it may be advisable to perform trache- | then drew off the products and analyzed otomy, and then actively curette, and them. As a result, he found that the apply lactic acid to the larynx, in the chloroform was chiefly decomposed endeavor to avert the difficulty of nu- into hydrochloric and carbonic acids, a trition, which arises in late stages from small quantity of free chlorine being the exquisite pain in swallowing, due also present. As one-tenth per 1,000 of to the passage of food over ulcerated hydrochloric acid in air is sufficient to surfaces. The truth is, that in no dis- cause severe respiratory irritation, it is ease is more discretion required of the evident that this amount can be prophysician in applying general rules to duced by comparatively little chloroindividual cases.-Med. News. form. Kunkel explains that irritating effects are comparatively infrequent, owing to the moisture in the air absorbing the free hydrochloric acid, and combining with it. Cloths or sheets dipped in a solution of washing soda, and hung up in the operating room, will absorb any hydrochloric acid or chlorine, and thus obviate their unpleasant effects. THE ACTION OF COD-LIVER OIL. Drs. Gautier and Mourgnes, in a recent communication to the Academy of Sciences, discuss at some length the reasons why cod-liver oil is superior to other fats as a therapeutical agent, and arrive at the following conclusions: 1. It is more easily assimilated, owing to its containing free fatty acids and some biliary matters which render its emulsion specially easy when it comes in contact with the pancreatic juice. 2. It is rich in phosphates, phosphoric acid, lecithin, and phosphorus in organic combination; the phosphorus, especially in the last-mentioned form, is very readily assimilated to form protoplasm, and thus nutrition is greatly stimulated. The small amounts of bromine and iodine being also present as organic compounds exercise a beneficial influence on the general metabolism. 3. The alkaloids present-butylamine, amylamine, morrhuine-and morrhuic acid stimulate the nervous system, increase the amount of sweat and urine, and act as nervine tonics. British Med. Journal. DECOMPOSITION OF CHLOROFORM It has long been known that the administration of chloroform in gaslighted rooms causes decomposition of the chloroform vapor, and that the persons present suffer from irritation of the respiratory passages, with coughing, sneezing, and lachrymation. Professor Kunkel (Therap. Monatshefte) introduced chloroform vapor into a glass chamber in which a gas was burning, and -Sup. Brit. Med. Journal. MISCARRIAGE MORE DANGEROUS Goodell (Arch. Gyn. Obstet. and Pæd., June, 1890) answers this question as follows: Because the fact of a miscarriage implies something abnormal; because owing to the attachment of the chorial villi over the whole surface of the uterus which obtains in the very early months, portions of the membranes are liable to be retained and give rise to hemorrhage and sepsis; because the cervix not being effaced the small canal is liable to close on the retained fragment. Retention is far more likely to occur in criminal abortion since the gestation is abruptly interfered with before any detachment has taken place. AND THE LAST SHALL BE FIRST. -According to the French law (so says the New York Medical Record) the last born of twins is said to be the elder of the two. This curious decision was arrived at on the authority of the faculty, who held that the last to be born was the first to be conceived. As seniority no longer confers any privileges in respect of property in France, the matter is not of very great importance, otherwise one might be tempted to call the validity of the opinion in question. Med. Press and Circular. LIVING BY RULE. Oliver Wendell Holmes thinks that he owes his good health and the retention of his mental vigor in his eightyfirst year to the extreme care he has long taken of himself. Never robust, he was still wiry in his earlier and maturer life; but since he reached eighty, his hygienic vigilance is unceasing. The rooms that he daily occupies are equipped with barometers, thermometers, ærometers, every kind of instruments, in short, to prevent his incurring the slightest risk of taking cold. He knows that pneumonia is the most formidable foe of old age, and he is determined to keep it at a distance, if possible. He never gets up until he knows the exact temperature, during winter, or takes his bath without having the water accurately tested. He lives by rule, and the rule is inflexible. His time is scrupulously divided; so much allotted to reading, so much to writing, so much to exercise, so much to recreation. His meals are studies of prudence and diges tion. He understands the specific qualities of all ordinary foods, and never departs from the severest discretion in eating.-Times and Register. It is reported that the United States Marine Hospital Service will recommend the plan of having a systematic examination of all persons intending to immigrate to this country. This examination would be made by physicians attached to the United States consulates. It is to be hoped that some measure may be attempted. It is cheaper to keep out the sick, criminal, and defective classes, including anarchists, than to support them here or send them back.