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surprised at this, as Dr. Sturgis, not very long ago, was at least a skeptic as regards the specificity of the chancroid, if not a pronounced unbeliever.

In turning over the leaves at random, we find a number of examples of loose construction and ungrammatical or undignified expression, which might readily have been remedied by a careful revision.

Such points are, however, only alluded to because so good a book should not be marred by errors which would seem to indicate haste or carelessness in preparation. On the whole, we can cordially recommend it as a reliable and satisfactory guide in the diagnosis and treatment of venereal disease, and as containing much useful information, not found-or, what is nearly as bad, very difficult to find-in many more elaborate and pretentious volumes.

A SYSTEM OF SURGERY. Edited by T. HOLMES, M. A. First American from Second English Edition, thoroughly revised and much enlarged, by JNO. H. PACKARD, M. D., assisted by a large corps of the most eminent American Surgeons. Three volumes. Vol. I., 8vo, pp. 1007, Pl. ix and 245 wood-cuts. Philadelphia: H. C. Lea's Son & Co., 1881.

To edit Holmes' "System of Surgery" is no light work, and we must congratulate Dr. Packard on the manner in which it has been done. The authors of the original English edition are men of the first rank in England, and Dr. Packard has been fortunate in securing as his American coadjutors such men as Bartholow, Hyde, Hunt, Conner, Stimson, Morton, Hodgen, Jewell and their colleagues. They have revised and added to all the articles except three, which were found so complete as not to require any additions. The new matter varies considerably in amount and character, but is always judicious and useful. In some cases it is very slight, while in others the additions are large in amount and radical in character. Perhaps no chapter has been more difficult to revise than the one on Tumors and Cancers, by Sir James Paget and C. H. Moore. The nomenclature and classification of such new growths has undergone such a decided change within the last few years, that Dr. Longstreth has had no little trouble in welding the old and the new matter into one homogeneous whole. It has been well done, however, and presents the matter intelligibly, and as briefly as possible. To our thinking, it would almost have been better to have written the chapter entirely anew, as is to be done with the articles on the Skin, and Absorbent System. But in view of the still unsettled state of our knowledge, perhaps it is better as it is, since it makes the reader more familiar with the different methods of classification, and therefore the varying terms employed by different authors.

The illustrations of a technical book, especially one that is intended to be so widely circulated among practitioners in the country, where they can have access to no museums and rarely perhaps have post-mortem specimens to examine and study, are of the greatest importance. We are glad, therefore, to see that the original number of wood-cuts has been increased about fifty per cent., while the chromo-lithographs of the second English edition (for they did not appear in the first) have been very well reproduced, but their lettering is too faint, and at night especially is not readily legible.

As a whole, the work, if we may judge by this first volume, will be solid and substantial, and a valuable addition to the library of any medical man. It is more wieldy and more useful than the five volume English edition; and with its companion work-Reynolds' "System of Medicine,"-will well represent the present state

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of our science. One who is familiar with those two works will be fairly well furnished head-wise and handwise.

A TREATISE ON THE DISEASES OF THE NERVOUS SYSTEM. By JAMES Ross, M. D., M.R.C.P., Lond.; Assist. Phys. to Manchester Royal Infirmary. 2 vols., pp. 594, 1000. New York: William Wood & Co., 1881. These portly volumes are intended, in the words of the author's preface, to give a tolerably full account of the diseases to which the nervous system is liable, with the exception of the mental diseases. The first volume opens with a consideration of the structure and functions of the nervous system, in which the author treats of the anatomical arrangements and the physiological functions. This is well brought up to date. Thus he gives an account of Meynert's Projection System. He follows Landois' Physiology in his accounts of the anatomical structure, and his figures are derived from this source chiefly. As regards microscopic structure, he has based his account on Ranvier's largely. General etiology and general symptomatology close the first, or general part of the work.

In Chapter VI., he discusses trophoneuroses. In this we observe that he passes under review the contributions of Waller, Schiff, Erb, and especially of Ranvier. In the chapter on the diseases of the nerves of special sense, there is a good account of the ophthalmoscopic appearances in optic neuritis, and a plate exhibiting the changes in the fundus of the eye. This part of the work relating to diseases of the cranial nerves, is well illustrated by cuts taken from Landois' and Hermann's physiology.

