An unusual method of contracting venereal disease is reported from France. A citizen was accidentally struck in the face by the whip of a passing teamster, a syphilitic, who was in the habit of sucking on the end of his whiplash. In due time a chancre developed on the nose of the victim at a point where the lash had penetrated the skin.

A NUMBER of physicians of Saint Louis are fostering the idea of establishing a goat farm in the vicinity of that city and supplying the residents with goat milk, which is said to be immune from the germs of tuberculosis. If the scheme materializes goats will be imported from Switzerland, France and Germany. The animals will be rented to families desiring them and indigent persons may have them free of charge.

DOCTORS HENRY PICKERING BOWDITCH, William Williams Keen, William Henry Welch, William Osler, Russell Henry Chittenden and Charles S. Sherrington were the recipients of the honorary degree of LL. D. from the University of Toronto on the occasion of a special convocation which was held October 2, 1903, for the purpose of conferring honorary titles in connection with the opening ceremonies of the new physiological and medical laboratories.`

AN ordinance, to prohibit spitting in public places, has been introduced in the city council of Baltimore. The measure is more in detail than any other that has heretofore been presented, as the author contemplates suppressing the practice, not only on public thoroughfares, but also in all vehicles which carry passengers for hire, on the floors of depots, stations, theatres, stores, factories and hotels. Notices will be posted and a fine imposed on any person violating the ordinance.

MICHIGAN'S death rate during the month of October, 1903, was two thousand six hundred twenty-four, ninety-eight less than for the preceding month. The death rate was twelve and five-tenths per cent per one thousand population. There were four hundred eighty-nine deaths of infants under one year; one hundred eighty-five of children from one to four years inclusive; seven hundred sixty-six deaths of elderly persons, all over sixty-five years. Causes of death were as follows: Tuberculosis of the lungs, one hundred ninety; other forms of the same disease, thirty-five: typhoid fever, ninety; diphtheria and croup, seventy-eight; scarlet fever, seven; measles, three; whooping-cough, sixteen; pneumonia, one hundred forty-three; diarrhea and enteritis in children under two years, one hundred seventy-three; cancer, one hundred twenty-nine; deaths due to accidents and violence, two hundred two. Smallpox was the cause of one demise-in the city of Hillsdale. There was a slight increase of mortality from tuberculosis, diphtheria, croup and pneumonia. Typhoid fever caused sixteen more deaths than during the preceding month. A large decrease in deaths from diarrheal diseases of children was reported, also a decrease in deaths from cancer. The report shows an increase in deaths of elderly people, while there was a considerable decrease in deaths of infants and children.

1

CENTENARIANS who have recently departed for the elysian fields of paradise: W. H. Seymour of New York City, died on October 6, at the age of one hundred one years two months and twenty-one days, having been born on July 15, 1802. His age added to that of his four predecessors in line amounted to four hundred twenty-eight years. His father and uncle were soldiers in the Revolutionary war. Patrick Scanlon, of Wendell, Massachusetts, died November 21, aged one hundred three years, having been born in Ireland, March 15, 1800. Isaac Mitnitsky died at Brooklyn, New York, on November 28, aged one hundred nine years, having been born in Moscow, Russia, in 1794, his birth being recorded in the official records of that city. He came to this country when he was ninety-two years of age, and has since journeyed back to Russia no less than four times.

THE vaccine building recently erected by Frederick Stearns & Company is now finished and occupied. This building is quite distinct from the biologic stable completed about a month ago at a cost of $25,000. This building is entirely of brick, has but one outside entrance and no windows whatever, being lighted by skylights of the most modern and approved form, fitted with prismatic glass which diffuses a very strong light without allowing direct rays of sunshine to enter. Ventilation is had by means of powerful patent ventilators and electric fans. Thus the dust from outside sources is absolutely excluded, which is ant important item in the production of pure vaccine. The building is heated by steam, lighted by electricity and provided with hot and cold water throughout. The large incubating room is equipped with iron stalls provided with small racks which the calves stand on. This raises the animals from the floor so that they do not stand in their own excretions even for a moment. The walls of this room are of pressed brick, enameled white, and the ceiling is arched or "coved," doing away with corners. The floor is of concrete, drained by a number of sewers. There is no wood in this room at all, even the racks on which the animals stand being iron, and these racks are scrubbed, sunned and sterilized daily, there being two complete sets. The room is cleaned daily. The cleaning and sterilizing room adjoins the operating room. Both of these are practically porcelain lined, the walls being of glazed white tile with all joints enameled, making a continuous snow-white waterproof surface as smooth as glass. The ceilings are covered here also, doing away with corners. The light is from skylights and the ventilation through flues. Neither of these rooms has an outside door or window. The sterilizing room is provided with electric clippers, by means of which the calves from the quarantine barn are very closely clipped; then the calves are scrubbed in a hot antiseptic bath in the vats with which this room is provided. After being thus thoroughly cleansed they are shaved over the area to which the vaccine is applied. Then being transferred to the next room, they are vaccinated and placed in the incubating room first described and fed on sterilized milk during the progress of the vaccinia which has been induced. It should, perhaps, be stated here that when the calves are first received from the

farm they are placed in a quarantine station devoted entirely to their use, and are kept here for some time under the inspection of our head veterinarian, to demonstrate their entire healthiness, before being vaccinated. The operating room is as clean and aseptic as that of a modern hospital. It is provided with all necessary apparatus, and, like the operating room of the antitoxin laboratory, is considered without an equal. In this building also, but entirely separate from the vaccine department and not communicating with it in any way either by door or window, are the large injecting and bleeding rooms of the antitoxin laboratory. In the first of these rooms horses are injected with the toxins. The walls of this room are of pressed brick covered with white, waterproof enamel, and having coved ceiling and concrete floor. The operating room which communicates with this has walls of white glazed tile, exactly like those in the vaccine operating room, with arched ceiling and cement floor. The instruments are kept in plate glass cases, the antiseptic solutions, et cetera, on plate glass shelves-in fact, the arrangements are very similar to those of a hospital, as has been stated.

