less. No septic infection need be feared from absorption of pus. The dressing remains sweet until it is so saturated that the discharge comes through, when a change should at once be made. By actual experiment, the superi After the cotton dressings are no longer needed, the surface may be dressed with zine ointment, after irrigation with carbolic acid; if more stimulation is desired, a 24 per cent iodoform ointment answers admirably. Grafting should be employed if the ulcer is of great extent. the degree of LL. D., from the Illinois Wesleyan University. He is an honorary member of the New York Academy of Medicine, of the College of Physicians of Philadelphia, and of many other scientific and medical soties in his own country. In 1883, the Amer-ority of this dressing over the method of ican Medical Association having decided to compression by adhesive plaster strips has publish its transactions in the form of a weekly been demonstrated. medical journal, Dr. Davis was chosen its. chief editor. In 1886 he was appointed secretary-general, and, after the death of the late Professor Austin Flint, he was unaniinously elected president of the Preliminary Organization of the International Medical Congress, to held in Washington in Septemter, 1887. The above is a brief description of Professor Davis's career. It remains only to state how highly he is esteemed by his com peers in the United States. He stands now as the recognized head of the profession in his country, the successor of the lamented Flint and the other great men who preceded him. Probably no physician in the United States has done more to keep up the tone of the profession, and to make the profession one solid, earnest body, desirous of advancing science, benefiting humanity, and adding to the glory of the country." TREATMENT OF CHRONIC ULCERS.-Dr. A. Heidenhain, of Coeslin, has arrived at the conclusion that by far the best method of dealing with old chronic ulcers, especially of the leg, is to dress them with a considerable thickness of absorbent cotton. Volkmann has long since practiced this method, which, we believe, was original with Guerin, the French surgeon. The absorbent cotton is pressed upon the ulcer by a roller bandage, and is allowed to remain undisturbed until, after the lapse of five days or a week, the secretions come through. Then it will be found that delicate healthy granulations have sprung up in place of the dirty necrotic appearance erstwhile presented, and the torpid callous margins are considerably improved in appearance. The dressing is then re-applied and changed as before. The advantage of this method lies in its being absolutely pain In order that the new formed skin does not crack and break, when the limb is again put to active use, it is advisable to oblige your patients to take some exercise during the process of repair. The ulcer does not heal so quickly as if absolute rest be ob served, but the result is a more permanent one. In such cases that are obliged to be a bed on account of the large size of the ul cer, Heidenhain has found it of great advan tage to bandage the limbs in a flexed position. Thus the skin and the soft parts are kept at a certain tension during the healing process. If the limb be kept at rest fully extended, the cicatrix will surely tear open when walking is resumed. To keep the leg flexed, the use of a double inclined plane is very serviceable. BROMINE IN DIPHTHERIA.-A valuable contribution on the use of bromine in malignant diphtheria has been written by P. Hesse in the Deutsches Archiv fuer klinische Medicin. He considers bromine as of especial penetrative power, and ascribes to it antiparasitic and solvent qualities. The solution employed consists of about ten grains each of pure bromine and of bromide of potassium in six or seven ounces of distilled water, and is to be inhaled. To this end, an ordinary lampchimney into which a piece of sponge packed answers perfectly. About half a teaspoonful of the solution is poured upon the sponge and the end of the chimney placed be fore the mouth, in such a manner that the mouth-end is slightly elevated. The brom. ine-fumes rise upwards. These inhalations can conveniently be kept up, even during sleep. In severe cases, the procedure is to be repeated every half hour or oftener. Cold compresses are to be applied to the throat, and chipped ice may be given. Contraindications to the bromine treatment are excessive swelling of the pharynx, laryngeal manifestations and bronchial irritation. Sharp pain in the chest is a sign that demands a temporary interruption of the treatment. POISONING BY PAIN EXPELLER.