THE NEW TREATMENT OF STONE OF Here, then, was an operation which rids the bladTHE BLADDER. der of a stone as thoroughly as a lithotomy, but leaves no wound behind it.

The discussion which has followed has shown the versatile Sir Henry to be as skillful with his ren as with his lithotrite, but even this has not availed him to convince the world that he had been previously familiar with the principles of litholapaxy, namely, the tolerance of the bladder to instruments, and its complete evacuation with large tubes.

The leading journals both of this country and of England have placed the credit where it belongs, and even Sir Henry himself has finally yielded to the inevitable. This is an American invention, and one which cannot fail to promote the prestige of Boston and the Massachusetts General Hospital as sources from which so many surgical innovations have emanated.

The Boston Medical and Surgical Fournal has Dr. Bigelow's new lithotrite is a valuable instruthe following on the above subject. There has per- ment, but should not be regarded as an inseparahaps been no greater revolution in any department ble part of his method. The ball handle, the lockof surgery in a brief space of time than that which ing of the screw by a turn of the wrist, the rectanhas occurred during the past two years in the man- gular blades, and the peculiar construction of the agement of stone in the bladder. When lithotrity jaws to prevent impaction of fragments are great was first introduced it was thought that the dang improvements, as is also its size, which enables the ers and terrors of lithotomy were to be a thing of operator to crush the hardest as well as the largest the past, a memory of the Middle Ages; but grad-stone. This instrument without the essential feaually it was discovered that this operation was also tures of "rapid lithotrity with evacuation," hownot without its sufferings and dangers, and many ever, would not have saved the traditional operaingenious instruments and much skill and practice tion of lithotrity. were employed to reduce these to a minimum. The perfection of the modern lithotritist was supposed to have been realized in that distinguished London surgeon, Sir Henry Thompson. Here was the man who could count his cases by the hundreds, whose delicate touch with an instrument of his own device was supposed to have conquered that dread sequel of the operation, cystitis, if it was within the limits of human skill and ingenuity to accomplish it The accumulations of a few great surgeons in the English metropolis made it possible to collect valuable statistics on the different modes of operating, to compare the old with the new, lithotomy with lithotrity. An inventory was accordingly taken some two years since, when, alas for modern science, the prestige of the latter operation was evi lently about to wane. In vain had Sir Henry perfected himself in his art, in vain had he reduced the manipulation of the bladder to an almost incredibly brief space of time; many of his colleagues, led by Sir James Paget, were about to tender their allegiance once more to lithotomy. It was interesting to those whose privilege it was to witness the experiments quietly going on in this country at that time to watch the ebb and flow of the discussion, and to note with no small satisfaction how thoroughly each master stood committed to his own favorite procedure. As lithotrity was on the point of being abandoned, the key to the problem was discovered in the new operation which Dr. Bigelow has given us, rising, as it were, from the very ashes of the old. The establishment of the principle that the dangers of lithotrity were due to sharp fragments and decomposable debris, and not to the use of instruments, was a genuine and valuable discovery. A few years ago Mr. Clover invented a syringe to remove the sand left by the lithotrite, but the diameter of his tube did not permit fragments of even moderate size to pass, and its employment produced, therefore, no modifica tion in the operation of lithotrity. The large tubes, of a size supposed impracticable before Otis had shown the capacity of the human urethra, and the evacuting apparatus devised by Dr. Bigelow first made a thorough emptying of the bladder possible.

THE TREATMENT OF FRACTURE OF
THE LOWER END OF THE RADIUS.

BY R. J. LEVIS, M.D., PHILADELPHIA.

The primary line of separation in the characteristic fracture of the carpal end of the radius is, with little tendency to deviation, transverse in its direction. Associated and secondary lines of fracture are generally those of comminution of the lower fragment, and are caused by the angular edge of compact tissue on the posterior aspect of the superior fragment being driven into the lower fragment and splitting it, usually in directions towards its articular surface. The displacement of the lower fragment is towards the dorsal aspect of the forearm, its articular surface being inclined so as to be abnormally presented backwards and upwards.

The mechanism of the fracture is simple. By a fall the weight of the body is suddenly thrown upon the hand, which undergoes extreme extension. If the force be sufficiently great, a fracture of the radius ensues, being caused by an act of leverage, or transverse strain. This direction of force has also been termed cross-breaking strain. Displacement of the fragments may not take place at all, or it may exist to the extent of complete separation of the surfaces from each other, the de

very large, the child being apparently of full size. The head presented, but was freely movable above the brim of the pelvis. The pelvis was of the rachitic type, with an antero-posterior diameter of two inches. The operation was performed soon after the beginning of labor, by Professor Carl Braun, assisted by Professor Gustav Braun, and other gentlemen.

