tive of on-coming menstruation, yet development is normal for a girl of 18. Upon examination the uterus is found to be normal in size and the ovaries to be present. A high frequency current is used ten minutes daily, percutaneously as in Case II. cites for ten days, and this treatment is repeated monthly with the result that at the third month, after using a vaginal electrode for four successive days, a very slight blood discharge appeared when the electricity is stopped and not repeated until the next month, then a scanty discharge lasting three days made its appearance. The fifth month the flow is about normal as it continued to be. Electricity was kept up until the menses were normal for the third time in succession. Recent word reports the patient as having had no further trouble.

In closing I would like to ask if among those of you who are using electricity daily, you find it efficient in any wider range of cases of amenorrhea? Is it of any use where, for instance, the uterus is under size?

REPORT OF ONE YEAR'S WORK IN SURGERY.

BY J. EMMONS BRIGGS, M. D., SURGEON, MASS. HOMEOPATHIC HOSPITAL, BOSTON, MASS.

Intestinal Obstruction

Perforated Duodenal Ulcer, with General
Peritonitis

Carcinoma of Gall-Bladder and Liver (6
weeks after operation)

Cholelithiasis and Gangrene of the Gall-
Bladder,

3

I

I

I

I

I

4

I

I

22

12

4

3

30

25

149

ΙΟ

16

74

12

5

Total

340

These operations were performed at the Massachusetts Homoeopathic Hospital (Boston), Frost Hospital (Chelsea), Whidden Memorial Hospital (Everett), Newton Hospital, Westboro Insane Hospital, Anna Jaques Hospital (Newburyport), Morton Hospital (Taunton), Brockton Hospital, Hampden Homoeopathic Hospital (Springfield), and in private houses. These operations include both hospital and private work done. during the year 1905, but do not take into account operations performed by my assistants.

It would seem decidedly discouraging if in reviewing a year's work in surgery one could not see some true progress made. But what of Progress? Is it not a sort of "will-o'-the-wisp," a phantom idealized? In medicine heralded as a specific, in surgery as "a solution of the whole problem." But have we ever discovered a specific, and do we not have to solve the surgical problem over and over again?

The degree of civilization attained by a people can be estimated by the care and attention bestowed upon its aged, sick, and infirm. Wealth can contribute its treasure in no greater philanthropy than in erecting and supporting hospitals. Benevolent individuals have founded these institutions; the nation, state, city or town draw upon the common fund for their erection and maintenance.

Nearly every city and many of our larger towns support one or more hospitals, and the suburban hospital has become an important factor in the commonwealth.

In the majority of these suburban hospitals both schools of medicine are represented upon the staff, and very amicable relations exist. No other one factor has contributed so much toward unity and good fellowship among professional brethren who in an evil hour became estranged. The suburban hospital has been a potent factor in elevating the standard of medical knowledge, as a wholesome rivalry has been engendered among the members of the staff to excel, especially along surgical lines. The suburban hospital has been to a great extent responsible for the great change which has occurred in our city hospitals as well as the character of the operations which drift into the hands of specialists.

Judging from my own work this inference can be drawn, that practically all of the minor gynecological cases, such as lacerations of the cervix and perineum, are operated upon in suburban hospitals by general practitioners, or repaired immediately after confinement. This leaves for our large city hospitals and specialists a greater portion of capital operations than ever before. In my own hospital and private work during the past year over three hundred and sixty abdominal operations were made.

In presenting this paper the writer will make no claims to have excelled in any respect, nor to have been the originator of any original methods, but rather to have laboriously toiled along well trodden paths in quest of ways and means calculated to relieve suffering, hasten convalescence and restore to perfect health.

This article will resolve itself into the writer's personal methods and opinions on matters surgical, and will deal, first, with those topics considered in minor surgery, but that, however, holds no minor position in modern surgery.

Anaesthetics and Anaesthesia.

Selections of anaesthetics: Shall it be ether or chloroform? No new light has been thrown upon this subject, but gradually the world is being converted to the former. Ether is unquestionably safer, both as regards primary and secondary effects. Chloroform is only to be selected when ether is contraindicated, and I am free to say that the contraindications are growing fewer

and fewer. Chronic alcoholism, pulmonary and cerebral conditions, and possibily nephritis, form the only indications for the use of chloroform.