Pursuing an anatomical arrangement, he discusses diseases of the cervical and brachial plexuses after the study of the cranial nerves. He first takes up the sensory, and follows with the motor affections. In the diagnosis of paralyses, he uses electricity in accordance with the most recent views, and gives a good account of the reactions of degeneration in the peripheral and spinal paralyses.

The second volume opens with the diseases of the spinal cord and medulla oblongata, or rather with an anatomical and physiological introduction. The "system diseases of the spinal cord and medulla oblongata

the poliomyelopathies-are well handled, and the articles are illustrated with plates and wood-cuts. The contributions of the most recent publications are here fully presented. In "the mixed diseases of the spinal cord and medulla oblongata," we find the same careful and thorough treatment.

The last part is devoted to the diseases of the encephalon, in which the doctrines of the localization of functions are fully stated, and the various maladies adequately described.

From this brief sketch, it will be seen that this work presents in full detail the diseases of the nervous system. It is a highly creditable production. It is, however, too voluminous, and might be much condensed with advantage. The anatomical and physiological introductions to the several divisions of the subject, might have been omitted, because these topics are treated of more fully by those special works devoted to anatomy and physiology respectively. On the other hand, it may be alleged that the student of nervous diseases will nowhere else find all the facts brought together in a form so convenient and serviceable. Again, cases are related in detail occupying much space, and although interesting enough in themselves, are out of place in a strictly didactic treatise. With these exceptions, we have only praise for the work; which we regard as eminently suitable to the needs of students of nervous diseases. It is true we do not find any original contri

butions to knowledge, but we have offered that which is better for the purposes subserved by such a worka full and accurate account of the subject, showing the author's mastery of the whole domain of nervous maladies.

THE MOTHER'S GUIDE IN THE MANAGEMENT AND FEEDING OF INFANTS. BY JOHN M. KEATING, M. D., Lecturer on the Diseases of Children at the University of Pennsylvania, etc. 12mo, pp. 118. Philadelphia: Henry C. Lea's Son & Co., 1881.

Though the average of births to marriages may be steadily decreasing, the number of "Mothers' Guides" and “İnfant Managements" is decidedly on the increase, and in a time which may be calculated with some accuracy, there will be a special guide, neatly bound and convenient for the pocket, for each mother. But as by that time the number of medical graduates will allow of one for each family, he will probably recommend his own guide for his family, or furnish it at a reasonable rate.

Dr. Keating's Mother's Guide is of a higher order than usual, and draws dangerously near that line which should separate the popular from the true scientific medical work. Perhaps he even oversteps the line, but if so, he does it with rare judgment and discretion. It is just the book to give the mother about to take her family to the country or sea-shore, where doctors are scarce or difficult to reach. Guided by it, almost any woman of average intellect will be rendered better able to cope with the sudden emergencies of croup, cholera infantum, or convulsions, and yet, we trust, will still feel that the doctor, when he comes, knows a little more about the case than Dr. Keating's book has taught her; for on this point the author has been especially on his guard. While we do not agree with him in his estimate of the relative success of wet nursing and bottle-feeding, still his recommendations are in the main safe and simple, and his descriptions of the salient diagnostic points in the few diseases of which he treats are admirable.

SOCIETY PROCEEDINGS.

NEW YORK SURGICAL SOCIETY. Stated Meeting, November 22, 1881. DR. T. M. MARKOE, PRESIDENT, IN THE CHAIR. Congenital Dislocation of the Hip.-Dr. C. T. POORE presented a patient, a child seven and a half years of age, who had congenital dislocation of both hips. It existed without assignable cause. The deformity was not noticed until the girl began to walk. Referring to the pathology of this affection, Dr. Poore, remarked that there were two classes of cases; the first, that in which the capsule of the joint is very much elongated, and permits of a sliding up and down of the head of the bone; the second, that in which there is no motion permitted by the capsule, and in that form the limb could not be drawn down. In some cases the head of the bone is much diminished in size, and it had been supposed that the dislocation was due to an arrest of development in the head of the bone as well as the malformation of the acetabulum. With regard to treatment, there had been four cases in which it had been said that the affection had been cured. One case was treated by simple extension. Mr. Brodhurst, of London, had divided all of the muscles inserted in the trochanter, and brought down the limb into its proper position, and held it there, and the patient went about without an instrument at the end of six months. Mr. Holmes saw Mr. Brodhurst's case, and testifies in re

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gard to its success. In France, cases had been treated by scarifying the point in the pelvis where it was desired that the head of the bone should be placed, and then bringing the head of the femur down to this point, and retaining it there, and it had been said that very good results had been obtained. It had been claimed that the muscles in this class of cases are apt to be atrophied, but the patient which Dr. Poore presented did not illustrate that statement.

