in France, and with such tireless workers through the posterior wall of the gut, and as Simon in England, all engaged in push- this corresponded with a depression in the ing a single and really very simple inquiry, bony tissue of extreme end of the sacrum. the question will be settled in Europe Dr. Kinloch determined upon an operation before its vast importance is adequately as offering the best chance for life under understood by American practitioners, and the very gloomy prognosis. At 9 P. M., the while yet the American Medical Association is engaged in vain disputation on points of medical ethics.-Times. GUNSHOT WOUND OF ABDOMEN TREATED Amos Ray, colored male adult, admitted into city hospital, November 1st, 1882, P. M., with gunshot wound of abdomen. Wound received about 10 A. M., from discharge of pistol (32 calibre, Colt's) in hand of a fellow laborer with whom there had occurred a difficulty. The party firing necessary preparations having been completed patient was chloroformed and the operation performed under carbolic spray and with full antiseptic precaution. The cavity was opened by an incision in the median line from the umbilicus nearly to the pubes. The intestines were turned out, and carefully examined. There were discovered five preparations in the calibre of the small gut, and two in the mesentery. The wound in the rectum, after very careful examination, could not be discovered. The edges of all the intestinal wounds were trimmed with the scissors, and the wounds closed with fine carbolized silk sutures (suture of Lembert.) There was considerable blood in the cavity and but very little fecal matter. The cavity was carefully sponged out, and cleansed with a warm two per cent. carbolized solution. The abdominal wound was closed with silver sutures except at the lower angle where a rubber drainage tube was inserted. Carbolized oiled lint, several layers of borated absorbent cotton, and a broad bandage completed the dressing. Examination. The orifice of entrance of ball was found midway between the umbilicus and pubes, a little to the left of the mesian line. There was general abdominal pain, and an inability to pass water,* with Patient was ordered gr. 1 of opium every symptoms of slight shock. The bladder four hours. Hot bottles to extremities. was emptied by a catheter, and the urine Internally nothing more than pellets of ice found of natural character; a little blood ad libitum. escaped from the urethra, which was sensitive and slightly strictured at two points. Nov. 2d, 9 A. M. Patient in good spirits, has no pain but is troubled with hiccough. Pulse strong, 116. Temperature 100.2.° Removed dressing and sponged off abdowater. men with carbolized Removed warm At 7:30 P. M., Dr. Kinloch examined patient. Abdomen was slightly swollen and tender, and in addition there was complaint of pain at end of spinal column just drainage tube, and inserted one of larger above the anus. The oiled-finger passed calibre. Washed out cavity with a into the rectum discovered an orifice two per cent. solution of salicylic acid. Reapplied dressing to wound, ordered opium to be given every three hours. 12 A. M. Condition unchanged. Patient asked for nourishment. Allowed a spoon *NOTE.—Was this paralysis of the bladder following this kind of wound, according to the views of Baudens, Legouest, and Hamilton, or a mere sympathetic retention ? + The report of this case is taken from the Hos- ful of milk and lime-water every hour. pital Record Book. 6 P. M. Changed for the worse. Abdo men very tympanitic. Pulse 128, and weak. was fixed that the case was not one of those Temperature 100.2°. Washed out cavity again. II P. M. Patient sinking. Pulse 170, and scarcely perceptible. Temperature 100.2°. Extremities cold and surface generally bathed in cold sweat. 2:15 P. M. Patient expired. Nov. 3, A. M. Autopsy revealed the fact that the mesentery and omentum had five perforations, and the intestines four, two or three were orifices of entrance and two of exit. All the openings but one were closed; this apparently had escaped detection. The ball had passed downwards and slightly to the right, entering the rectum just below the recto-vesical fold, and traversing the sacro-coccygeal articulation, scaling off a piece of the sacrum and imbedding itself in the glutei muscles from whence it was extracted. There was a very little fecal matter in the abdominal cavity, together with some bloody serum. The whole mass of the small intestines exhibited signs of acute inflammation, and here and there presented ecchymotic patches. remarkable instances said to