-Med. Record. THE University of Michigan, in Ann Arbor, has opened its current Winter Session with the largest class in its history. This is to the surprise of the officials, as the required course in the medical department is four years instead of three. Everything points to over a hundred gain for this year. THE HANDSOMEST STORE IN THE U. S.; THE LARGEST GROCERY STORE IN THE WEST. YOU SEE IT IN EVERY DEPARTMENT. THE HIGHEST GRADE OF ALL KINDS OF GOODS. IMPORTED WINES AND LIQUORS. BISSINGER'S FINE CONFECTIONS. CIGARS, CIGARETTES AND TOBACCO. Complete Assortments in Cheeses, Sauces, Imported Delicacies, Appetizers, etc. HEADQUARTERS FOR IMPORTED AND DOMESTIC MINERAL WATERS, ALES, PORTERS, BITTERS, CORDIALS, ETC. Housekeepers make light of housekeeping when they purchase Peebles' high grade of CANNED GOODS AND VEGetables. PRICES ARE ALWAYS RIGHT FOR QUALITY. THE JOSEPH R. PEEBLES' SONS CO., GROCERS PIKE'S BUILDING, CINCINNATI. Ask for Peebles' “Cabinet" Whiskey and take no other. In Corresponding with Advertisers, please mention THE LANCET-CLINIC. THE them the only chance, even if it is ever so small. No patient should be refused an operation where there is the slightest that the justification of any operation is possible chance of recovery. The fact, its necessity, and not the numerical recoveries from its performance, makes it none the less galling to the operator to A Report to the South-Western Ohio Medical have deaths occur in his practice, which Society, October, 1890, BY RUFUS B. HALL, M.D., CINCINNATI. Mr. President and Gentlemen: The great secret of success in ovariotomy is to have the patient submit to the operation early, while the tumor is yet small, and free from adhesions; before the patient's health is broken down from suffering, and complications occur which so frequently exist in large tumors. I am convinced that there are a great many good physicians practicing medicine at this time who honestly believe that a woman suffering from an ovarian tumor should not be subjected to the operation of ovariotomy until the tumor has grown to such a size as to compel her to do so; or serious complications arise. I am convinced of these facts from every day experience. While the men engaged in this special work are a unit in urging early operations in these cases, the profession at large is not. There is still to be found the doubting Thomas, the man who says to his patient wait until the tumor bothers you before you bother it, or some such subterfuge; and who sends these cases to the operator when they can not live any longer as they are. But if the operation has been postponed until the patients are in extremity, and they and their friends request that it be made, knowing the danger of it, it is then our duty to operate and give a must in all honesty be charged to the It is not consequences of delay. pleasant task for any one to report his cases which have died after operations. But I believe that there is as much, or more to be learned from a careful study of the report of these cases, as there is from the report of cases which recover, and that they should be just as carefully reported. For these reasons I will give you a short history of a few delayed operations; operations where they could not live any longer as they were. Not that I am ashamed of the mortality, or proud of the percentage of recoveries, but to illustrate the necessity of early operation, and at the same time the dangers of delay. You will observe that they are all of that class which are called desperate cases, and are selected for that reason, and if death followed it was not so much a matter of surprise, as the recovery was a gratification. CASE I.(1) Mrs. K., aged seventy years. For two months preceding the operation she could not lie down, and was compelled to sit half propped up in a reclining chair. The tumor was first noticed two years before my visit. She had been an invalid for twenty years, and now as she rests in a half sitting position, the I Reported in full in Transactions Ohio State Medical Society, 1887. radial pulse is barely perceptible. It was with many misgivings that I made the operation September 23, 1886. The cyst and contents weighed fifty-nine pounds; it was adherent to the whole abdominal wall. The omentum was so firmly adherent that it was ligated in sections and removed with the tumor. The posterior surface was adherent to several coils of intestine. The bladder was spread out over the front of the cyst like a great fan, and was so firmly adherent that it had to be dissected from it. The hemorrhage was severe, and a great number of vessels were ligated. A drainage tube was placed, the incision closed. Patient recovered. CASE II.(1) Miss I., aged forty years. The tumor was first observed about one year before the operation. For six months she had suffered from great pain, and lost much flesh. The cyst was tapped in November, 1887, and again the middle of January, 1888. After that date she was tapped by her physician every twelve to eighteen days until the operation was made, April 19, 1888. Extensive adhesions to abdominal wall, in the pelvis, and intestines. Irrigation. Drainage. Tedious recovery. CASE III.(*) Mrs. L., aged fifty years. For more than a year she was known to have an ovarian tumor. For ten months before the operation she was subject to sudden and severe attacks of pain in the abdomen. These attacks varied in frequency, and always left the abdomen sore and tender for several days afterwards. She was advised to submit to an operation at once. That she would not do until July 11, 1888. She was at that time suffering from septic peritonitis of twelve days' duration, caused by a gangrenous cyst, due to a twisted pedicle. She had a rapid and feeble pulse and a high temperature for twelve days preceeding the operation. At the operation the cyst wall was found to be quite black in many places. The cavity I LANCET-CLINIC, May 26, 1888. 