-At a recent meeting of the Koenigsberg Society of Scientific Research, Dr. Mescheds reported on a case of poisoning by pain-expeller, a popular remedy consisting of caustic ammonia, tr. capsici and alcohol. Pain-expeller is designated as a patent medicine that is extensively employed in Europe as well as in America. It is, according to competent analysis, reported to consist of twenty-five parts of tinctura capsici ex semin, of twenty parts of alcohol, and twenty parts of aqua ammonia. The chief constituents are, therefore, aqua ammonia, of well-known caustic qualities, and the strongly irritant tincture of capsicum. URETHAN as an antidote to strychnine has been mentioned by us. We learn from the N. Y. Medical Abstract that Professor Coze counteracted the tetanus produced by grain of strychnine in a frog weighing an ounce by five grains of urethan. In a dog weighing twenty-five pounds & grain of strychnine was completely counteracted by seventyfive grains of urethan. The effect of the urethan upon the blood appears to be due to an increase of oxygen. The drug has been employed with good re In the case observed, the patient was a woman of middle age. After a confinement that occurred in October, she suffered severe abdominal pain, and, in January of the follow-sults in tetanus. ing year, sought relief in Carlsbad salts and 10-20 drop doses of pain expeller. From all of the circumstances no doubt existed as to the toxic influence of the pain expeller. Gastric pain, vomiting, bloody stools and a dark urine of penetrant odor gave indication of ammoniacal poisoning. These symptoms iucreased in intensity, the remedy being continued. The pulse was rapid, the temperature below the normal. The patient recovered; the whole report however, is a caution against the free and reckless use of aqua ammonia internally. DISGUISING QUININE is such a desirable object in pharmacy, that efforts are continually being made to accomplish this desired end. Dr. Keens says in the New England Medical Monthly that the syrup of yerba santa is a vehicle that renders the sulphate of quinine not only tasteless but absolutely palatable. Five grains are rendered tasteless by one drachm of the syrup. The licorice and ulmus preparations, and the tannic acid formula are inadequate when large doses are to be given. SOCIETY PROCEEDINGS. ST. LOUIS MEDICAL SOCIETY. Stated meeting held Saturday evening, September 18, 1886. Dr. D. V. Dean in the chair. DR. HURT spoke of the fatality of scarlet fever through the summer months; that of a great many cases of his own and of those of which he had heard, many had proved fatal. Mentioned a case which he saw, in which there was no eruption, but in which he had diagnosed latent scarlet fever, and later on the child was found to have been exposed to the disease, thus rendering very probable the correctness of the diagnosis. In speaking of the treatment of the disease, said he did not think medicinal agents accomplished much good, but the best treatment to consist of placing the patient under such circumstances as would favor a mild development and course of the disease. Said that although belladonna had been highly recommended and extensively used as a specific for the trouble, he was of the opinion that it accomplished very little good. DR. WILLIAMS related a case, which he thought presented a point of some diagnostic importance. A child brought to him for complete deafness, gave a history of having had a very sick spell at the age of four months, which the mother stated was pronounced brain trouble by the doctor in attendance. A few days after the beginning of the disease, the child had become totally deaf. Upon inquiring into the symptoms of the disease, was convinced that it had been a case of cerebro-spinal meningitis,and felt more certain of it from the very fact which he thought to be of interest in the case, which was, that deafness complete, occurring in the course of a brain affection, nearly always meant cerebrospinal meningitis. DR. WOLFNER related a case of tumor of iris, in a girl eighteen years of age, which had been growing for three months; the girl had had no iritis, nor other affection of the eye; tumor was situated on the pupillary_margin of the iris, and when first seen, was about the size of a hemp seed, and was adherent to the capsule of the lens. Adhesions readily broke down and freed the tumor under the use of atropia, and suspecting a syphilitic origin for it, mercury and iodide of potassium were administered, and after the lapse of a short time, the tumor had entirely disappeared, leaving but a small spot on the iris. DR. WILLIAMS remarked that the small DR. WILLIAMS spoke of two cases of small abscesses in the iris, which had opened and discharged their contents. Also, related a case of a girl who had a varicose state of the veins of the center of the upper and lower lips, which had followed a blow received some years before. The tumors could be emptied by pressure. The swellings were cut into, and a small amount of chromic acid introduced. There was a great deal of bleeding from the upper lip, which was avoided in the lower by pressure upon the supplying vessels. In a short time both swellings disappeared. The doctor then spoke of the efficacy of chromic acid in these cases. DR. HURT thought that in too many cases, especially such a one as the tumor of the iris which was just related, the conclusion of syphilis being the cause was too frequently arrived at; that the same remedies used on account of the supposed syphilitic origin, would be the best to be applied if its causation was different, and that we were not always to conclude that the diagosis of syphilis was the correct one because the trouble disappeared under their use. DR. MEISENBACH said that the Chinese in California had great success in treatment of syphilis, and thought there must be some remedies made use of by them which were unknown to us, although all clinical experience pointed the other way. DR. MOONEY stated that a missionary who had spent many years in China, had informed him that their physicians were in the habit of using mercury for syphilis, and that it had been the remedy used by them for hundreds of years. Society then adjourned, SICK HEADACHE is relieved by Dr. Gill Wylie, New York Med. Journal, by a pill or capsule containing one grain of inspissated oxgall and one drop of oil of gaultheria, given every hour until relief is felt or six doses have been taken. CHICAGO GYNECOLOGICAL SOCIETY. [CONCLUDED.] II.