trolling bleeding was so pronounced that I am persuaded that my experience may interest others.

The first case was one of a minor character, namely, one of sebaceous cyst. I injected the solution hypodermatically in the region of the cyst, and was then enabled to do a bloodless operation. It had been my experience that these little tumors are not infrequently troublesome on account of the persistent oozing of blood that follows their removal but, as I have stated, in this case the operation was practically a bloodless one.

The second case was one of carcinoma of the superior carotid triangle. After the administration of chloroform had begun, and about twenty minutes before I commenced to operate, I injected aoruud the growth thirty minims of the 1:1000 Solution Adrenalin Chloride. To my surprise the first incision was bloodless, and this feature prevailed during the entire operation. Occasionally, as I proceeded, a little oozing would take place, but in every instance the application of the Adrenalin Solution by means of a pledget of cotton controlled it immediately. Not only was capillary and venous oozing kept in check, but the Adrelnain served as a stimulant to the patient who, though sixty-four years of age, was kept under the influence of the anesthetic for fully two and a half hours. The perfect control which I was enabled to exercise over the bleeding in this case facilitated the complete separation of the growth from the surrounding structures; reduced materially the risk of injury to adjacent vessels, nerves and muscles; and obviated the necessity of continually mopping the wound, thus shortening the period of anesthesia and consequently minimizing the patient's risk. The tumor was removed two weeks ago and the patient will soon be discharged. My friend, Dr. T. S. Dabney, witnessed the operation, and I am sure that he will confirm the statement that not more than a tablespoonful of blood was lost in all.

The third case to which I wish to refer was one of schirrus of the right breast, of eight month's standing. I operated upon this woman, who was forty years of age, upon November 8, 1900, Dr. Dabney assisting me. During anesthesia I injected twenty-five minims of Adrenalin Chloride Solution, 1:1000, around the tumor. In about fifteen minutes the surface of the mass became blanched and I proceeded to do what proved to be

a practically bloodless operation, which lasted for fully one hour. Considering the fact that the operation was an extensive one, and taking into account the vascularity of the mammary gland, the result in this case is more than surprising.

I feel that I cannot commend Adrenalin too highly; I would advocate its use in all surgical cases in which a clean and bloodless field is a desideratum. In conclusion, I wish to state that I have observed no ill effects from its use in these cases, not even secondary capillary hemorrhage.

Clinical Reports.

REPORT OF CASES.*

BY EUGENE CARL ROEMLE, PH.D., M.D., LOUISVILLE, KY., Professor of Materia Medica and Therapeutics in Hospital College of Medicine, of Louisville, Ky.

Gentlemen Kindly allow me first to thank you for your exceedingly great courtesy of reading a paper before your honorable society. I do, however, wish to report to you a few cases in which I have used severel preparations, which have proved to be very efficient to me.

CASE I.-Mr. A. L., æt. 28; occupation, carpenter. Diagnosis, chronic gastritis, presenting the following symptoms. The appetite was sometimes very good, but most always very greatly impaired. Especially after eating, the patient would complain of great oppression in the region of the stomach, this would become aggravated and actually amount to pain. There was also pain when the stomach was empty. The tongue was coated and the patient complained of a very bad taste in the mouth; the tip of the tongue was unusually red. The salivary and pharyngeal secretions were greatly inoreased. Nausea and vomiting were also present, especially in the early morning. Although the in

*Read before the Kentucky Society of Medicine.

testines were not greatly distended, there was some eructation of gas, which would sometimes continue for several hours after eating food. With the gas bitter fluid would also be brought up.

Treatment.—The patient was given, by his former physician, the regular treatments. When the writer was called he gave him a thorough purge and some digestive ferments, but without any good results. After trying these for several days, he placed the patient upon Peptenzyme, also using Trophonine and Protonuclein as nutritive products. Within two days the patient ceased to vomit and feel nauseated, and within three weeks made a complete recovery, having suffered for nine months before the writer was called to attend him. The second case is as follows:

CASE II.-C. F., a victim of typhoid fever, presenting the following symptoms. (I deemed it necessary in this case to discuss the symptoms separately). The onset was not abrupt, there being at first a general feeling of lassitude and inaptitude for work. There was no absolute chill, but a chilly feeling, nausea, vomiting, hebetude, loss of appetite, pain in the back and nose bleeding. These symptoms increased in severity until the patient took to her bed in the second week. There was a steady rise in temperature, it reaching 1041°, the pulse was rapid, reaching 120, the tension was low and often dicrotic, tongue was coated and white. Although the patient was not delirious, she did seem to wander a great deal. The bowels were not constipated, but the patient had three or four actions a day. Toward the end of the second week, the spleen became enlarged and the characteristic pathognomic spots made their appearance. Cough and bronchitic symptoms made the first appearance during the first few days of the disease. I feel that I have mentioned enough of the symptoms to convince any physician as to the diagnosis. I will therefore come to the treatment.

Treatment. The writer used all medications, but the nausea and vomiting caused all to be thrown up. The intestines were thoroughly cleaned with the following:

Also the following as a stomachic tonic which gave no results whatever:

The patient did not seem to get along well at all. Finally, she was given the Peptenzyme and Protonuclein. The stomach at once began to retain the emulsion of turpentine, which was given as an intestinal antiseptic, and after the lapse of four weeks, the patient made an uneventful recovery.

CASE III. Mrs. M., æt. 36. This lady has been passing from two to four litres of urine of a specific gravity of 1012 per day. Albumin was abundant in great quantities, showing on either the heat or nitric acid tests. The number of white blood corpuscles were greatly diminished, which we all know are increased by the employment of Protonuclein in five grain tablets (and the writer prefers it in this form in order to prevent substitution.) It was necessary for the patient to get up several times during the night to relieve the bladder, which would become very greatly distended. The inability of the stomach to retain any medicine whatever, seemed to be the greatest trouble. She had been given the so-called stomachic tonics without satisfactory results. Finally, I gave her the Peptenzyme and Trophonine. This was firmly retained, and after she had taken the five grain tablets of Protonuclein she was able to retain all other medicines given for Bright's disease, which she had been suffering from.

CASE IV. Mr. L. T., æt. 42. This patient presented the following symptoms. Very uncomfortable feeling in the abdomen. Headacha, mental depression, dyspepsia, in which there was invariably attacks of vomiting. Tongue was coated and he suffered with constipation and biliousness. Although there were no tube casts found in the urine, albumin was constant in its presence to a very great extent, showing upon the heat and nitric acid tests. He was also placed upon the Peptenzyme and Trophonine, using the Protonuclein as a tonic. After twelve days the patient was entirely well. It has been six weeks now, gentlemen, since I have had to see this patient and know that he has had made a very satisfactory recovery.

CASE V.-Miss K. J., æt. 21; occupation, school teacher. Diagnosis, hysteria. Would arise in the morning and be very

nervous, in fact, so much so that she was entirely unable to carry food to her mouth. Upon getting up in the morning she would reject any food that would be taken. She had been under treatment of several other physicians before the writer was called, and he also at first placed her upon the bromides and the regular treatment for such disorders, but without gratifying results. She was then placed upon Pentenzyme and Protonuclein, and has, after one week's treatment, made a most happy recovery.

Gentlemen, I could cite a greater number of cases, but since. my time is so limited I must stop. I thank you very kindly for the attention given me during the reading of my essay this evening.

Abstracts.

THE TREATMENT OF NASAL CATARRH BY THE

GENERAL PRACTITIONER.

BY EUGENE C. UNDERWOOD, M. D.,

Surgeon B. & O. S. W. R. R.; Surgeon K. & I. C. Co, etc., Louisville, Ky.

(Abstract from St. Louis Medical and Surgical Journal, July, 1901.)

I have long entertained the view that the general practitioner neglects to treat his patients for catarrh and sends them to a specialist when he could successfully manage these himself. In fact, the treatment of catarrh is very simple and the results which follow correct and systematic treatment are very satisfactory. In practice, two forms of chronic nasal catarrh are met. These are hypertrophic rhinitis and atrophic rhinitis.

The hypertrophic form is more generally seen, and is chacterized by a thick mucous discharge from the nose, great liability to colas, obstruction of one or both nostrils, which forces the patient to breath through his mouth, nasal intonation of the voice. There is more or less headache and the sense of smell is lost or impaired. There is dryness of the throat, deafness