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EDITORIAL.

THE CONTAGIOUS DISEASE HOSPITAL.

It is sincerely to be hoped that ere the present winter is fairly upon us the new contagious disease hospital at Flatbush will be ready for occupancy. That Brooklyn has been so many years behind other cities in the provision which it has made for those afflicted with contagious disease is a disgrace, which will, we trust, soon be wiped out. The want of such an institution has long been felt by the profession, and that the laity are beginning to appreciate it is shown by the fact that at the recent Commencement Exercises of the Packer Institute, an essay by one of the graduating class on "A Hospital for Contagious Diseases," was listened to with intense interest and the sentiments of the essayist heartily applauded. In speaking of the new hospital, Miss Evans, the essayist, said:

"The city has purchased five acres of land at Flatbush, where it will open in the fall a hospital for contagious diseases. It will consist of one pavilion for small-pox, another for scarlet fever, and a third for diphtheria. Careful provision is made for disinfection, and the building, when completed, will be one of the best equipped in the country. Unfortunately, it will also be one of the smallest. It accommodates at most but ninety patients. The same short-sighted policy which allowed the evils at Flatbush to continue so long, cut down the original appropriation from $65,000 to $45,000, and made no provision for measles, typhus or erysipelas. Even if more pavilions were built, the great need for convalescing wards and private rooms for pay

patients would not be touched. Few things can be more revolting to a person of even moderate refinement than to share a sick-room with twenty others. And a municipality has no right to force a citizen

to either clear his house of boarders or send a sick man to a Flatbush hospital. The pennywise spirit of these grants is shown in the inadequate appropriation for salaries. Although scientific nursing may make a drain on the city's purse, it would be true economy to take advantage of the training that makes a genius of the born nurse and a capable caretaker of the intelligent woman."

PRELIMINARY EXAMINATIONS.

So much interest attaches to the subject of the preliminary education of medical students that we have thought it would interest the profession to see a list of the questions prepared by the Board of Regents and propounded to the would-be student of medicine. We have, therefore, in the present number published the questions submitted at the spring examination held in New York. It will be seen that these questions are confined to the subjects specifically mentioned in the law of 1889. The law of 1890 permits an examination "in their substantial equivalents approved by the regents," and in the recent regulations published by that body, a large number of studies are mentioned from which a student may make his selection. If, for instance, he has been so long out of school as to have forgotten his geography, he may substitute for it mineralogy or zoology, or botany, and a similar choice may be made from a prescribed group to take the place of the other subjects mentioned in the act.

The Regents have shown admirable judgment in the rules which they have adopted for the enforcement of the law, and from a conversation which we have had with the Secretary of the Board, Melvil Dewey, Esq., we are satisfied that everything will be done by that board to make the law beneficent and not oppressive.

THE MATTISON METHOD.

Dr. J. B. Mattison, of this city, is certainly entitled to have his name associated with the method which he has devised and perfected for the treatment of the opium habit. This method is distinct from either that of Erlenmeyer or of Levinstein, and is as original as either. In an exhaustive paper on "The Treatment of the Morphine Disease,” contributed by the doctor to the September number of the Therapeutic Gazette, the details of his method are fully described. Those who are interested can obtain reprints on application to the author.

THE OPEN HORSE-CAR NUISANCE.

The long-suffering public is again to be subjected to the semiannual outrage inflicted on it by the street-car companies. In the spring and autumn of each year the strong and the weak, the old and the young, all in fact whose duties require them to use street-cars, are compelled to run the risk of contracting bronchitis or pneumonia, without apparently any good reason therefor. Whether this treatment of the public is actuated by the sentiment attributed to the late W. H. Vanderbilt, or whether it is because railroad officials are so pachydermatous as not to know when the wind is from the east, or the thermometer in the fifties, we do not know. Certain it is that their attention has been repeatedly called to this nuisance through the press; that it is continued is a sad reflection on their regard for the welfare of the public.

PROGRESSIVE PHARMACY.

As John was leaving for business one morning, his wife said: "John, the doctor says I must take a dose of castor-oil; I wish you would stop at the drug store on your way home and get me a dose. I don't know exactly what the dose is, but, I suppose two or three tablespoonfuls. And ask the druggist if he can't put it up so that it can't be tasted." On his way from business John stopped at the drug store, and when his turn came, asked the clerk if he could put up castor-oil so that it could not be tasted. The clerk said he could. "Well," said John, "put me up a dose, three or four tablespoonfuls." The clerk said that was a pretty large dose, but John said it was all right, that was what his wife said, and she knew all about it. The clerk disappeared behind the prescription desk, and presently returned with a bottle wrapped in white paper, which he placed on the counter. John asked how much it was; the clerk said twenty-five cents; John handed him a fifty-cent piece, which he took and, as John thought, went to make change. In a moment the clerk called John and asked him if he wonld not like a glass of soda-water. "It is so hot," said John, "that I don't care if I do." Very courteous clerk, thought John. After drinking the soda, John took up the bottle and started to go. "I beg pardon," said the clerk, "but that is this lady's prescription." "Where is the castor-oil?" said John. "Why," said the clerk, "you took that in the soda-water. I said that I could fix it so that you would not taste it." "Thunder and Mars! that was for my wife." Exit John with both hands under his vest.