-DR. A. REEVES JACKSON, in beginning the discussion on Dr. Parkes's paper on the treatment of uterine fibroids by ergot, said: I was very much pleased to hear the reading of Dr. Parkes's paper. I commenced using ergot in the treatment of fibroids in June, 1873. I had used it in eight cases at the time Dr. Byford read his paper based on 103 observations gathered from various persons in this country. I was extremely pleased with the result; two of the patients seemed to be practically cured-that is to say, while there could be distinguished some remaining enlargement of the uterus, the symptoms that were referable to the presence of the tumor were entirely removed, and the patients suffered no inconvenience from the bulk of the uterus. In nearly every case there was improvement. I continued to use it for several years, but have not used it lately-I do not know why. The cases that have been pub lished by those who use it extensively have all shown favorable results except those of Martin, of Berlin, and perhaps two or three others. There seems to be no reason to doubt that ergot, whether given hypodermically, by the mouth or rectum, does have some controlling influence on the development of uterine myomata, checking the growth or lessening the size of the tumor. Indeed, there is reason to believe that it is one of the very best means of dealing with these tumors. I have used the remedy in perhaps thirty cases. I do not know just what the ratio of success was. In about three-fourths of these cases there was benefit. Sometimes the good effect did not consist in diminution of the size of the neoplasm, but from improvement in the general health of the patient. I was very glad to hear of the almost phenomenal success that followed the practice of Dr. Parkes. In some of the cases he relates the patients were, however, in great jeopardy from the sloughing of the mass, and the difficulty of getting it away before septicemic symptoms came on. There is great danger, unquestionably, in having a sloughing fibroid retained. within the uterus. The treatment by ergot should be accompanied by dilatation of the cervix, so that the mass, when separated from the wall of the uterus, may escape readily. This would lessen that danger. In some cases death has occurred very soon after the stinking discharge appears. Nevertheless, the treatment by ergot is very much less dangerous than any of our surgical methods of dealing with uterine fibroids. THE PRESIDENT.-Have you kept records of any of your cases? DR. JACKSON.-Yes, and I shall be glad, if the interest continues, to report them in detail. I kept accurate notes of the first cases so far as I had charge of the patients. Some of them occurred in the Woman's Hospital, and the patients would go away, and we did not always have the means of ascertaining the final results. But of others, occurring in private practice, I can give accurate details. I DR. H. T. BYFORD.-I made the assertion that there was no danger of a sloughing of the tumor when it is not situated so that it can be expelled by way of the vagina. This was based on the fact that, unless submucous, it cannot be firmly enough compressed. have reported a case of fibroid tumor of the vagina (Chicago Med. Jour. and Exam., August, 1885), whose thick pedicle was gradually cut through by daily tightening a fine wire about it; when the wire had cut through the pedicle, it was found to have re-attached itself and retained its vitality, showing that tumors of this nature require very little nourishment to keep them from undergoing sloughing. The cases on record are very few in which subperitoneal growths have sloughed from the use of ergot. fi. DR. W. W. JAGGARD said, with reference to priority in the use of ergot in the treatment of uterine broids, that Hildebrandt, of Koenigsberg, had published a paper in 1872, in which he recommended the drug. The growth of the neoplasm was limited by diminished access of blood, and, in some cases it was actually expelled from the uterine cavity. Hildebrandt's recommendation was the revival of an old practice. Dr. Wm. H. Byford's paper-Ad. dress on Obstetrics-was read in Philadelphia in 1875. During the interval of three years, several papers were written, extolling the action of ergot in the treatment of uterine fi broids, both in the diminution of the quantity of blood flowing to the tumor, and also in actively causing its expulsion from the uterus. DR. HENRY T. BYFORD, said: Dr. Jaggard fails to take into consideration the different ways in which ergot acts. It acts first, in a radical way by expelling the tumor, as in the submucous variety; second, in a gradual way by causing atrophy and absorption, as in the interstitial variety; third, in a partial way, by arresting the tumor's growth and activity, as in the subserous one; fourth, in a palliative way by relieving the