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the forces which regulate its action, and themade. An incision was carried down to the muscle. mechanism by which it distributes the constant streamThe biceps was injected with cocaine and divided with of blood ...... ; to determine the causes which impair the scissors. By retracting the triangular flap of skin and circulatory functions ; to see more clearly the means of muscle the vessels and nerves were exposed by blunt disprevention and the remedies which palliate where injury to section. The median nerve was isolated and moistened with the heart or vessels is concerned." These objects are to be the cocaine solution. The needle was then plunged into the attained by the publication of original work only, and the nerve and a few drops of the solution were injected. The first number could not be opened more fittingly than with nerve was divided in the cocainised area. The musculoa prefatory writing by Dr. W. H. Gaskell, who holds the cutaneous and ulnar nerves were exposed and similarly place of honour in this country amongst those concerned treated. Neither sensation nor muscular contraction was proin throwing light upon the obscure nervous and muscular duced during division of these nerves. The brachial artery processes which bring about and regulate the beat of was isolated, ligatured in two places, and divided between the heart, upon which all human activities depend. Dr. the ligatures. The basilic vein was treated in the same way Gaskell’s claim that " medical science is losing its empiric and found to be thrombosed. It was therefore dissected character and is founding itself on the well-ascertained facts upwards towards the axilla in order to get above the thromof physiology and its cognate sciences, pathology and bosis, but this could not be done and the vein was therefore pharmacology," is justified by the scientific output in the again divided. The anterior group of muscles was divided past of workers of his own quality. We content ourselves with scissors down to the bone. The musculo-spiral nerve in this note with the enumeration of the four papers con- and superior profunda artery were exposed. The nerve was instituting the first number of Heart. Professor A. R. Cushny, jected and divided, and the artery was ligatured in two places whose pharmacological researches are known to all modern and divided. The skin on the posterior aspect of the arm and physicians, writes on the Irregularities of the Mammalian the triceps were divided by a single sweep of a long bistoury Heart Observed under Aconitine and on Electrical down to the bone. The muscles were peeled back from the Stimulation. Dr. James Mackenzie, whose demonstration humerus for two inches and the bone was sawn through. of his cardio-polygraph before the Royal Society of The tourniquet was removed and there was only slight Medicine and whose publication of a remarkable work on oozing from the muscles. The muscles were gathered round "Diseases of the Heart" will be within the recollection the end of the bone by a purse-string catgut suture, care of our readers, contributes a paper on Nodal Bradycardia, in being taken to exclude the nerve stumps. The wound was which we find the methods of the laboratory applied at the closed by interrupted silkworm-gut sutures without drainage. bedside in the manner recently made familiar to us by The operation occupied 40 minutes. The patient felt no himself. The editor is responsible for a detailed study pain and the only disagreeable feature was the noise of sawof Paroxysmal Tachycardia, and Dr. Leonard Hill describes ing the bone. No change in the pulse followed division of the methods which, with the cooperation of Mr. Martin Flack the nerves. About four drachms of the cocaine solution were and Dr. W. W. Holtzmann, he has devised for the measure- used. Care was taken to open up the injected areas after ment of systolic blood pressure in man. This paper com- about a minute, so that no cocaine remained in the tissues pletes the first number of .ZZMM, which, as our readers will for any time. There was no evidence of any toxic effect. agree, shows every promise of a scientific future of exceptional After the operation the patient appeared better, there was clinical utility. no evidence of shock, and she passed a comfortable night. The left thigh became red and swollen, suppuration occurred AMPUTATION OF THE ARM UNDER LOCAL in the amputation stump, and the patient gradually failed ANÆSTHESIA. and died three days after operation. The necropsy showed IN the Boston Medical and Slb’1’gical Jozcrnal of June 10th I extensive thrombosis involving the left brachial, subclavian, The superior Dr. J. H. Cunningham has reported a case in which the arm jugular, femoral, and external iliac veins. and other contained old friable cranial sinuses longitudinal was successfully amputated under local anasthesia when the general condition rendered administration of ether unsafe. thrombi. The patient was a woman, aged 65 years, who for some years THE "E.M.I." had been treated at hospital for gastritis, myocarditis,