September, 1877, two months after the operation; extracted. In the second case both mother and anasarca developed later, and there was frequent child were saved. Professor Gustav Braun has diarrhoea; so that she sank from the internal com- operated once, the mother dying, and the child beplications in October, 1878. At the post mortem ing saved. examination, the empyema was found to occupy Professor Carl Braun performed his fourth operchiefly the posterior part of the chest, reaching ation at 10.40 p.m., May 25th, in the lecture room, from base to apex. The lung was airless, except about fifteen spectators being present. The patient at the apex. There was no tubercle. The sixth, is a dwarf, four feet in height, and is twenty-five seventh, and eighth ribs were united by bony years old. She had rachitis when a child, and is bridges. The liver, kidneys, and intestines were frightfully deformed. She was raped by a drunken lardaceous, and there was recent acute peritonitis. man, thirty-six years old, last August, and had no The operation performed in this case permitted difficulty during her pregnancy, coming to the hosmore falling in of the chest than would have other-pital soon after labor pains began, and being in wise taken place, but did not facilitate the drain-apparently excellent condition, with the exception age so much as was desired. This was due to the of a slight attack of bronchitis. The abdomen was rapid development of granulations and bone which took place after the operation, the opening being quickly reduced to a narrow sinus. In another case, it would probably be advisable to remove the periosteal tissue much more freely, even if it necessitated also the removal of the thickened pleura. The large opening thus obtained would also allow more complete exploration of the smaller cavities, apparently distinct from the main cavity, such as The patient was narcotized with a mixture of were found in this case at the time of the opera- ether and chloroform, which is in general use here, tion. Dr. Powell said he had now a patient under the abdomen washed with carbolic acid and water, his care where something of the kind must be the pubes shaved, and the catheter introduced. done. Would not gouging away a portion of the The membranes had ruptured spontaneously about rib, so allowing a kind of bed for the canula, be half an hour previously. An atomizer with a soequally satisfactory? Dr. F. Taylor said their ob-lution of thymol stood in the room, but the stream ject was to prevent closure of the opening, and, if possible, to aid in the falling in of the ribs. Gouging, he thought, might fail, as this plan had done. Hence they did not repeat the operation, on account of the bad constitutional state. Mr. Howse thought gouging had little chance in such cases. The operation itself was easy enough.-Brit. Med. Four.

CÆSAREAN SECTION, WITH EXTIRPA-
TION OF UTERUS AND OVARIES.

was not directed over the abdomen. The incision was made from the umbilicus downward within. three inches of the symphysis, in the linea alba, and carefully deepened until the peritoneal cavity. was opened. The arteries, two small branches, were secured by torsion, and then a probe-pointed bistoury was introduced, and the incision prolonged upward and to the left one and a half inches. The uterus was thus exposed, and was pushed forward by an assistant, so that its anterior surface protruded through the abdominal wound, and an incision being made with a scalpel, a probe-pointed bistoury was introduced, and the incision prolongA Vienna correspondent of the Boston Medical ed to about four inches. The gush of blood which and Surgical Journal says:-On Sunday, May followed was prevented from entering the abdom25th, I had the good fortune to see a case of Ca-inal cavity by the forward position of the uterus. sarean section with extirpation of the uterus and The child was then extracted by the feet, and the both ovaries, a description of which may be of in-placenta was torn off at the same time. The uteterest to your readers. This operation, which ori-rus was then grasped around the vaginal portion ginated in America, has lately been revived here, and is now well established, having been done, in all, twenty-two times, and seven times in Vienna alone. Professor Carl Braun has operated three times previous to the operation I am about to describe. One of the patients was in a very bad condition at the time of the operation, and died soon after, but the other two cases were successful. Professor Spaeth has operated twice. In one case, the patient was almost dead at the time of the operation, dying soon after, and a putrid child was

and compressed, the bleeding being controlled in this way until the chain of Billroth's ecraseur was adjusted. This was so applied as to inclose the uterus at the anatomical internal os, both ovaries thus being above the chain, and was strongly compressed. The uterus was then excised three-quarters of an inch above the chain, the ovaries being included in the excised mass. The stump of the uterus was then inclosed in a steel clamp, below the chain of the ecraseur, and, the latter being removed, the stump above the clamp was transfixed