symptoms, as in cases of large tumors near the menopause. Schroeder, in the last edition of his Krankheiten der Weiblichen Geschlechtsorgane, gives Dr. Wm. H. Byford credit for suggesting the use of ergot for the expulsion of the tumor. There is no longer any reason to doubt that ergot is the surest and safest cure for all but the very exceptional cases of uterine fibromyomata. A tolerance of moderate doses is quickly established both by the organs both by the organs through which it is absorbed and by the general system. Sloughing is almost never produced except in the submucous variety, when it need not be dangerous. For several years past, with one or two exceptions, I have not given ergot in any other way than by the rectum. I use 5 to 8 grains of Squibb's extract of ergot twice a day, and continue it for two or three years, with favorable results. I remember one case in which the tumor ex tended almost to the umbilicus when I first saw her, five years ago. It was an irregular nodulated tumor, mostly subperitoneal, with projections larger than the fist, filling up the pelvis, and to a great extent the false pelvis also, and sometimes, caused excruciating pain by its pressure. The patient had repeatedly bled through six and eight weeks, and must have lost 100 pounds. Tampons were required to save her life. I never saw paler mucous membranes in a living being. It was a very much worse case than many which I continally find cited in medical literature, in which hysterectomy is considered necessary. The patient begged to have the tumor removed. She could not take the ergot for any length of time either by rectum or mouth; but after a while she tolerated 5-grain rectal suppositories, and has passed the menopause. The tumor, having lost its activity, has become considerably smaller; while she, having regained her hundred pounds, has become considerably larger. I have a case which had been treated for a year with all of the most approved methods, except ergot. When I first saw the patient, two years ago, she weighed eighty-three pounds; she had a nervous chill and almost fainted when I entered the room, because I was a stranger. She had not slept for weeks, except under the influ. ence of narcotics, and had symptoms of acute tuberculosis. She was in the habit of bleeding steadily from three to six weeks, and was being so rapidly destroyed by the loss of blood that I first had to use the tampon. She was put upon 8 grains of Squibb's fluid extract of ergot per rectum and tincture of iron by the mouth. Her health improved rapidly, and the hemorrhage progressively diminished. Her lungs were recently examined by Dr. H. A. Johnson, who found the remains of old trouble, but no tendency to unfavorable changes. Her cough, which had lasted so long, has entirely left her. She now takes the ergot a part of the time only. Her menses last four days, are natural in quantity and quality, and are followed every two or three months by a watery discharge of a faint pinkish tinge. She cannot feel the tumors now, although a projection the size of a child's head was formerly felt by her between the umbilicus and left groin. It might be said of this case that it was also a very proper one for operation, and one in which ergot, if harmful to the system, would have done injury. I have similarly relieved other cases nearly as bad, and cannot help believing that, when treated early, judiciously and persistently by ergot, fibroid tumors of the uterus will show a mortality of one or two per centum instead of ten per centum as at present; that hysterectomy for fibroids, with its mortality of twenty to forty per centum, will eventually become an interesting relic, and the removal of the appendages a precious rarity. DR. E. W. SAWYER said: There is one point that was not alluded to by the reader of the essay, and that has not been spoken of in the discussion. The fact that the point has been proved in practice shows that it is worthy of attention. That ergot will cause atrophy of a uterine fibroid, causing a detachment by ulceration and expulsion, is a well-estab lished fact. When the fibroid is submucous, or nearer to the mucosa of the uterus than to its peritoneal surface, I have no doubt that process can be continued and completed with safety. But let us suppose a tumor very close to the peritoneal surface; this process of atrophy takes place, the peritoneum ulcerates through, and the life of the woman is jeopardized. Such a condition occurred in a patient seen by the President of this Society, and it was shown that, had the patient lived long enough, the fibroid might have been thrown off through the abdominal parietes. This patient died of peritonitis. The large and partially detached fibroid was in a sac containing a great quantity of pus. This sac had ruptured, occasioning the peritonitis. DR. F. E. WAXHAM said: I would simply add my testimony as to the value of ergot in the treatment of submucous fibroids, by cit ing a case: A woman 45 years old came to me some time ago complaining of copious hemorrhages at her menstrual periods, and upon careful examination an enlarged uterus was found, which nearly reached the umbiliThe diagnosis of fibroid of the uterus made. This woman was placed upon ergot, combined with opium, to control the pain, which she took for several weeks. Be cus. was |