Surgical Observations.

BUSHROD W. JAMES, M. D. " PHILADELPHIA, EDITOR.

ATLEE'S NEW OVARIOTOMY CLAMP.

Operators who use the clamp in the treatment of the pedicle in ovariotomy, find the application of the clamp to flatten and spread out the pedicle, and then take up a considerable space in the abdominal wound. In order to get rid of this objection, Dr. W. L. Atlee has modified the ordinary clamp in use by himself by adding several small holes for the insertion of a pin through the blades of the clamp whereby the pedicle can be crowded up in one corner of the clamp after it is applied, and before it is screwed up, so that when the compression is made the pedicle cannot spread beyond the confines of the pin. The several openings are made so that the same clamp may be applied to various-sized pedicles.

The engraving (A) shows the instrument open, as when not in use. The notched portions are the blades, and the serrations are made to enable it to hold with a tight grasp on to the pedicle and prevent slipping. The arms, F F, are projections for the blades, and are simply useful to steady the instrument on the abdomen and assist in holding it in position. A A are the jointed hinges, to which male screws are fastened, as shown at B B. One of them, you will notice, passes through a perforation in the clamp at C, and over this male screw is a tubular female screw, E, which is put on and screwed down by twisting the expanded thumb-piece observed on the end of E. You will see that the lower B male screw is not to be slipped through a perforation, but it is intended to slip into a slit into the opposite blade, and then the lower female screw is slipped over, after the pedicle is within the clamp, and ready for tightening.

30-October.

The small dots on the other blade show the orifices through which the pin is to be placed.

The lower instrument shows how it is applied; G G G being the pins, and H H exhibiting the line of the abdominal incision. In putting on the clamp, in order that you may always keep a good view of the wound above, the pin should always be on the pubic side and below the pedicle. Atlee claims that this instrument compresses the pedicle into the smallest space, and favors greatly the more complete closure of the wound as well as aids the approximation of its edges. Wells' circular clamp for this object is not much more satisfactory than the simple ligature of the pedicle at the point where the clamp is to be applied.

SINGLE FLAP OPERATION IN AMPUTATION OF THE LEG AND THIGH.-Dr. Carpenter, in the transactions of the Pennsylvania Medical Society (Medical and Surgical Reporter), claims the following advantages for the single flap (anterior) operation in amputations of the leg and thigh: The vessels being divided transversely, as in the circular method, are more readily secured. Drainage is more perfect, and there is, therefore, less liability to bagging of pus; and that, under these circumstances, union by "first intention" is more likely to occur. With regard to the stump, no tenderness can be caused by pressure upon the nerve in the face of the stump, inasmuch as it has been cut off with the main vessels in the rear; the unbroken surface of normal tissues extending across the end of the bone is not liable to bruising, or to ulceration, or tearing open, and an artificial limb can be adjusted much more satisfactorily, its pressure being exerted mainly against the anterior portion and face of the stump. In performing the operation it is important that the flap be made of sufficient length to reach the rear of the stump without stretching, and that the soft part, posteriorly, be divided by a perpendicular sweep to the bone. The results of this operation were exceedingly satisfactory where used during the late war.-Medical Archives.

ELECTRICITY IN CANCER.-The London correspondent of the American Practitioner recently heard at the Clinical Society

the description of a case of encephaloid of the femur treated with electricity. The pain had gone beyond the control of morphine up to twenty-four grains per diem hypodermically, and enormous quantities of chloral. The continued current was based upon it, with the effect of destroying the pain and lessening the tumor somewhat, but death ultimately followed. Fourteen cases of cancer were also referred to by Althaus in which the remedy had been used. In all of them pain was destroyed; in two the tumor disappeared; in the remainder the disease progressed to death. The two successful cases were in the breast; the others were advanced cancers of the womb. These are unpublished cases. Althaus' apparatus consists of a gilt needle for introducing the continued current, or, when the tumor is large, a number of them joined to one wire. The theory is (partly, at least,) that a caustic alkali is set free or formed interstitially. Twenty-five applications were used in one of the successful cases. During the treatment the patients experienced no inconvenience; attended as usual to their daily work and pleasure. He says that Althaus has a broad, high forehead, with a large, open face, lighted up with intelligence. With the most varied information on all subjects he is as modest as a child.

MEDICAL USES OF CARBOLIC ACID.-Dr. N. S. Davis, of Chicago, Ill. (Chicago Med. Examiner) in his "Report on the Medical Uses of Carbolic Acid" to the Illinois State Medical Society, refers to two cases of cancerous disease and ulceration of the os and neck of the uterus which were much relieved by using the solution of carbolic acid internally, at each meal time, and a stronger solution twice a day as a vaginal wash. They were kept comparatively comfortable for many months, but the effects were only palliative. A neighboring physician informed him that he had a case of cancerous disease, of well-marked character, that had been kept stationary and the patient comfortable more than twelve months, under the constant use of carbolic acid. Dr. Davis has also used it with temporary benefit in two cases of cancerous disease of the stomach. He does not regard carbolic acid as a specific for the cure of any form of disease, but from its mildly sedative influence on the organic

nervous system and mucous surfaces, coupled with strong antiseptic properties, it is admirably adapted to meet certain indications that arise during the progress of a great variety of diseases.

A SIMPLE DRESSING FOR FRACTURE OF THE CLAVICLE.— Dr. Lewis A. Sayre, of New York (American Practitioner), has finally reduced the treatment of this fracture to two strips of adhesive plaster, without any axillary pad; and as such he now gives it to the profession as the simplest and most efficacious plan yet devised. His method of keeping the inner portion of the clavicle from riding over the outer portion is by putting the clavicular portion of the pectoralis major muscle on the stretch, and compelling it to pull the clavicle in place, and thus overcome the tendency of the clavicular portion of the sterno-cleidomastoid to elevate it, which it will always do unless this precaution is taken. After drawing the arm backward and retaining it there by a strip of adhesive plaster, pass another piece of plaster from the well shoulder across the back, and by pressing the elbow well forward and inward, the first plaster around the middle of the arm is made to act as a fulcrum, and the shoulder is necessarily carried upward, outward, and backward; and the plaster, being carried over the elbow and forearm (which is flexed across the chest) to the opposite shoulder, the place of starting, and then secured by pins or stitches, permanently retains the parts in position. Dr. Sayre formerly commenced the first plaster on the inner side of the biceps; but he found that that muscle would roll around and the plaster would lose its hold, requiring to be renewed occasionally; and if it completely encircled the arm for the purpose of a stronger attachment, it would arrest the circulation, and thus prove dangerous. He uses strong and good adhesive plaster (Maw's moleskin is the best) cut into two strips, three to four inches wide (narrower for children). By this plan of treatment the patient is only detained from his daily avocation a sufficient length of time to properly adjust the strips of adhesive plaster. In one instance a prominent lawyer of New York city slipped upon the ice and fractured his clavicle on the way down-town. He was brought to his office. Dr. Sayre dressed him in the manner described