The case was afterward shown at the American Dermatological Association, where most of the members, I believe, agreed in the diagnosis of hypertrophic lupus. The microscopic findings were not conclusive, and in

order to exclude syphilis, the case was for two and a half months put under full doses of iodides and mercury and mercurial ointment locally. This treatment had no effect.

After the failure of mixed treatment, the case was put under daily Xray exposures in June, 1901. The effect was not prompt, but after two months considerable erythema was produced, which was accompanied by marked shrinkage of the lesions. The exposures were continued until August 26, with the production of an acute dermatitis, and by this time the tubercles had shrunken until the surface was flat. The dermatitis was curiously enough confined sharply to the diseased area. Since their first disappearance, seven months ago, there has been no recurrence of the disease. The areas are still red from exposures which the patient has recently had. The only scarring is that which existed before treatment with X-rays was begun. The present condition is shown in the accompanying photograph (Fig. 6).

CASE IV. I have under treatment a fourth case of lupus which I have not cured. It is a very severe case of at least twenty-five years' duration in a woman 41 years old. She had had all sorts of treatment, and in October, 1898, the diseased area was removed and a plastic operation for the restoration of the nose and the central part of the face done. The disease recurred in the scar and has since involved the nose and all of the parts around. The nose has been almost entirely destroyed since the recurrence. The disease, which has been under treatment more or less constantly for a year, has not spread in that time, which is in marked contrast to the history of the previous year, but it has not been eradicated. The result thus far in this case is similar to those reported by Finsen in cases where the disease has recurred after plastic operations. I have recently treated her much more vigorously than ever before, with very considerable improvement in her condition, and in view of this and the fact that we have succeeded in stopping the spread of the disease, I still have hopes of curing her.

I have had under treatment two other patients who were thought to have cutaneous tuberculosis and who have gotten entirely well while having X-ray exposures. The diagnosis, however, in neither of these cases was fully established and both patients had other treatment besides the use of X-rays, so that in my opinion they are not entitled to consideration in this connection.

The results obtained in cases one, two and three are, I believe, as good as can possibly ever be hoped for by any method. There has been no destruction of healthy tissue in getting rid of the disease and less scarring could not possibly remain after disease as extensive as these cases had. The scars are white, soft, pliable and, indeed, in cases two and three are hardly to be called scars. As to the permanency of the results, case one has been well eighteen months, case two, twelve months, and case three, six months, and none show any evidence of recurrence. But grant that recurrences should take place, there is every reason to suppose they can be controlled by the same method without scarring or pain. When one contrasts such results with those obtained by former methods of treatment and remembers the endless routine of pain that the patients suffered in treatment, the fact that this treatment is painless becomes no small consideration.

EPITHELIOMA.

CASE V. Referred to me by Prof. John L. Porter of the University of Illinois. Woman, age 68, with extensive epithelioma of shoulder of fifteen years' duration. The disease entirely disappeared April, 1901, after two months and a half of treatment, with the formation of healthy scars. There is no evidence of recurrence after a year. (Fig. 7 and Fig. 8.)

This case was reported in detail in the Journal of the American Medical Association, September 28, 1901. Since that time Dr. Ludwig Hektoen, professor of pathology in Rush Medical College, has very kindly examined my slides from the case and given me the following opinion: "I have examined the sections from Mrs. C.'s shoulder, both yours and those

from 1894, and in my opinion there is no question as to the correctness of the diagnosis of carcinoma (roden ulcer).

The histological character of the scar tissue is shown in the accompanying photo-micrograph (Fig. 9) of a section of tissue taken from the shoulder at the site of the largest ulcer.

CASE VI. Mrs. T., age 68, referred to me by Dr. Martin F. Engman, of St. Louis, late house surgeon New York Skin and Cancer Hospital. The history of the case is as follows: Twelve years ago a small nodule developed upon the ala nasi, which ulcerated and was removed, but soon recurred. În the last ten years the lesion has been treated by almost every plan short of complete ablation of the nose, but always with prompt recurIn the summer of 1900 she consulted Dr. Frank Hartley of New York, who advised a plastic operation, but she declined further operative procedures.

(TO BE CONTINUED.)

Society Proceedings.

MISSISSIPPI VALLEY MEDICAL ASSOCIATION.

