breathe plenty of fresh air along with the anesthetic, and for this reason he must avoid using a towel or closed funnel; a flannel stretched over a small wire basket affords the very best means of administering an anesthetic.

The man who has never given an anesthetic, or who has never assisted in the administration of one on a number of occasions, is poorly fitted for such purposes, and would be unsafe as an administrator of a general anesthetic because of his lack of knowledge. The knowledge necessary to understand the administration of a general anesthetic can only be acquired by clinical experience; that is, the doctor, to understand the administration of a general anesthetic, must have given one himself or must have been with those who have given it a number of times, in order to observe the maneuvers of the patient under its influence, as they behave so differently under certain circumstances and conditions.

People exhibit their temperaments frequently while under the influence of a general anesthetic. The Irishman invariably becomes boisterous and manifests his pugnacious disposition. The Germans and colored people, on the other hand, frequently enter into the stage of full anesthesia without the slightest resistance. Again, they become somewhat hilarious, and often sing and pray. From this it will be seen that it is necessary to know the characteristics and nationality as well as the other conditions of the person who is to be anesthetized. In addition to chloroform the anesthetist should always have ether at hand, and see to it that both the chloroform and the ether are pure, that is, Squibb's best. Always have the necessary hypodermic loaded with strychnia. The choice of which anesthetic should be used is sometimes governed by the condition of the patient and sometimes by the knowledge possessed of one or the other of the anesthetics by the operator. Those persons who are suffering from kidney lesions, chronic bronchial trouble; that is, chronic bronchitis, are not fit subjects for the use of ether as an anesthetic, and for that reason the condition of the kidneys and the lungs should always be ascertained, if possible, before giving the anesthetic, and particularly in those cases where the persons are of the middle age of life or addicted to the use of alcohol, as those individuals are most likely to be the subjects of kidney lesions.

It should be remembered that chloroform is depressant, and while this is true, many persons who are nervous and have an irritable heart and pulse will quiet down under its influence and take it well, and often

with organic lesion of the heart chloroform may be safely given. However, if the heart muscles are weak, then the greatest care must be taken, or else the heart will become paralyzed under its influence if it should be pushed. The ether is undoubtedly a heart stimulant, and in its first action certainly has a tendency to force the blood from the heart out into the capillaries, thus relieving venous congestion. It will be seen in some cases that it is preferable to begin the anesthesia with chloroform, as in a person with an irritable heart, whereas in a person with a weak heart it is best to use ether. If the heart becomes weak the ether may be substituted for the chloroform. If the operator possesses a full knowledge of both ether and chloroform, he can use both as demanded. If he understands only the use of chloroform, he had better use that, and only use ether when it is absolutely indicated. In the event of the appearance of a fatal result from the use of a general anesthetic, the question arises as to how long the efforts to resuscitate should be persisted in. We should certainly say from one to three hours. Be absolutely sure that the patient is dead before desisting in your efforts to resuscitate, and in your excitement do not forget the very great importance of rhythmical traction of the tongue in and out sixteen or eighteen times in a minute. This certainly is a means that should not be overlooked. We do not deem it wise to precede the use of the anesthetic by morphia or by the use of any stimulant, such as whisky or brandy. If the morphia is used, it may render the respiratory effort sluggish at the time when it should be most active, and the same is true of whisky or brandy, as the depressant effect of either of these may manifest itself at the most inauspicious moment.

WILL THEY REJECT TUBERCULOUS TEACHERS?

At a recent meeting of the trustees of the public schools of Louisville, Mr. Bruce Lentz introduced a resolution, the purport of which is to prohibit the employment as teacher in any of the public schools of this city a person affected with tuberculosis. This is a laudable movement in the right direction. There is no more effective way of spreading tuberculosis than to have a tuberculous person in a crowded schoolroom. On more than one occasion have we known a teacher in a public school, afflicted with tuberculosis, to remain at his post of duty until exhausted, breathing and expectorating poisonous germs into the

school-room. It is to be hoped that all cities will adopt this movement. While it may prove a hardship to a few, it will prevent the loss of many lives. This class of people ought also to be excluded from factories and other crowded places. They should be prohibited from places of public amusement and worship, and especially when such amusements and worship are held in crowded rooms or halls. This may seem far-fetched, but if we are to be rid of phthisis, as we ought to be, and as we believe we can be, at least ordinary precautions should be taken, and this is nothing more than ordinary precaution. A patient with smallpox would not be permitted in any of these places, and smallpox is not necessarily a fatal disease, while phthisis is, so far as we are able to determine at the present. It is the insidiousness of the "white monster" that makes us such an easy prey to his insatiable greed.

Current Surgical and Medical Selections.

PRIMARY SARCOMA OF THE STOMACH.-Mintz (Berliner klin. Wochenschrift, 1900, No. 32) reports a case of this kind, which, with those he has found in the literature and others overlooked by him but given in the report of Dock (Journal of the American Medical Association, July 21, 1900), raises the total to about fifty-five, including some not fully recorded. Mintz' patient was a man, aged thirty years, who for one month had complained of eructations, pyrosis, tugging pains in the abdomen, and increasing weakness. Vomiting was rare, and the vomitus without striking appearances. For a week before admission the symptoms were severe. Appetite was retained, but the patient avoided food on account of pain. There was rapid loss of weight. For some weeks the left testis had been enlarging. The patient was cachectic and jaundiced. There was a diffuse, firm tumor in the epigastrium, reaching almost to the navel, with a horizontal, movable, cord-like mass passing to the left. Lavage brought up abundant decomposed food remains, with blood at the last. Hydrochloric acid was absent, lactic present in large amount, with Oppler-Boas bacilli and no sarcinæ. The diagnosis was carcinoma of the pylorus with metastasis in the testis. An operation for gastro-enterostomy showed that the tumor occupied the right half of the stomach. Death resulted in four days. Autopsy revealed adhesions between the pylorus and the liver; in the pyloric region a hard tumor the size of a fist, spreading out toward the fundus in a diffuse manner. The mucosa in the pylorus was the seat of an ulcer 2 cm. wide, occupying almost all of the circumference. The lymph glands in the lesser curvature were much enlarged, as also those in the hepato-duodenal ligament. With the exception of the testis, there were no other metastases. The growth

proved to be a lympho-sarcoma. The author gives a résumé of the clinical features of sarcoma of the stomach, and thinks it should be considered more frequently in the diagnosis of gastric tumors.-The Amer. Jour. of the Med. Sciences.

