THE OPEN HORSE-CAR NUISANCE.

The long-suffering public is again to be subjected to the semiannual outrage inflicted on it by the street-car companies. In the spring and autumn of each year the strong and the weak, the old and the young, all in fact whose duties require them to use street-cars, are compelled to run the risk of contracting bronchitis or pneumonia, without apparently any good reason therefor. Whether this treatment of the public is actuated by the sentiment attributed to the late W. H. Vanderbilt, or whether it is because railroad officials are so pachydermatous as not to know when the wind is from the east, or the thermometer in the fifties, we do not know. Certain it is that their attention has been repeatedly called to this nuisance through the press; that it is continued is a sad reflection on their regard for the welfare of the public.

PROGRESSIVE PHARMACY.

As John was leaving for business one morning, his wife said: "John, the doctor says I must take a dose of castor-oil; I wish you would stop at the drug store on your way home and get me a dose. I don't know exactly what the dose is, but I suppose two or three tablespoonfuls. And ask the druggist if he can't put it up so that it can't be tasted." On his way from business John stopped at the drug store, and when his turn came, asked the clerk if he could put up castor-oil so that it could not be tasted. The clerk said he could. "Well," said John, "put me up a dose, three or four tablespoonfuls." The clerk said that was a pretty large dose, but John said it was all right, that was what his wife said, and she knew all about it. The clerk disappeared behind the prescription desk, and presently returned with a bottle wrapped in white paper, which he placed on the counter. John asked how much it was; the clerk said twenty-five cents; John handed him a fifty-cent piece, which he took and, as John thought, went to make change. In a moment the clerk called John and asked him if he wonld not like a glass of soda-water. "It is so hot," said John, "that I don't care if I do." Very courteous clerk, thought John. After drinking the soda, John took up the bottle and started to go. "I beg pardon," said the clerk, "but that is this lady's prescription." "Where is the castor-oil?" said John. "Why," said the clerk, "you took that in the soda-water. I said that I could fix it so that you would not taste it." "Thunder and Mars! that was for my wife." Exit John with both hands under his vest.

PROGRESS IN MEDICINE.

SURGERY.

BY GEO. RYERSON FOWLER, M. D.,

Surgeon to St. Mary's Hospital, and to the Methodist Episcopal Hospital, Brooklyn.

THE TREATMENT OF SUPPURATING CAVITIES WITH RIGID WALLS.

Kuester, Berlin (Centralblatt f. Chirurgie, 1890, No. 29). K. calls attention to the error committed by surgeons in the treatment of abscess cavities with rigid walls, in delaying opening of the same, and in frequent irrigations of the same after opening. He insists upon the following: 1. The earliest possible incision. 2. The incision must be made at the most dependent point. 3. In case of large cavities, a counter-opening is to be established. Repeated irrigation of the abscess-cavity is to be avoided as far as possible. He dwells particularly upon the subject of empyema, and describes his method of dealing surgically with this condition as follows:

After exploratory puncture, an incision is made at the lowest point of the dull percussion note, usually in the fourth or fifth intercostal space, giving exit to the accumulated pus. A probe is then passed through the wound to the posterior boundaries of the cavity and pressed firmly between the ribs posteriorly until its point is felt in an intercostal space, at which point a portion of the superadjacent rib is resected. The opening thus made must be sufficiently large to enable the surgeon to obtain a view of the interior of the cavity. Should the lowermost portion of the cavity not have been reached by the first resection, a portion is removed from the subadjacent rib, until the junction of the diaphragm and inferior reflection of the pleura is reached. The cavity then, under slight pressure, irrigated with a warm solution of salicylic acid, and the walls of the cavity carefully sponged of all traces of fibrinous matter, by means of a sponge in a handle, and through and through drainage established by drawing a tube from. one opening to the other, and securing it. The wounds upon the anterior and posterior chest wall are covered by iodoform gauze, upon which is laid a cushion of moss, which may remain undisturbed for upwards of eight days. If, in case of a recent empyema, the lung begins to expand in the course of ten days, the through and through drain is substituted by a short tube through the posterior wound. The author anticipates that complete cure will follow this treatment, in recent cases, in from three to six weeks.

The author further treats of the treatment of cavities, which, unlike the pleural, are surrounded upon all sides by rigid and unyielding walls; as for instance, empyema of the antrum of Highmore. Of the three methods usually employed for gaining access to diseased conditions of the antrum, K. chooses that which perforates its wall from the face, for the reason that the indications considered by him most important of fulfilment can but be followed out by this router (thorough cleansing of the walls, and the identification by the fingers of the different portions of the cavity). This is done subperiostically, and the cavity is irrigated but once with an antiseptic fluid, and then tamponned with iodoform gauze. As soon as the suppuration becomes but slight (which sometimes occurs in a very short time), the iodoform gauze is removed and a small drainage tube substituted therefor. In empyema of the frontal sinuses, K. drains through the nose. Diseased conditions of the mastoid cells and of the cavity of the tympanum belong to this division of the subject; their treatment, however, is somewhat complicated, as compared to the others; the preservation of the hearing, as well as the prevention of brain complications entering into the question. The same principles, namely, early and free opening, however, should be followed.

DELTOID NEURALGIA.