Compound Fracture of the Leg.-Dr. ERSKINE MASON read a paper on this subject (which will appear in full in an early number number of the MEDICAL NEWS), in which he considered especially the period of time required for repair of compound fracture of one or both bones of the leg, as well as the method of treatment according to his own experience. He had had thirty cases of which he had complete notes from the time of the accident up to the date of their discharge from the hospital. In reviewing the notes of the cases which he had met in his private practice, about the same results had been obtained. He had used almost every variety of splint, and finally reached the conclusion that the plaster-of-Paris dressing, in some one of its varieties, with or without brackets, met the indications in the majority of cases, applied either early or late, better than any other appliance. He had used "through-drainage," in connection with the plasterof-Paris splint, and it had become with him a favorite mode of treatment. The results which he had obtained had been better than those which usually followed the old practice of sealing the wound. Dr. Mason then spoke of the too free use of the drainage-tube, or at least its too early introduction. His observation in these cases had also led him to believe that we might have too implicit faith in antiseptic dressings, at times, and attempt to save limbs which results proved should have been condemned to amputation.

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Of the thirty cases, there was fracture of the tibia in sixteen; of the fibula, in three; of both bones, in eleven. In seven cases amputation was required, primarily in five, of which three recovered and two died; secondarily in two, and both recovered. Eighteen cases were treated by plaster-of-Paris dressings, either by the bandage alone, or assisted and strengthened by brackets. Of these, nine were put up at once, and nine were dressed after the lapse of some days, the average period of treatment being twenty-four days. In the cases in which plaster was applied immediately after the accident, the average period of removal of the dressing was twenty-four days, and in the other cases thirty-eight days. Among the eighteen cases, there were four deaths; one from pyæmia on the eighth day; one from shock, the patient dying on the forty-first day; one from alcoholism on the seventh day; one from erysipelas, death occurring on the sixty-first day. The average duration of the treatment was eighty-two days. Four cases were treated by "through-drainage." average duration was forty-nine days. Several other cases were treated by the same method, and his impression was that they had all done well. Some of the cases had been treated by Volkmann's posterior tin splint with jute, and the average duration of the treatment was sixty days. Of these, there were two deaths; one of pleuro-pneumonia and septicæmia on the eighth day, and one of erysipelas on the seventyeighth day.

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Dr. POST asked whether fracture involving the tibia without the fibula in sixteen out of thirty cases was not an unusual proportion.

Dr. LITTLE remarked that, with fracture involving the lower third of the tibia, fracture of the fibula at the junction of the middle and upper third also took place in the majority of cases, consequently the fracture of the fibula was well covered with muscles and frequently

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Dr. SANDS said that his experience accorded with that given by Dr. Little.

Dr. W. T. BULL remarked that fracture by direct violence frequently involved the tibia without implicating the fibula. He had seen three or four such cases. Again, fracture produced by heavy weights falling upon the limb, might fracture the tibia without involving the fibula. He thought that in a fair proportion of the fractures produced by direct violence, the tibia alone, without the fibula, was involved.

The PRESIDENT remarked that his impression was that the proportion, as it appeared in Dr. Mason's paper, was placed much too high, and suggested that it might be apparent rather than real, from the fact that the fracture of the tibia might have been reported as compound, and that of the fibula as simple.

Dr. YALE suggested that the cases reported by Dr. Mason were only those of which he had complete notes, and, therefore, it may have occurred that in those there was fracture of the tibia only.

