to five grains in an ounce of alcohol and water. This must be repeated two or three times a day and persisted in.

TREATMENT OF REFLEX CONVULSION OF DENTITION PERIOD.

Cartaya summarily treats these convulsions, dependent, according to Brown-Sequard, Jaccoud and Sarrazin, upon the transmission of the irritation of the terminal branches of the dental and gingival nerves, to the nervous centers, to be reflected upon their trophic nerves, and thus producing the so-called reflex convulsions, by pulling out the offending teeth.

In five cases which came under the author's observation, recovery followed the adoption of this method, while two died of concomitant scarlet-fever.

BERGEON'S METHOD.

A lengthy discussion on the subject of the treatment of phthisis by the injection into the rectum of sulphuretted hydrogen and carbonic acid gas took place at the meeting of the Association of American Physicians, the general result of the discussion being that the method was far from being satisfactory. Dr. Bennet described the discussion in the Brit. Med. Jour. at the time, and said that between fifty and sixty cases altogether were mentioned but in no one did they consider that the im' provement was very marked; in a very con. siderable proportion the treatment had to be abandoned owing to the occurrence of colic,diarrhea, vomiting, or collapse. The most san. guine advocate of the method claimed for it only that it mitigated cough, diminished fever, and lessened night-sweats. Dr. William Pepper had used it in thirty-four cases, but had been compelled to abandon it in ten ca. ses; in the remaining cases it was continued for an average of twenty-five days. The improvement in the cough was not marked; the expectoration was diminished in four cases. The weight was recorded in twenty cases; in eight there was a gain, amounting in one case

to 8 lbs. in thirty-seven days; in six cases there was no change; and in six the weight decreased. The temperature was systemati cally taken in sixteen cases; in four it was reduced, but in no one case was it maintained continuously at the normal. Night-sweats were not very numerous, but the treatment had a beneficial effect on them in eight cases. Dr. Forchheimer related a control experiment which he had made. He began by giving sulphuretted hydrogen and carbonic acid. After some time carbonic acid was given alone for several days, then air was injected through the Bergeon apparatus. He stated that the patients treated with air did about as well as those treated with sulphuretted hy drogen, and the injection of air did not give rise to any special inconvenience.

HYPNOTISM AND ITS EFFECTS.

If the exponents of hypnotism had lived a hundred years ago, instead of at the present time, and had practiced their methods as they do now, the chances for their being seized and burned for practicing the black art would have been very good. Dr. S. L. Trivus relates a case in which he performed avulsion of the great toe nail while the woman was under the influence of hypnotism. The operation lasted about twenty minutes. At first the woman occasionally moved her foot about, but when the author had suggested that no more pain was to be inflicted, and that the foot must be kept at rest, she sat quite quiet until the matrix of the toe was incised. At that point of the operation she shrieked out, and when questioned about the cause, stated that "a dog had just bitten her." After applying the dressing, Dr. Trivus woke her up, and asked whether she would consent to the operation. She hesitated a little, and then said, "Yes, go on." said, "Yes, go on." On his pointing to her bandaged foot, however, she at once guessed that all was over already, and burst into laughter followed by hysterical sobs. No pain was felt until the next day, when she became somewhat lame. Dr. Trivus also reates an instructive case in which a young

SOCIETY PROCEEDINGS.

ST. LOUIS MEDICAL SOCIETY.

Stated meeting Oct. 15, 1887, the President, S. Pollak M.D., in the Chair. F. D. Mooney, M.D., Secretary.

