Fifty-second Annual Report of the Massachusetts Charitable Eye and Ear Infirmary, for the Year 1877.

Fourteenth Annual Report of the Board of State Charities of Massachusetts. January, 1878. Public Document No. 17.

Circular No. 10. Approved Plans and Specifications for Hospitals. Surgeon-General's Office, Washington, October 20, 1877.

A Manual of Nursing prepared for the Training-School for Nurses attached to Bellevue Hospital. New York: G. P. Putnam's Sons, 1878. Twenty-Fifth Annual Report of the Pennsylvania Training-School for Feeble-Minded Children, Media, Delaware County.

Reports on the Progress of Medicine.

CONTRIBUTED BY DRS. GEORGE R. CUTTER, EDWARD FRANKEL, AND W. T. BULL.

SURGERY.

Treatment of Transverse Fractures of the Patella and Olecranon Process.-Schede (Centralblatt für Chirurgie, 42, 1877) considers the obstacle to bony union in these fractures to be not so much the difficulty of coaptation as the delay (two weeks) in applying apparatus, occasioned by waiting for the absorption of effusion into the joint and the overlying bursæ. For the patella this treatment is recommended: Puncture of the joint (and the bursa patellæ, if necessary) with a good-sized trocar, with antiseptic precautions, injection of 3-per-cent. solution of carbolic acid, closure of the wound with a piece of protective silk and a ball of salicylic cotton, approximation of the fragments by means of adhesive straps, and a gypsum splint from the ankle to the hip. The splint and plaster should be replaced by a second similar dressing at the end of eight days, and by a third in eight or ten days more. In three (3) cases bony union was obtained, the bursa patella being punctured in but one. In two others, a short ligament united the fragments. In these, failure is attributed to omission of some of the details above given-e. g., irrigation of the joint and renewal of dressing. In a large number of fractures of the olecranou in which bony union resulted, fixation of the fragments with adhesive straps and the plaster-of-Paris splint (in extended position), with frequent renewal, was the method employed. No case yet has demanded puncture of the joint. W. T. B.

Morphine and Chloroform Narcosis. (König, in Centralblatt für Chirurgie, 39, 1877, and Hueter, Idem, 43, 1877.) König recommends strongly this combination. It is especially valuable in drinkers, and those who, for various reasons, are questionable subjects for chloroform, and in operations, too, which do not permit profound narcosis, as those about the face. One or two, or even three, hypodermic injections of onefifteenth to one-seventh of a grain of sulphate of morphia precede the chloroform, and the patients are rendered insensible to pain, yet not wholly unconscious.

Hueter confirms König's statements, and says that Nussbaum used this method in 1863, six years before Uterhart (1869), refers to the demonstration of its advantages in experiments on animals by Claude Bernard (1869), who believed that morphine diminished the irritability of the nerve-centres, and thus facilitated the action of chloroform. W. T. B. Disarticulation of the Hip-Joint.--M. Verneuil has proposed the following method, and Rose (of Zürich) has practised it with success: An incision is made through the skin and subcutaneous tissue, beginning a finger'sbreadth below Poupart's ligament, in the line of the femoral vessels, for a distance of five or six centimetres, then crossing obliquely the great trochanter, following the gluteal fold to the inside of the thigh, to be continued upward two fingers'-breadths below the genito-crural fold to its starting-point. The sheath of the vessels is next opened, and ligatures applied to the common femoral and its two branches and the vein. The muscles on the outer and inner side are then divided in the following order, the vessels being ligated as they are cut: The adductors, psoas, and pectineus, the sartorius (and fascia lata), and those inserted into the great trochanter (after forcible adduction). The joint is opened, and the head freed from capsule and tendons. The limb being allowed to hang from the table, the posterior group of muscles are cut through slowly, and the gluteal and ischiatic arteries, with their branches, are successively ligated. Esmarch's bandage is to be employed.-Gaz. Hebd., November 9, 1877.

W. T. B.

Treatment of Suppurative Osteomyelitis.-Dr. E. Boeckel considers the diagnosis and treatment of suppurative osteomyelitis very important. He thinks the most certain sign of acute osteomyelitis is the elevation of temperature, which persists after large divisions of the periosteum. For the treatment, he advises trephining and scooping out the bone.

