STATED MEETING, NOVEMBER 7, 1892.

THE PRESIDENT, FREDERICK W. MANN, M. D., IN THE CHAIR.

PATHOLOGICAL SPECIMENS.

DR. H. W. LONGYEAR: The patient from whom this specimen was removed, suffered from a cystic ovary. Many operations have been made upon the vagina without effect. She suffered a great deal with very acute pain. The ovary was found displaced and adherent in Douglas' cul-de-sac. She developed a pelvic peritonitis and the abdomen was opened twenty-four hours after the peritonitis developed. The specimen which I show you was removed from Douglas' cul-desac, and shows its cystic condition, together with a hole in the middle of the organ from which pus was oozing. The operation was done two days ago and the patient is doing well. Temperature before the operation was 102°, a few hours after the operation, normal. This case shows the necessity of removing these cystic ovaries immediately.

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DR. J. H. CARSTENS: I agree with DR. LONGYEAR in his assertion that we should not procrastinate in the removal of cystic ovaries. (1) The patient from whom these pus tubes were removed had an attack of so-called cellulitis more than a year ago; I advised operation at that time, but she made such a good recovery that it was not deemed absolutely necessary to operate then. A few days ago she had another attack, and this morning I removed these pus tubes at Saint Mary's hospital. (2) Cancer of the uterus, removed by vaginal hysterectomy. This specimen, the result of a vaginal hysterectomy, shows the following pathological condition: (1) Typical cauliflower growth at lower lip of cervix; (2) Mucous polypi in cervix; (3) Fibroid polypi at fundus; (4) Two interstitial fibroids; (5) Chronic salpingitis; (6) Cirrhotic ovaries.

DR. FARNUM: I would like to ask DR. LONGYEAR how long his patient had been suffering from pain and how long it is since her last child was born?

DR. LONGYEAR: Her last child was born five years ago. She first began to have pain three years ago, but she had trouble seven years ago.

DR. CHITTICK: Is the temperature still normal?

DR. LONGYEAR: The temperature went up a little to-day on account of the drainage tube.

DISCUSSION OF PAPERS.

DR. F. A. VOTEY read a paper entitled "The Healing of Chronic Ulcers." (See page 5.)

DR. F. W. ROBBINS: The great trouble that we encounter in treating ulcers, is that our patients cannot or will not carry out our directions. The chronic condition of the skin, the induration and enlarged veins, are the conditions to be overcome. Bandaging from the toe up with a flannel bandage is an important procedure, the flannel being much more preferable than the rubber, especially during the summer months. Antisepsis and protection should be properly looked after. Aristol and the newer antiseptics are in my experience of no more value than blue ointment or the ointment of the oxide of zinc. Skin grafting is always good, especially when the ulcer is very large. I do not see that there is any advantage in using chicken skins, rabbit skins, or any other method over the ordinary method, as we all know it. The entire surface of the wound should

be covered with the skin graft, dressed antiseptically, and the patient kept quiet.

DR. CHITTICK: DR. VOTEY has covered the subject well and I agree with DR. ROBBINS in his remarks. The remedies which I have found of most value are the flannel bandage, the elastic stocking, rest, position, peroxide of hydrogen and grafting.

DR. E. T. TAPPEY: DR. VOTEY might have had equally good results from merely keeping his patient in bed. The most important thing is the position in bed. I would choose that in preference to all the other remedies combined. I have found that extirpation of some of the enlarged veins above the ulcer is of great value.

DR. F. H. FARNUM: We get healing by resting, very quickly, but as soon as the patient gets up again the cicatrix breaks down and our patient is as bad as Now, if DR. VOTEY'S grafting produces a stronger cicatrix which will resist the tendency to breaking down, it will prove of very great value.

ever.

DR. CARL BONNING: DR. VOTEY'S method is a good one. The important points are, antisepsis, bandaging and protection. I recall a case of large chronic indolent ulcer of the leg, which had resisted all forms of treatment, but which healed rapidly under a weak carbolic acid spray which was kept playing on the parts from a steam atomizer four or five hours each day.

DR. D. L. PARKER: The internal treatment is very important. Iodide of potassium, bichloride of mercury, and iron, should be administered in suitable cases. Any local application should be free from grease or oil.