with a long needle, with the idea of preventing the portion of it yet adhering to the middle turbinated clamp from slipping when sloughing began. Two bone, the other having dropped off the fourth day rubber drainage tubes were then inserted, and the after the injection; this remaining portion was inedges of the abdominal wounds were brought to- jected with four drops of the same acid, and on gether, the stump and clamp remaining outside. the third day dropped off, leaving his nose clear, Silk sutures were used, being inserted over a flat without sore or a vestige of it. Neither of the sponge, and tied after the sponge was removed. two operations were followed by any unpleasant The wound was dressed with a Lister's bandage, symptoms, save a slight smarting from the pricking some preparation of tar being applied immediately by the needle when the acid was injected. The ofover the wound. The whole operation took just fensive odor arising from the decaying mass was an hour, and the patient rallied well, and seemed corrected by a weak carbolized wash. The long much comforted at the promise of a glass of bran- interval from the destruction of the first, and the dy. The child was a large girl, and was in excel- appearance of the second-ten years between— lent condition. precludes the possibility of this last being a portion of the first, but a new one.

The whole operation was exceedingly well done, and four days later the patient was doing well, and seemed in a fair way to recover, though the bronchitis caused some anxiety. The advantages of this operation are, first, tha the patient is never exposed again to the danger of a similar operation, should she survive; secondly, that the bleeding is absolutely controlled after the extraction of the contents of the uterus; and, thirdly, that the dan ger of peritonitis is much lessened by avoiding uterine sutures, and secondary hemorrhage from the uterine wound, which was so often the case when uterine sutures were not employed.

The results of the Vienna cases are certainly very favourable, and so far seem to recommend a wider adoption of the operation.-ED.

SPEEDY CURE OF NASAL POLYPI.

Dr. Caro in the Medical Record, gives the following painless method of removing nasal polypi, never before made public by the originator :

Mr. G. M, æt. 60, ten years ago applied to me for relief from a soft polypus in the left nostril. I proposed evulsion; but not liking the proposition, he left, and I never heard of him until last May, when he returned with another polypus in the same nostril. I advised evulsion once more; he declined it again, and desired me to cure him the same way as did Dr. G. Ceccarini the first time (ten years ago). On inquiry, Dr. C. kindly answered: "The medicine which I use for removing nasal polypi is four or five drops of pure acetic acid injected with a hypodermic syringe within the body of the polypus once only, very seldom twice; the polypus generally drops off within three or five days without discomfort or pain. Disinfecting lotion will correct the offensive odor." With this information, on the 12th of August, in presence of my friend Dr. J. L. Little, I injected the polypus with six drops of chemically pure acetic acid, and instantly we saw the discoloration of it from red to white. Business preventing him from returning, I could not observe the daily progress; but when he called on September 2nd, he had only a small

MEDICAL RECEPTIONS.-The old saw, that all work and no play helps to make the subject of that condition a dull boy, has a striking application to members of our profession. At best, our calling is an exacting and tiresome one, and its followers need something to offset a more or less continuous mental strain. We are glad to see that the old notion that the physician must be different from other men, is fast passing away. On the contrary, some of our best workers are those who seem to enjoy life the most. They are to be seen at the opera, the theatre, the concert hall, and at the fashionable receptions, with a regularity that would surprise the man who says he never has time to do anything but strictly professional business. The secret of the whole matter is, that some amusement gives in the end a better capacity for real work, when the latter is necessary. It is a promising sign that such amusements are beginning to be common among medical men. Medical receptions are becoming quite frequent, and their enjoyable character is likely to make them still more popular. Aside from showing honor to distinguished strangers, we know of no means better calculated to edify the man medical as a social being, and to give him a closer sympathy with his medical brother, than the receptions to which we allude. On such occasions the individuals meet on the common ground of enjoyable sociability, and lose sight of mere differences of opinion in a common desire to be happy themselves, and agreeable to their companions. Already the receptions which have been recently held are beginning to bear good fruit, transforming apparent strangers into congenial associates, and in creating a better understanding with all as to the true relation which professional gentlemen should bear to each other. We have a slight suspicion that the expression, more the merrier," will not be considered original with us, but it is nevertheless applicable to the occasion.--(N. Y. Med. Record,)