RECENT LITERATURE.

REVIEWS.

PRACTICAL MEDICINE SERIES.*

VOLUME III, practical medicine series-pediatrics and orthopedic surgery, by Abt and Ridlon. This volume is of special value to the general practitioner as it is a careful abstract selection by the author of the important pediatric literature of the year. Particular attention has been paid to the infectious diseases, and great care used in the selection of such material as will help the practitioner to become familiar with any recent literature that pertains to infant feeding and the other discases of childhood. This book will be a convenient one of reference to the physician who wishes to keep himself posted on the pediatric and orthopedic work of the past year.

*The Year Book Publishers, Chicago.

A QUIZ-COMPEND OF ANATOMY.*

THIS book was first issued twenty years ago and is now brought out in its seventh edition. It has been rewritten and plates have been added to make it harmonize with modern text-books of anatomy. Considering the purposes of compends, this is an excellent one and will help the student to grasp the essential points of anatomy for examinations.

*By Samuel O. L. Potter, M. D., San Francisco. Price, eighty cents. Published by P. Blakiston's Son & Company, Philadelphia.

REPORT ON THE RESULTS OF THE USE OF THE ELASTIC LIGATURE (McGRAW) IN FIFTEEN CASES

OF GASTROENTEROSTOMY.*

BY CHARLES B. NANCREDE, A. M., M. D., LL. D., ANN ARBOR, MICHIGAN.

PROFESSOR OF SURGERY IN THE UNIVERSITY OF MICHIGAN,

THE brief remarks which I propose making are not intended to do more than call attention to an easy, expeditious and safe method of performing gastroenterostomy or enteroenterostomy in certain classes. of cases. It will not be urged that this method should supersede all others, or that it is fitted for all varieties of disease wherein gastroenterostomy is indicated.

Any method of performing a gastroenterostomy which advances claims to superiority over other forms of technique must substantiate these by showing that it is (1) more simple, hence easier of performance by the less expert; (2) that it is inherently safer, both theoretically and practically; (3) that it can be done more quickly by the average operator, or at least that it requires no more time to complete than other methods; (4) that it demands less complicated instruments; and (5) that it is especially adapted to the majority of cases which demand gastroenterostomy for their relief. Incidentally, other advantages can be claimed, but the five already mentioned should suffice.

I shall briefly describe the technique of this operation which has doubtless escaped the memory of some present, because the mere relation of the details will prove some of the claims advanced for the method.

As the only peculiarities of the method are those concerned with the formation of the communication between the stomach and intes

* Read at the Elkhart (Indiana) meeting of the NORTHERN TRI-STATE MEDICAL ASSOCIATION.

tine, any incision through the abdominal walls may be made which the experience or the fancy of the surgeon dictates. Personally, if I think it is possible that a pylorectomy can be done I prefer the oblique (Billroth) incision; when I am sure no removal of the stomach is indicated, I employ a median incision above the umbilicus.

I do not propose to argue as to the advantages of anterior or posterior gastroenterostomy, the advisability of enteroenterostomy in addition to gastroenterostomy, or the proper direction in which to secure one viscus in relation to the other.

Having identified and selected the portion of intestine, this should be held, together with the stomach, by an assistant, gently upon the stretch, when a continuous seromuscular suture must be passed uniting the two for a distance of two or more inches, according to the size of the opening desired.

If the assistant will so hold the stomach and intestines that they are somewhat distended with flatus, this maneuvre will facilitate the next step by preventing the needle point catching in the valvulæ conniventes or the opposite wall of either viscus. A good-sized darning needle threaded with rubber ligature about three millimeters in diameter (one-eighth of an inch) must now be thrust through the stomach. wall near one extremity of the suture line and made to emerge near the termination of the same. It will thus be seen that any-sized opening desired can be secured. An assistant, by maintaining traction on the elastic ligature, renders it much smaller so that it can readily be drawn through the stomach for about half its length. Next the needle should be made to penetrate the intestine opposite its point of emergence from the stomach and be brought out again, with the ligature, at a point corresponding to that where the stomach was first entered. This order of passing the ligature is better than the reverse, being not so liable to produce infection should the ligature touch any viscus, and is also advantageous by not putting so much strain on the suture line. Needless to say, tension on the ligature favors its passage, and a careful wiping of the cord by a wet sponge after its emergence first from the stomach and later from the bowel, is advisable. Done in this way I cannot conceive how infection can occur, even if the ligature breaks an accident which has happened to me-because the opening is tensely filled by the ligature, and if this breaks, the orifice is so small that I have never seen the fluid visceral contents escape. A stout silk ligature must next be laid between the points of emergence of the rubber cord from the stomach and intestine. The rubber ligature must now be firmly drawn upon, an assistant crowding the included visceral walls well along the stretched ligature, after which the first half of an ordinary square knot should be tied and tightened until the ligature will stretch no further, as shown by the two members of the tie no longer slipping past one another. Proceed deliberately at this point, for a steady, prolonged pull must be maintained, otherwise the cord will either break, or will not be tight enough to cut as quickly as desirable. The assistant should tie the silk ligature