Dr. J. L. LITTLE believed that his success in the treatment of compound fractures during the last twenty years, had been due especially to the use of a fixed apparatus, so that the limb could be dressed at any time without disturbing the fragments. That method of treatment he learned in the New York Hospital. Before he introduced the plaster-of-Paris dressing, the ordinary method of treating compound fractures was by the use of the fracture-box with bran, which permitted the fragments to move upon each other every time the limb was removed from the box for the purpose of renewing the dressings. After the introduction of plaster-of-Paris, he treated a large number of cases by the use of the posterior plaster-of-Paris splint, which left the anterior portion of the limb uncovered, a piece being cut out so as to expose the wound, and then the limb was placed in a fracture-box. To prevent pus from running between the splint and the limb, he applied a piece of oiled silk, which was made to adhere to the limb by the application of collodion, and made a little trough through which the pus could flow, and not enter the fracture-box. Under such treatment, the limbs did better than under the old plan of treatment, by the use of only the fracture-box and bran. During the last few years, he had added to that mode of dressing the limb the antiseptic method, and under the combined treatment, his cases of fracture had uniformly done well. He retains the limb in the fracturebox not more than a week or ten days, if the case does well, when it is removed, and a new plaster splint and bandage is applied, and the patient is allowed to sit up and support the limb upon a chair. He had uniformly used Lister's dressing up to about six weeks ago, when he had a case of compound fracture of the leg, in which the tibia protruded through the clothes so as to be seen upon the outside. In that case, after reducing the fragments, he injected the wound with a solution of carbolic acid, one to fifty, then covered it with borated cotton saturated with the same, and over the whole he placed ordinary cotton and secured it with a bandage. The limb was then tied up in a pillow, and a straight splint applied upon either side of the pillow, and it remained in this temporary dressing for four days, during which time there was no rise of temperature, and no discharge appeared through the dressings. He then removed the dressings, and applied a plaster-of-Paris splint; dressed

the wound again with borated cotton and carbolic acid, which had been continued up to the present time, and there had been no bad symptoms whatever, except at the end of fourteen days, when some displacement took place accidentally, and there was slight inflammation about the wound. There was, however, no rise of temperature, and no chill, and the patient, who was a man sixty years of age, at the present time was doing well. Dr. BRIDDON thought that the fracture-box had been discarded altogether. He could not conceive of a more painful plan of treatment. He advised the application of the plaster-of-Paris dressing immediately, introducing a drainage-tube, covering the wound with thick pads of oakum, and suspending the limb in a sling. This method of treatment he thought was much more comfortable than the use of the fracture-box. He certainly believed, with Dr. Little, that the means which obviated the necessity for frequent change of dressing were the best.

Dr. LITTLE said that he had always condemned the plaster-of-Paris bandage in the treatment of recent fractures. He was well aware that experts could apply such a dressing without danger, but for the ordinary practitioner, he thought that the use of the plaster-ofParis bandage was always attended with a great deal of danger, such as might arise from interruption of circulation and consequent gangrene. On the contrary, the plaster-of-Paris splint, which he used, leaves the limb open upon its anterior aspect entirely, and it is almost impossible to have obstruction to the circulation occur as a result.

Dr. Post believed that in compound fractures, attended with severe injury to the soft parts, it was safer to place the limb in a fracture-box than it was to put it up immediately in an immovable apparatus. He believed that he had seen cases of gangrene which were due to the fact that the limb had been placed in an immovable apparatus at once, and that the limb could have been saved had it not been subjected to such pressure. The fracture-box with bran possessed the advantage of giving equable support without producing undue pressure upon any part of the limb.

Dr. BRIDDON said that he could accept Dr. Little's treatment by the use of the posterior splint, as it was about as serviceable as the plaster-of-Paris bandage, but he could not see the necessity of putting the limb in a fracture-box.

Dr. LITTLE thought that it was easier to put the limb in a fracture-box than it was to put it in a sling.

Dr. W. T. BULL had abstained from the use of the plaster-of-Paris bandage where it was necessary to frequently change the antiseptic dressings during the first two weeks, inasmuch as it would be laborious to remove and reapply the plaster dressing every three or four days. Again, he thought that the drainage-tube should be withdrawn after the period of granulation had been reached, and the wound treated openly. Then the limb might be placed in a plaster-of-Paris splint, and the dressings applied to the wound through a fenestrum. Previous to that stage, he had almost always used Volkmann's posterior tin splint, and suspended the limb in an iron cradle.