Osteomyelitis following amputation occurs much more frequently than is commonly supposed. He says: "Generally, whenever a patient, after amputation, has a chill, or presents an abnormal elevation of temperature, one should think of the possibility of osteomyelitis. The condition of the bone should be carefully ascertained. If it is no longer accessible to sight, do not fear to open the wound in order to recognize the condition of the medulla. If it appears infiltrated with pus and diffluent to a certain elevation, if at the same time periosteal phlegmons exist, immediate and energetic action is necessary. In the slighter cases it may be sufficient to empty the medullary canal with the rasping gouge, and make a continuous carbolized irrigation. If more severe, the bone should be trephined at several places, extending as high as the disease. Too often, when a patient, after amputation, has a chill, he is regarded as lost; the surgeon crosses his arms, and contents himself by ordering some internal medication. When, at the autopsy, osteomyelitis is found, it is declared to be secondary, and produced by the pyæmia; while in reality it is the suppuration of the medulla, left to itself and not treated energetically, which has ended by infecting the blood."-Gaz. Méd. de Strasbourg and Jour. des Sciences Méd. de Louvain, September, 1877. G. R. C.

The Relation of Rheumatism to Traumatisms. In a work recently published, M. Verneuil studies the relations between traumatic lesions and constitutional diseases, more particularly those between traumatism and arthritisın. In studying this question, the coincidence between the patient's injury and the constitutional malady should be first established, and then the case will come under one of the following categories: 1. The injury and the diathesis exist together, without appearing to influence each other in any manner. 2. The traumatism modifies materially the evolution of the constitutional disease. 3. The course of the surgical lesion presents

anomalies imputable to the constitutional condition. This apparently simple classification will not be found easy of application in all cases; for, though in the immense majority of cases the injury can be established, the constitutional condition of the injured can be determined with less facility. In some cases, the relation existing between the injury and the diathesis is very distinct, of which the author cites two examples: A patient, formerly affected with malaria, enters the hospital for a simple fracture of the leg, and the same evening is attacked with violent and well-characterized fever. Another patient, syphilitic, sustains a slight bruise on the tibia, and, notwithstanding appropriate treatment, a specific exostosis appears some time after at the place of injury, which yields to treatment by mercury and iodide of potassium. In these cases the relation of cause and effect was manifest, because the subsequent phenomena bore the undoubted stamp of specificness, and the traumatism had only awakened the slumbering diathesis. Unfortunately, such cases are not the most common, and the physician feels embarrassed when unusual symptoms supervene in subjects whose history does not reveal any previous constitutional disorder. But the influence of the diathesis will be most manifest: 1. When insignificant injuries, benign in themselves, are followed by severe symptoms; 2. When these symptoms resemble those which the constitutional disease would call forth if the traumatism had not occurred. In accordance with the foregoing classification, Verneuil divides the cases into three categories: As they behave like those not influenced by a diathesis; as the diathesis appears to reflect toward the injured part; or, lastly, as the injury provokes general manifestations of rheumatism. The cases of the first category, in which the traumatic lesion follows its usual course, are certainly the most numerous; provided the case receives proper attention and care, the wound, or traumatism, as a rule, pursues a normal and classic course. Generally, the influence of rheumatism on the traumatism is but slight, and the diathesis does not sensibly modify the reparative process; special arthritic symptoms have not yet been established for these cases, while the changes caused by the influence of syphilis or scrofula are well known. According to Verneuil, the reflection of the rheumatic diathesis on the injured part will be manifested by symptoms which are neither uncommon nor difficult to recognize and classify; such as serous effusions, ædema, pseudo-phlegmons, often accompanied by intense fixed or shooting pains, etc. The influence of traumatism in arousing long latent articular symptoms is more apparent, and can be demonstrated. It is difficult, for instance, to diagnosticate local articular symptoms, which sometimes, accompanied by violent chills and an intense fever, strongly resemble those of pyæmia. In two cases, the patients presented all the symptoms of purulent infection, and the most unfavorable prognosis was made; to the author's astonishment, they recovered, and it was then ascertained that they had had rheumatism. The author believes that, in the occasionally reported cases of recovery from pyæmia, these were merely simple symptoms of the rheumatic diathesis, called forth by the traumatism. He also believes that arthritism constitutes a serious predisposition to the development of traumatic erysipelas. This is one of the complications which he fears most in the operated or wounded who also have the uric diathesis, or have had previous well-marked attacks of acute articular rheumatism. The conclusions at which he arrives are: 1. That the traumatism can awaken the dormant rheumatic diathesis, or it can cause the extension of the rheumatic symptoms to organs which were not affected before. Furthermore, it can provoke the primary and premature appearance of rheumatism in subjects not previously so affected, but only predisposed. 2. That the most varied injuries possess this exciting tendency (fractures, contusions, slight or severe superficial ulcerations). 3. That the diathesis, pro