DR. EDWARD BORCK.-July 24, 1887, I first saw a man, who had got caught in some machinery, which tore off all the muscles of the extensor side, laying bare the radius. The pronator brevis was also torn in two; I was at a loss what to do. The man would not listen to amputation. No large blood vessels or nerves being injured, I removed all the superfluous muscles and let it stay till morning. He had a powerful constitution, and we determined to try to save the arm. The third day the pulse and temperature rose some for a day or two, then it sank down afa dose of epsom salts, and the pulse varied from 82 to 83 for four weeks. One morning about the end of August, he told me he had a chill during the night; then fever, and fearful suppuration set in; the elbow joint inflamed, and the case looked very bad. The periosteum being destroyed, nature pushed out the ulna leaving it almost bare. What to do with the case, was the question. I showed it to Dr. Dean. I intended to save part of the bone, to saw it longitudinally, but the patient went from bad to worse, and I finally determined that the bone would have to be removed. The tendons were all cut and I took the tendon of the extensor minimi digiti, and fastened it to the tendon of the communis digitorum, holding them together with a fine needle. For a while he could move all the fingers except the little one; now he can move that too. I removed the whole ulna; nature had already thrust it nearly out. Already new bone had formed on the flexor side. From that on, the patient did well; the wound healed kindly except the formation of a few abscesses. The power of repairing was so great that after opening one, the next day it would be healed. I removed the bone Sept. 11. For the first time he walked about today. I will present him here for your inspec. tion. I kept the arm at a right angle. In the beginning, of course, I gave him nothing but a dose of epsom salts, and a dose of morphine when he could not sleep. When the fever and chills began, I put him on iodide of potassium, because it is the best antiseptic we have, I think-in large doses. After the removal of the bone we gave him quinine. Dressing consisted in the rinsing with Condy's fluid and dressing with iodoform guaze.

In the beginning, nothing but warm salt water and antiseptic gauze.

DR. T. F. PREWITT, presenting cases, said, the first case is that of a colored boy, aged 18 years. He noticed about a year ago a little warty growth on the antitragus, and after about three weeks it was taken out. He subsequently noticed that it had commenced to grow again in a month: it grew rapidly be hind the ear. He first came to the clinic the 13th of June, and then had a projection on the front of the cartilage of the ear, about as large as the front end of a thumb, while the whole base of the ear was lifted up. I diagnosed sarcoma, and as there was nothing else to do, I removed the whole ear. It did well, was healing kindly for a while, but later it commenced to grow behind the ear rapidly. I concluded to attempt its removal a second time, and again commenced pretty well up and denuded bone, along the border of the superior maxilla, tied the external carotid artery-cutting the seventh pair of nerves in the first instance. I removed the parotid gland, laying bare the internal carotid and vein. That was three weeks ago. Now it is granulating and there is no evidence of its reproduction so far.

The second case is a boy 15 years old. He had an attack of pneumonia beginning March 23. July 17, he first came to me, and I found an extensive effusion in the left chest, the heart pushed to the right, and respiration exceedingly difficult; he had fever and was looking badly. I told the mother and himself that it would be necessary to open the chest ; he was frightened and ran away, but he came back, and he permitted me to make an aspiration, when I drew off a pint of pus, and stopped then on account of dyspnea. The next day I aspirated and drew of three pints of pus; the 20th of July, 1 pints: again July 22 and 24, and a week afterwards I aspirated. By that time it was evident that aspiration would do no good. I had expected as much at first. August 4, I opened the chest and resected the fifth rib, withdrawing an immense amount of pus, nearly two gallons. I

introduced a drainage tube, making also an opening lower down through which to run the tube. Before opening the chest, there had begun to be a projection at the upper part anteriorly, about the third interspace, and looked as if it would ulcerate through in a short while. The cavity was washed out, the boy improved, and he is now quite fat. The tube came out a few days ago.

One year ago, an old man came to me, with an epitheliomatous ulcer on the side of the face, which I removed. It healed kindly, but

he came back with the growth behind the ear as large as a hen's egg, firm, interfering with the movements of the jaw, and he was anxious to have something done. I didn't give him an encouraging prognosis, but there was nothing else to do, and I attempted to remove it. I cut down on it, found it necessary to resect part of the zygoma, and of the upper jaw, on account of the adhesions, and for the same reason removed the cartilage of the ear in front. I had to remove also the parotid gland, tied the external carotid, and subsequently the internal maxillary on account of the recurrent flow. The only things left in that region were the large blood vessels. The old man bore the operation and went home this morning.

