her life as a housemaid and cook. Family history not clear, more or less negative. Had been in fairly good health until a week before taking to her bed, during which time she felt very tired and worn out, with some crampy pains on right side. Bowels for several weeks prior to this sickness were alternating between constipation and diarrhea. On August 25th she went to bed, and being sent for, I found upon my arrival that she had a temperature of 101°, pulse 96, some nausea, a decidedly tender tumor in right iliac region, with a markedly tender McBurney's point. Repeated applications of the tincture of iodine, followed by hot compresses frequently applied to the site of the tumor, and internally a saline purge, aconite, acetanilid and codeia, were followed with negative results, except to make the pain a little more bearable. At the end of three days' treatment I felt, not only justified, but called upon to open the abdomen, so on August 28th, with the advice and assistance of Drs. Lasher, Moore and Kingsbury, I did so, making the incision in the usual position and in the same manner as when operating for a diseased appendix vermiformis. The matting of the tissues was so great around the head of the colon, that it was deemed best to pack aseptic gauze as close to the appendix as possible, and defer further manipulation for 48 hours. At the end of that time the dressing was removed and the tissues found in the same state as when last seen. Careful separation of the adhesions revealed not a diseased appendix, as was expected, by all of us, but a mass of cheesy glands surrounding the caput coli. As much of the diseased tissue as could be, without too much risk, was removed, its site disinfected, and as there was no indication for drainage, the wound was closed with interrupted silk-worm gut sutures, and primary union secured. The temperature, which prior to the operation, had been ranging from 100° to 102° F., dropped to 99° F. and below, and so remained for nine or ten days. In fact, the case progressively improved till September 23d, when she left the hospital. While a cure is too much to be expected, her present condition is much better than I ever hoped for, and I am watching further progress of the case with great interest.

I am aware that there have been a number of cures reported-by abdominal section and drainage-of tubercular peritonitis, where the peritoneum was studded with miliary tubercles, but I have never seen a case, nor do I recollect to have seen a report of any case of recovery, where the glands were so much enlarged and in a state of caseation.

OBSERVATIONS.

The only point of unique interest in regard to the first case reported is that, so far as my knowledge goes, it is the first case of hysterectomy in a full blooded or wild Indian on record.

Case No. III. would seem to give confirmation to the now mooted theory, that malignant disease is first constitutional, with a subsequent local develop

ment.

The last two cases have been reported to show the impossibility of making an exact diagnosis of appendicitis in apparently typical cases.

Pico and Hope Streets.

DISCUSSION.

Dr. F. T. Bicknell, Los Angeles: With large fibroids one of the safest operations is the extra-peritoneal; it is not so clean, perhaps not surgical; they don't get well so quickly, but it has the least mortality. As to the diagnosis in sarcoma, think you could not determine the difference between it and fibroma without curettement and microscopic examination. In diagnosing appendicitis any one may miss it, frequently cannot tell what the organs are that are handled

should be very slow and careful as may get pus into abdomen. There seems to be a difference in the pus in appendicitis, in some cases virulent; in others, less harmful.

Dr. E. A. Praeger, Los Angeles: With reference to case of sarcoma with foul discharge, the diagnosis would lay between sarcoma, carcinoma and degenerating fibroid.

I had one case of fibroid of uterus where the only symptom was pain in the rectum-the tumor was so wedged down in the pelvis that a great deal of force was required to draw it above the sacrum.

SELECTED.

DEPARTMENT OF MEDICINE.

UNDER THE CHARGE OF DRS. F. D. ANd rose t. BULLARD.

BROMINE FOR RHUS POISONING. (The Medical Summary.)—Dr. J. W. Higgins regards it as a specific. His method is to dissolve bromine in olive oil or vaseline, 10 or 20 drops to the ounce, and gently rub this over the parts three or four times a day, and wash the parts afterward with soap. Lathering the seat of the eruption with a soft shaving brush is very relieving to the itching and burning which attends this poisoning.

TREATMENT OF QUINSY. (Jr. Amer. Med. Ass'n., Nov. 7, '96.)-Dr. J. Homer Coulter, after discussing the differential diagnosis of quinsy and alluding to the stereotyoed lines of treatment, advocates the use of lactophenin, 10 grains every three hours, having first given a mercurial cathartic followed by a saline. He also recommends the usual hot gargles and external applications. His reasons for preferring it over salol are: It is more prompt; it has thus far given no undesirable after-effects; it not only relieves pain but reduces the fever with equal certainty. He adds that in cases of evident rheumatic diathesis he would employ in addition thereto his customary remedies.

FORMALIN AN APPROXIMATE SPECIFIC FOR RINGWORM.-The Therapist (London) states that this treatment is now so well known in Guy's Hospital and had such conspicuous success that it should be part of the ordinary practice of every old Guy's man. There seems no doubt that it is the almost specific treatment for the disease, especially in obstinate and hitherto incurable cases. And yet this discovery arose from the annoying fact that the inventor's cultivation of the ringworm microbe were all killed in one night through his having left the stopper out of the formalin bottle.

