coveries, or about one cure in every four either to reflex action or to the paralyzing cases. An estimation of recoveries in pro- influence on the heart walls of the sudden portion to operations performed between the removal of the pressure of the effusion. Northern and Southern States, showed that Convulsions dependent upon reflex action or the proportion was about equal in the two due to minute emboli in the cerebral vessels. The doctor deduces the annexed Pulmonary congestion and edema, suddenly conclusions: (1) That tracheotomy is, per developed, either with or without the rapid se, devoid of danger. (2) That fatal hem-accumulation of serous exudation into the orrhage should almost never occur, and care bronchial tubes and producing asphyxia. and coolness in operating will nearly always Embolic obstruction of the pulmonary artery prevent apuca from intracheal bleeding. (3) of the sound lung. Embolic processes in That age offers no contra-indications, although various organs and of various grades of sethe average of success is less in early infancy verity, which have their origin in clots preand adult life. (4) That early operative in-viously in the pulmonary veins of the comterference, whenever the paroxysms of dysp- pressed lung. These last, when they occur nœa become at all lengthened, is demanded, at the time of or soon after the operation, since delay only adds to the suffering of the may have been excited by it. When they patient and materially lessens the chances develop days afterwards, they must be held of recovery. (5) That the after attention is as incidents of the original trouble, and in of prime importance; careful attention to no way connected with the operative measthe wound, proper treatment of the disease ures taken. In this resumé mention of a and proper nursing, with fair hygienic sur-transformation of a serous into a purulent roundings, being the essentials to a success ful issue.

effusion is purposely omitted, because it was thought that the proof is insufficient to hold the operation responsible for the change from serum to pus. No case of serious accident from wounding the lung seems to be recorded. While the conclusions are not repetition, and that surgeons cannot be too new, the doctor thinks that they will bear careful in undertaking this operation.

ACCIDENTS THAT HAVE BEEN OBSERVED TO FOLLOW THORACENTESIS BY ASPIRATION PRACTICED FOR THE REMOVAL OF PLEURITIC EFFUSION.-N. P. Dundridge, M. D. (Cincinnati Lancet and Clinic, Jan. 3, 1880), thus closes an article under the above caption: The statement that this operation, mentioned in the caption, is a trivial operaOSTEOMYELITIS OF THE LONG BONES.tion, entirely devoid of danger, is to be Dr. N. Senn (Chicago Med. Jour., January, most strongly condemned, while the practice 1880) concluded an extended paper: (1) which would undertake its performance Spontaneous osteo-myelitis is an infectious without due regard to the conditions and disease. (2) It is most prevalent in damp, surroundings, which would render accessible changeable climates and during the winter the most efficient means for combating any and spring months. (3) It affects with unpleasant consequences which might arise, preference individuals during the period of is certainly not justifiable. Syncope has growth and development of bone. (4) developed half an hour or more after aspira- Traumatism and other agencies which protion has been performed, so that the opera- duce a retardation or arrest of circulation in tion should only be undertaken when com- the vessels of the marrow, act only as deterplete rest and repose can be secured after mining cases. (5) Its primary seat is its performance, for the least exertion might usually in the marrow of the cancellated determine an accident, otherwise avoidable, tissue, in close proximity to the epiphysary which may prove fatal. The doctor feels cartilage. (6) Joint affections are frequent himself justified in formulating the follow- and prominent complications of this disease. ing as the accidents which have followed, (7) Thrombosis and inflammation of the thoracentesis for pleuritic effusions. Some veins of the marrow, bone, periosteum and of these may be considered as mere con- soft parts are of frequent occurrence, and comitants of the puncture. Others must be are the direct cause of pyæmia. (8) Swellheld to be more or less dependent upon the 'ing is absent for the first few days, and operation or the measures by which it was when it does occur, it becomes rapidly dif followed: Syncope, fatal or transient, due fuse, and is attended by edema and enlarge

Physiology.

