Surgeons have come to recognize this of so great importance that many hospitals have expended large sums of money for the erection and equipment of operating-rooms and wards exclusively for abdominal surgery.

Unquestionably excellent work is done and very good results are obtained in hospitals where abdominal operations are performed in a general operating-room; but, to-day, results are not reckoned alone upon the recovery of the patient, but also, whether or not the patient's convalescence has been prolonged by suppuration.

In accordance with the most recent ideas of abdominal surgery, a portion of one of the new additions to the Massachusetts Homœopathic Hospital has been set apart for that exclusive use.

An operating-room with a plate-glass window six feet four inches by five feet nine inches, admitting the northern light, and with a sky-light, has been arranged.

The floor is of German asphalt laid in the most perfect possible manner, with a very slight inclination from the periphery to the centre. The walls are finished with zinc enamel.

The heating is effected by a large wall-coil so arranged that it can be used in common with the other steam-heating apparatus under low pressure in winter, and in the warmer months, when steam heat is not in use in other parts of the building, connection is readily made with the high-pressure pipes, such as are constantly in use, the year round, for the jacket-kettles and for running the machinery of the Hospital. A fireplace and two flues give abundant facilities for ventilation. A marble dado extends across the side of the room where the water and antiseptics are in use. A porcelain-lined sink, with hot, cold, and filtered water supplied, furnishes facilities for hand washing. A marble slab, eight feet long and fifteen inches wide, is placed on a level with the top of the sink. A steam jacket-kettle, by means of which water can be heated to the boiling point in a few seconds, is arranged near one end of the sink. Two plateglass shelves, each ten inches wide, are placed at a height of six feet, and extend over the sink and marble slab; upon these are placed the filtered-water tank, jars for sponges, sutures, etc. The basins, pails, etc., are all of the best quality agate ware, and are designed to be kept upon another plate-glass shelf beneath the marble slab.

The water is filtered, under pressure, through a Pasteur filter which is coupled onto the cold-water supply-pipe, and in turn has an outlet leading directly to the reservoir; the latter having a capacity of ten gallons. The reservoir is provided with an overflowpipe so that, in case of neglect to shut off the water from the filter at the proper time, the overflow finds its way to the sink.

The room is provided with a complete set of laparotomy instruments, exclusively for that apartment, which are kept, when not in use, in an upright iron case with plate-glass shelves, and side and front panels of glass. Preparatory to each operation, the instruments are sterilized in a Lauterschläger sterilizer, in which they are kept, for at least a half-hour, at a temperature of 212°, F. This sterilizer is heated by gas flames, and, for accuracy, is provided with a thermometer and thermostat.

The operating-table is of iron and zinc, and is made after the pattern of Martin, of Berlin.

An instrument-table, also of iron, upon casters, with a glass tray and plate-glass rack, is designed for the instruments during an operation. Another iron table, upon rubber casters, with plate-glass top, is designed for dressings, towels, etc.

It is designed to keep the temperature of the room at about 80°, F. Preparatory to an abdominal operation, the room is thoroughly heated by having the steam on during the preceding night, and the atmosphere of the room is charged with steam, which is allowed to settle, carrying with it any particles of dust; and the floor of the room is sprinkled.

The assistants in an operation are either required to wear a washed suit which has not been used in other parts of the Hospital, or a long frock which completely covers the clothing.

The patient is prepared by having a full enema the night before the operation; a bath; the abdomen and external genitals scrubbed in three changes of soap and water, followed by ether, and lastly by 1:1000 sublimate solution; the pubic hair also is removed and a sublimate compress bound over the abdomen, to remain until the time of operation. The morning of the operation the patient is early given a cup of beef tea. She has a pair of leglets of canton flannel made like large stockings, put on, which fasten about the thighs with lacing-strings, and a clean undervest and nightdress.

She is etherized in her own bed, and transported to the operating-room on a rolling stretcher.

Anæthesia is effected with etherated air. This method seems particularly valuable in abdominal surgery, since there is far less profound intoxication than results from the old method, and correspondingly less of the usual unpleasant after-effects. The prolonged nausea and vomiting from the effects of the anæsthetic have, in the past, been an extremely annoying sequel to abdominal operations. The extremely minor character of this, or entire absence, since anæsthesia by etherated air was adopted, has been very satisfactory. By this method the total amount of ether used has usually been less than three ounces. The contrast between this and ten to fifteen ounces, as commonly

consumed by the old method, is quite sufficient comment. At the present time there is but one other hospital in New England which has an operating-room exclusively for abdominal surgery, which can compare, in completeness of equipment, to this. It is the only hospital in New England to which persons in affluent circumstances can come, and secure the much greater safety in passing through the critical ordeal of an abdominal operation which this perfectly-organized department affords. Curiously enough, the other hospital referred to, admits only charity cases, thus debarring the well-to-do from securing that which their means should enable them to get.

The doors of the Hospital and the benefits of this department are open also to the poor, who receive exactly the same care and attention, as far as the operation is concerned, and all necessary isolation and nursing during convalescence.

RULES FOR THE USE OF THE LAPAROTOMY ROOM.

First. No furniture, instruments, apparatus, utensils, operating-frocks or dressings are to be removed from, or transferred to, this room from other parts of the Hospital.

Second. This room is to be used exclusively for Non-suppurative Abdominal cases, and Brain Surgery, but not including compound fractures of the skull.

