The Pressure and Ligature Methods of treating Aneurism.—In the course of a lecture on aneurism of the femoral artery Mr. Paget, adverting to these two methods, speaks of them thus: “Taking large numbers of cases of aneurism together, they are very nearly balanced, on the one side for pressure, and on the other for ligature. In favour of pressure there is the experience of the surgeons in Dublin. They seem to have a much larger number of aneurisms, especially of aneurisms of the popliteal artery, to treat than we have in England, and they have certainly a large amount of success. I have no doubt this is in part due to a well-arranged system, and to the house-surgeons and dressers acquiring a more special skill than we have yet achieved. On the other hand, there is the remarkable success attained by surgeons who have constantly practised, with great skill, the ligature. The success of Mr. Syme in the ligature of the femoral artery for popliteal aneurism has been so great that any one who might fairly expect to attain nearly the same measure of skill would undoubtedly follow the ligature rather than the pressure. I would prefer, however, to leave the subject open for your own observation, and say, endeavour to ascertain, as far as you may be able, which are the cases for the ligature and which are those in which pressure is more likely to lead to a good result. And in many cases in respect of which you are doubtful, pressure may be tried first and the ligature afterwards.” (See Lancet, April 24.)

Treatment of Atonic Dyspepsia.—Dr. Thorowgood, in a paper just published, refers to the existence of torpor of the colon as a complication in cases of this kind. In treating cases of dyspepsia occurring in those who work hard with their brains and have but little “tone” about the stomach and bowels, he is convinced that the more we refrain from the administration of purgatives the better. At one time he used to think that when the tongue was crusted a purgative could not be amiss; but to whatever degree this holds good with strong country people and over-fed townspeople, it does not apply to those who have feeble appetite and who work hard. In these cases he has seen an acid mixture or a chalybeate do more service in cleaning the tongue and promoting digestion than alkalies or aperients. If the colon be filled with scybalÆ, the best evacuant is a table-spoonful of castor-oil in peppermint water. When the constipation takes on a less or more obstinate character, he uses a saline chalybeate in imitation of the saline chalybeate waters of Kissingen, Harrogate, &c. In addition he gives a zinc pill, with extract of henbane, at night. But he avoids the use of opium. (See Lancet, April 24.)

Anaemia and Chlorosis treated by Nickel and Manganese.—Dr. Broadbent lately read a paper before the Clinical Society (April 9th), in which, on the principle that chemical substances closely allied have similar action, he recommended manganese and nickel as substitutes for iron in the treatment of chorea. He recorded various cases, in some of which good results appeared to follow this method.

Operation for Chronic Inversion of Uterus.—At the meeting of the Royal Medical and Chirurgical Society, on the 13th of April, Dr. Barnes read a paper, in which he described a new operation for the relief of chronic inversion of the uterus. He gave the statistics of the different methods now in use. He stated that the ligature and excision were open to the double objection that, besides being very hazardous to life, success was only achieved at the expense of mutilating the patient. Forcible taxis was a violent and often fatal proceeding. Sustained elastic pressure had given remarkable results, but cases would occur where the constricted cervix uteri would resist simple pressure. He then described a case of inversion of six months’ standing, which had resisted elastic pressure kept up for five days, and in which he resorted to a plan then practised, he believed, for the first time, of making three longitudinal incisions into the os uteri, so as to relax the circular fibres; taxis then applied quickly succeeded, and the woman made an excellent recovery. He proposed, therefore, as the best proceeding where simple sustained elastic pressure fails, to make an incision on either side of the os uteri, and then to re-apply the elastic pressure, as being safer from the risk of laceration than the taxis. (See British Medical Journal, April 24.)

A Presse-artÈre for Compression of the Arteries, which may be found useful in some cases, has been described by Mr. B. Wills Richardson, of Dublin. The tubular presse-artÈre which he has invented is intended only for immediate compression, but it was used with good result in the amputation of the fore-arm. The new instrument is composed of two parts. (1) A fine silver or a fine German silver tube. To the upper end of this tube a small milled button is soldered. The button facilitates the turning or screwing of the tube by the fingers of the surgeon. A female screw is formed upon the upper half of the inside of the tube. (2) A steel stem having two jaws at its lower end. These jaws are perfectly smooth on their opposed as well as on their outer surfaces, and free from any cutting edge. They are so arranged as to open and close parallel to each other. At the upper end of the stem there is a handle nut. It is hexagonal only in the present instrument; but, for recognition in wounds, the handle nut of the presse-artÈre intended for large arteries should have some other form when more than one instrument is in use. The nut is fitted to the stem by means of a square mortise to prevent it from turning on the stem during the screwing or unscrewing of the tube. The handle nut is secured in its position by a smaller but screw nut. The upper half of the stem has a male screw cut upon it, and is adapted to the female screw on the inside of the tube. The inventor claims the following advantages for this piece of apparatus:—(1) The smallness of the space it occupies. (2) Facility of application and removal. (3) Accurate graduation of the compression by means of the fine screw arrangement. (See Medical Times, April 24.)