ment of the superficial veins. (9) Fluctua- of transfusion, such as the introduction of air tion is diffuse as soon as its existence can be or clots into the veins and phlebitis, were abascertained. (10) A constant high tem- sent from this operation. In the human subperature and typhoid symptoms indicate the ject the dorsal artery of the foot, both as regravest type of the disease. (11) Death cipient and donor, was recommended. may result from the intensity of the primary regards the vein to vein transfusion, it was infection, but is usually produced by some both easy and rapid in its effects. The simcomplication. (12) Early removal of the ple glass canula and India-rubber tube conproducts of inflammation under strictest an- stituted the apparatus. tiseptic precautions and local disinfection of the tissues are of paramount importance for its successful treatment. (13) Epiphyseolysis VISUAL SPHERE OF THE CEREBRAL CORTEX. may become completely repaired. (14) Ex--Munk (Archiv. Phys. Jour. Nerr. Discision of shaft may become necessary during eases,) finds by experiment that the destructhe acute stage to prevent exhaustion from tion of the upper and posterior apex of the profuse suppuration; this rule is not appli- occipital lobe of the cerebrum in the dog, cable if the humerus or femur is affected, on destroys permanently the sense of sight. account of the impossibility of keeping the Further, each hemisphere is connected with limb in position until regeneration of bone the median half of the other retina and the has taken place. (15) In most cases fixa- corresponding lesser half of the retina on tion of the limb is necessary for rest and the same side. Partial extirpations in the reprevention of deformity. gions of the visual centre showed that the different regions of the retina are repreMETHODS OF TRANSFUSION-AN EXPERI-sented by distinct and corresponding cortical MENTAL INQUIRY.-Mr. E. A. Schäfer (Brit. localities. The extreme lateral portion of Med. Jour., Dec. 20, '79) has been endeavor each retina connects the lateral part of the ing to ascertain if any other food, as milk cortical visual sphere of the same side. The for instance, could be advantageously substi- remaining large median half of each retina tuted for blood in the performance of transfusion. He found that rabbits, into whose veins milk had been injected, died within twenty-four hours. However, milk just drawn from a cow and milk which had been

boiled were inocuous. In animals reduced almost to a lifeless condition the injection of milk into the blood vessels was never permanently beneficial. Such animals always died. No fluid lacking hæmoglobin was of benefit in acute anæmia. When the blood of other animals was transfused into the human subject the red blood corpuscles of one or both kinds of blood quickly became

dissolved. The amboid movements of the

white corpuscles quickly ceased and the corpuscles perished. The blood of the lower animals is an active poison to the human blood corpuscles. In man human blood only can be used with advantage for transfusion. In experiments on dogs and cats, the animals were first depleted of blood until the arterial pressure was almost zero; the femor. al artery was then connected by means of glass canula and India-rubber tube, filled with solution of carbonate of soda, with the artery of another animal. In every case the depleted animal recovered. The ordinary risks

a

is united to the balance of the cortical cen-
tre in the opposite hemisphere, in such a
manner that the lateral border of the retina

corresponds to the lateral border of the cor-
tical centre, while the median retinal end
belongs to the median part of the cortical
the retinal expansion are similarly repre-
spheres. The upper and lower borders of
sented by the anterior and posterior ends of
the cortical centre. The middle portion of
the cortical centre, the destruction of which
causes the greatest visual impairment com-
the point of
paratively, corresponds to
acutist vision of the opposite retina, the
which in the dog is situated 30° laterally
homologue of the human fovea centralis,

from the retinal centre.

Increase of population for Switzerland for 1878 was 22,522, or a proportion of 81 per 10,000 inhabitants. In other countries this

proportion was: For England, 145; Germany, 136; Belgium, 122; Austria, 87; Italy, 77; France, only 36.

A German physician asserts that railroad employes are more liable to affections of the spinal cord than any other class of men.

Bromide of Ethyl-Its Toxicological Action, chest. During profound anesthesia, the

N a previous paper in this journal, I have cle continued beating for a long time. Heart considered the effect of ethyl when pushed perfectly flaccid and in diastole after its to the extent of anesthesia.

3.52.45 3.54.45

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82

98

94

94

82

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inhibitory ganglia are not concerned in this reduction of the frequency of the heart, for then it would not take place after the injection of atropia.

The fall of pressure is mainly due to the reduction of the frequency and force of the heart, and partly to a partial paralysis either of the spinal vaso-motor centers or the peripheral vaso-motor system. In a previous paper I have shown that ethyl stimulates either the spinal vaso-motor centers or the peripheral vaso - motor system. During these experiments, when anesthesia was kept up for a long period, no action on the intestinal canal was noted, which would have probably taken place in this animal, as being a herbiverous creature his peristalsis is nominally active compared with that of

the carnivora.

These experiments demonstrate that in ten-drop doses it temporarily depresses the heart's rapidity, this depression being followed by a rise which remains permanent till another dose of ethyl is given, which In Fig. 1 is shown the depression of presagain reduces the heart beat. The pressure sure, whilst the rapidity of the heart is in ten-drop doses falls steadily. In five-drop somewhat increased. The interrupted points doses the pulse follows the same track as are the markings of each second. The described, even when atropia has been given previously. The pressure, after five-drop doses, falls, but rises till five drops more are given, when it falls.