The treatment referred to, carried out by Dr. Alfred Salter in 40 cases, was as follows: The fluid, formalin, was vigorously rubbed in with a largish mop or brush for ten minutes, the hair having been shaved from the margin of the patches. The application was repeated every other day on four occasions and then discontinued. In some patients the head was painted daily for four successive days. Of the forty cases only four required repainting from the non-eradication of the disease, and in these the fault lay not with the remedy but to its improper application owing to the struggles of the child. Only three cases showed suppuration and in these the hair follicles were not destroyed. It produces a thick crust and the subsequent application of an emollient is advisable to accelerate the removal of this exudation. (We have treated one case successfully by this method, the only objection being the little patient's vigorous objection to "that burning stuff." B.)

CHRONIC PLEURISY WITH EFFUSION TREATED WITH PROTONUCLEIN. (N. Y. Med. Jr., Oct. 10, 1896.)-Dr. Almon H. Cooke reports the following case:

A lady, very thin, had lost ten pounds or more, complained of severe pain at base of right lung when she took more than a shallow inspiration. Examination gave evidences of adhesions and the exploring needle proved the presence of serous fluid containing a few pus cells, temperature 100.5° F. Protonuclein tablets were given (five per day). Also ten minims of fl. ext. cascara at bedtime. The surface over the painful area was painted with iodine every second or third evening. Her diet consisted of not less than half a pound of lean beef or chops at two meals each day, with vegetables in limited quantities, to which was added one half pint of cream each day.

She gained flesh at the rate of a pound a week. The temperature became normal at the end of the second week; deep inspiration gave no pain early in the third week. No trace of fluid could be found by tenth day, while after eight weeks she declared she never felt better in her life.

Dr. Cooke thinks without active treatment the case would have terminated in empyema and advises a similar treatment in all cases of pleurisy where absorption of the effusion is delayed.

CONTAGIOUS IMPETIGO. (Pediatrics, October, 1896.)-William S. Gottheil, M.D. This is a self-limited contagious disease of children appearing in localized epidemics, and first described by Tilbury Fox in 1864. Accompanied by a moderate fever and some gastric disturbance, there appear on the face and hands groups of flat vesicles filled with transparent or cloudy serum. These dry up into characteristic golden-yellow crusts, which fall off in two or three weeks, leaving circular, reddened, non-ulcerated areas behind. Successive crops of vesicles may prolong the disease for two months or more. It is undoubtedly parasitic, but, though Kaposi claims to have found it, the etiological factor is still unknown. The treatment consists in removal of the crusts with olive oil compresses, cleansing the skin with hot water and soap, boric acid solution, etc., followed by the use of Lassar's paste:

UNDER THE CHARGE OF JOS. KURTZ, M. D., PROFESSOR OF CLINICAL SURGERY IN THE COLLEGE OF MEDICINE, UNIVERSITY OF SOUTHERN

CALIFORNIA, AND CARL KURTZ, M. D.

NEW METHOD OF CIRCULAR SUTURE OF THE INTESTINES. (Wien. klin. Rundschau.)-E. Ullmann recently presented at a meeting of the k. k. Ges. der Aerzte in Vienna, a patient cured of a tuberculous neoplasm in the cecum by resection of part of the ileum and cecum. One end of the intestine was then turned inside and the other end inserted in it, like an intussusception, thus bringing the surfaces of the serous membrane on each end into contact inside the intestine for quite a little distance. A piece of carrot shaped like a cylinder, with a hole through it and a deep groove around the center outside, had been placed inside the intussusception. A strong catgut ligature was then made around it, fitting into the groove and pressing the two serous surfaces together.

Gas passed through the first day and feces in a week, followed by rapid recovery. This simple operation requires but a couple of minutes and after the abdominal wound is closed the union is very firm, as the intestines grow together at once, and the carrot forms a strong enough support, which even force will not dislodge, as Ullman states. He has found by various tests that the catgut remains unaltered long enough to accomplish its purpose.

PNEUMOTOMY IN THE TREATMENT OF HYDATIC CYSTS OF THE LUNGS. (Presse Méd.) -Tuffier has collected the statistics of 58 pneumotomies on record for the relief of hydatic cysts of the lung, and 71 pleurotomies with two deaths, and four interventions in non-suppurated central cysts. He advises the oblique thoraco-abdominal incision on the rear edge of the axillary line, on account of the extreme difficulty of differentiating a cyst in the lung from one in the liver, as the neoplasm pushes the lung so far out of its normal position. He concludes that pneumotomy is the operation to be preferred, as it has given over 90 per cent. of recoveries, while medical expectation has entailed mortality of 64 per cent. He prefers chloroform in these cases to ether, and advises long tamponing to avoid danger of hemorrhage.