Catgut in the Ligature of Arteries.—In a communication to the Lancet, Professor Lister, after giving numerous pathological details, refers to the practical importance of catgut as a ligature. He states that by applying a ligature of animal tissue antiseptically upon an artery, whether tightly or gently, we virtually surround it with a ring of living tissue and strengthen the vessel where we obstruct it. This antiseptic animal ligature consists of catgut steeped in carbolic acid and oil. And with such a ligature Professor Lister says he should now “without hesitation undertake ligature of the innominate, believing it to be a very safe proceeding.” He thus expresses himself as to the necessary qualities of the ligature:—“The method which I have found to answer best is to keep the gut steeped in a solution of carbolic acid in five parts of olive oil, with a very small quantity of water diffused through it.” A larger proportion of the acid would impair the tenacity of the thread. If a mere oily solution is employed, the gut remains rigid, the oil not entering at all into its substance. But a very small quantity of water, such as the acid enables the oil to dissolve, renders the gut supple without making it materially weaker or thicker. And, curiously enough, the presence of this small amount of water in the oily solution gradually brings about a change in the gut, indicated by a deep brown colour; after which it may be placed in a watery solution for a long time without swelling, as a portion prepared in a simple oily solution does. This is a great convenience; for an oily solution is unpleasant to work with during an operation, and exposure to the air soon renders gut suppled with water rigid from drying. But when it has been treated in the way above recommended, it may be transferred to a watery solution at the commencement of an operation, and so kept supple without having its strength or thickness altered. “For tying an arterial trunk in its continuity, catgut as thick when dry as ordinary purse-silk will be found best. But for ordinary wounds, where, if one ligature happens to break, another can be easily applied, much finer kinds may be employed, and are convenient from their smaller bulk.” (See Lancet, April 3.)

The Advantages of Tracheotomy.—Mr. T. R. Jessop corroborates the views expressed in our last Number by Mr. A. E. Durham. He gives some very remarkable cases, showing the great usefulness of the operation. Indeed, one case was a veritable resuscitation of life. (Ibid.)

Arsenic a Cause of Shingles.—The very important problem as to whether arsenic, when continuously administered, is productive of shingles, is again discussed by Mr. Hutchinson. Mr. Hutchinson does not assert the fact to be more than a coincidence, but he relates several very interesting cases in which the prolonged use of arsenic was followed by shingles. (See Medical Times, April 17.)

The Treatment of Diabetes.—Dr. Basham records some cases of diabetes treated very successfully with alkalies and the phosphatic salts of ammonia, and he expresses an opinion very favourable to this method of treatment. The following is the prescription employed:—Phosphate of ammonia and carbonate of ammonia of each ten grains, aromatic spirit of ammonia half a drachm, water an ounce, added to the juice of a fresh lemon, and taken three times a day. This line of treatment was continued for four months, with the results tabulated below:—

(See British Medical Journal, April 10.)

Silver-wire Ligatures for the Pedicle in Ovariotomy.—Dr. Marion Sims calls attention to a recent case in which he performed ovariotomy, in order to explain his method of dealing with the pedicle. In the particular instance the walls of the abdomen were so thick, and the pedicle was so short, that it would have been impossible to secure it in the usual way by the clamp externally. In such cases he has always held that the pedicle is best secured with silver-wire ligatures and dropped back into the pelvic cavity. “If the pedicle be small, it is enough to transfix it with a double silver-wire and secure the two halves by firmly twisting the wires on opposite sides.” If it be broad, it requires a number of separate wires. This case required eight deep silver sutures for closing the external wound, care being taken to pass them through the divided edges of the peritoneal coat. A piece of lint, wet with carbolic lotion, was laid over the wound, and secured by a bandage, and a large compress of cotton wadding. The urine was drawn off for three days. There was no constitutional disturbance, and the patient was convalescent from the moment of the operation. (See British Medical Journal, April 10.)

Perchloride of Iron in Post-partum HÆmorrhage.—Mr. Hugh Norris corroborates the testimony of the various obstetricians who have spoken so favourably of this styptic. Injections of strong solution of the salt instantly arrest the hÆmorrhage in this dangerous class of cases. He noticed also that the perchloride has a peculiar corrugating effect on the superficial muscular fibres, as well as on the mucous surfaces. He has noticed in less than five minutes after injection that the sphincter vaginÆ, which had previously allowed the passage of the hand, became so contracted that it barely admitted a single finger. From this he concludes that one of its beneficial effects in these cases is the contraction of the muscular fibres of the uterus. He lays down the following conclusions in reference to this preparation:—(1) We possess no topical styptic in efficacy at all approaching the perchloride of iron; its effects being certain, perfect, and instantaneous. (2) In post-partum hÆmorrhages, a solution of this salt, applied in the form of an intrauterine injection, is of the utmost value both in immediately arresting the flow of blood and also in causing a permanent contraction of the recently emptied uterus. Its presence in the cavity of the uterus post-partum is not only not injurious, but on the contrary, from its well-known antiseptic properties, may frequently be productive of positive benefit in more ways than one. Mr. Norris employs a saturated (?) solution of the perchloride. All clots must first be removed, and the long tube of the syringe should be introduced thoroughly into the uterus before injection. (Ibid.)

The Cure and Prevention of Scurvy.—In a paper in the Lancet, Mr. Archer Farr starts a doctrine which is yet, we think, to be proved, viz. that scurvy is not caused by the absence of certain alkalies and the presence of others. Indeed, he refers scurvy to the absence on ship-board of proper flesh-food, and he thinks that by supplying flesh in thoroughly good condition scurvy may be avoided. Lime-juice acts, he says, by taking the place of the gastric juice and digesting the food, and thus promoting the nutrition of the body (!). (See Lancet, March 27.)

Treatment of the Vomiting of Pregnancy.—Mr. John Harrisson recommends that in these cases hypodermic injection of morphia be tried. He gives the report of a very decided and serious case, in which nearly every conceivable remedy had been employed in vain. He then tried the subcutaneous injection of acetate of morphia, in doses of one-sixth of a grain, three times a day, and this instantly arrested the vomiting. (See British Medical Journal, April 3.)