PROGRESS IN MEDICINE.

SURGERY.

BY GEO. RYERSON FOWLER, M. D.,

Surgeon to St. Mary's Hospital, and to the Methodist Episcopal Hospital, Brooklyn.

THE TREATMENT OF SUPPURATING CAVITIES WITH RIGID WALLS.

Kuester, Berlin (Centralblatt f. Chirurgie, 1890, No. 29). K. calls attention to the error committed by surgeons in the treatment of abscess cavities with rigid walls, in delaying opening of the same, and in frequent irrigations of the same after opening. He insists upon the following: 1. The earliest possible incision. 2. The incision must be made at the most dependent point. 3. In case of large cavities, a counter-opening is to be established. Repeated irrigation of the abscess-cavity is to be avoided as far as possible. He dwells particularly upon the subject of empyema, and describes his method of dealing surgically with this condition as follows:

After exploratory puncture, an incision is made at the lowest point of the dull percussion note, usually in the fourth or fifth intercostal space, giving exit to the accumulated pus. A probe is then passed through the wound to the posterior boundaries of the cavity and pressed firmly between the ribs posteriorly until its point is felt in an intercostal space, at which point a portion of the superadjacent rib is resected. The opening thus made must be sufficiently large to enable the surgeon to obtain a view of the interior of the cavity. Should the lowermost portion of the cavity not have been reached by the first resection, a portion is removed from the subadjacent rib, until the junction of the diaphragm and inferior reflection of the pleura is reached. The cavity then, under slight pressure, irrigated with a warm solution of salicylic acid, and the walls of the cavity carefully sponged. of all traces of fibrinous matter, by means of a sponge in a handle, and through and through drainage established by drawing a tube from. one opening to the other, and securing it. The wounds upon the anterior and posterior chest wall are covered by iodoform gauze, upon which is laid a cushion of moss, which may remain undisturbed for upwards of eight days. If, in case of a recent empyema, the lung begins to expand in the course of ten days, the through and through drain is substituted by a short tube through the posterior wound. The author anticipates that complete cure will follow this treatment, in recent cases, in from three to six weeks.

The author further treats of the treatment of cavities, which, unlike the pleural, are surrounded upon all sides by rigid and unyielding walls; as for instance, empyema of the antrum of Highmore. Of the three methods usually employed for gaining access to diseased conditions of the antrum, K. chooses that which perforates its wall from the face, for the reason that the indications considered by him most important of fulfilment can but be followed out by this router (thorough cleansing of the walls, and the identification by the fingers of the different portions of the cavity). This is done subperiostically, and the cavity is irrigated but once with an antiseptic fluid, and then tamponned with iodoform gauze. As soon as the suppuration becomes but slight (which sometimes occurs in a very short time), the iodoform gauze is removed and a small drainage tube substituted therefor. In empyema of the frontal sinuses, K. drains through the nose. eased conditions of the mastoid cells and of the cavity of the tympanum belong to this division of the subject; their treatment, however, is somewhat complicated, as compared to the others; the preservation of the hearing, as well as the prevention of brain complications entering into the question. The same principles, namely, early and free opening, however, should be followed.

Dis

DELTOID NEURALGIA.

Golding Bird (Guy's Hosp. Reports, 1889, vol. xlvi.). The author applies this somewhat ill-chosen name to designate those rather frequently-observed cases of intense pain at the point of insertion of the deltoid muscle, and which, during the attempts to move the arm, in passing the horizontal position while being elevated simulates a paralysis of this muscle. The cause of this is always found to reside in a traumatism, and frequently this is found upon inquiry to be of so slight a character as to have been considered quite unimportant. In the first few weeks the patient favors the arm by restricting its movements, or supports in a fixed position. The restriction of the movements does not depend upon changes of the joint, as would appear, but from decreased tone of the surrounding structures. Examination shows swelling of the entire muscle, varying from slight thickening to decided swelling simulating fluctuation. This is explained by the presence of unusually loose connective tissue filled with wide lymph spaces between muscle and bone. This connective tissue becomes filled with extravasated lymph and blood resulting from the injury and the subsequent inactivity assumes a condition of chronic engorgement. The effect of this latter, and occasional retractions of the muscle, is to produce irritation of the terminal distribution of the circumflex nerve, upon attempts to perform movements of the arm. It likewise appears