have occasionally occurred, in which a ball had traversed the abdominal cavity and not wounded any of the viscera. This, in part at least, decided me in my resolve to adopt the active or "heroic" practice, which has the sanction of Heisten, Fallopius, Cheselden, Baudens, Legouest, Pirogoff and Lohmyer in Europe, and Hewitt, McGuire, Lincoln, Billings, Sims and a few others in our country. While this adds another fatal case to the list of those in which similar treatment has been instituted, it does not alter my belief in the correctness of the practice in the class of injuries presenting so gloomy a prognosis. Though I cannot feel as hopeful in regard to the future of such practice, as my distinguished friend, Dr. Sims, nor partake of that degree of enthusiasm which comes of successes in ovariotomy, I do look forward to better results than have been so far obtained. There is, strictly, no ground for comparing ovariotomy with the operations for intestinal lesions, unless it be in Remarks. My postion in regard to the contrasting the conditions in the two proquestion of treatment of abdominal wounds ceedings to determine at once how much has been long since recorded, when report- more serious must ever be the prognosis in ing the case of W B., successfully operated the latter. Listerism, however, and much upon, during the war, in the July number of knowledge acquired by ovariotomists of the American Journal of Med. Sciences, will embolden many surgeons, who up to for 1867. This question, too, has been thoroughly examined by the late lamented Dr. Otis, U. S. A., in the surgical history of the war. More recently, Dr. Hunter McGuire, of Richmond, and Dr. Marion Sims, of New York, have given to the profession valuable papers in connection with the subject. this time have favored the passive policy in the treatment of intestinal wounds. We shall soon have evidence of this, and fuller statistics upon which to base conclusions. From the report above, it will be seen that the autopsy disclosed the fact that one of the perforations in the intestine was overlooked at the time of operation. This has occurred before in at least one reported case, and such an accident is a strong argument with many who are opposed to the active treatment. This failure to close one of the wounds would, with most surgeons, be regarded as a fatal mistake-one that There was no need to discover fecal ex- would always seal the fate of the patient. udation through the wound of the abdom- I think this by no means a legitimate inal parietes to determine a diagnosis of conclusion. Where drainage can be insured, intestinal lesion. Beyond a doubt the fact and the cavity washed out, such a calam In the case now presented, it will be seen that the diagnosis of intestinal wound was fully established before operation, as was also the direction, course and position of the ball. ity, fearful though it be, may at times be and a five per cent solution is necessary to My failure to find the wound in the rectum, which I knew to exist, was a sad disappointment to me, but I looked for help to the drainage tube. But for this failure I should have closed the cavity. I do not think that open wound of the intestine determined the fatal result. The autopsy proved that there had been but little escape of intestinal matter into the cavity, or that such discharges had been washed out by the injections thrown into the cavity. Death, apparently, was neither from peritonitis nor septicemia. The little suffering of the patient after the operation was a marked feature. The opening of the abdominal cavity seemed to save from suffering, if it did not save life. The lateness of the operation (eleven hours after injury) militated against its success, and the numerous perforations of the gut perhaps rendered success impossible.-S. C. Trans. But what is the most interesting is the fact that carbolic acid dissolved in oil or water proved itself totally inert! What do our surgeons who still make use of so-called carbolized oil say to that? Koch found that carbolic acid, when dissolved in oil or in alcohol, had not the slightest influence on the vitality of any ot the micrococci or bacilli, Concerning sulphurous acid, it was found. to be powerless against spores; bacilli and micrococci, when exposed to the fumes in a box, were killed within twenty minutes, but were very little influenced, or not all, when exposed to the fumes in a room at the usual temperature. Chloride of zinc showed itself just as harmless. A five per cent solution exerted absolutely no influence on the spores of anthrax, notwithstanding