My preference is for an initial use of nitrous oxide, followed by ether, both to be given in Prof. Packard's inhaler. This inhaler is so arranged that there need be no interruption in changing from nitrous oxide to ether.

Anaesthesia is commenced with nitrous oxide and continued. until the patient is unconscious, usually about one minute. Ether vapor is gradually allowed to enter the apparatus, and complete surgical anaesthesia is established in from two to three minutes. There has been no method ever devised which produces complete anaesthesia with so slight discomfort to the patient.

The use of oxygen with ether or chloroform is highly recommended in severe or prolonged operations. It is invaluable in those cases where cyanosis becomes a troublesome feature.

Now and then on attempting to anaesthetize a patient, usually an alcoholic, one finds that as soon or just a little before surgical anaesthesia is induced, the patient becomes alarmingly cyanotic. This leads us to desist, give air, and then re-apply the anaesthetic, when the cyanosis recurs, and in this way much time is wasted and annoyance occasioned.

The combined use of oxygen and chloroform or ether will entirely obliterate this difficulty; the patient will relax, the breathing becomes natural and the turgidity of the face dis

appear.

After effects. Much has been written on the subject of post anaesthetic vomiting. Numerous remedies to be given by mouth or hypodermatically (such as ipecac, apomorphine, etc.), have been recommended, the giving of water freely or entirely withholding it, the use of the stomach tube, inhalations of vinegar or acetic acid.-these and a thousand other expedients have been recommended. The whole matter, however, resolves itself into the size of the toxic dose of anaesthetic vapor, carbonic acid gas, and the question of the patient's susceptibility to these irritants. The smaller the dose the less troublesome the after effects. Nausea and vomiting are reduced to a minimum when anaesthesia is induced with the least possible amount of the vapor. The average amount of ether used in the Packard inhaler is about four ounces per hour, and with its use ether vomiting is rare and of little annoyance.

I am not inclined to experiment with the new anaesthetics, for I see little of promise in them, nothing which surpasses the old and reliable ether, choloroform, nitrous oxide and cocaine.

Spinal anaesthesia has too many disadvantages to deserve more than passing mention, but I fully believe that we are not giving to cocaine the attention which it deserves. Given with care it is not dangerous, and it has greater possibilities than are usually attributed to it.

During this year, 1906, and therefore since the period with which this paper has to deal, I operated upon a woman fiftyseven years of age, who had an enormous goitre. I had read of Kocher's operation under cocaine, but had always felt that it was one thing to operate under local anaesthesia among the European peasantry and quite another proposition upon our American women.

In this case I resolved to try cocaine anaesthesia, but was prepared at any time upon the request of the patient to administer ether; in fact we had an understanding that she was to ask for the ether any time she wished it.

Three hypodermic syringes of I per cent. cocaine were injected along the line of the proposed skin incision. The platysma was divided, the goitre was cut down upon, the incision was carried through the capsule but did not penetrate the parenchyma. The gland was now found to be very readily enucleated. The finger was swept about its surface and it was delivered through the wound. The superior thyroid artery was found and ligated. There was no difficulty experienced as regards the inferior thyroid or the recurrent låryngeal nerve.

With the patient under cocaine anaesthesia she conversed with us throughout the operation, and tests were frequently made while working in the region of the recurrent laryngeal. The operation progressed without any trouble whatever, the patient experiencing scarcely any pain.

This operation demonstrated the superiority of cocaine over any other anaesthetic in goitre and has wonderfully increased my confidence in its use.

Nitrous oxide is capable of inducing surgical anaesthesia, but it is not as pleasant a narcosis as that induced by ether or chloroform. It does very well, however, in operations of magnitude, if not of too long duration. It is often sufficient in suprapubic prostatectomy.

Antiseptics.

Preparation of Patients. Thorough bath. On the day preceding operation scrub thoroughly the field of operation, shave, and apply soap compress.

After anaesthesia is induced, remove the soap compress, and scrub with soap and water, rinse with alcohol and sterile water.

Preparation of Surgeon's and Assistant's hands. First, a thorough and prolonged scrubbing with ammonia, soap and water, using a sterilized scrubbing brush, and cleansing the nails. Rinse with several changes of water. Next, the hands are scrubbed with a solution made as follows: two tablespoonfuls of chloride of lime and two of acetic acid to the quart of water. A brush is used and about three minutes spent in this way. Next, rinse the hands in sterile water.