voked by this accidental influence, manifests itself in various ways, such as articular inflammation, cutaneous eruptions, disseminated neuralgic pains, pericarditis, cystitis, pulmonary congestion, etc. E. F.

Miscellany.

Appointments, Honors, etc.-Dr. Salvatore Caro has been elected president of the Obstetric section of the New York Academy of Medicine, and Dr. H. E. Crampton secretary. Dr. Calvin S. May has been appointed medical superintendent of the new insane asylum at Danvers, Mass., and Dr. Walter Channing assistant. Dr. J. P. Brown, first assistant physician at the Concord (N. H.) Insane Asylum, has been appointed superintendent at Taunton, in place of Dr. Godding, who resigned to succeed Dr. Nichols in the District of Columbia Asylum. Dr. J. F. Ensor has resigned the superintendency of the Insane Asylum of South Carolina, and is succeeded by Dr. Peter E. Griffin. Dr. John H. Callendar has been reëlected superintendent of the Tennessee State Asylum for the Insane at Nashville.

Dr. Alfred Hudson has been appointed one of the physicians to the Queen, in Ireland, in place of the late Dr. Stokes. Mr. Callender, of London, Prof. Arlt, of Vienna, and Prof. Reverdin, of Geneva, have been elected corresponding members of the Société de Chirurgie de Paris. The chair of Surgery in Würzburg, after having been refused by Profs. Volkmann, of Halle, Czerny, of Heidelberg, and Socin, of Basel, has been accepted by Prof. Bergmann, of Dorpat.

Dr. Sayre's Missionary Work abroad.-At a meeting of the Clinical Society of London, held January 25th, Mr. Berkeley Hill exhibited twelve patients with various degrees of angular and lateral curvature of the spine, who had been under treatment during the preceding six months by Sayre's plaster jackets. Mr. Hill summed up the benefits of the method, which were, briefly, arrest of pain, ability of the patient to walk about with comfort, restored control of the lower extremities, the healing of abscesses, and permanent improvement in the shape of the spine. He believed the plan was

more rapid and less irksome than any other. Mr. Lucas reported twelve cases also, which had proved satisfactory. Mr. Golding Bird said he had used the method in eighteen cases, with complete relief in all.

Metallo-Therapy.-Prof. Charcot is lecturing in Paris on the results of his experiments with metals in the treatment of disease, after the method of M. Burq. The method consists in finding a metal which has some mysterious affinity for the patient, or to which there is a certain sensitiveness, as shown by its application to the skin. Then there follows a series of peculiar phenomena, beginning with anesthesia. The right metal having been decided on, the system contemplates its administration in some form internally at the same time that it is applied externally. The patients on whom the method has been tried seem to have been mostly hysterical women, and it is natural to suppose the phenomena to be rather mental than physical.

The Last Illness of the King of Italy.-A correspondent of the Lancet states that the proximate cause of King Victor Emanuel's death was asphyxia, due to complete arrest, from red hepatization, of the function of the right lung, the function of the left having been impaired by the same disease in 1869. The patient having the malarial cachexia, there was a copious sudaminous eruption. The inhalation of oxygen was practised at the close, to mitigate the extreme suffering. The chief medical attendant of the king was Dr. Bruno. Venesection was resorted to early in the attack, but it seems questionable whether it did good or harm.

Strychnia in Bronchitis. In a letter to the Philadelphia Medical Times of January 19th, Dr. Fothergill dwells at some length on the great value of strychnia as an expectorant in bronchitis. By its action on the respiratory centre, it proves useful when increase of respiratory power is needed for the expulsion of mucus gathered in the air-tubes. He gives it either alone or in combination with the ordinary coughmixtures. On the same principle it has proved useful in