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THE entente cordiale medicale has by no means been enteritis, arterio-sclerosis, emphysema, and chronic bronchitis. On March 5th, 1909, her left hand became painful, forgotten by our friends over the water even if we have swollen, bluish, and cold. Some degree of circulation per- not heard so much of it this year as last, when the Francosisted, for the colour returned after pressure on the fingers. British Exhibition filled London with French visitors, amongst

Venous thrombosis was diagnosed and a protective dressing The condition extended to the forearm. On was applied. the 6th there was pain in the left groin and both legs were cedematous. The circulation in the veins of the right leg had ceased. On the 15th there was a line of demarcation about 12 centimetres above the wrist, with a blackened, sloughing, gangrenous mass below, and amputation of the left arm under local anaesthesia was decided upon. The arm was held up so as to expose the axilla and a tourniquet was applied as high as possible. An area three inches long, beginning at the lower border of the axilla and extending along the inner edge of the biceps muscle, was anaesthetised by injection of a 1 per cent. An incision was made through solution of cocaine. the skin and superficial fascia until the border of the biceps was exposed. The skin was then cocainised in a line extending across the anterior surface of the biceps at right angles to the incision already

were a large number of members of the medical profession. Some of them will be soon renewing their recollections of this country under the auspices of the (Euvre d’Enseignement Medical Complementaire, which is also known as the Enseignement Medico-mutuel International, or more shortly the "E.M.I.," and which forms one of the chief organisations for post-graduate study in France. The " E. M. 1."has decided this year to hold its annual tour in the British Islands between July 28th and August 16th, and a very interesting and comprehensive circle of visits has. been arranged through the chief centres of medical activity in Great Britain and Ireland. The party will start from Boulogne on Wednesday evening, July 28th, and spend the next four days in London. On Sunday evening it will enter upon the following itinerary : Oxford, Cambridge, Sheffield, will be reached on Friday, Manchester, Edinburgh, August 6th, and left on August 9th, and Glasgow, which will be reached on the same evening by a detour through the-

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AORTIC INSUFFICIENCY SIMULATING ANEURYSM.

