though it is simply absurd. A true disinfectant is a substance that will kill the germ or living particle in which the contagious principle resides, or through which it is conveyed." Acids, caustics and fire do this; what else can?

SANITARY RIGHTS OF TENANTS.-The frequency with which people go to court for redress from injury suffered through poor plumbing makes the following comment of one of the New York City judges quite appropriate :

"It would seem, however, from the number of cases which come before the court for determination, that plumbing is deemed exceptional in its character. "The roof may leak, the plastering give way, the doors and windows be broken, and other misfortunes incident to housekeeping may occur, and no claim is made that an eviction has been established, or a right of action has accrued against the landlord for the tenant's ill health; but if a pipe becomes filled up (by neglect or otherwise), or if the solder becomes loosened, or the pipe itself becomes deranged, or the main sewer is in such a condition as to empty the traps, the tenant for some reason claims that a different rule applies.

"Now, if a tenant elects to hire a house which empties into a sewer, with ramifications throughout his sleeping apartments, he does so with all the liabilities that such an election engenders, and with full knowledge that no plumber has yet been able to keep out the gas or prevent the smells.

"The repairs of a sewer-pipe are not different from the repair of a window or a door, and the distinguishing injury arising from such neglect is not only incidental and remote, but, as a matter of fact, is the result of the tenant's own election. He hired the premises with full knowledge of these connections, and the landlord is not chargeable with such consequential injuries as may arise from any defect that time and use produce. Under such circumstances, smells and even sickness are not only not extraordinary, but are inevitable; and I fail to see how this furnishes any ground of action against the landlord. The charge of concealment and deception in this class of cases is undoubtedly an outgrowth of anger, which has its source from the painful effects of such defects; but the law in its present state furnishes no remedy to the tenant that I know of, and it rests with the Legislature to make landlords and builders liable in such cases, for the common law throws the responsibility upon the tenant, and I know of no provision which exempts the plumbing or the sewer fixtures from these well-settled provisions."

A LESSON TO BE REMEMBERED.-On the morning of Friday, September 1, 1854, the cholera suddenly attacked a number of persons residing in the subdistrict of Berwick, in the city of London. The outbreak was confined to the immediate vicinity of a well situated on Broad street.

This well was the centre of an infected district: "a person starting from thence and walking at a moderate pace would have got beyond its limits in three minutes" (English Rivers Pollution Reports). During the month of August preceding the outbreak, only twenty-six cases of cholera were reported to the London authorities from this district (Berwick).

SANITARY.

The epidemic reached its height on September 2nd, and declined about fifty per cent. on the 5th; after which it dwindled off until the 20th, this day being the first on which no death took place. The total number of deaths in the district from the 1st up to this date was 609.

Investigation showed that about seventy-eight hours before the great outburst of the disease a child was attacked with cholera in the house No. 40 Broad street, and its dejections were emptied into a drain which ran within a few feet of the well. The water from this well was very popular with the neighborhood.

Analysis showed that it contained in 100,000 parts 137 parts total solids, and 7.72 parts organic and volatile matter. It was clearly shown that nearly all the persons attacked with the disease had drunk the water from this well.

In one case, an old lady and her niece, residing at a distance, had been in the habit of having the water sent to them daily. They both had cholera, while none of their neighbors contracted it.

The history of this well should be engraved on the mind of every sanitarian. The activity displayed by health authorities in searching out and stopping the water from city wells shows that it has not been lost on them. such water for the preparation of aerated drinks is the more dangerous, since The use of such beverages are prescribed for invalids.

The history of the cholera in Manchester and Glasgow illustrates most forcibly the importance of a pure water supply for cities. people of Manchester and Salford obtained water partly from wells and partly Until 1851 the from the River Irwell. Both these sources were much poluted with excrementitious matters.

In 1851 a pure supply of water was introduced into these towns. The following figures, taken from the report of the Rivers Pollution Commission, show the mortality during the polluted and pure-water periods :

66

'Total mortality in Manchester and Salford, polluted-water period: 1832, 890; 1849, 1,115; pure-water period: 1854, 50; 1866, 88.

The history of the disease in Glasgow affords evidence equally conclusive. Until 1859 the water supply was drawn from the Clyde, and was polluted by the drainage of towns higher up the river. After that year a pure supply was obtained from Loch Katrine.

Total mortality in Glasgow, polluted-water period: 1832, 2,842; 1849, 3,772; 1854, 3,886; pure-water period: 1866, 68. Mortality per 10,000 of population, polluted-water period: 1832, 140; 1849, 106; 1854, 119; pure-water period: 1866, 16.

These facts are not new to sanitarians who have studied the subject, and they can be multiplied to any extent desirable to prove the intimate connection of cholera with water supply. We repeat, then, we are glad to see that the health authorities in this city are so thoroughly alive to the necessity of inspection of wells, and are so strenuously in favor of preventing the use of the water from them for drinking purposes.-Record.

SELECTIONS.

SURGERY OF THE HAND-ESPECIALLY APPLIED TO RAILROAD INJURIES. Read before the American Surgical Association at Washington, D.C., May, 1884, by JOSEPH W. THOMSON M.D., Paducah, Ky. Man's usefulness and happiness in every calling in life depends to a great extent upon the hand. The hand is the most essential member of the body, as it is the means by which the intellect and genius of the mind are carried out and perfected. This makes the study of its anatomy and surgery of the first importance. Its perfect mechanism commands our admiration, and the beauty and symmetry of the human hand points conclusively to the high position man was intended to fill, and these suggestions taken together should invest the study of its injuries with much interest. Its constant exposure in every vocation, and more especially in this age of machinery, when the liability to such various injuries is so multiplied, demands on our part a thorough knowledge of its anatomy and surgery.