2 Loc. cit., Dec. 22, 1888. was irrigated and drained. Patient died the fourth day from exhaustion, due to the existing septic peritonitis. The preceding cases, and all of those which appear in this paper in which the name of the attending physician is not given, have been reported in full in various medical journals. CASE IV. Miss Z., aged thirty-three years. Was treated by an irregular physician for three weeks, during which time she had a suppurating cyst in her abdomen, with profound septic poisoning. That physician was laboring under the mistaken idea that she was suffering from typhoid fever. Dr. DeWitt, of Cincinnati, saw the case after the family had become thoroughly alarmed, and at once recognized the true condition. I saw the case a few hours later, April 28, 1889. She had a pulse ranging from 130 to 150 per minute, and a temperature fluctuating from 101° to 105°, with a history of daily chills and high tem perature with profuse perspiration, for three weeks. She had a cyst in the abdomen about the size of an adult head, tender upon pressure, with marked fluctuation in every portion of it. She had taken but little nourishment during her illness, on account of the nausea and vomiting, which had been constantly present. The patient and friends were plainly told her true condition, and that an operation for the removal of the suppurating cyst was the only hope, and that a forlorn one. They decided not to have an operation made, but four days later they requested it and I operated May 2, 1889. That morning she had a temperature of 104.5°. The cyst proved to be an intra-ligamentous one, which was extremely difficult to enucleate on account of the friability of its wall. The bleeding was profuse and many ligatures were used. There was no pedicle, and after the operation was completed, in examining the specimen it was found that the whole tumor had been enucleated from the broad ligament except an area of two and onehalf by three and one-half inches. cavity was irrigated. The broad liga The ment was stitched together, and the cavity drained and closed, after an operation of nearly one hour's duration. The temperature fluctuated just as before the operation. She died of exhaustion three days later. CASE V.(1) Mrs. W., aged forty years. She had an obscure abdominal enlargement for two years. Twenty months previous to the operation she had an attack of abdominal inflammation, from which she never regained her usual health. After that date she had three septic attacks of inflammation, the last one in February, 1889, after which she was confined to her bed almost constantly until the operation was made. I saw the case June 19 and urged an immediate operation, which was made June 24, 1889. She was emaciated to an extreme degree, with a morning_temperature of 101°, evening 1030. The tumor was a suppurating multilocular cyst weighing twenty-four pounds, with firm and extensive adhesions to abdominal wall, omentum and intestines. Irrigation. Drainage. Recovery. CASE VI. Mrs. H., aged forty years. Case of Dr. C. D. Fishburn, of Cincinnati. She had been conscious of an abdominal enlargement for many months, but as it gave her but little inconvenience she did not send for her family physician until December 19, 1889, when he was called to relieve the existing pain in the abdomen. He at once recognized the enlargement as an ovarian tumor, complicated with pregnancy at about the fourth month, and the existence of acute peritonitis, with high temperature, and rapid pulse. She was very ill for the following ten or twelve days, when her condition improved somewhat for a week or so, at which time she commenced to grow worse, and her condition soon became alarming. During her illness I saw her a number of times in consultation with her physician, and the advisability of an operation had been thoroughly discussed. She had taken I LANCET-CLINIC, Oct. 12, 1889. but little nourishment during her illness on account of the nausea and vomiting. She was in an extremely critical condition for an operation. At this time Drs. Reed and Ricketts were asked to see her with us, which they did on January 18, and it was decided that an immediate operation was the best course to pursue. This was made January 20, and a tumor about the size of an adult head was removed without difficulty. She did well until the 23rd, when uterine contractions came on and she aborted a few hours later, and died the following day from exhaustion. CASE VII. Pa Mrs. R., aged fifty-six years. tient of Dr. Bohl, of Watertown, Ohio. A tumor in the abdomen was first discovered about two years ago. For the past eight months she had lost considerable flesh. She suffered little from the tumor except from the weight and pressure. She complained most of losing her strength. The tumor filled the whole addominal cavity. She gave no distinct history of having had inflammation. saw her first August 28, 1890, and operated September 1, at my "Home." The tumor was a multilocular cyst weighing forty-seven pounds, and firmly adherent to the whole anterior wall of the abdomen. The adhesions were so firm that the abdominal peritoneum was stripped off on both sides over an area as large as my hand. The omentum was so firmly adherent that it was ligated in sections and removed. The intestinal adhesions were firm but not extensive. Irrigation. Drainage. Recovery. This series of seven cases form an exceedingly interesting group. The operation was not made in any case until the patient could not tolerate her existence any longer, or was doomed to speedy death-not from any fault of the attending physician at the time I first saw the individual cases, but from the patient's own neglect because of the fear of the operation. I have reported this group of cases of delayed operations to show that a large per cent. of delayed cases die, and those who do recover are subjected to unnecessary risk, which |