"the

CHANGING PHYSICIANS.-The Medical Record

If

in an article on "Consultations" in a recent num- little work on "Coughs, Colds, and Consumption," ber says: "The patient has a right to change his gives the following plan for stopping a cold. physician if he so pleases, and, having notified him employed sufficiently early it is said to be almost to that effect (after having, of course, paid the bill), infallible: 1. Give five grains of sesquicarb. of is under no more obligations to him. Any physi- ammonia and five minims of liquor morphine in an cian who would refuse to accept such a case would ounce of almond emulsion every three hours. 2. manifest a species of transcendental fastidiousness At night give 3 iss of liq. ammon. acetatis in a that could hardly be appreciated by the most up- tumbler of cold water, after the patient has got right member of the Medico-Historical Society. It into bed and been covered with several extra blanis another thing, however, when a gentlemen is kets. Cold water should be drunk freely during called after having, during the same illness, attend the night should the patient be thirsty. 3. In the ed the case in consultation. Under such circum- morning the extra blankets should be removed, so stances he is bound, in honor, invariably to decline as to allow the skin to cool down before getting having anything further to do with the case. As up. 4. Let him get up as usual and take his it is presumed that through the practitioner he be- usual diet, but continue the ammonia and morphia came known to the family-that the same practi- mixture every four hours. 5. At bed time the tioner, perhaps, gave him his reputation-he mast second night give a compound colocynth pill. No not in any manner supplant him. If the latter did more than twelve doses of the mixture from the not actually occur sometimes, it would appear al- first to the last need be taken as a rule; but should most like an insult to honorable men to refer to it the catarrh seem disposed to come back after leavas a possibility." ing off the medicine for a day, another six doses may be taken and another pill. During the treatment the patient should live a little better than usual, and on leaving it off should take an extra glass of wine for a day or two.-London_Medi.al Record, Aug. 15, 1879.

CARCINOMA OF THE STOMACH.-The following on the treatment of cancer of the stomach is from a "Treatise on the Practice of Medicine," by Prof. Robert Bartholow, which is announced for an early

appearance:

REMOVAL OF GLANDS OF AXILLA WITH TUMORS OF THE BREAST.-Lecturing at La Patié on a case of amputation of the breast, Prof. Verneuil observed that sometimes the indurated glands extend very far under the pectoralis, where it would be difficult, as in this case, to follow them. He therefore made at the anterior edge of the axilla a section of the pectoralis major by means of the linear écraseur, thus rendering the search for the glands much easier. In this way this thick muscle was divided without giving rise to any bleeding, "Although cancer of the stomach is incurable, and the search was easily pursued. These glands, much may be done by treatment to render the paexcepting those situated at its outer border, are tient's decline tolerable. The first and most imchiefly situated along the vessels, and especially portant point is to regulate the diet. By the withalong the axillary veins in the deeper-seated drawal of solid food, and the substitution of milk regions. It is especially in removing these deep- alone, or milk and beef-juice, the greatest relief is seated glands that we have to fear hemorrhage afforded, and for a time there may be a gain in from the axillary vein-hemorrhage which is easily weight, but of course this is not long maintained. and rapidly produced on the slightest detachment If the diet is restricted to the articles mentioned, it of the glands, even when the use of a bistoury is should be supplemented by that important means abstained from. It is not the vein itself which is of rectal alimentation, the injection of defibrinated wounded, but every gland is connected with this blood. The burning pain is much diminished by by means of a short venous branch with a relatively washing out the stomach once a day with the large caliber. On detaching the glands by the stomach-pump, especially in dilatation from stenofingers or a blunt instrument this vein of the gang-sis of the pylorus. By removing acrid and acid lion becomes torn, and bleeding is produced, owing matters in this way, much straining efforts at vomitto the absence of valves, just as if the principal ing will be saved. trunk were injured. It is impossible to find this little branch to tie it; and the ligature of the axillary vein should be practised at two points, as bleeding takes place at both ends of the divided. vessel. Difficult as this proved in this case, it would have been infinitely more so if it had to be done under the great pectoral in a wound inundated with the blood. The operation is therefore greatly facilitated by the previous division of the muscle. -Gazette des Hopitaux. (Med. News)

Of all the remedial measures proposed there is no prescription which is so generally useful in these ture of iodine, of which one or two drops may be cases as equal parts of pure carbolic acid and tincadministered in water three times a day. For the vomiting only, a solution in cherry-laurel water of carbolic acid, or a combination of carbolic acid with bismuth in an emulsion, will be found effective. Nitro-glycerine, benzine, and bisulphate of carbon have been used, with advantage, to allay HOW TO STOP A COLD.-Horace Dobell, in his nausea and vomiting. The most effective means