DR. C. W. HITCHCOCK: Dermatol or a dry dressing has been found particularly good in ulcerations complicated by eczema and varicose veins.

DR. G. W. STONER: I have been in the habit of immersing the ulcer in very hot water and scarifying the edges under the water. I look upon hot water as a very important treatment in chronic ulcers.

DR. J. V. BECELAERE: We may do away with the necessity of keeping the patient in bed by employing the following dressing: A thick three per cent. ointment of zinc salicylate is applied to the surface of the ulcer. Over this antiseptic gauze and cotton batting are held in place by a roller bandage, and on top of this is placed a liquid glass bandage. This dressing should remain on until some odor from the dressing is detected, when it should be removed and fresh ones should be applied.

DR. A. E. CARRIER: I believe that a one to four thousand bichloride solution applied to the granulations and to the grafts would render them incapable of growing. A salt solution is the best. The non-use of fatty substances is very important, especially if they are liable to decomposition. The rolling over of the edges of the ulcers is one reason why they do not heal; it is, therefore, these edges that should always be scarified. Equalization of the circulation is an important point in the treatment.

DR. J. B. NEWMAN: There is usually some malnutrition of the body in these According to DR. VOTEY's paper nothing but local treatment is required, but this I cannot accept as true. Cold water is a very efficient remedy; cold water braces up the circulation, hot water depresses it. An ulcer of the wrist which recently came under my observation, and which looked malignant, healed rapidly under the application of the acid nitrate of murcury and has remained

healed. It is well after the ulcer is healed to make applications of cold water, friction, and give attention to the general nourishment.

DR. F. A. VOTEY: When I treated the cases which I reported to-night, the use of salt solutions for skin grafts was not in vogue, but the bichloride of mercury solution, one to four thousand, certainly had no bad effect, because nearly all the grafts took. I would further say that I have found it an almost invariable rule, that my patients much preferred having the grafts taken from under a chicken's wing than from their own backs.

REPORT OF CASE.

DR. A. E. CARRIER: I wish to report a case of diphtheria which was not laryngeal, but as the exudate cleared from the pharynx the child became hoarse and had great difficulty in breathing. I called DR. JENNINGS in consultation, and he performed intubation. The child did well. I saw him on the morning of the second day about 8 o'clock, when he was practically convalescent-at 10 o'clock he was dead. The nurse noticed that something was wrong, and she attempted to remove the tube but could not. DR. JENNINGS and I saw the child shortly afterward, and upon removing the tube a small piece of membrane was found completely closing the lumen. This patient, practically well, literally choked to death. Some means of quickly removing the tube should be invented. DON. M. CAMPBELL, M. D., Secretary.

CORRESPONDENCE.

LONDON LETTER.

BETTER RESULTS FROM MEDICAL MEETINGS.

MEDICAL circles in all parts of the United Kingdom have had ample food for reflection for some time, and practitioners generally are of the opinion that the frequent meetings which now take place at regular intervals in all provincial towns of any importance should show better results than they have hitherto done. It cannot be said that physicians are not enterprising for the members of the profession have long since come to the conclusion that from a business point of view a medical practice requires the same attention as a merchant bestows upon his vocation.

ELECTRICITY AS A CURATIVE AGENT.

THIS is another question which is agitating the minds of both the older school of physicians and also the younger and more go-ahead branch of the profession. Considerable doubt has been placed in the public's mind by the revelations of a well-known electrical engineer in connection with a law case relating to a so-called electric belt. Few people doubt that the suffering public are victimized by electric belt firms who obtain large prices for worthless appliances, but it is a pity that an exposure of such should be the means of shaking the confidence of any one in the general usefulness of electricity, particularly as in this country it has never been accorded a fair trial. The opinion is in eminent medical circles that it forms a remedy for many infirmities, but that the proper method of application has not yet been discovered.

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PROFESSIONAL ADVERTISING.

THE subject of advertising is, at present, a vexed question, and various opinions have recently been set forth by persons well known and qualified to speak on the matter. Both sides of the problem have been well cited by supporters of and those against the idea of doctors building up a practice through the instrumentality of means which many consider pertain only to mercantile pursuits, but the matter still remains in its old rut as none of the authorities will sanction advertising, but, on the contrary, put down in the most emphatic manner any one who attempts to gain publicity by the system alluded to.

HYPNOTISM.