No case of cancer, of any description, or suppurative cases, or cases in which suppuration is suspected, shall be operated upon in this room.

The room shall be used for no other purpose than as above stated, and shall be kept locked when not in use.

Third. The Internes, when occupying the room in preparation for, or during an operation, must wear white cotton suits which have not been in use in other parts of the Hospital.

Fourth. After an operation: (a). The instruments and apparatus must be cleansed without delay, by the senior Surgical Interne, or under his supervision.

(b). The room, utensils and tables must be promptly cleansed, and all soiled linen and débris removed by the Nurse in charge (see sect. VII.), or under her supervision.

Fifth. Physicians or students, not to exceed twelve in number at one time, may be admitted by special invitation only of the Operating Surgeon.

Physicians in attendance upon septic cases, and students attending exercises in the dissecting-room, are not to witness operations in this room.

Visitors may be admitted for the inspection of the room only when accompanied by the Superintendent, or some member of the Surgical Staff, and when the room is not otherwise in use.

Sixth. The temperature of the room is to be kept approximately at 80°, F., during an operation.

In cold weather the steam heat is to be turned on the night before the date appointed for the operation.

Two hours previous to an operation, the steam stop-cock is to be opened, and the atmosphere filled with steam vapor, and the same allowed to settle.

The floor, previous to every operation, shall be sprinkled with sterilized water.

All instruments, silk and silver wire, to be used in an operation, shall be wrapped in gauze and sterilized by dry heat for a half-hour at a temperature of 100°, C.

Gauze dressings shall be sterilized by steam heat for one halfhour preparatory to each operation.

Seventh. The Surgical Staff recommend: (a.) That the general care and supervision of the room be given to a responsible permanent nurse, who shall attend at all the operations.

(b). That each Surgeon provide two operating-suits, which shall be kept exclusively for his personal use in this room.

Preparation of Catgut and Silk-worm-gut. — First, thoroughly scrub, with a hand-brush, in soap and water, after which place for half an hour in ether, and then macerate in a 1:500 alcoholicsublimate solution for twenty-four hours; finally, transfer to a 1:1000 alcoholic-sublimate solution for permanent preservation. A half-hour before using, place in plain 95% alcohol.

Preparation of Silk. (Iron-dyed silk to be used exclusively.) Scrub the silk in several changes of soap and water, until all excess of coloring material is removed, then wind on glass spools and preserve in a 1:10,000 alcoholic-sublimate solution. (See sect. vi.)

Preparation of Silver Wire. - Carefully cleanse, as mentioned for other sutures, cut into ten-inch lengths, place in a clean ignition-tube, plug the opening with absorbent cotton, and sterilize by keeping it at a temperature of 100°, C., for a halfhour.

Preparation of Sponges. — Thoroughly beat them to remove dirt and bits of shells, then macerate in six changes of water for at least twelve hours, squeezing them dry at each change. Next, place in a saturated aqueous solution of potassium permanganate for twenty-four hours, renewing it once during the time; then rinse very thoroughly in clear water. Transfer them to the bleaching-solution, which is a 1:100 aqueous solution of sodium hyposulphite, to which a little hydro-chloric acid should be added, (a half drachm to the quart). As soon as decolorized, remove at once and wash thoroughly in several changes of water. Carefully pick out all bits of foreign matter,

such as shells, and trim off any loose bits of sponge. Keep them in a 1:1000 aqueous sublimate solution until required for use. All soiled sponges are to be discarded and removed from the room.

A CASE OF COMPOUND FRACTURE.

BY W. K. BOUTON, M. D., MELBOURNE, AUSTRALIA.

That the world is small and experiences similar is exemplified by a case which happened here in Melbourne under my care, and which I have decided to report after reading the February number of the GAZETTE, in which a case of "compound fracture of the tibia and fibula" is reported by Dr. Rand, of Monson. I do not offer the case for comparison, nor that I may tell a "bigger one," but simply to show that at times cures will occur in spite of all rules, and without the consent of the surgeon.

In 1891, March 18, J. S., a man, aged 29; height, six feet; weight, about 170 pounds; was engaged in a contract of removing a bank of earth. A two-wheeled dray was loaded with nearly two tons, and the horse, a large, powerful brute, started off in a wrong direction, whereat J. S. ran forward to turn him, and before he could save himself his feet had slipped forward in front of the wheel, which passed over the legs at the lower third. The ground being soft, the left leg being underneath came off with but serious bruising and a wound, which required only two stitches. With this we have nothing more to do. But the right leg was decidedly a serious matter. Both bones were badly broken, and the tibia laid bare nearly its entire length, a wound twelve inches long, with tissues sadly mangled. To be candid, of several surgeons who saw the case, not one of us but thought it waste of time to defer amputation. But the patient was determined to have a trial made to save it. Consequently a dressing of sponges was used, side-splints applied, then the whole put in a box-splint with adjustable flaps, and a beginning made. Within three days the crushed and injured tissues were actively gangrenous. On the sixth a line of demarcation began to form, and in eight days there was a sloughing surface commencing just below the knee, at a point running diagonally backward on both sides, seeming to follow the outer margin of the soleus muscle, until it reached the lower third of the leg, when it dipped backward, passing directly round, leaving the whole anterior portion denuded of skin, and a space at the back three inches in length; thus a full half of the leg was laid bare, and the muscles exposed. The tibia for half its length was to be seen, even the periosteum being torn away. Dressings with sponges were continued, renewed every six hours. As soon as