All these injections toward the heart prove that bromide of ethyl acts directly on the heart in temporarily depressing its action. Now I have proven that it has considerable action on the unstriped muscle. May it not depress cardiac activity by an action on the muscular structure of the heart? Cardio

abscissa line is not given, being, however, in this experiment eleven millimetres below the level of the second line. The slight intermittency of the heart is well shown in the pulse curve, which was obtained in an experiment upon a rabbit. The conclusions to be drawn from these experiments are as follows:

1. Bromide of ethyl, by either inhalation or subcutaneous use, kills by a toxic action on the centers of respiration.

2. That the decrease of force and fre- represented wrongly in the illustrations in quency of the heart contribute to the par- the books. It is not an open canal, as usualysis of the respiratory centers. ally represented, but closed in its entire 3. That injections of ethyl into the jug-length, except during the act of urination, ular toward the heart kill by cardiac arrest, and perhaps seminal emission These lacerprobably due to an action on the cardiac muscle.

4. Bromide of ethyl in toxic doses depresses momentarily the frequency of the heart, followed by a subsequent permanent rise to normal rate.

5. Bromide of ethyl in toxic doses depresses the actual tension steadily, due in major part to the depressant action of the drug upon the heart; and in minor part to a partial loss of tone of either the spinal vasomotor centers or the peripheral vaso-motor system.

ations are usually transverse. Longitudinal lacerations are not apt to be followed by stricture. When we cut the urethra in operations upon it, the incision is longitudinal and not followed by stricture, as is the case where the incision is made across the urethra. Terillion says that such injuries are rarely met in the membranous portion of the urethra, but are almost always anterior to this. Cicatrices of chancres and chanchroids bring about stricture in the outlet of the urethra, when the strictures are usually quite severe. Strictures from this cause is

6. The inhibitory power of the pneumo- very rarely met with further from the gastric is not paralyzed.

Lecture on Stricture.

BY PROF. R. F. WEIR,

College of Physicians and Surgeons, New York.

THE

meatus than one inch, although I have occasionally seen them at a distance of an inch and a half.

The next cause of stricture mentioned is congenital narrowing of the canal. A case has been reported in one of the journals where the patient died from the effects of

HE subject to-day is of great interest and importance to us all, although it is such a stricture. There was in the urethra somewhat hackneyed. Stricture can occur from a great variety of causes, the most fre. a fold of membrane which looked backward quent of which, however, is gonorrhoea. In toward the urethra, so that it would allow a Thompson's work on this subject, which is sound to pass readily, lying flat then, on especially valuable because of the accurate the floor of the urethra, but when the urine statistics it contains, he gives a list of 220 passed it pouched outward in the direction cases of stricture, 164 of which resulted of the meatus, and so produced retention. from a previous gonorrhea, 28 from injuries Inflammatory strictures are usually caused to the perineum, 4 from cicatrization follow-by gonorrhea, the swelling of the mucous ing chancres or chancroids, 6 were congeni- membrane closing the canal.

Masturbation is a very doubtful cause of stricture, and cannot give rise to it, I think, When you unless it sets up an urethritis. do have a stricture from such a cause, it is almost always single.

tal, 1 resulted from masturbation, 7 were spasmodic strictures, and 10 inflammatory. By far the greater number, therefore, were the result of an antecedent gonorrhoea. The next most frequent cause of stricture is traumatism. For instance, a man is walking Spasmodic stricture has received a great along the street and steps on the iron cover deal of attention of late years. It has been of a coal hole. The cover gives way, slides said to be very common, and many new to one side, and the man falls into the hole, points have been made concerning it, but I the legs straddling and is caught on the do not give them much credence. The old crotch, the whole weight of the body being facts which have been known to the profesthrown on that part. Bleeding from the sion for a long while, I believe to be true. urethra follows, and an inflammation is set Spasmodic stricture is the result of a spasm. up which results in a traumatic stricture. of the compressor urethra and other musOr a boy may be walking along the top of a cles, as the circular fibres which surround fence, and fall in the same manner, with a the neck of the bladder-the sphincter similar result, or the injury may result from vesica-and also the unstriped or involuna kick, or, as in one case which I had; from tary muscular fibres which are merged in a blow from a machine. The urethra is with the striped or voluntary muscles.