the same had been exposed to the action of the remedy for a period of thirty days. Of other drugs, the spores of the bacilli were killed by chlorine water, fresh preTRUE DISINFECTANTS. Many a so- pared; two per cent bromine water, one called disinfectant is employed to-day in a per cent aqueous solution of corrosive certain solution, when it does not possess sublimate, five per cent solution of permanany value whatever, under the circum-ganate of potassium, one per cent osmic stances. If it is really our intention to acid, within one day; formic acid, four disinfect wounds, we must be certain, at least, that we will achieve our object with the remedy we use; if such is not the case, we only irritate without doing good. days; ol. terebinth, five days; solution of The Imperial Board of Health of Berlin has published a number of experiments which have been made by Dr. Koch, with Inert or possessing very little influence: the view of establishing the real value of distilled water, alcohol, glycerine, oil, sulmany so-called disinfectants. It would phur-carbon, chloroform, benzol, petrolead us too for to give the whole procedure leum-ether, ammonia, concentrated solution. employed to ascertain the facts men- of common salt, bromide and iodide of tioned, and we will, therefore, confine common salt, bromide and iodide of potourselves to giving the more important assium, 1 per cent sulphuric acid, sulphate results of the investigations of this cele- of zinc and copper, alum, 1 per cent perbrated physician. mang. of potash, chromic acid, the chromates and bichromates, chlorate of potash 5 per cent, boracic acid 5 per cent acetic acid 5 per cent, tannic acid 5 per cent, benzoate of sodium 5 per cent, quinine Most surgeons have been satisfied to wash their hands and to clean their instruments with a two per cent solution of carbolic acid. Such a solution is almost inert, As regards remedies which prevent the further development of spores, the following results were obtained. The first number means retarding the developmement, the rest totally preventing it: Corrosive sublimate, Oil of sinapis, Arsenite of potash, Thymol, I: 1,600.000 I : 100,000 I: 80,000 I: 320,000 I : 10,000 (2 per cent, in water 40, alcohol 60, iodine) persons, and can distinguish the taste of a (1 per cent in alcohol), thymol (5 per cent mathematician from the flavor of a philosoin alcohol), salicylic acid (per cent in alco- pher, we have a right to suppose that scihol, 2 per cent in oil.) entific persons have, as a result, a thorough and accurate knowledge of flies. In fact, they have always claimed to possess such knowledge. They have written elaborate text-books on flies, dividing them into a dozen different species such as the bluebottle fly, the up-stairs fly, the dinner-table fly, and the early morning fly, etc. They have told us all about the habits of flies, and one scientific person has invented an instrument with which, as he pretends, he can hear the footsteps of flies when walking and the deafening sound made by them when trumpeting through their probosces. We have believed all these assertions, but now comes a German scientific personProf. Deintz-and alleges that a great mistake has been made in point of flies, and that we must abandon as untenable one of the most pleasing peculiarities hitherto attributed to flies. Ol. terebinth, Oil of peppermint, I : 75,000 Picric acid, I : 40,000 Iodine, I : : 5.000 Salicylic acid, 1: 3.300 Permang. of pot., I : 3,000 Muriatic acid, I: 2,500 Camphor, I : 2,500 I : 2,000 I : 8,000 I : 5,000 I : 1,500 I : 1,700 I : 700 Carbolic acid, We have always been told that the fly is enabled to walk on the ceiling by reason of the air pumps with which he is provided. He was said to carry an air pump in each hand-or foot, and, by exhausting the air from under the soles of his feet with those pumps, to be able to fasten himself to the ceiling by atmospheric pressure. This was a beautiful theory, and it was often referred to in illustration of the intelligence of flies and of the wisdom of nature in making ceilings horizontal, and smooth enough to AIR PUMPS, FLIES, AND GLUE.