Trossachs in order to give the visitors an opportunity of and dilated right auricle. The mitral valves showed slight enjoying some of the most famous scenery in Scotland. The general thickening and the aortic valves were sclerosed. next day will be spent in Glasgow, and on the llth the party The aorta exhibited no evidence of dilatation, but was the will cross to Belfast, proceeding to Dublin on the 12th. On seat of endarteritis, probably syphilitic. The lymphatic the 13th Liverpool will be the objective, the journey being glands generally, and especially the mediastinal ones, were made vid Holyhead, and on the following day the party will enlarged. The latter were connected by a few adhesions. go south to Bristol, returning to London the next evening There was also chronic interstitial nephritis. How were the (Sunday, August 15th), and to Paris on the following afternoon. signs of aneurysm to be explained ? The episternal pulsaDuring the tour the mornings will be devoted to its scientific tion was doubtless partly due to widening of the aorta, but its objects, including visits to hospitals and infirmaries, and the principal cause was increased action of the hypertrophied afternoon to sightseeing. It is probable that some of our pro- left ventricle. The abnormal dulness was due to the greatly fessional countrymen may like to improve their knowledge of enlarged left auricle, the widened aorta, and the enlarged their own country and their acquaintance with the French mediastinal glands. The tracheal tugging, always slight and language by participating in this projected tour, in which inconstant, was attributed to the mediastinal adhesions. case they should signify their intention to do so to M. Sewall, an American writer, has shown that pleural adhesions Etienne Bazot, President of the Central Council of the at the left apex may produce slight tracheal tugging, and "E.M.I.", 12, rue Francois-Millet, Paris, and forward their has reported a case in which slight tracheal tugging was subscription to M. Amedee Schmitt, 1, rue de l’Echelle, apparently due to adhesions involving the mediastinal Paris, sending 20 or 15 francs according as they wish to pleura. The inequality of pulses is difficult to explain, become Members or Associates of the "E.M.I."" Whatever as their cause was not investigated at the necropsy. be the number of their British (joi1frères who may join them, Probably the left carotid and subclavian arteries were we wish our visitors from France a profitable and enjoyable partially occluded by obliterative endarteritis. In the trip, with better weather than the official summer has yet second case a man, aged 37 years, was admitted into afforded us. hospital complaining of cough, dyspnoea, palpitation, and weakness. He had suffered from syphilis and taken AORTIC INSUFFICIENCY SIMULATING ANEURYSM. alcohol freely. There was a heaving impulse over the IN the University of Pennsylvania Medical Bulletin for May bulging prsecordium. The apex beat was heaving and visible, Dr. G. M. Piersol has reported two cases of aortic in- and palpable in the sixth interspace almost in the anterior sufficiency simulating aneurysm. A negro teamster, aged axillary line. In the second interspace, about one inch to 36 years, was admitted into hospital on Feb. 1st, 1909. His the right of the sternum, was a visible and palpable pulsaillness began in July, 1908, with paroxysmal cough and tion with a diastolic thrill. Less marked pulsation was dyspnoea. For three months there had been in addition to present in the third interspace, one and a half inches to the these symptoms swelling of the feet and legs. On admission left of the sternum, and in the suprasternal notch. In the there was considerable oedema of the legs. The upper half latter area, as well as in the carotids, there was a systolic of the sternum and entire prascordium showed marked thrill. The upper part of the sternum was dull. There were bulging and diffuse pulsation. Visible and palpable pulsa- systolic and diastolic murmurs. The peripheral arteries were tion extended upwards to nearly an inch above the upper thickened. The urine was albuminous and contained casts. edge of the sternum and laterally beneath the insertion of Skiagraphy showed an enormous heart, and only an unduly the left sterno-mastoid muscle. Over this area a systolic high and widened aortic arch. thrill was felt. The apex beat was visible in the sixth ELECTRIC NARCOSIS AND RESUSCITATION. interspace one and a half inches to the left of the midclavicular line, and was heaving and accompanied by SOME time since we had occasion to refer to the condition a thrill. The upper limit of cardiac dulness was continuous known as "electric narcosis,"first discovered by Professor with an area of dulness which extended upwards to the first Leduc of Nantes. It is brought about by passing through interspace. Rough systolic and diastolic murmurs were the nerve centres a current, preferably from a battery, heard over the whole prascordium. The peripheral arteries which by means of a special commutator was interrupted were sclerosed. The pulses in the left carotid, brachial, 100 times a second, the current actually flowing for oneand radial arteries were much smaller than in the right. tenth of the period between each interruption. This is now Slight tracheal tugging was sometimes present. The urine known as the Leduc current; and if there are no signs was of specific gravity 1040, and contained a trace of of its displacing ether and chloroform for producing and and albumin, hyaline granular casts, many red anaesthesia in human beings, it certainly has done so corpuscles. There was a history of a venereal sore. Aortic to a large extent in the conduct of laboratory experiinsufficiency, complicated by aneurysm of the ascending and ments upon animals. We have received copies of a series transverse portions of the arch of the aorta, was diagnosed. of papers by Dr. Louise G. Robinovitch of New York, in The diagnosis of aneurysm seemed amply justified by the which she makes several important communications regarding marked sternal and episternal pulsation and thrill, the the uses and properties of such currents. Speaking of electric abnormal dulness, the inequality of pulses, and the tracheal anesthesia in laboratory work, she points out the following tugging. But skiagraphy showed a much enlarged heart, advantages among others : 1. The blood pressure, respiration, above which the shadow of the aorta, though somewhat and temperature remain about normal, even after eight hours broader and higher than normal, nowhere gave evidence of or longer anaesthesia. 2. It can be induced not only centrally circumscribed or even diffuse dilatation. Near the aorta were but locally. 3. No animals have been lost from this an2esseveral enlarged peribronchial glands, the shadows of which thesia. 4. A voltage of from 5 to 10 is all that is reblended with that of the aorta and increased the appear- quired to produce electric anaesthesia, and this potential is Within ten days a striking change quite free from danger to life. Finally, Dr. Robinovitch ance of broadening. occurred. The episternal pulsation subsided so as to be has been able to perform important operations, such scarcely visible and the episternal thrill disappeared. as exposure of the brain, carotid artery, vagus nerve, and Death occurred six weeks after admission from cardiac and abdominal organs, under its influence. Carrying her investirenal failure. At the necropsy was found an enormous heart gations further, she has made the somewhat paradoxical with dilated and hypertrophied ventricles and left auricle, discovery that if properly applied this current can resuscitate ____