long board splint on the outer aspect. This dressing was allowed to remain on one month. Before applying this dressing the child was anesthetized to make sure the dislocation had not recurred, and the dressing was applied under the anesthetic. The deformity was found to be due entirely to muscular spasm, as it could be made to disappear altogether under the influence of the anesthetic. When this dressing was removed at the end of a month the little patient was left free, but kept in bed. At the end of a week the deformity had all returned. The limb was again dressed in plaster, and the patient allowed to go about with crutches and a high shoe on the good foot. This treatment was persisted in for something over two months, and when the dressing was removed the limb lapsed again into the same condition-flexion, adduction, inversion and shortening. The patient was then allowed to go without any support except crutches and a high shoe on the good foot, but the deformity failed to improve or progress. Then, at the suggestion of Dr. A. M. Vance, who saw him in consultation, he was sent to the Children's Hospital, and placed in bed with a Buck's extension. In twenty-four hours all deformity disappeared, and the injured limb showed half an inch longer than the other. This treatment was persisted in for eight weeks, and the patient sent home with a molded leather brace, crutches and a high shoe. There was a slight relapse of adduction which produced about half an inch of shortening, which is the condition now, a year and a half after the injury. It was not deemed advisable to apply any further methods of treatment, and all appliances are removed, and the child allowed to run at will. The result in this case is far from perfect, but the patient is by no means a cripple. The recital of this experience may serve to illustrate the effect of age in an injury of this kind. The injury must be very rare, because I have not been able to find one reported as early as three and one-half years. We are taught that dislocations of the hip when reduced and dressed in extensions usually recover in three or four weeks. That may apply with adults, but it evidently does not in children of tender years.

CASE No. 7.—A very robust mulatto woman, aged forty-five, applied to me on account of a fibroid tumor, which was giving her trouble by its mechanical pressure. The case was operated on jointly by Professor McMurtry and myself. The tumor proved to be one of the heavy set variety, and had to be removed by morcellation. The patient made a smooth recovery, the incision healing by first intention at the end of the fourth week. She was sitting up in her bed, and had

been promised she might go home in a day or two. I was called one night about this time, the nurse saying that Kate's pulse was feeble. She had dyspnea and a terrible pain in the left leg. I realized at once the gravity of the situation, and gave instructions accordingly. When I saw the patient in two or three hours dissolution had commenced. The left thigh was swollen to twice its normal size and marbled; the whole limb was cold and pulseless. Dyspnea was the most distressing of all the symptoms. The patient died within another hour, and, although no post-mortem was held, the clinical evidence was sufficient to warrant the conclusion that an embolus had lodged in the popliteal vein, had been detached and carried to the pulmonary artery, plugging the vessel and producing death. Whence it came I have no means of knowing, unless from some of the large sinuses that supplied the fibroid. This case illustrates the extremely hazardous vocation of the surgeon, and how utterly helpless we ofttimes are to deal with an unexpected emergency, and how the most remote of all the risks. will be the one to bring us to grief.

CASE NO. 8.-I have here another specimen of an appendix removed ten days ago. I merely exhibit it to show again the extent of pathological involvement in a short time. This young man was about twenty two years of age, and of the short, tat type. I saw him on Thanksgiving night, about two hours after the onset of the symptoms. He had the localized tenderness, and a temperature of 99°, pulse 132. I removed the organ the next morning, about fourteen hours after the beginning of the attack, and was astonished to find the gangrenous condition of the parts as here illustrated, the necrosis extending to the adjacent fatty structure and omentum. The abdomen was closed with through and through silkworm gut sutures, and a cigarette drain communicating with the site of the buried stump of appendix. The patient made a good recovery.

FOLLICULAR TONSILLITIS*.

BY SAM. P. MYER, M.D.

This variety of inflammation of the tonsil differs very little from the superficial variety, the main point of difference being the extent of the structures involved, it chiefly affects the young adult and those of middle life, between ten and thirty-five years of age. Owing to

* Read before the Louisville Society of Medicine and Surgery, December 19, 1904.

wet.

atrophy of the lymphatics of the the throat we rarely encounter it in the aged. The attack is usually the result of exposure to cold and Those who have had one attack are more liable to subsequent attacks. The rheumatic or gouty diathesis no doubt plays a part in the production of attacks. The first symptoms noticed by the patient are a dryness and stiffness of the throat, soon followed by difficult swallowing, pain is felt in the back and legs; at the onset there is chilliness, the temperature rises abruptly in a few hours, reaching 104 or 105°; pulse rapid. The extension of the inflammation in the nasopharynx involving the Eustachian orifices and tubes gives rise to pain in the ear. In quite a number of instances the inflammation produces a catarrhal otitis media. On inspection, which at times is quite difficult on account of the pain it gives to open the mouth, one or both tonsils are seen deeply reddened and swollen; here and there on the tonsil are seen yellowish or whitish points showing the opening of the crypts. If the inflammatory exudate has been profuse there will be oozing over the surface a serofibrinous material. The symptoms are those which accompany all inflammatory conditions, skin hot and dry, nausea, tongue coated, breath foul, thirst almost constant, obstinate constipation, urine scanty in amount, high colored. If there is an uric acid diathesis. or if cold and exposure have been the exciting factors, small amount of albumin will be found in the urine.