Dr. BRIDDON thought the danger of gangrene from pressure, mentioned by Dr. Post, incident to local swelling of the limb, could be obviated by using cottonwool very thick next the limb, and over that applying the plaster-of-Paris bandage.

Dr. Post remarked, with regard to drainage-tubes, that he had known mischief to be done by their acting as foreign bodies when retained too long in the wound.

Dr. LITTLE said that Volkmann, at the London International Medical Congress, referred to the fact that drainage-tubes had been permitted to remain in various

parts of the body without producing any irritation, and it subsequently became necessary to cut them out.

Dr. Post had known indurated sinuses to be the result of leaving them in position too long.

The PRESIDENT asked Dr. Mason what his impression was with reference to sealing the wounds in compound fracture, after the old plan, which might be called Sir Astley Cooper's method, as compared with covering them with antiseptic dressings.

Dr. MASON replied that his experience had been limited to five cases; two of the leg, two of the thigh, and one of both bones of the forearm. In those cases the strict antiseptic dressing was used, and he believed the wounds closed sooner than they would have done under the old plan of sealing the wounds with collodion and cotton. He was satisfied that the antiseptic dressings gave the best results.

Dr. YALE referred to one case of compound fracture of the leg, in which the Lister dressing was applied to the wound, and in less than ten days it was removed, and the case was treated as one of simple fracture.

Dr. BULL thought that the surgeon might be guided somewhat by two considerations; first, the character of the violence; second, the damage done to the soft parts. If the violence was such as did not comminute the bones, and the opening was small, and there was evidence that the soft parts had not been extensively contused, and no great amount of blood had been effused into the tissues, he would prefer to use the antiseptic dressing. To settle these questions, however, was sometimes a matter of considerable difficulty, and required a somewhat, varied experience. He had seen perhaps half a dozen compound fractures of the leg, involving both tibia and fibula, where pin-hole wounds of that kind existed, and there was no reason to believe the fracture in the bones was extensive or comminuted, and he had put on the antiseptic dressing, and the result had been entirely satisfactory, and he should prefer it to sealing up the wound in the old-fashioned

way.

Dr. SANDS thought that the results of treatment of such cases of compound fracture of the leg were very much better than the results obtained ten or fifteen years ago at the New York Hospital. In those days it was rather expected that complications would ensue in such cases; but, at the present time, serious inflamma- | tion or septic infection seldom occurred during the treatment of a compound fracture. In the Roosevelt Hospital there were now three cases of compound fracture of the leg, treated simply by washing out the wound with carbolic acid, and then covering it with antiseptic dressings; in two of these the wounds had closed entirely, and in the other, although the wound was not completely healed, it was nearly so, and no bad symptoms had at any time been developed. He had no doubt whatever that the antiseptic plan of treatment gave much more favorable results than the old-fashioned practice of sealing the wound.

Dr. LITTLE said that at St. Vincent's Hospital a large number of cases of compound fracture were treated, and the rule was always to wash out the wound with carbolic acid and apply an antiseptic dressing, and it had now been four or five years since he had seen a case of compound fracture in which there had been discharge sufficient to penetrate the dressings; certainly he had not met with a case in which it became necessary to make a counter-opening to afford exit for pus.

Dr. Post referred to a compound fracture of the leg, situated in the immediate vicinity of the ankle-joint. The bones were badly comminuted, and the soft parts were extensively lacerated. He attempted to save the limb. He washed the wounds thoroughly with carbolic lotion, inserted drainage-tubes, and put up the limb in a plaster-of-Paris apparatus, and for several days there

were good prospects for saving it; gangrene, however, occurred, and amputation became necessary. The patient died on the following day of tetanus.

Dr. MASON asked Dr. Little if, in the treatment of cases of compound fracture at St. Vincent's Hospital, drainage-tubes were used.