Golding Bird (Guy's Hosp. Reports, 1889, vol. xlvi.). The author applies this somewhat ill-chosen name to designate those rather frequently-observed cases of intense pain at the point of insertion of the deltoid muscle, and which, during the attempts to move the arm, in passing the horizontal position while being elevated simulates a paralysis of this muscle. The cause of this is always found to reside in a traumatism, and frequently this is found upon inquiry to be of so slight a character as to have been considered quite unimportant. In the first few weeks the patient favors the arm by restricting its movements, or supports in a fixed position. The restriction of the movements does not depend upon changes of the joint, as would appear, but from decreased tone of the surrounding structures. Examination shows swelling of the entire muscle, varying from slight thickening to decided swelling simulating fluctuation. This is explained by the presence of unusually loose connective tissue filled with wide lymph spaces between muscle and bone. This connective tissue becomes filled with extravasated lymph and blood resulting from the injury and the subsequent inactivity assumes a condition of chronic engorgement. The effect of this latter, and occasional retractions of the muscle, is to produce irritation of the terminal distribution of the circumflex nerve, upon attempts to perform movements of the arm. It likewise appears

that the disease may have its origin in a rheumatic diathesis, without the aid of an injury as a causative agency.

The treatment recommended is that of passive movements with the scapula fixed, massage, and possibly blistering. To this may be added faradisation, as strongly recommended by Kulenkampf, of Bremen (Centralblatt f. Chirurgie, No. 32, 1890, p. 607.

THE TREATMENT OF GENU VALGUM.

Casse (Bull. de l'acad. roy. de méd. de Belg., 1890, Hft. 1). The author claims that genu valgum in the great majority of cases is of rachitic origin, particularly when it occurs during the period of growth of the individual. The rachitic cases may be divided into three periods, for considerations relating to the treatment:

1) That of softening, the bone possessing a more than ordinary flexibility. In this period much can be accomplished in a prophylactic way by supporting apparatus, sparing the child, compelling it to maintain the recumbent position; and finally, by means of a general régime directed to the rachitis, fresh air, healthy surroundings, preparations of lime, etc., particularly the phosphorus combination of the latter. If in this period the deformity has already become pronounced, the latter will undergo spontaneous improvement from simply keeping the child in bed; as, however, the bones are soft and easily bent, straightening may be accomplished and maintained by means of a fixation apparatus.

2) The period of rehardening (réfection).-The bones become again. hard and easily broken. This is the period during which forcible redressment and osteoclasis may be performed with advantage. The author prefers the osteoclast of Robin, and has used it frequently with good result. He breaks the femur above the condyles from behind forward, and not laterally, and finds the former method much easier. of performance; the larger vessels are not endangered, and no splintering of the bones occurring. He then restores the limb to its proper shape, applies a plaster-of-Paris bandage and suspends the leg from the ceiling by strongly flexing the hip-joint at a right angle, in order to avoid the soiling of the bandages.

As a

3) The period of eburnation.-Here osteotomy is indicated. rule, by the time this period is reached the patient attains adult life.

BY CHARLES JEWETT, M.D.,

Professor of Obstetrics and Diseases of Children and Visiting Obstetrician, Long Island College Hospital; Physician-in-Chief of the Department of Diseases of Children, St. Mary's Hospital, Brooklyn.

TREATMENT OF POST-PARTUM HÆMORRHAGE BY TAMPONNING THE UTERUS.

Schouman (Arch. d'obstet. et de gyn., Mai, 1890). This paper is based on results obtained in Prof Treub's clinic with the method of Dührssen. In hæmorrhage from atony of the uterus as well as from tears the uterine tampon with iodoform gauze has proved of invaluable service. No accidents have been observed from resorption and only in a few cases has there been any increase in the frequency of the pulse. An attempt made to replace iodoform with carbolized gauze had to be abandoned because the woman began to have fever. The author thinks the tamponade is less painful, more easily executed, and more effectual than any other procedure for the control of hæmorrhage in atony of the uterus. The method is not dangerous when practised with aseptic care. Thus far iodoform gauze is the only material suitable for the purpose.

MISCARRIAGE, WHY MORE DANGEROUS THAN NATURAL LABOR.

Goodell (Arch. Gyn. Obstet. and Pæd., June, 1890) answers this question as follows: Because the fact of a miscarriage implies something abnormal; because owing to the attachment of the chorial villi over the whole surface of the uterus which obtains in the very early months, portions of the membranes are liable to be retained and give rise to hæmorrhage and sepsis; because the cervix not being effaced the small canal is liable to close on the retained fragment. Retention is far more likely to occur in criminal abortion since the gestation is abruptly interfered with before any detachment has taken place.

MECHANICAL STUDY OF THE FORCEPS.

Hubert (Arch. d'obstet. et de gyn., Mai, 1890). The author condemns the classical forceps as dangerous to the child and the mother. In proof of his claim he cites experiments upon artificial heads filled with water. The amount of water lost under the pressure showed how great is the possible compression and how much the nerve centers may suffer thereby. Furthermore his experiments showed that the compressing action of forceps tended to lengthen the long diameter but little and expended itself mainly in elongating the transverse. The diameters which take the pressure of the blades are those which do not need to be reduced and moreover are irreducible. The biparietal diameter, as appears from the forceps marks on the head after birth, escapes pressure. Between parallel blades the cranial ovoid may be