Diphtheria is the most likely in which to be mistaken

of the microscope that will easily be determined.

By the use

Prognosis is good, but those that have once been effected are more liable to subsequent attacks.

As Sternberg has found twelve different varieties of micro-organisms in the mouth and throat, they very abundant, it is easily understood how any local weakness of the structure of the throat can readily form a nibus for the more virulent organisms and for the entrance of its toxins into the tissues of the body, therefore the preventive treatment is one of extreme importance.

In those that have had repeated attacks much can be done to prevent the recurrence by the daily use of alternating hot and cold douching of the front of the throat, washing the mouth and spraying throat with some antiseptic, thus preventing the accumulation of the micro-organisms

Doubtless many of the subjects of repeated attacks have become so because of the fact that the overlying structures have been unable properly to react on exposure to cold. The one most frequent cause for

this failure for reaction is the bad habit of keeping the throat invested in furs and ruffles, the leaving off at times removes the protection previously afforded.

If the case is seen early much can be done to lessen the inflammatory process by applying a local anesthetic, then using a blunt probe curet opening the crypts and removing as much as possible of the accumulated material, then cleaning the tonsil with hydrogen per oxide, afterwards painting them with sol. nitrate silver 60 grs to 3i. The stronger solution gives less discomfort than the weaker ones. The silver solution should not be used late in the trouble, as it does. only harm.

Again, if it is convenient, instead of using the blunt curet, the crypts can be emptied by using compressed air, as first suggested to me by Dr. P. R. Taylor.

As to internal treatment, the bowels should be opened by small doses of calomel given every hour, followed by citrate of magnesia.

The salicylates are indicated; the best is the stronim salt. Owing to the systemic depression produced by the toxins it is not safe to use the coal tar products, but if used small doses must only be given. Quinnie is reccommended, but do not believe it should be used, as it has a harmful effect upon the ear, and often inflammation is extended into the tubes. As to gargles, I do not believe they ever reach the tonsil, but are good as a mouth wash. When we wish to use an antiseptic wash they are best used in an atomizer or by mopping.

The most serious complication which we meet is where the inflammatory reaction has been so intense that pus formation has occurred. If this should occur prompt surgical interference is demanded. It should be opened with a sharp point curved bistoury, incision being made through the upper portion of the anterior pillar of the fauces, the pus being more frequently encountered there than in the tissue of the tonsil. The incision should be made from the tonsil toward the pharynx so as to avoid injuring the blood vessels lying external and anterior to the tonsil. The diet must necessarily be one of liquid because of the two conditions present, the fever and inflamed condition of the throat. Cracked ice should be given freely, as it is agreeable, and has an advantage in the local treatment.

Convalescence is marked by the extreme prostration, and tonic treatment is demanded by the use of iron, strychnine and arsenic.

711 SECOND STREET.

SOCIETY PROCEEDINGS.

LOUISVILLE ACADEMY OF MEDICINE, DECEMBER 7, 1904.

Dr. J. T. Windell: I have a patient to exhibit to-night who has been, before the Society on a former occasion, with a perforating ulcer of the foot; the gentlemen present will probably remember the case. This patient has been under my care for nearly two years, and it is with a great deal of satisfaction that I state that the ulcer is cured, although the cure is due as much to the persistence of the patient as to my own efforts. I used everything that had ever been heard of for healing ulcers, and finally tried a sample bottle of a preparation of carbolic acid, alum and boric acid, which has given very satisfactory results.

I do not know what causes these ulcers, but in this case I believe it is due to specific trouble. In addition to the preparation mentioned, the patient has

been taking iodide of potassium a great deal of the time.

I have another very interesting patient to exhibit to-night, who has very kindly consented to come here in the interest of science. In 1884 this gentleman had a chancre on his penis. He has at present some scars from the syphilitic ulceration which he had at that time. He undoubtedly had syphilis at that time. On the 25th of October last he came to me with a sore on the left side of the meatus, but did not have any sore on the outside of the penis at all. The sore was indurated and did not secrete much pus; in fact, it was almost a typical chancre. He gave a history of several suspicious intercourses, and although having his former trouble in mind, I was able at the beginning to diagnose it as syphilitic reinfection. I think if you will examine this gentlemen you will all agree with me that he has the very rare occurrence of syphilitic reinfection.

Dr. Simrall Anderson: I think Dr. Windell is to be congratulated on the result of his first case.

The second case reported by the doctor is interesting. I have seen only one case of a similar nature. The patient, a woman, contracted syphilis the first time from her husband. She recovered from the attack, however, and bore a child. The doctor who attended her at delivery had a chancre on his finger, but did not know it was a chancre at that time. The woman was infected, developed secondary eruption, and had syphilis over again. She has also recovered from the second attack. This is the only case of syphilitic reinfection I have ever seen

Dr. James B. Bullitt: I would like to ask Dr. Windell if he can not tell me something about the course of syphilitic reinfections. I have known that it does occur, but would like to know what effect the previous infection is likely to have on the course of the second, and if more than two infections have