Every step made in the way of perfecting machinery increases the perils to the hand, and it remains for us to bring to bear every resource of investigation to establish a conservative practice in such wounds. The anatomy of the hand can only be thoroughly studied in the dissecting room. On the cadaver alone can we make ourselves familiar with its interesting and intricate regional anatomy. Practitioners so situated as not to be able to have the benefit of the study of the anatomical parts by dissection can secure a good knowledge by studying "Gray's Surgical Anatomy," "Holden's Guide," and Maclise's old, accurate and splendid plates. A thorough knowledge of the anatomy of the hand is essential as a foundation for the proper surgical management of its injuries.

The rich blood and lymph supply of the palm and the dense connective tissues cause the inflammatory action to be rapid in its course and soon becomes destructive to the soft tissues. As soon as the swelling and effusion require it, relief must be given to the distended tissues by a prompt and free incision, as by this treatment alone can the destruction of the parts be prevented. In cutting into the palm high up the surgeon must carefully bring to bear his anatomical knowledge and avoid wounding the palmar arches, which would result in troublesome and in some cases dangerous hæmorrhage.

Acute paronychia should be treated by prompt incision down through the periosteum, as neglect of this precaution is very liable to be followed by such destruction of the soft and bony tissues as to impair the functions of the finger or necessitate amputation. If the incision is early and thoroughly made relief with prompt recovery is generally the result. Wounds of the palmar arches are among the most difficult injuries we have to contend with, and to treat such wounds successfully often taxes

the ingenuity of the surgeon. The contrariety of opinions among the various surgical authors as to the proper treatment of wounds of the palmar arches is conclusive proof of the difficulties met with in this class of cases. In primary injuries a majority of opinions seem to be in favor of enlarging cautiously the wound and ligating the vessels. This may be proper in wounds of the superficial arch, but it does not seem admissible to extend the incision into the deeper fascia of the palm to secure the bleeding ends of the deep arch. In punctured wounds more especially is this rule applicable. Ligation of the principal vessel forming the arch, and compression of the opposite one, together with acute flexion of the forearm on the arm, will generally succeed in controlling the hæmorrhage. Ligation of both radial and ulna at the wrist and flexion of the arm is a good practice. If compression and other means have failed, and the palm and dorsum have become infiltrated and much swollen, it is sound practice to at once ligate the brachial artery, as it secures against further loss of blood.

A patient with wound of both arches by the plunge of a knife was brought to me one week subsequent to the injury. Too much pressure had been applied, resulting in infiltration and sloughing, so that when the pressure was lightened copious bleeding would result. I ligated both the radial and ulnar arteries at the wrist and elevated the arm. Pulsation continued in the wound, and on the fifth day after ligation of the vessels hæmorrhage recurred. I then flexed the arm on the forearm and secured it in that position with a roller bandage. After this the hæmorrhage did not recur, and the recovery was prompt and satisfactory. I am inclined to think that the advantage of acute flexion in wounds of the palmar arch is not properly appreciated by surgeons. In many cases bleeding from the superficial arch can be controlled by judiciously applied pressure and flexion of the forearm on the arm.

In cases of the bones of the hand, a free incision extending down to the bone will usually suffice. In necrosis of these bones, cutting down on the diseased structure and removing the detached portions is a very successful practice. It may require several operations to secure a good result, but pursuing this course will often prove successful. By these incisions we secure thorough drainage, which is so essential. When we consider the ample lymph and blood circulation in the hand we can readily appreciate the superior tissue-making element it possesses, and can, therefore, safely give proper credit to nature's reparative power in injuries and diseases of the hand. Experience teaches that amputation of the hand or any part of it is seldom required for the relief of necrosis. As a rule, preference should be given to secondary amputations in hand injuries.

Resection of the metacarpal bones has proven a very successful practice, especially to the extent of removing the fragments of bone and smoothing the sharpened ends. If due care is given to preserving the periosteum, reparation of the part will generally be prompt and thorough.

Resection of the phalanges is seldom admissible, except those of the distal row. When it seems necessary to remove the first and second phalanges, it is better to substitute amputation, as a useless finger would be the result of resecting those bones.

Excision of the carpal bones is of doubtful propriety, and can scarcely be considered an established operation. Prof. Lister has given much attention to excision of the wrist, and claims it to be a successful operation, but I think the majority of surgeons look upon the propriety of this operation with much doubt. Most cases will terminate well if properly treated by free incisions, drainage and removal of the dead portions of bones as they become detached. In amputation, to remove as limited a portion of the finger as possible is in the main proper, but exceptions should be made to this rule in amputating the middle and ring fingers, especially among the laboring class. Experience satisfies me that among that class it leaves the most useful hand to remove the middle and ring fingers at the metacarpo-phalangeal articulation, as a stump from amputation of these phalanges in the continuity or at the first phalangeal joint, the flexor and extensor muscles having been severed, renders the hand comparatively useless, and is therefore much in the way of the laborer in performing his work.

Cut No. 1 exhibits the stump from amputation of the middle finger at the first phalangeal joint in July, 1883. This stump is comparatively useless, and from its position (as is plainly shown in the cut) is liable to be in the way when performing manual labor. The man informs me that he is so inconvenienced by the contact of the end of the stump with bodies that he handles, that he would much prefer that the finger was off at the knuckle joint.

The case represented by cut No. 2 presents the appearance of the hand with amputation of the middle finger at the metacarpo-phalangeal articulation. It will be observed that the hand is not very unseemly. The man assures me that the function of the hand is but little impaired, and that he does not meet with the inconvenience of other co-laborers with stumps from amputation of that finger. This man and the one represented with the stump of the middle finger are both still at work for the railroad with which I am connected as surgeon, and within the last week I have examined both hands and had them photographed.