I ought also to say a word concerning certain resources of modern surgery, which have done so much to banish pain and fear from the operating-theatre. ANESTHESIA. Before the method of anesthesia was perfected, it passed through a number of phases; at first ether, then chloroform, then injections of chloral, and lastly the bichloride of methylene, which may be considered as definitive, since with it there is no danger to those patients who undergo operations. Bichloride of methylene does not manifest its action on the heart, like chloroform; the patients fall asleep as in natural slumber; and their countenances remain rosy and bright. It would even appear that the circulation is facilitated. There is not that intermediate period of agitation or intoxication, which appears with chloroform. The surgeon has not, therefore, to occupy himself with his patient: perinde ac cadaver. ARREST OF HÆMORRHAGE. Formerly, that which impeded the surgeon and compelled him to terminate the operation before he had completed all the necessary details, was more or less of hæmorrhage. Thanks to Esmarch's bandage, he can now operate as though he were in the dissecting room; the operation is also no longer hurried through, it is performed with calmness and reflection. The needful retouchings can also be made, with as much leisure as the tailor trims his cloth. Before the application of Esmarch's bandage, certain precautions must be taken; thus, as the surgeon repels the blood upward, he must assure himself that there is no danger of producing internal congestion. If the patient is plethoric, it will be an advantage to allow a certain quantity of blood to in the practice of all surgeons. M. Alph. Guérin's dressing is a poor reproduction of the irremovable dressings of Larrey père. It was unnecessary to make so much noise, and it was especially unnecessary to involve the scientific responsibility of the Academy of Medicine of Paris in a manifest plagiarism. escape. The above is so far true, that recently an accoucheur availed himself of Esmarch's bandage, after great loss of blood from flooding in lying-in women. He applied the elastic bandage to each lower extremity, so that the blood being driven from below upward, the circulatory circle was contracted a full third, and thus the vital organs were supplied anew with blood. When the surgeon operates on limbs in a state of suppuration, the bandage must be applied, at first from above -downward, in order to squeeze out all the vitiated blood; and afterwards Esmarch's tourniquet must be applied at the upper portion of the limb, so as to prevent afflux of fresh blood. The above precaution is quite necessary, in order to prevent putrid infection. CARBOLIZED PULVERIZATIONS. During the entire duration of the operation, carbolized vapour of water should be projected over the raw surface. This vapour kills the microscopic ferments, so that they are not transformed at a later period into purulent or other corpuscles. When ablation of a cancer is performed, great care is taken that no diseased tissue is left in the wound; but that which cannot be prevented is the infiltration of microscopic ferments; now, it is probable that these organisms cause the cancer to reappear.* * I have already had occasion to draw attention to the morphological views of Konheim and Koeliker. M. Béchamp, of Montpellier, has extended them to all organic productions, healthy as well as pathological. Thus, he has shown that the white liquids proceeding from the blood and tissues can become organized, and that these new organizations or neoplasies vary according to their nature or composition. The corpuscles, or minute organisms which those liquids contain, are so many germs which multiply by endogenesis, and which, consequently, it is very important to kill on the spot. Such is the object of carbolized pulverizations. It would, therefore, be wrong in all operations not to employ the steam or other atomizer. This apparatus is now made so small, that it can be carried about everywhere. It can equally be used in diphtherias, either of the throat and air-passages, or of the vagina and uterus, making use of a glass or porcelain speculum. ANIMAL LIGATURES. The operation being completed, the surgeon proceeds to apply ligatures to the vessels. Formerly, surgeons rested satisfied with tying the principal arteries, and they allowed the oozing from the smaller vessels to be arrested by coagulation but the coagulated blood which remained in the wound gave rise to putrescence of the stump. It is, therefore, very important that no extravasated blood be permitted to remain in the wound. All oozing vessels must, consequently, be tied, without distinction. Those vessels, the mouths of which are gaping, must be seized, and after having isolated them, they must be tied with catgut which has been previously soaked in carbolized oil. One of the advantages of these ligatures, is, that they may be left in the wound; the ends also may be cut off close to the tied vessels. The vessels which cannot be seen, but the presence of which is surmised on account of the oozing of blood, must be seized with the hæmostatic forceps, and a ligature applied to them en masse. There need be no fear of including nerve filaments, as these generally follow the principal arteries. Thus, then, every vessel which oozes must be tied: arteries and veins. When all the ligatures have been applied, the tourniquet (Esmarch's) must be gradually slackened, until the wound ceases to bleed. The wound must then be cleansed with fine sponges soaked in carbolized water, which must be changed each time, so as not to transport the micro-organisms. If the wound presents palish points, it must be painted with a solution of chloride of zinc. This precaution is especially necessary in a case of cancer, or of an ulcer of a malignant nature.