SURGICAL HINTS

(International Journal of Surgery.)

To obtain the best results of Colle's fracture the patient should be placed under an anesthetic during reduction.

In septic conditions of uncertain origin, the presence of localized pain will sometimes afford a clue to the portal infection.

To operate and find that a suspected osteomyelitis is actually an acute rheumatism is far preferable to deferring operation until an exact diagnosis can be made.

In operations on alcoholic subjects it should always be remembered that the vitality of the tissues is often so low that the application of even moderate degrees of heat may give rise to sloughing.

The transformation of uterine fibromata into malingant growths is comparatively common, and hence the possibility of such an occurrence should always be taken into consideration in the prognosis and treatment.

Patients with long and thick foreskins when suffering from gonorrhea are rather unfavorable subjects for a speedy cure. The prepuce seems to keep the urethra in an abnormally hyperemic condition, thus favoring microbal growth.

A condition sometimes simulating inguinal hernia is the protrusion of masses of fat through the canal in front of the peritoneum. If this fat be later absorbed a true hernia may result, owing to the dilated condition of the canal which remains.

Fecal fistula, if uncomplicated, small and situated in the vicinity of the ileocecal valve, will often close spontaneously. Operation should therefore be postponed until it seems certain that a cure cannot be hoped for by nature's unaided efforts.

In the treatment of intussusception the ir rigation method should not be persisted in for too long a period, 48 hours being the maximum limit. The fluid should not be injected under high pressure, the irrigator not being suspended more than one and one-half or two feet above the patient.

The possibility of urethral stricture in young children suffering from urinary disturbances (frequent micturition, vesical tenesmus, retention of urine, etc.) should always be considered even in the absence of a traumatic cause or gonorrheal infecton. Internal urethrotomy followed by systemic dilatation is as successful in these cases as in older per

sons.

Among fractures of the carpal bones the scaphod is the one most liable to be involved. This injury is often overlooked on account of the absence of the ordinary signs of fracture, but should be suspected in the presence of localized pain, tenderness and swelling over the region of the bone.

Inflammation of the pleura are so often of tuberculous origin that it is well to treat all these cases as if they were acturally tuberculosis. Hence after operations upon the pleural cavity an antituberculous plan of treatment should be pursued and the patient kept under observation for some time.

For the control of nasal hemorrhage tampons can be readily prepared as follows: A layer of cotton is wound around a pen holder or similar object until the desired thickness is obtained and then withdrawn. The cotton cylinder is then moistened, squeezed dry and inserted into the nasal cavity. If the projecting end of the tampon is now moistened it will swell up and thus produce sufficient compression.

An excellent ointment for the treatment of boils is that recommended by Bulkley. It consists of carbolic acid, 5-10 grains; fl. extract of ergot, dr.; starch, 2 dr. ; zinc oxide, 2 dr.; and ung. aquae rosae, 2 oz. It is spread upon the center of a moderately thick layer of absorbent cotton, several times the size of the inflamed area, and secured with strips of adhesive plaster. This dressing can strips of adhesive plaster. be left on for ten or twelve hours.

Injuries to the elbow-joint the rapid development of marked swelling frequently prevents the diagnosis of a suspected fracture or dislocation. Under these circumstances the plan suggested by Gerster and described by Dawbarn will prove of value when the X-ray is not available. The patient having been anesthetized, an Esmarch elastic bandage is slowly and firmly applied from the hand up the forearm and over the elbow to the arm-pit. This is left on for about fifteen minutes and then removed from below upward, the final turns upon the upper arm being allowed to remain. The removal of the edema in this manner permits of the recognition of a fracture or dislocation, and this having been accomplished, the upper turns of the bandages are removed.

BRITISH MEDICAL ASSOCIATION.-The seventy-fourth annual meeting of the British. Medical Association will be held at Toronto, Canada, on Tuesday, Wednesday, Thursday, Friday and Saturday, August 21, 22, 23, 24 and 25, 1906.

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and wake without experiencing any inconvenience. In some cases the ipecacuanha does produce sickness in spite of the chloral draft, but in these the author has not known it to come on in less than one and a half hours, and in no case did the vomit contain ipecacuanha, showing that it had already been absorbed.-Jour. of the Royal Army Medical Corps.

BASEDOW'S DISEASE. That the antithyroidin of Mobius seems to have acquired a lasting place in the treatment of exophthalmic goiter, is evident from two articles contained in the Muench. Med. Woch. Glomer gave the serum internally (0.5 c.c.) three times daily, to a patient suffering from general paresis, complicated by Basedow's disease. The pulse improved at once and became slower, the goiter and the exophthalmos were less marked after eleven days, and the tremor and Graefe's sign disappeared almost completely. As soon as the treatment was stopped the symptoms reappeared. R. Durig recommends much larger doses (up to 150-210 drops daily), even though slight after-effects (headache, apathy) may appear. The rectal application is indicated where the serum is not well tolerated by mouth, but somewhat larger doses are then necessary.-Medical News.

