soreness. She fell asleep at 10 P. M. and slept five and a half hours, waking every half-hour.

December 3.- Complained of aching in the back; no nausea or vomiting; pulse, 70; temperature, 99.4. The urine drawn by catheter every six hours was normal and of the usual quantity. December 4. Slept seven hours; felt refreshed; desired food, and took with relish gruel made of imperial granum. Complained of slight flatulence, which was relieved by Chamomilla, and passed naturally from the bowels. Each night after this she slept quietly and soundly nine hours or more. On Dec. 7, the fifth day after the operation, the antiseptic dressing was changed under the carbolic spray, the wound was found nearly healed, and four of the stitches were removed; they were very clean, without any trace of suppuration. On the seventh day the remaining stitches were removed, the wound being healed. the thirteenth day after an enema she had two copious movements of the bowels, with very slight pain and discomfort. On the fifteenth day she sat up, and on the twenty-first was discharged cured, and rode to her home, about fifty miles, without trouble or inconvenience.

On

CASE II. Miss C, age forty-six, had been very healthy during her entire girlhood. Menses were regular from thirteen to eighteen, when they ceased for fifteen months. For ten years

or more she suffered severely from dyspepsia, after which she was comparatively well for the next ten years; has always led a very active life; is tall, and naturally very slender. Five years ago she first noticed a tumor in the left ovarian region, unaccompanied by pain or sensitiveness. This gradually increased to its present size, without seriously interfering with her activity. She now measures fifty inches at umbilicus, which is twelve inches from pubis and scrobiculus. The sides of the abdomen project about equally. The fluctuation wave is distinct over the entire abdomen. The floating ribs and lower part of sternum are pressed outward to an unusual degree by the tumor. Heart and lungs are sensibly compressed; at times has considerable dyspnoea and impeded circulation. There is oedema of the whole lower extremities. On examination the uterus was found retroverted, and pressing upon the perinæum. She entered the hospital for an operation on May 18, 1882. Her last menses had continued from April 19 to May 10. They had been irregular of late, but at times quite profuse ; reappeared to-day.

On May 25, the patient being in fairly good condition, I operated, assisted by Drs. Boothby, Jackson, Bell, Dillingham, Sutherland, and the house physician and surgeon. Drs. Selee and McCrillis and several medical students were also present. An incision eight inches in length was made through the linea

alba, commencing two inches below the umbilicus. The abdominal walls were very thin and profusely marked with veins. The superficial hemorrhage was easily controlled by torsion, and on opening the peritoneum, the tumor was found quite free from adhesions. A large trocar quickly drew off a dirty grayish fluid, and reduced the size so that the sac could be extracted from the opening. A single adhesion connected the sac with the greater curvature of the stomach; while another, somewhat firmer, attached it to the right ovary. These were ligated and easily separated without hemorrhage by the thermo-cautery. A double ligature of carbolized catgut perforated, and was thrown around the pedicle, which was on the left side, and it was divided by the thermo-cautery. But very little blood escaped into the cavity of the abdomen, and this was all carefully removed. The weight of the fluid was sixty-three and one half pounds, the sac weighing one and one half pounds. The cavity presented a remarkable appearance after the removal of the tumor. The intestines were crowded backward, empty, and of the smallest dimensions. The form of the kidneys was distinctly visible through them. The stomach was small and easily traced, and the spleen in full view. The diaphragm was forced strongly upward, and with the outspreading ribs resembled an opened umbrella. The liver was pale, concave on the under surface, with the dark gall-bladder apparent.

The wound was brought together by eight wire sutures carefully passed through the peritoneum. The immense mass of abdominal wall made the adjustment and retention of the wound a little difficult. The patient had of course been under the influence of ether, and the operation was performed under a five per cent carbolic-acid spray. The spray entered freely into the abdominal cavity, and the sponges used were thoroughly saturated with carbolized water. The patient had some symptoms of collapse, but quickly rallied under the subcutaneous injection of two drachms of brandy.

May 26. Slept six hours; has no nausea. imperial granum, two ounces every two hours.

Takes a gruel of

27. Slept eight hours last night; marked distention of descending colon, but no pain.

29. Removed three sutures; no suppuration; wound doing well.

31.- Removed the remaining five sutures.

closed.

Wound well

20. Had a natural movement of the bowels without pain.

The temperature for the ten days after the operation stood usually at 99°, and the highest point it reached was 100.8°. The pulse at one time reached 112, but was ordinarily from 90 to 98. Her sleep after the operation was uniformly better than it had been for months, and pain was almost entirely absent.

In both of these cases, as has been said, the operations were performed under carbolic-acid spray of a strength sufficient to benumb the hands of the operator and to leave an eruption upon them for two or three days. It would be an easy inference that such an irritating substance brought in contact with the extensive surface of the extremely sensitive peritoneum must prove a serious if not a fatal injury. Yet so far was this from the case that neither patient exhibited any symptom of inflammation or irritation of the peritoneum. The urine was in both cases free and not even discolored. Though the cleanliness which is so strongly insisted upon in the antiseptic treatment is undoubtedly of great importance, yet the favorable results in a large number of cases treated antiseptically has convinced me of the great efficacy of carbolic acid in warding off inflammation after severe surgical operations.

MILK AS A NASAL DOUCHE.

Translated from the French of Dr. Paul Reclus by D. G. WOODVINE, M. D., of Boston.