-It is afford opportunities for the use of these all very well for the Positivists and other air pumps. We were told that we ought contemners of Christianity to tell us that to imitate the wisdom and forethought of we must have faith in science, but how can flies, and to provide ourselves with air we have faith in it when it is constantly pumps so that we too could walk on ceilconfessing its own mistakes? If there is ings; and we were warned not to be proud anything with which science ought to be of our steam engines and bicycles when an perfectly familiar it is flies. The average insect as small as the fly could "lay over scientific person is bald-headed, and such us "-to use a scientific term-in connecare the chosen victims of flies. When tion with air pumps. And now we are told occupied with his microscope or blackboard by Prof. Deintz that the fly has no air the scientific person affords a field of activ-pumps and never had any, and that no fly ity to flies which they never fail to improve, ever dreamed of walking on the ceiling. and since they know all about scientific with his pumps. Of course, Prof. Deintz has a theory of seen by the human eye, but if the fly makes his own. It is that every fly carries a the hole with his proboscis it must be quantity of Spaulding's or Peter Cooper's there whether we can see it or not. The Prepared Glue with him, by the help of instant the hole is made the fly inserts one which he sticks his feet fast to the ceiling foot in it and pulls himself up or along, as or to the wall, and walks safely where, the case may be, while he makes a new hole were it not for the glue, he would be with his proboscis. The system is pretotally unable to walk. This is, in the cisely like that in use among the Alpine Professor's opionion, an admirable theory, mountaineers, who climb perpendicular but a little examination will show that it is walls of ice by cutting holes with an axe utterly untenable. and inserting their hands and feet in the Let us suppose that a fly, intending to holes. A fly's proboscis is comparatively climb up a smooth and perpendicular sur- a vastly more efficient tool than the Alpine face a mirror for example-glues two of climber's axe, and he wields it with such his fore feet to it, and then pulled his hind rapidity that he is able to move over a perfeet after him glues them also to the mirror. fectly smooth surface at the rate of eleven So far his exploit has been an easy one feet per second, while making the holes at -providing his glue is of a good quality. distance of one-quarter of an inch apart. But now, if he intends to pursue his jour- There is not the slightest proof of the ney, he must lift his fore feet and glue them truth of this theory, but there was not the to the mirror at a point just above his head. | least proof of the truth of the air pump How is he to do this? If the glue is strong theory which scientific persons compelled enough to keep him in position in spite of the weight of his body, it is so strong that he cannot wrench his feet loose from the mirror without a tremendous effort. Even if we grant that he can loosen his feet by sheer muscular force, it must take some time to do this and to glue himself fast to a new place. That a fly should be able to run under such circumstances is simply preposterous. It would take a fly of average strength fifteen minutes to creep over a THE SYSTEMATIC TREATMENT OF Aggra foot of perpendicular mirror, and two or three hours to cross the ceiling of a large room. We all know that flies can run as rapidly across the ceiling as they can across a table. The fact completely overthrows the theory that they use glue in the manner described by Prof. Deintz, and leaves us without any answer whatever to to the question. How do flies walk on the ceiling? us to believe for nearly a hundred years. The ease with which this latter theory has been thrown aside shows us that we can place no sort of confidence in science, since it is liable to change its mind concerning flies at any moment, and since what it does in regard to flies it may do in regard to any other subject.-N. Y. Times. VATED HYSTERIA AND CERTAIN ALLIED FORMS OF NEURASTHENIC DISEASE. Being an Introduction to a discussion in the Medical Section of the British Medical Association at Worcester, on August 9th, 1882. By W. S. PLAYFAIR, M.D., F.R.C.P., Professor of Obstetric Medicine at King's College, and Physician for the diseases of Women and Children at King's College Hospital. Fortunately, it is not difficult, by invent- GENTLEMEN-When your President did ng a new theory, to answer this question. me the honor of asking me to open a disThe proboscis of the fly is a wonder- cussion on the Systematic Treatment of fully strong weapon, ending in a diamond- Hysterical and Neurasthenic Diseases, to pointed drill. with this he can make a which I had already drawn the attention of hole in the hardest substance with a single the profession in a series of papers in the blow. Of course, the hole is too small to be Lancet in May, June, and November of last |