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gout ; (2) the symptoms developed with fever ; (3) thecourse of their development was suggestive of an inflam-matory process ; and (4) they indicated enlargement of theorbital contents. The conclusion is arrived at that the casewas one of orbital cellulitis of rheumatic origin, and theopinion is expressed that the more severe inflammation onthe left side may have spread to the membranes, causingirritation sufficient to evoke manifestations at first uni-

lateral and subsequently general. The treatment recom-mended was inunction of mercury and the administrationof salicylates. The patient gradually recovered and remainedwell for six months. He then had an attack of perityphlitis,from which also he recovered under the use of salicylates.

NERVE GRAFTING FOR INJURY.

AMONG the clinical memoranda in a recent number of theAmerican Medical News is a very interesting account of animportant case. The report is furnished by Captain Bradley,Assistant-Surgeon in the UniLed States Army. The patientwas a trooper who, by a fall from his horse, fractured hishumerus. The fracture was an oblique one, and it was com-plicated from the first by paralysis affecting the extensors of the forearm, giving rise to the characteristic wrist-

drop, and no doubt due to injury to the musculo-spiral nerveat the time of the accident. The fracture quickly healed,but the paralysis persisted in spite of treatment by massageand battery. The muscles of the forearm were atrophied,but still reacted to galvanism and to direct percussion.Operation was advised with the view of suturing the nerve ifpossible, but it was found, after a hard nodular enlargementinvolving the whole trunk had been removed, that thedivided ends could not be brought together. A dog hadpreviously been secured and its sciatic nerve isolated underanaesthesia. A piece of this, five centimetres in length, wastaken and carefully sutured into position between the endsof the patient’s musculo-spiral nerve and the wound closedand dressed. Union took place by first intention. Unfor-

tunately, on account of change of station, the patient passedaway from Captain Bradley’s observation four weeks afteroperation. At that time it was thought that there wereindications of returning sensibility over the area of dis-

tribution of the affected nerve. All efforts to obtain sub-

sequent details of the patient’s progress have been unavailing.It would have been very interesting to know whether anyimprovement resulted from this procedure.

DEATH UNDER CHLOROFORM AT A DENTIST’SROOMS.

IN the Report of THE LANCET Commission appointed toinvestigate the subject of the Administration of Chloro-form and other Anaesthetics from a Clinical Standpoint 1attention was drawn to the alarming number of deaths underchloroform which have occurred while dental operations werein progress. It is matter of no small regret that dental prac-titioners should not be better informed upon these mattersthan to permit the employment of chloroform upon theirpremises as an anaesthetic. There is ready to hand a safeand convenient anaesthetic in nitrous oxide gas, which fulfilsall the requirements of the dentist, and this anaestheticshould in dental cases be resorted to rather than chloroform.Had this been done in the case given below there is littledoubt that a valuable life might have been spared. A

youth aged fifteen required eleven teeth to be taken outto qualify him for admission into the Royal Navy. An

appointment was made by a dentist with the youth’s ownmedical man to give chloroform. We do not wish to

pillory this particular gentleman, with whom we deeplysympathise, for the terrible disaster with which he is

1 THE LANCET, March 18th and 25th, April 1st, 15th, and 22nd,May 6th and 20th, and June 17th, 1893.

associated ; we are aware that very many practitioners adoptthe plan he resorted to and recognise it as a routine

procedure in dental operations. We must, however,most emphatically denounce it as a dangerous andundesirable one. Chloroform was administered from a

towel-a method which easily induces an overdose ofthe anæsthetic-and the pulse was kept under obser-vation. We read nothing of the respiration or the

pupil, though doubtless they, too, were kept under obser-vation. The dentist removed one tooth and findingthe second somewhat difficult some delay arose, duringwhich the boy partly came round. The chloroform wasreadministered and the remaining teeth were removed.

Then the patient died. In a report which is before us weread that the medical man in his evidence said, " Turninground again he noticed a change in the patient’s condition."It is significant how often "going wrong" occurs whenthe back is turned. The necropsy - performed by anindependent medical man-revealed, we are informed,the startling fact that on examination of this boy, whois described as being in "perfect health and as havingbeen passed for the Royal Navy at headquarters except asregarded his teeth, that his lungs were in such a con-

dition that the boy could not have lived above two

years." Surely no lesion so serious could have escapedthe examination at headquarters and that of the medicalman who expressly states he scrutinised the lad before

giving the chloroform. The posture of the patient is not

mentioned ; probably the boy was in a dentist’s chair-a position of body unsuited for the administration of

chloroform. ____

SERUM THERAPEUTICS BY RECTAL INJECTIONS.DR. CHANTEMESSE recently read a paper before the

Société Médicale des Hopitaux in Paris on some investiga-tions he had made in administering various forms of anti-toxin serum by means of rectal instead of hypodermicinjections. He pointed out that various unpleasant symptomsdeveloped after the hypodermic use of the antitoxins, suchas pain at the site of puncture and urtioarial or erythematouseruptions. At the present time this treatment is also

employed in some diseases in which a septicæmic conditionis more or less pronounced. When the liquid is at all

irritating (and this irritation may depend upon the methodof injection, the idiosyncrasy of the patient, or defective

cleaning of the syringe) acute pain may be caused, andat the site of injection there may be a considerableamount of swelling and even the formation of an abscess.Again, in some cases the mere fact of a hypodermic injectioncauses the greatest distress to the patient. Dr. Chantemesse

adopted the plan of introducing the serum by rectal injectionin twenty cases, and convinced himself that the fluid waseasily and quickly absorbed, and no untoward effects werenoted in any of the cases. The bowel was first washed out

by means of a simple enema, and then by means ofan ordinary enema syringe and a gum elastic catheterof medium size and about twenty centimetres long theserum was introduced into the rectum. This methodof administering the serum, even in repeated doses,caused neither pain nor any other unpleasant effects,and was never followed by cutaneous eruptions. Thecurative effect seemed equally as efficacious as whenthe antitoxin was given by hypodermic injection. The usual

improvement followed as indicated by the general conditionof the patient, the fall of temperature and improvement inlocal conditions, disappearance of albuminuria, &c. The

question of the specific action of the serum, the rapidity ofthe same, and the absence of unpleasant or injurious sequelaehaving been solved, the respective doses have also to beconsidered, whether an equal or larger dose should be