DR. FRANK GLASGOW.-In regard to the sarcomatous patient, the Society has met him before. Two years ago Dr. Jones sent me a small wart from the concha of the ear of a colored man, the nature of which he did not understand. It had been growing for three or four months. I made a section of it and found it a mixed celled-sarcoma, and he published the case, I believe. He probably read a paper on the subject, as it was an unusual site for a sarcoma to originate.

DR. ROBEBT BARCLAY.-This is as the doctors have said, a very rare affection in these parts. Malignant disease of the ear is very I have seen but three cases, one of sarcoma and two of carcinoma. Another case, a tubercular syphilide, might have been taken for a carcinoma.

rare;

The sarcoma of the right concha was one inch long, inch thick. It began as a small blue spot extending directly outwards. It was thought at first that it was an angio-sarcoma; subsequent microscopic examination cleared the diagnosis. There was nothing the matter with the ear except this growth; the glands were not involved. It is the generally accepted opinion that sarcoma is very apt to be carried by the blood vessels, while carcinoma and syphilis are borne by the lymphatics. If the poison in this case had been carried, we would hardly have thought that the glands would be involved, accepting this theory. However, any inflammation about these is apt to cause enlargement of the glands. The case I spoke of was operated upon by first removing with curved scissors, curetting and then the Paquelin cautery at a red heat. It healed over, and several years afterwards there was no return of the growth.

After the removal of the auricle, it is a difficult matter to keep the canal from closing. I have one case of atresia of the canal. It was first a tubercular syphilide, then ulcera

tion, and the thing closed with a very thick scar, except at one spot where it had been rather thin. I operated and had the usual difficulty in keeping it open. First with cotton, a compressible rubber tube which dilated the canal, and then introduced an elliptical cylinder which has kept it open ever since. It is cicatrized and I hope to keep it there long enough to make the dilatation permanent.

DR. BORCK.-I think that a plain glass tube will probably keep open the canal. In the other case, Dr. Prewitt employed the rubber tube; the question occurs, is it actually necessary? Why do we resect the rib? I think you can do away with that part of the operation. In my last case, I simply opened it with the knife, introduced a glass tube. It does not irritate, and the wound can not close on it and contract the tube, as it does with the rubber one.

DR. F. J. LUTZ.-Eight years ago I was subjected to severe criticism for resecting a rib because it was supposed to be unnecessary. I resected a portion of the ribs for pyo-thorax and I was, five years afterwards, fortunate enough to obtain a portion of the thorax post-mortem. What was then a comparatively new procedure, has since become established in surgery of the thorax in certain cases. Itsobject in empyema is not simply an evacua tion of the pus; there is another object, the approximation of the costal and pulmonic pleuræ, the obliteration of an abscess cavity hastened by diminution in the size of the thorax. There is a marked difference in the two sides of the case; left thorax is compressed. Whilst in children, in whom all reparative processes are carried on rapidly, it may not be the sine qua non, it may not be necessary, yet in adults, many cases which are treated simply by incision and drainage tube are subsequently converted into chronic inflammatory troubles of the pleura and lung. It has been suggested that a portion of several ribs be removed to facilitate the dropping in of the thorax. The simple introduction of the tube does not in many cases accomplish the proper drainage of the cavity, unless it be placed in the most dependent portion, assuming the patient to be in the erect position, and a portion of the pus remains. If laudable in the beginning, exposure will convert it into fertid pus, and in spite of our efforts to wash it out, the fever does not subside, septicemia, and possibly pyemia set up. I believe it to be better surgery, and safer to proceed as Dr. Prewitt has in this case.

DR. D. V. DEAN.-One method of treatment not mentioned, that of introducing a

tube and having its other end in a fluid, keeping it constantly drained, might be better than resection.