* *The caustic or chloride of zinc paste of Dr. Canquoin, is well known to the surgeon. That honourable physician, whom his traducers have desired to confound with the quacks, had at first in view only the destruction of diseased tissues. During a recent visit which I had occasion to pay him at Dijon, he assured me that some cancers: those of the mouth, tongue, pharynx, etc., he is satisfied to paint over with carbolic acid. His The wound must be afterwards dressed in the manner previously described. (Vide Dressings.) INTERNAL MEASURES. REGIMEN. The diet of the wounded should be analeptic; that is to say, calculated to refresh and restore the blood. Broths, animal jellies, and milk foods should form the basis of it. By degrees, more solid articles of diet, wine and beer may be allowed.* Formerly, it was the custom to keep wounded patients very low, and thus fever was fostered, and at the same time the danger of morbid absorption was increased. It is necessary to consult before everything the digestive aptitudes of the patient, and to keep the tongue clean by means of the Seidlitz salt; the patient can then be nourished as though in perfect health. I consider this point to be extremely important. A wounded person is not a diseased patient, but he must be prevented from becoming one. In some cases-but rarely-I give decoction of cinchona. I have remarked that this medicament, when it is not well borne, is apt to give rise to diarrhœa, and it thus prevents the administration of nourishing foods.. Mucilaginous bitters, such as calumba, are preferable; but quassine may be advantageously substituted for them- Three or four granules a-day. Sleep at night should be solicited by maintaining the regularity of the functions. Narcotics must be abstained from, object is thus to destroy the ferments, and thereby to prevent the rapid increase of the cancer. There is nothing, however, to prohibit the employment of the chloride of zinc solution in such cases. * If wine be indicated, the surgeon should have its administration under perfect control, fixing the daily doses himself, and not allowing the patient to take it ad libitum. The St. Raphael Tannin Wine is perhaps the best. The various Maltine preparations may often advantageously replace beer. Rubine or Bark Beer, in moderation, is an excellent substitute for malt liquors. Koumiss is also very beneficial, as well as the fresh juices of grapes and other fruits bottled by Mr. F. Wright, of Kensington, London. (Vide "Medical Temperance Journal," April, 1882.-H.A.A. therefore, as much as possible. Nevertheless, in case of need, three or four granules of narceine may be given, which alkaloid, unlike morphine, does not produce constipation. ANTIFEBRILE TREATMENT. Tendency to fever must be prevented by the alkaloids. A distinguished surgeon, Chassaignac, was in the habit of administering for some days before every serious operation, the alcoholate of aconite in a potion, in the proportion of two to three grammes daily. This is that preliminary treatment which was called "surgical training," the patient being prepared or trained for the operation, like horses are trained for the race-course. a The practice was judicious, since aconite moderates fever, and it was given for the same reason that we now administer aconitine. However, I will here make a remark concerning traumatic fever. This fever ought not to be considered as an extra-physiological reaction, any more than the fever which precedes digestion in delicate persons; it is, on the contrary, preparation for the work of reparation; moreover, it is not followed by that profound depression which an accession of pathological fever causes; it is usually dispelled by a wholesome moisture of the skin, etc., and by a calm sleep. It is not, then, that fever which must be prevented; it is even necessary in some cases; and so salutary was it considered among the ancients, that they even raised altars to the goddess Fever, Febris diva. Now aconitine, far from preventing this fever, favours it; causes it to be evolved with greater calmness and regularity, and removes all mental agitation, thus enabling the wounded patients to recover from their moral shock, a matter so very necessary to accomplish. But what must be prevented is inflammatory fever, with violent shivering at the commencement; with dry, pungent heat, nervous prostration, and disturbance of all the nutritive functions, especially of the important function of digestion. Every elevation of tempera |