8. If the anesthetist has had much experience with the administration of chloroform and none with ether, in all cases except affections of the heart, especially a fatty heart, chloroform under such circumstances being never justified. ETHER IS PREFERRED— 1. In cases of heart diseases of all kinds-imperative in cases of fatty heart, should the administration of an anesthetic be decided upon by the surgeon. 2. In all cases where the operation will likely consume more than three-quarters of an hour, or an hour. 3. In the feeble and debilitated from any cause. 4. Individuals addicted to the excessive use of alcohol. Chloroform here contraindicated, positively dangerous, and should under no circumstances be given. 5. If the anesthetist has had no experience with the administration of anesthetics. Fatal results less likely to occur under influence of ether in his hands. 6. Generally speaking, all things being equal, the patient who is given chloroform is subjected to a risk, according to statistics, five times as great as if ether were the agent selected. CONDITIONS OF THE GREATEST DANGER ARE 1. An operation being performed during incomplete anesthesia. 2. It is unpardonable and hazardous to administer an anesthetic, especially chloroform, with the head of the patient elevated or in the upright position, such as a dentist's chair, for two reasons: first, the operation is performed, extracting the tooth, during incomplete anesthesia, plus the danger of the field being supplied by the fifth nerve; second, operations anywhere along the distribution of the fifth nerve are especially dangerous if operation be commenced before the stage of surgical anesthesia has been reached, for the reason that its nucleus is so intimate with that of the pneumogastric, reflex inhibition might be transmitted over it, arresting the heart's action. This could not occur under complete anesthesia. DANGER SYMPTOMS. Dangerous symptoms should be met by a prompt resort to the measures laid down for ether, which will bear repetition with some additions: Vol. 23-15 1. Immediate withdrawal of chloroform-substituting oxygen and ammonia. 2. Lift jaw forward, also draw tongue forward, raise glottis and straighten neck. 3. Dilate sphincter. 4. Dash ice water in face. 5. Inhale nitrite of amyl. 6. Hypodermic use of strychnia, digitalis and atropin. 7. Inject ammonia directly into the vein. 8. In desperate situation, phlebotomy. Inject spirits ammonia directly into heart muscle. 9. Massage of heart where practicable. 10. Lower head at first, then raise slightly. 11. Continuous artificial respiration. The intravenous use of ammonia, phlebotomy, injection of ammonia into heart muscle, massage of heart, and the intravenous use of adrenalin, to be resorted to only where death is imminent and the usual remedies and methods have manifestly proven incompetent. Porter Building. PROGRESS OF MEDICINE. MEDICINE. UNDER CHARGE OF B. F. TURNER, M.D. Visiting Physician St. Joseph's Hospital, Memphis. Mediastinal Dermoid Tumor. At the Gesellschaft der Innere Medizin Türk (Vienna Cor. Med. Press & Cir., vol. 75, no. 3329) showed a man, aged 57, who had fallen ill two weeks before admission to hospital with severe shivering, followed by running at the nose and cough, but no pain in the chest. On October 20th the case was diagnosed to be one of pleuritic effusion on the left side, and was admitted to the second clinic as such, although no objective symptom bore out the diagnosis. After prolonged and repeated examination the extent and appearance, with the slight subjective disturbances and no continuance of fever, led finally to some doubt. The history was gone into afresh, and the diagnosis again conjectured to be thickened pleura, with adhesions. In view of the persistence of the supposed effusion other conjectures were hazarded, such as interlobular exudation or possibly some complication of the mediastinal folds of the pleura with obliteration of the thoracic portion of the left side. It was also thought possible that it might be a tumor, but if so not of a malignant nature, no cachexia or other indication of exhaustion being present. The Röntgen rays revealed nothing beyond the clinical observations noted. On November 10th, it was decided to explore the region with a needle, but after six insertions in different spots only a few drops of a thick white fluid could be obtained. Under the microscope this appeared to consist mainly of large epithelial cells without nuclei, resembling the corneal cell of the epidermis but containing cholesterin crystals. The patient refused any further exploration and left the hospital, but returned again on December 16th, after two days fever and feeling generally unwell. Again he submitted to exploration, and again the squamous cells and cholesterin crystals, with a few fatty and epithelial cells, were met with. There were no leucocytes or erythrocytes, which proved that the original diagnosis was in error. It was now surmised that the thoracic dullness