THE naso-pharyngeal douches have been used in therapeutics for a score of years. The works of Weber and Trölsch, in Germany, of Thudicum, in England, of Prof. Duplay, in France, demonstrate their efficiency, and at this time there are few practitioners who may not at least have heard them spoken of; but all do not appear to use them sufficiently. Accordingly, we judge it useful to recapitulate in a rapid manner some short observations where their employment has brought about a complete and prompt recovery.

We know in what the method consists: the patient introduces into one of the nares, the olive-like ferrule of the injector or siphon of Weber. He thrusts this ferrule horizontally from one to two centimeters in such a manner that the jet of liquid will not strike too violently against the summit of the nasal fossæ and frontal sinuses, which has sometimes produced severe pain. Then the syringe having been opened, or the siphon loaded, the liquid fills the nasal fosse and the upper part of the pharynx. It does not flow, as one would suppose, into the oesophagus or towards the mouth, a contraction of the veil of the palate and the posterior pillars being produced which completely obliterates the orifice. The liquid having passed from one nasal fossa into the other, runs out of the one not obstructed by the siphon.

The method has value only when the quantity of liquid which is made to pass into the nasal fossæ is considerable. As to the liquid, its nature seems to us of secondary importance. Pure water, however, is generally intolerable. It excites, Weber says, swelling of the epithelium. This author also recommends the addition of a certain portion of sea salt, tar water, or carbolic acid. The astringent injections of tannin, of alum, and sulphate of zinc rendered great service. Some extol a weak solution of bichloride of mercury. As for us, we use milk almost altogether, and the results we have obtained are so good that we should not think of resorting to any other substance.

But we repeat, the quantity of the liquid which should pass through the nasal fossa ought to be large. We have recently attended a young girl who injected into the nasal fossæ more than fifty litres of milk daily: twenty-five in the morning and twenty-five in the evening. Three quarters of an hour were sufficient for each sitting. It is useless to add that fifty litres of milk were not necessary, and that two litres only would have been sufficient to accomplish this cleansing. The milk was put back into the empty injector, and repassed fifty times through the nasal fossæ.

It is in chronic coryza, nasal catarrh, ulcerations of the mucous membrane of the nares and their more disagreeable sequela, ozæna, that this treatment has rendered great service with us. In 1878 we were consulted by a young girl, a little lymphatic, although of robust appearance. A short time after a severe

attack of scarlatina she took chronic catarrh. The nares were ulcerated; the mucous membrane of the fosse was of a reddish and violet color, thickened; the villi covered with brownish crusts; the secretion was so abundant that the patient was obliged to protect her pillows at night in order not to find them in the morning absolutely soiled with the muco-pus.

I ordered the nasal douches, and the young girl, very desirous to recover, increased the quantity of the liquid to twenty-five litres per sitting, without asking counsel of me. The amelioration was very rapid; eight days later the stoppage in the nose had ceased; the respiration at night was no longer exclusively buccal; the secretion was very much diminished. At the end of fifteen days I discovered new progress: the mucous membrane was no longer stretched and swollen; finally, at the end of a month, the recovery was complete. The expiration had lost its former fetidity, and the young girl was rarely obliged to recur to the use of the handkerchief. The recovery has been maintained. The year following she had a slight new attack, but some douches easily made her all right.

In 1879 a person brought to me a little girl of twelve years,

clearly strumous, and who had upon the upper lip quite an abundant and tenacious eruption of impetiginous eczema; the ozana was very disagreeable and the mucous secretions very abundant, troubling the little patient and disquieting the parents. The rhinoscopic examination gave me a result analogous to that which we have noted in the preceding observation. There was no ulceration, but a thick, swollen, and stretched violet appearance of the mucous membrane. The nasal douches were ordered, and here again the success was marked; at the end of thirtyfive days of conscientious treatment, by injections of milk night and morning, a cure was effected.

I might add to these observations two others; but they would be but repetitions of the first. They were cases of chronic coryza, accompanied by ozæna; and were cured in less than two months. We prefer to add a very recent case, which differs from the preceding affections.

The mayor of a village in the lower Pyrenees came to consult us two months ago for a very extensive ulceration of the nasal septum. He had been to a specialist at Bordeaux, who had without doubt believed he had an epithelioma and proposed to extirpate it. This radical operation frightened the patient, who has put himself into our hands.

The diagnosis appeared difficult; the case was of a man fifty-six years old, of splendid appearance and without any organic defect; no scrofula during childhood and no vestiges of syphilis ; elsewhere iodide of potassium had been used in large doses and without any especial result. Now a rhinoscopic examination revealed to us a deep ulcer of 2 or 3 millimetres and larger than a franc; the cartilage, however, was not made bare, although the mucous membrane of the nasal fossa opposite was swollen and villous. An albuminous crust, very concrete, covered the ulcer.

We ordered injections of milk; at the end of ten days, when he came again to see us, the ulcer had not only been cleansed but diminished in size, and we saw upon the circumference a cicatricial border some millimetres in length. In less than a month the cure was nearly complete. The continual stoppage of the nose, which had fatigued the patient, had disappeared, and none of the primitive ulcer remained except one little red spot 3 millimetres in diameter, surrounded by a cicatricial tissue of lighter color. We have not seen the patient again, but a letter from him reports his good condition. The diagnosis remains in suspense. Perhaps it was a case of ulceration of the nasal fossæ, that Trosseau and Boyer associated with a herpetic diathesis.

However it may be, we recall this case in order to introduce this method of naso-pharyngeal douches. We believe that they are not only a useful adjuvant in the treatment of these consti