Dr. LITTLE said they were very rarely introduced. Dr. LANGE thought it was especially important in cases of compound fracture to consider whether or not the wound was already infected. If the wound was perfectly fresh and without infection, antiseptic dressing might be applied simply to prevent infection, but if infection was already present, then the application of an antiseptic dressing alone could not prevent inflammation. In the latter class, disinfection of the wound should first be made, and each case must be treated according to its special features. He thought it was according to common experience in compound fractures that large, open, external wounds were not so dangerous as those of moderate or small size, with extensive injury to the soft parts and the bone inside. Therefore, it was important to decide, with reference to every surgical wound or injury, how extensive had been the injury to the bone or the soft parts, whether a great deal of tension and swelling was to be expected, and how profuse the discharge would probably be, and if the circumstances were such that a profuse discharge was to be expected or such loss of vitality in the parts as is favorable to the development of inflammation or decomposition, as free exit for it as possible must be maintained. With a view to prevent inflammation in a case of compound fracture, or if inflammation was present to counteract it, immobilization must above all other things be observed. It must, however, be kept in mind that through immobilization we prevent inflammation in so far only as we avoid that condition of tissues in which they represent a more favorable soil to the development of inflammation. Inflammation in compound fractures in most cases was infection from without. Immobilization had been practised long ago. The good results, however, dated since that comparatively recent period when surgeons learned to combine it with strict antiseptic measures. Listerism, of course, had not the monopoly for the latter, although it was a very efficient method. Antiseptic procedures, however, were indispensable for good results in compound fractures, and it was more than probable that all kinds of successful treatment owed their efficacy to their antiseptic qualities. It was only necessary to state what constitutes the latter.

Dr. SANDS remarked that the difficulty hinted at by Dr. Lange was an objection to the employment, as a general rule, of the plaster-of-Paris splint, which envelops the limb except where it is exposed at the situation of the fenestra. The advantage of the plasterof-Paris splint in simple fracture, is the immobility of the limb which it secures, preventing thereby pain and injury of the soft parts caused by movement of the fractured ends of the bone. If this end could be accomplished after compound fracture, the use of the splint would be equally advantageous as in a simple fracture, but he thought that this was rarely the case. If the plaster-of-Paris splint was applied with sufficient pressure to secure immobility, we expose the patient to the risk of mischief resulting from swelling, and may be obliged to remove the plaster-of-Paris splint after the lapse of a few hours or days. If, on the other hand, to avoid this danger liable to arise from swelling of the limb, we put it up loosely, or insert large pads of cotton, as suggested by Dr. Briddon, we shall find, if no swelling takes place, that the limb will soon be too loose, and the dressing will rather cover the limb than keep the fractured bones in position. Another objection to the use of the plaster-of-Paris splint in compound

fractures of the leg, was the difficulty, unless the fenestra was exceedingly large, of applying efficient antiseptic dressings. For this reason he had followed the practice adopted by Dr. Bull. Volkmann's posterior splint gave adequate support to the limb, while it left the anterior part, where the wound in the skin usually existed, open for inspection, and allowed the application of antiseptic dressings without much disturbance of the fractured bones. Furthermore, it allowed the application of the bandage over the limb with just such an amount of pressure as was necessary to give proper support. He should, therefore, defer the employment of the plaster-of-Paris splint until all inflammatory swelling had subsided, when he thought it could be used with the best results.

Dr. LITTLE thought it a good plan to make a distinction between the plaster-of-Paris bandage and the plaster-of-Paris splint. The plaster-of-Paris bandage was a dressing which enveloped the limb entirely, whereas the plaster-of-Paris splint was an apparatus which could be applied to the posterior aspect of the limb, and did not render the limb liable to be injured from obstruction to the circulation, and, at the same time, it rendered the fractured bones immovable, and allowed them to be inspected at pleasure.

Division of the Tendon of the Flexor Profundus Digitorum. Dr. Post narrated a case as follows: A male patient presented himself at his clinic, who, two months before, had wounded the palm of the left hand very nearly in front of the articulation of the first phalanx of the ring finger with the metacarpal bone. After that injury he was able to flex the finger with the other fingers for three days, and then suddenly, after tossing a child, something gave way in the finger, and he lost the power of flexing it entirely. After the lapse of two months the wound had healed entirely, and passive motion could be made, but the patient had no voluntary power over it. It was evident that there was division of both tendons belonging to that finger. Dr. Post made an incision down to the sheath of the tendon, which he divided, and found the distal end of the tendon lying loose in the sheath, entirely separated from the proximal end, and division had taken place just at the point where the tendon of the flexor profundus passes through the slit in the flexor sublimis. He found that the end of the tendon of the flexor profundus was smooth and rounded, and there were little rounded bulbs in the incision of the tendon of the flexor sublimis. He then extended the incision to the extent of about three centimetres, but was not able to find the proximal end of the tendon. He believed that there was incomplete division of the tendon at the time of the injury, and that the separation became complete at the time when the patient felt something give way in the palm of the hand three days afterward. The case was interesting, from the fact that the division was not perfect at the time of the receipt of the injury, and from the fact that there was such a wide separation of the ends of the tendon. A carbolic lotion was applied to the wound, and no unfavorable symptoms had followed the operation.