was due to a neoplasm composed of epithelial cells and cholesterin, and that no exudation or empyema was present. Again it was clear that no cyst such as echinococcus existed, while the absence of leucocytes and the presence of these suspicious keratin cells, which retained the iodin coloring matter in Gram's test, were confirmatory of a morbid growth in the mediastinum. Therapeutic measures in such a case would necessarily be limited to a surgical operation. If no operation were undertaken the history of such cases pointed to the probability of ultimate rupture of the lung or pericardium and death. The operations which have been performed have resulted favorably, and where no cysts exist the whole mass can be easily removed, allowing the surrounding tissues to contract, but not always without leaving a fistula, which must be guarded against. SURGERY. UNDER CHARGE OF W. B. ROGERS, M.D. Professor of the Principles and Practice of Surgery and Clinical Surgery, The Radical Cure of Hydrocele. In his paper read before the Société de Chirurgie, Fangère (Paris Cor. Med. Press & Cir., vol. 75, no. 3328) remarked that hydrocele, usually styled idiopathic, was not the less provoked by a lesion of the epididymis, as a careful examination of the organ would show; spermatic cysts, traumatism, rheumatism, syphilis, etc., only acted through the influence of the gland. He would not go into the pathological anatomy or the symptoms of the affection, but he would say a few words on the different varieties of hydrocele and the treatment. Besides the multilocular, diverticular, chylous and milky varietes of hydrocele, there was the infantile or congenital hydrocele and hydrocele in woman. The infantile variety was generally attributed to a traumatism during delivery. It got well spontaneously. Congenital hydrocele was not, properly speaking, a hydrocele; it should be considered as a vagino-peritoneal hydrocele, as in reality it was an accumulation of peritoneal serosity in the tunica vaginalis. It was called congenital because it was due to a congenital malformation and not because it was itself congenital. The lesion was due consequently to an arrest of development. In the normal condition the testicle descended into the scrotum, carrying with it a fold of the peritoneum. It became invaginated in the inguinal canal like the finger of a glove, forming in this way the tunica vaginalis. That canal was only temporary, became obliterated by degrees, and finally in its place was found a thin cord called the ligament of the vaginalis. At birth the canal existed still, establishing a communication between the vaginalis and the peritoneum, but the obliteration was effected rapidly in a few days. Where the obliteration is not effected, congenital hydrocele was the result. Although observed at every age, congenital hydrocele was more frequent between the ages of three and ten; spontaneous reductibility in the horizontal position or provoked by pressure was the fundamental character of that kind of hydrocele, that benign affection, which called for treatment only because it favored the production of a hernia, was chronic in its evolution, and disappeared frequently spontaneously, especially in the child, by obliteration of the canal. Hydrocele in the woman consisted in a serous cyst of the labium majus. As regarded the treatment, numerous were the methods recommended; puncture followed by a modifying injection, tincture of iodin, iodoform and ether, nitrate of silver and chlorid of zinc. All those injections were more or less painful, and followed by considerable inflammation of the scrotum, that of the first and last named more particularly. The chlorid of zinc solution was composed as follows: Chlorid of zinc, grs. xvj; water, 3iij. After having removed one or two ounces of the liquid, from five to twenty drops of the solution should be injected by the ordinary hypodermic syringe. Inflammatory swelling was the result, but quickly subsided, and in two or three days the patient was cured. The method was much less painful than the use of tincture of iodin. The radical cure by operation was the best method of treatment, since antisepsis had so much facilitated the use of the knife. Several methods were employed-simple incision, partial resection of the tunica vaginalis, total resection of that membrane and inversion as practiced by Doyen and which he considered the best. OPHTHALMOLOGY. UNDER CHARGE OF A. G. SINCLAIR, M.D. Professor of Ophthalmology, Otology and Laryngology, Memphis Hospital Medical On the Danger of Conservation of the Ocular Stump; Galezowsky (Recueil d'Ophtalmologie) writes a vigorous protest against the preservation of atrophic ocular stumps and any attempts to make them presentable by tattooing. He likewise disapproves of any efforts to obtain esthetic results by conservation of a part of the globe with the placing of glass balls, etc., in its interior. These plans, he says, are illogical, and it may seriously compromise the fellow eye by |