DR. E. H. GREGORY.-I agree with Dr. Prewitt, Dr. Lutz and Dr. Borck. I endorse everything that I have said. There are comparatively few cases that require this graver procedure, but I certainly agree with Dr. Lutz that there are certain cases where it is required. There is only one thing that I might take issue with Dr.Lutz on, and that is regarding laudable pus. I have been an advocate of that for many years, but there is a question in my mind whether there is any such thing. DR. PREWITT.-So far as resection of the rib is concerned, I cannot see that it adds a great deal to the gravity of the operation. It is easily done; you simply enlarge the opening into the chest, and the ribs are stretched apart, but as the contracting process goes on, these ribs approximate more closely than in health. How could you retain any sort of drainage tube there without compression? Certainly, rubber will be compressed. As to the glass tube, it seems to me that you don't want a solid tube sticking out into the cavity of the chest until the cavity is closed up. If one could have a tube so arranged that the ends would turn up and lie against the wall it might do, but I didn't have such a tube. Contraction of the chest is favored by resection, as Dr. Lutz says, especially in the long standing cases of pyothorax, where the lung cannot expand, and the space would be too great for the pleura to come in apposition. So we must provide for the further contraction by the removal of the bony wall. I agree with Dr. Lutz that, in adults, aspiration is truly worthless. In regard to the antiseptic drainage to which Dr. Dean refers, we might do it in hospitals, but it is not easy to do it in clinical practice, and it is out of the question in a case like this; he would never have staid on his back.

DR. GLASGOW read a paper on "A New Method (closed) of Treating Abscess Cavities." (p. 511).

DR. PREWITT.—I have been in the habit of injecting abscess cavities for several years with an emulsion of iodoform in glycerine. I remember one case of a man who was shot in the chest. I took out the ball posterior to the scapula. Pus formed and suppuration ensued, and an opening was made in the axilla.

I

was anxious to enlarge the opening of entrance, but he would never allow me to do it; finally, I injected the cavity with an emulsion of iodoform in glycerine. He sprang up and seemed almost on the point of suffocation, and I really thought he was going to die, but

reassured him. It had gotten into the bronchial tubes, but from that time the cavity scarcely secreted any pus and, he rapidly recovered.

Recently we had a woman, some months after parturition, with an abscess on the left side, just above the crest of the ilium, with an opening on the outer side of the ilium on the other side. I was convinced that the openings connected, but was not able to demon. strate it; and I made an opening above the crest of the ilium and carried it over, made an opening below, evacuated pus and repeatedly injected glycerine emulsion, and in one of the washings water came out of the opening on the other side. I don't know how the communication was made, but it seemed to pass across the pelvis. Iodoform has certainly been of benefit to her, but not quite so promptly as Dr. Glasgow mentions. I have not had such good results; whether it is on account of the oil, I do not know. As to its use in suppurating buboes, it would not be so successful; there you have a disintegrating gland which keeps up the suppuration, and often there is a chancroidal poison also.

DR. W. JOHNSTON.-Those who have injected laudable pus, and no fever or unfavor. able symptoms have been produced will say that there is such a thing as laudable pus. As regards injecting large abscesses, it is nothing more than applying nitrate of silver, etc., to an indolent sore, and the use of the oil would be to soothe the irritation.

DR. DEAN.-Beta-naphthol, it is said, is poisonous; hydro-naphthol is not so, it is claimed. I have often used it.

DR. GLASGOW.-One point that was not touched on was that of dressing the abscess and waiting until it was healed before reopening it, as in fresh wounds. By no other treatment can that be done, I believe.

Dr. O. A. HARTWIG.-Four years ago I saw large abscesses injected with iodine, and packed with salicylated cotton, also benzoic acid. The only thing I use now is iodoform in linseed oil. We might use Lugol's solution, which is more pleasant than iodoform.

Dr. DEAN.-I think he will have to admit that the wound must be made aseptic before closing it, and that the solution that might remain would meet anything that might still exist there, supposing it not entirely aseptic.

-Of 122 persons said to have been bitten by rabid dogs in one year, and to have been treated within ten days by Dr. Ullman, of Vienna,by Pasteur's method, three are reported to have died, while of several persons bitten at the same time who underwent no treatment, all have since died.