HYPNOTISM is again to the fore, and it would seem that it has the chance of a better hearing now than it has before had, as several eminent men have been giving the subject a considerable amount of their time, which from a pecuniary aspect is valuable.

ITINERANT PHYSICIANS.

IT is a regretable circumstance that many promising and well qualified young doctors are roaming about the country in the same predicament as Mr. Micawber-waiting to see if something will turn up. Sometimes while visiting a friend an accident occurs requiring the assistance of a doctor, and it is then that one begins to believe in the proverb, "It's an ill wind that blows nobody any good," as it has been the good fortune of one or two to get into a practice through a lucky accident.

SWEDISH MASSAGE.

MUSCULAR rheumatism seems to be alarmingly on the increase in these isles and many men have set themselves the difficult task to solve why it should appear in females between the ages of twenty-eight and thirty-five, as this has been noticed and commented upon by two or three of the professors at our universities. The climate is probably (in some measure) to blame. Swedish massage is usually the treatment prescribed, and, seeing that the profession is gradually becoming more and more over-crowded, it is quite a common thing to find an M. B., C. M. acting the part of masseur. It pays. How long it will be a remunerative occupation is a different thing, but what, in these times is a certainty? Ewoc.

EDITORIAL ARTICLES.

DIET IN FEVERS.

THE matter of diet in fevers is pretty generally supposed to be settled in favor of the exclusive administration of milk. The question whether it be necessary that the food be restricted to fluids was recently discussed at a meeting of the New York academy of medicine, and the views expressed by experienced men revealed some striking fluctuations of opinion regarding our present ideas of maintaining an exclusively milk diet in typhoid and other continued fevers. Whatever may be the value of a fluid food in fever, it was shown in the first place that milk should not be regarded as solely a fluid food, and moreover that

in the physiological processes of digestion milk is changed into a bulky solid. To maintain nutrition is one of the main objects of the treatment of typhoid. A diet of milk not only requires the ingestion of a large amount in order to insure the administration of the necessary quantity of nutriment, but the amount so administered dilutes the digestive juices to a formidable degree. That fluids are called for in typhoid cases seems indicated by the fact that the amount of water in the system is considerably reduced, as exemplified in the larger number of corpuscles in a drop of blood. This point could be met, in the administration of solid food, by accompanying it with an abundance of water. The two main indications in the dietetic management of continued fevers, are the maintenance of a high rate of nutrition, and the avoidance of the formation in the digestive tract of harsh masses which might scrape or irritate ulcerated surfaces and conduce to hæmorrhage. Chocolate, scraped meats, junket, or baked potatoes do not, as far as known, produce any digestive residues of an irritating nature, and there would seem no actual good reason why they should not be employed in dietaries unless accumulated experience tends to impugn the sagacity of such a line of action.

There seems little question that typhoid cases are sometimes prolonged and tend even to assume a final septic or scorbutic stage from malnutrition of the patient. In these cases it may be well to remember that while milk will always be the best general food in typhoid, there are substitutes and adjuncts which are universally accessible and can be made distinctly serviceable to the patient.

EDITORIAL BREVITIES.

LEGAL AND MEDICAL FEES.

The slayer of
The late Hall

THE lawyers have arranged some of the affairs of this world to suit their own convenience, and one of these is undoubtedly the matter of fees. Jim Fisk paid his lawyer about two hundred thousand dollars. McAllister received a fee of twenty thousand dollars in a suit in which he did not appear in court, and in which his labor did not equal that of a surgeon in any capital operation. Physicians' fees are far too low, and every endeavor should be made by medical societies and other professional agencies to increase them. The fee bill to be adopted by a local medical society will, it is hoped, tend to exalt physicians' opinions of the value of their own services.

NATIONAL QUARANTINE.

THE late cholera scare has had the merit of exciting public attention in sanitary matters. A bill is already before the house of representatives having for its purpose the promotion of a system of national quarantine. The measure projects the establishment of a bureau of health, the executive portion of which is to consist of a commissioner of quarantine, a commissioner of internal sanitation, and a commissioner of vital statistics, who are each to receive a salary of seven thousand dollars. Centralization of authority is probably the only way by which uniformity of action can be maintained. The governor of New York seems to think the state is competent to attend to its own sanitary affairs; so it may be, but does it possess a vital interest in the interests of other states? There is no