty-two years. Entered Harper Hospital June 14, 1906. Gives a history of having suffered abdominal discomfort four years previously. This in time passed away. In December, 1905, the abdominal distress again appeared, presenting marked evidences of intestinal obstruction. Pain, gurgling in the abdomen and constipation. When I first saw him in May he presented a marked cachexia, and was very much emaciated. Inspection showed at times considerable distension. This disappeared after a liquid evacuation of the bowels. A distinct tumefaction could be readily felt in the region of the sigmoid. I advised immediate operation, but he delayed until June 26, when I operated upon him, making the ordinary incision for colostomy. The growth not only involved the sigmoid, but a portion of the small intestine, due to contiguity. I resected the sigmoid as well as a portion of the small intestine. The approximations were done by an endto-end Connell suture. He died the following day from the shock of the operation.

CASE III.-Colostomy.

Mrs. L. J. P., aged sixty-five years, was operated upon July 31, 1906, at Harper Hospital. She gave a history of having been constipated for five years, and never had an action of the bowels without a cathartic. Relief was experienced after each cathartic. The distension in the left

E. O. T., aged fifty-eight years, complained of commencing constipation in March, 1906. After each evacuation he noticed a dull aching pain over lower part of abdomen, with the eructation of gas. After each meal his abdomen became distended. During the last year he has lost considerable in weight. A tumor could be felt in the region of the sigmoid. A colostomy was performed July 7, 1906, with very satisfactory results. CASE V.-Strangulated Hernia.

Mr. J., aged thirty-six years. Gave a history of right inguinal hernia for many years.

This

Three days previous to entering Harper Hospital he neglected to wear his truss during the day, and in the evening noticed that the rupture was larger and painful on pressure. He succeeded, however, after considerable effort, to reduce it, but the distress did not disappear, and he had to resort to morphine for relief, and toward morning he vomited. condition continued the next day, and his physician gave cathartics, enemas and morphine without relief. The pulse-rate and temperature was about normal, but the vomiting increased. During the night the symptoms continued, and on the morning of the third day the pulse-rate had increased, with quite a marked tympany. The vomit had also a fecal odor. I saw him for the first time at 5 P. M., July 21, 1906. He had just vomited a large quantity of fecal matter, pulse thready and 130, temperature 100°. Respiration labored. Anxious, cyanotic facial expression. Abdomen greatly distended. My diagnosis at the time was that there was a strangulated knuckle of gut held in the reduced sac. He was immediately taken to Harper Hospital and operated upon at 7:30 P. M. Incision was made midway between the umbilicus and the symphysis.

The intestine was cyanosed, the abdomen containing a large quantity of damson plum-colored fluid. The knuckle, as I had predicted, was caught in the returned sac, readily relieved and the abdomen closed. His general condition was bad and he did not rally, dying at 3 P. M. the next morning. No examination of the fluid was made, unfortunately. His death, in my judgment, was due to bacterial toxemia, probably of the colon bacilli, together with nervous irritation superinducing respiratory failure.

CASE VI.-Chronic Obstruction; Resection of Colon Near Splenic Flexure.

A. W., aged sixty-three years, gave a history of constipation on and off for the last six months. Two weeks before I saw him he evidently had complete obstruction of the bowels. Castor-oil, calomel and salts were given and proved effectual. August 23 he vomited fecal matter, suffering intense pain in region of epigastrium. From this time on until August 26 he was given nothing by the mouth except water. High colon enemas were given daily. On this same date he ate liberally and took a dose of castor-oil. In the evening he began to vomit, keeping it up constantly until next morning, when I saw him. At this time the pulse was 100, temperature 100°. The abdomen was very much distended, and after preparation he was taken to the operating.room at Harper Hospital at 10:30, August 27, 1906. The obstruction was found to be in the splenic flexure of the colon. The constriction was annular and was due to an adeno-carcinoma. It was resected and approximated with an end-to-end suture. He never rallied and died at I P. M. CASE VII.-Resection of Cecum and Portion of Ileum.

Mrs. A. C., aged twenty-one years, was married at eighteen, and has a little girl two years of age. Her family history is good. She was in good health until June, 1905, when she began having pain over the region of the stomach. These pains came and disappeared with varied intensity for one year, when she consulted Dr. Luce, July 6, 1906. She was somewhat constipated at times, when it became obstinate in June, 1906, with occasional vomiting and distension of the abdomen. I saw her August 16, through

the kindness of Dr. Luce. Examination revealed a distinct movable tumor in the region of the cecum. A diagnosis of chronic intestinal obstruction was made, probably malignant. She was operated upon August 17. The portion removed was ten inches in length, including lower part of cecum and a portion of ileum. Adjacent glands were removed and the ends approximated with a Murphy button, which was passed on the twenty-second day. She made a good recovery and left the hospital on the twenty-eighth day following the operation.

Pathological report: Tubercular. CASE VIII.-Acute Intestinal Obstruction; Laparotomy.

C. H., aged eighteen years, was operated upon by me August 24, 1906, for appendicitis. He did well until the third day, when there were evidences of obstruction. The lower bowel was cleaned out with a turpentine enema. This was necessary several times to relieve recurrent distension. On the evening of the sixth day he commenced vomiting, and kept it up more or less all night, with increased distension. I saw him in the morning, when he had an anxious facial expression, with greatly distended abdomen. Temperature 100°, pulse running from 120 to 130. Operation was made at 10 A. M., August 30, 1906, wound being reopened, and by means of my index finger I relieved a constricted intestine at the stump of the appendix. The intestine, as much as I dared pull out, was mottled in appearance and the abdomen contained a damson plum-colored fluid, together with pus. It was evident that a diffuse peritonitis existed. I made a counter-opening just above the symphysis, letting out a large quantity of the above-mentioned fluid. Through the opening I introduced a half-inch fenestrated rubber tube down to the bottom of the pelvis, also a same-sized tube in the original wound. The after-treatment consisted in putting him in a semi-sitting position (Fowler's method), while a long colon tube was introduced and a continuous irrigation of normal salt solution at a temperature of 110°. This was emptied from time to time, but, owing to a misunderstanding on the part of a nurse, it was not done until the water forced its way up through the intestinal canal, washing out fecal matter through the mouth.