CARDIAC DYSPNEA.-Satterthwaite ("Diseases of the Heart and Aorta") says that in severe attacks of dyspnea due to cardiac failure he gives nitroglycerine in doses of 1-100 to 1-25 of a grain. In sudden and violent attacks he gives a capsule containing: R Nitroglycerin.

Amyl nitrite.
Menthol......

Oleoresin of 'capsicum..

.....

gr. 100

gr. gr. o

gr. 100 Sig. One capsule every four hours. The Med. Bull.

CYSTODIAGNOSTIC EXAMINATION OF GON. ORRHEAL SECRETIONS.-Max Joseph and M. E. Polano, having made many examinations of this nature (American Journal of Urology), conclude with Pappenheim, that mononuclear cells are always the first sign of the extension of the catarrhal, epithelial process to the submucosa, and their appearance gives distinct indications for prognosis and therapy.-Denver Med. Times.

EARLY STAGE OF INTERSTITIAL NEPHRITIS.-Hughes prescribed:

R Hydrarg. chloridi corros...
Auri et sodii chloridi...
Ferri reducti....

Spir. glonoini..

.

gr. 3 gr. 1

m 1 One pill after meals.- Denver Med. Times.

FACTS AND FANCIES

A barber was busy trimming the heavy thicket of white hair by which Mark Twain is known, when the humorist's attention was drawn to a very small boy in buttons standing beside his chair.

"Hello, what are you, "asked the humorist. "A page, sir," replied the atom, swelling visibly.

"A page!" "exclaimed Mark in assumed scorn, "Why you aren't big enough for a paragraph!"

"I say," said the traveling man in the flyinfested dining room of the little hotel, "I'll take a piece of that blueberry pie, please."

"That?" said the fair waitress. "That ain't blueberry pie-shoo!"-with a wave of her napkin-"that's custard."

Waiter (approoaching guest): I have deviled kidneys, pigs' feet and calves' brains. Guest: Well, what are your ailments to me? I came here to eat.

"I have called to get some of the details of the wedding," said the reporter.

An expression of intense regret came to the dusky countenance of the servant.

"I'se awful sorry, miss!' she exclaimed, "but dey is all gone. You oughter come last night. De company eat up every scrap!"

"That old codger," remarked the traveling man "seems to be quite an independent old party.

"Waal," replied the village wit, "it's no wonder. He op'rated a purty successful corner in wheat this year. "What?"

"Yes, siree! that corner lot o' his'n yonder. It yielded 950 bushels."-Philadelphia Press.

The little girl was on her first trans-atlantic trip. She refused all substantial food but drank great quantities of lemonade.

"My dear child, "remonstrated her anxious mother, "why don't you eat something instead of drinking all that stuff?"

"Because," said the little girl, "lemonade is the only thing that tastes the same coming up as it does going down."

Nurse: "Tommy, dear, don't you want to come and see the sweet little sister a stork brought you?"

Tommy: "No. I want to see the stork."

"Isn't it nice," exclaimed the dear old lady who gets things all mixed, "that you can have some one look up your gynecological tree for you and tell you about what you come from?"

"That dog of mine," said a neighbor of Jim Spaulding, the witty farmer of Suncock, N. H., "has the keenest scent of any dog I ever saw. Why yesterday he traced me after I had gone seven miles from home. What do you think of that?"

"I think," said Jim, "that you need a bath."

His automobile had balked, as automobiles will. Fruitlessly he labored, with oil can and monkey wrench, until he was hot, dirty and disgusted, and only the presence of a crowd of children prevented him from expressing himself as the situation demanded. But at last he must speak or explode. Near him was a sweet little maiden with golden hair and deep blue eyes.

"Run away, little girl," he said, "there are a few things I would like to say.' "Go right ahead," said the child, "my pa has an auto too."

There is a little railway in Colordo on which no train was ever known to be on schedule time. But a few weeks ago the unexpected seemed about to happen, and the citizens of the terminal town assembled at the station with rockets, red fire and a brass band to welcome the punctual train.

"What's the celebration?" asked the conductor as he jumped off at the station. "Train on time," explained the crowd in chorus. "Put out your fires, you--fools," the conductor snorted; "we're just twentyfour hours late.

BUNIONS. Plummer treats bunions by making his patient wear right and left stockings and a shoe which has the inner edge perfectly straight. The bunion is bathed night and morning in a four per cent solution of carbolic acid for a few minutes, followed by plain water. If after several weeks the bursa is still distended with fluid it is aspirated. If the bunion is due to flatfoot, the arch of the foot must be restored by a plate. When the joints are enlarged because of gout or rheumatism the constitutional conditions must be treated. In other cases osteotomy and tenotomy are required.-The Southern Clinic.