Dr. SANDS remarked that he had been similarly disappointed in such an operation, and he also had the impression that, as a rule, the separation of divided pieces of tendon was so great as to discourage any attempt to replace the parts after the lapse of any considerable period of time.

The PRESIDENT remarked that he had had the same experience in divisions of the tendons of the fingers. Dr. POST remarked that when the tendon was within the sheath, it probably receded more than when elsewhere.

Dr. LITTLE remarked that he failed to reach the proximal end of the tendon in a case immediately after the injury.

Vesical Calculus. Bigelow's Operation.-Dr. LITTLE presented the fragments of a vesical calculus removed by rapid lithotrity, with the following history: A man, sixty-three years of age, a patient of Dr. A. H. Smith, had suffered from frequent micturition for six months. Symptoms of stone developed four weeks before he saw the patient. The patient was etherized, and Bigelow's medium-sized lithotrite was introduced. The stone was seized and crushed, and the fragments removed through the evacuating-tube, and the bladder irrigated until no further fragments could be found. The operation lasted only fourteen minutes. Before the operation, the patient was obliged to pass water every hour; after the operation, he could hold his urine for six or eight hours. Not the slightest unpleasant symptoms followed the operation.

Sequestrum from the Sternum.-Dr. Post presented a small sequestrum removed from the upper part of the sternum. The patient was a woman, forty-five years of age, who was under his care in the Presbyterian Hospital in August. She had had caries of the sternum for some time. He then removed portions of dead bone, and an opening was made extending into the anterior mediastinal space. The finger could be passed behind the sternum without unpleasant consequences following. She left the hospital, but subsequently came under his observation, and he found, on inspecting the wound, a piece of bone present at the deeper part of the cavity, which he seized with a pair of forceps and extracted, and it was the specimen presented. Since that time the sore had granulated, and the parts looked as if recovery would take place. There was no distinct syphilitic history in the case. The specimen was interesting, from the fact that it was a sequestrum from a spongy bone.

PHILADELPHIA ACADEMY OF SURGERY.

Stated Meeting November 7, 1881.

S. D. GROSS, M. D., PRESIDENT, IN THE CHAIR. Aneurism of the Femoral Artery Cured by Pressure.— Dr. S. W. GROSS exhibited a case, which he said was really under the treatment of Dr. S. D. GROSS, the President, with the following history:

About a year ago, a colored hod-carrier, aged twentyseven years, began to suffer from a constant dull, aching pain in the left knee, which he attributed to rheumatism, and which was increased by hard work. Four months prior to his admission into the Jefferson Medical College Hospital, he noticed a beating just above the middle of the thigh, and he found at this point a rather soft pulsating swelling, about the size of a common marble. On admission, there was an aneurism of the superficial femoral artery at the apex of Scarpa's space as large as the fist, and the pain was still present in the knee. There was no history of syphilis, but he fell from a ladder and bruised the corresponding leg a few months previous to the appearance of the tumor.

On the 7th of October, pressure was maintained for three hours upon the common femoral artery by means of a pestle, when it was discontinued on account of the severe pain which it produced. On the 9th of October, the same measure was employed for five hours, but without any benefit. Four days subsequently, two five-pound bags of small shot and a leaden weight of ten pounds were applied to the artery and the circulation completely controlled. The constant movements of the abdominal muscles in respiration, and the restlessness of the patient rendered it necessary to hold the weights in place, and at times to make slight pressure with the hand to overcome the pulsation. At the expiration of an hour and a half, with a view to relieve suffering, one-third of a grain of morphia was thrown under the skin, and the dose was repeated in

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