GONORRHEAL ARTHRITIS.-By Dr. F. Rubinstein (Berlin Klin. Woch.). The author reports eleven cases of gonorrheal arthritis as follows: Three of the knee-joint, two of the hip-joint, three of the wrist-joint, and one of the elbow-joint; also two cases of gonorrheal affection of the tendon sheathes.

In regard to therapy he states that gonorrheal hydrops is comparatively benign. Rest is necessary, combined with application of iodin, vesicatories, guaiacol-vasogen, or creosot-vasogen. When the exudate is very profuse, puncture and irrigation with carbolic acid or bi-chlorid of mercury solutions are indicated.

Bennecke recommends injection of five per cent carbolic acid; he has injected as much as eight grammes and allowed the solution to remain. He also recommends the same procedure in sero-fibrinous arthritis. On the other hand, as a rule, he advises against active treatment. In the fibrinous form he advocates rest, immobilization, elevation, splint and plaster dressings for the knee, foot, elbow, hand, and especially the hip-joint; free use of tincture of iodin, about twelve times in succession. On eruption of pus in the neighborhood, drainage of the joint, and, if indicated, resection are in order. He declares suppuration to be of rare occurrence—a statement which Rubinstein does not believe has been proven. Later, when the process has been arrested, he recommends active and passive motion, and when joint pain has subsided, massage and warm baths. However, not too much should be expected; finally, brisement and resection. In one of Bennecke's cases the ends of the bones were so firmly ankylosed that the natural lines of union of the bones could no longer be recognized. Of baths, he commends Gosten, Teplitz, Wiesbaden, Landeck.

Von Salzwedel recommends alcohol dressings, made by saturating cotton wool with ninety to ninety-six per cent alcohol; over this dry cotton is laid, the whole covered with some perforated impervious material so that the alcohol can evaporate. The dressing is changed every twelve to twentyfour hours; after subsidence of swelling only every two to three days.The Post-Graduate.

OPERATIVE TREATMENT OF CARBUNCLE.-Madelung is an advocate of the operative treatment of carbuncle; he objects to complete excision, because it is a severe operation, attended with loss of blood, needless sacrifice of tissue, and a considerable scar; for several years he has been very successful with the following operation: The carbuncle is encircled on three sides by an incision (down to the muscle), forming a tongue-shaped flap, with the carbuncle in its center; the flap is rapidly reflected like the skin

flap in an amputation; bleeding is arrested by inserting a large pad of gauze between the flap and the bed from which it was taken, and applying pressure; with the sharp spoon all obviously dead tissue is removed from the deep surface of the flap, and the entire wound is disinfected; the flap is replaced over a pad of gauze, and a dry dressing is applied. After an interval varying from the sixth to the ninth day, the flap is united by means of sutures. It is said to be surprising how little of the carbunculous flap dies.-Edinburgh Medical Journal.

SOME POINTS IN THE TREATMENT OF SPINAL ABSCESSES.—(British Medical Journal.) A. H. Tubby. The following points of treatment in cases of spinal abscess are emphasized by Tubby: 1. Do not wait to open a spinal abscess until the skin is reddened and involved. 2. As far as possible open the abscess at certain "seats of election," the places of evacuation to be decided by the direction taken by the abscess and by the surgeon. 3. Wherever evacuation is decided on, let it be done as far as possible away from the groin, and in such a position that more than one opening can be made into the abscess cavity. 4. Carefully cleanse the cavity and rub the interior thoroughly with menthol or iodoform solution. 5. Avoid drains of all kinds. 6. Be careful to carry out perfect aseptic measures from first to last. He enlarges upon these respectively. As regards the seat of election" he mentions a case where by waiting the abscess enlarged in its femoral portion and outward from the abdomen under treatment by prolonged rest. This multiple opening was employed, with recovery. The importance of making more than one opening of the abscess and sac away from the groin as a cardinal point is emphasized in the treatment of these cases. Evacuation is likely to be more complete, pockets of pus not so likely to remain, and all parts of the cavity can be brought within reach of the sharp spoon, the irrigator, and the cleansing sponge. Applications to the sac-wall are also rendered more easy, and the greater the number of incisions that can be made without risk, provided they are all sewn up after the operation, the better will be the result.Journal A. M. A.

Special Notice.

"It is doubtless of great

DR. RICHARD EICHE, of Cleveland, Ohio, writing, says: value to the medical profession that we have a remedy at our command like Sanmetto. I have used this remedy with much success in irritation and inflammation of the neck of bladder, in prostatitis, in nervousness arising from irritation of uterus, ovaries, and testes, in incontinence of urine, and in old cases of gonorrhea and gleet. This remedy also powerfully influences the reproductive apparatus. It is here not my intention to waste space in pathological discussions, but will say that Sanmetto is a weapon in the hands of the physician, and a backbone to the worn and old of both sexes."