a

SURGICAL TREATMENT OF CANCER OF THE STOMACH. (Bulletin Méd.)-Kocher, of Berlin, states that gastrectomy for cancer is now an absolutely certain surgical operation, and that physicians generally should be informed of this fact, so that they can have their patients operated upon at the earliest possible moment, with the guarantee of almost certain cure. Péan reports numerous operations for cancer, but only twelve gastrectomies, with four deaths: In four cases of chronic ulcer of the stomach, accompanied by such pain that it was impossible to refuse the patients the possibility of relief by an operation, all four were completely cured. He was also successful with several cases of non-cancerous stenosis of the pylorus. He advocates closing the stomach completely, and then making an anastomosis with some loop of the intestine near by (gastro-duodenostomy), in cases where it is necessary to remove a very large amount of substance on account of the extent of the cancerous growth. Intervention is always possible when the upper part of the duodenum alone is affected and a small, even very small, portion of the stomach near the cardia can be retained. He has performed fourteen gastro-enterostomies, and uses the Murphy button. Doyen reports a total of 94 operations on the stomach, including 55 for non-cancerous lesions, ulcers, dilatation or severe dyspepsia with advanced cachexia, cases abandoned by physicians. He attributes his surprising success in these latter cases to the fact that the dyspepsia is caused by some constriction of the pylorus, and disappears when normal communication is re-established between the stomach and the intestines. He has never used an anastomotic button, which he considers a step backward in surgery. He requires only 25 minutes at the outside to complete the operation. Roux has twelve successes to report with one failure. He makes a Y-shaped incision (gastro-enterostomy), to avoid "elbows," which are liable to occur with a lateral operation. He prefers a button to a poor suture, but considers a well-made suture far preferable to any button, as the patient can begin to take nourishment at once, a most important factor in rapid recovery.

A NEW OPERATION FOR FISTULA IN ANO. (Pittsburgh Med. Review.) Dr. Geo. W. Ely. When the patient is thoroughly anesthetized and placed in the dorsal lithotomy position the sphincters should be stretched; this can be rapidly and easily accomplished by the use of the two thumbs inserted in the anus and hinds supported upon the nates; when this is accomplished the rectum

should be thoroughly douched with antiseptics and plugged above extent of sinus with a sponge on a string.

Insert a grooved director into the sinus emerging at the inner opening, if one is present; if not, make one; insert the finger and draw this end outside the anus, thus having the entire extent of sinus external to the anus, when it should be laid open throughout its whole course. If any ramifications be present they should be summarily dealt with in a like manner, and all surfaces thus exposed thoroughly curetted and douched to prevent any infection of the subsequent wounds which are now to be made.

Thus far, as can be seen, the operation does not differ from those now in vogue; but, instead of stopping here, as all of them do, we proceed to the distinctive features of the operation, which consist in dissecting out all of the indurated tissues surrounding the previous sinuses and of necessity including all of the pus-secreting membrane which lined the cavities. After this is done, there is left a clean wound, in healthy tissues; evidently what remains to be done to complete the operation is to close the wound, to do which use a full curved needle on a holder threaded with catgut, beginning from above at the inner extremity of the cone-like cavity, formed by the excision, proceeding outward until enough has been inserted to insure a complete closure of the wound; it is to be borne in mind that these sutures are to be submucous-that is, insert the needle just beneath the mucous membrane on one side of the cut surface, carrying it completely around the wound and emerging just opposite, likewise excluding the mucous membrane. The reason for the sutures being thus inserted is to prevent any subsequent infection by capillarity.

When all of the sutures are in situ and tied, the remaining wound in the mucous membrane, which will be nothing more than a simple incision, is to be closed by a continuous catgut suture, after which all that remains to be done is to irrigate and dust the surface with a little iodoform powder, apply a T bandage and put the patient to bed, where he should be kept for at least one week; bowels kept confined, and the diet limited and fluid.

He may now be given an enema and allowed to get up, but for about a week longer should be guarded so as to insure soft stools if possible.

In a series of six cases thus operated upon three were completely successful, the patients leaving the hospital in a little over a week-cured. The first case was a failure, owing to an accidental pollution of the wound at the time of operation; the two others shared a like fate later, yet they were cured even in a shorter time than they would have been by the other methods, showing thereby that even if an ideal result is not obtained in every case, there is a decided advance in the method.

OBSTETRICS AND GYNECOLOGY.

UNDER THE CHARGE OF WALTER LINDLEY, M.D, PROFESSOR OF GYNEC OLOGY IN THE COLLEGE OF MEDICINE, UNIVERSITY

OF SOUTHERN CALIFORNIA.

CLEANING RUSTY INSTRUMENTS. (Jour. Brit. Dent. Assoc.)-Brodie gives the following as an effective method of cleaning rusty instruments: "Fill a suitable vessel with a saturated solution of stannous chloride (chloride tin) in distilled water. Immerse the rusty instruments and let them remain over night. Rub dry with chamois after rinsing in running water, and they will be of a bright silvery whiteness."-Clinique.