Proceedings of the Twenty-Eighth Annual Meeting, Held at Kansas City, Mo., October 15, 16 and 17, 1902.

STENOGRAPHICALLY REPORTED FOR THE MEDICAL FORTNIGHTLY.

[CONTINUED FROM PAGE 872.]

GASTRO-JEJUNOSTOMY WITH THE MOGRAW ELASTIC LIGATURE FOR THE RELIEF OF GASTROPTOSIS.

Dr. H. O. Walker, of Detroit, Mich., read a paper with this title. He said that little had been done surgically for the relief of this condition. He reported three cases operated on successfully, and closed by saying that of all methods that had been suggested for the performance of latter intestinal anastomosis, none, to his mind, possessed the advantage of the McGraw elastic ligature. (1) Its simplicity was far greater than any other method yet presented. (2) The ease and rapidity with which it could be done. (3) Less liability to sepsis than by any other method. (4) There was no danger in a foreign body. (6) A larger opening could be made without liability to cicatricial contraction.

Dr. Walker exhibited beautiful charts showing the steps of the operation.

SECTION FOLLOWING VAGINAL PUNCTURE.

Dr. John Young Brown, of St. Louis, Mo., read this paper in which he spoke of the value of vaginal section in selected cases of pus in the pelvis. He called attention to vaginal section in contradistinction to so-called vaginal puncture. He alluded to the post-operative complications following vaginal section, as shown by a series of cases in which abdominal section was subsequently done.

Dr. Emory Lamphear, of St. Louis, Mo., read a paper on

CANCER OF THE UTERUS IN THE MISSISSIPPI VALLEY.

The author said that Eastern surgeons did not operate on cancer of the uterus, while Western surgeons did. What was the result? The census statistics of 1900 showed cancer of the breast, on which all operated, East and West; cancer of the stomach on which no one operated, and cancer of the uterus, as follows: East, cancer of the breast, 613 cases; cancer of the stomach, 1785 cases; cancer of the uterus, IIOI cases. Mississippi Valley, cancer of the breast, 874 cases; cancer of the stomach, 3376 cases, and cancer of the uterus, 679.

The difference showed larger proportions of carcinoma uteri operated upon in the West, with either cure or a return of the disease in other or. gans; hence death was not included in the deaths from cancer of the uterus. Reports from 74 operators in the Mississippi Valley showed 274 cases which had lived more than five years. The diagnosis was confirmed by the microscope in most cases, a result encouraging for earlier diagnosis and prompter hysterectomy.

A PLEA FOR THE ABANDONMENT OF THE ABDOMINAL BELT AFTER CELIOTOMY.

Dr. Maurice Kahn, of Leadville, Colorado, read a paper on this subject. It was the writer's belief that if in consequence of his plea sufficient interest was arroused in the subject, it would be but a short time when the post-operative abdominal belt would be obsolete. Attention was called to the direction of the muscular fibres, which intersected each other at angles varying from about 25 to 90 degrees. By reason of a common nerve supply, the abdominal muscles acted synchronously. The excellent cancellated arrangement of the abdominal muscle fibres made the gridiron operation the one of choice, for then the contraction of the muscles tended in itself to safeguard against hernia. He believed the straight through technique to be the most effective factor in subverting an ideal result in most cases, not so much because the muscles were cut transversely, but because of inaccurate sutturing.

The application of an abdominal belt, which, if tight enough to exert any influence,must receive the muscles of their usual labor, resulting in the atrophy of non-use, whereas it would be desirable to have the hypertrophy of over-use. If it were possible to apply a belt internal to the abdominal wall, it might perhaps be of service in giving the cut edges an opportunity to firmly unite before any strain was imposed upon them. Such arguments could not be advanced in favor of the external abdominal belt, which would not prevent the exertion of pressure on structures external to itself. It had been his practice for over three years, after removing the first dressing, which was applied snugly for comfort and removed at the end of a fortnight, to allow patients to go without any support,

EARLY DIAGNOSIS AND CONSERVATIVE TREATMENT OF FIBROMYOMATOUS TUMORS OF THE UTERUS.

Dr. L. G. Bowers, of Richmond, Ind., called special attention to the importance of the early diagnosis of fibrinoids, thus leading to conservative methods of treatment. He enumerated some of the symptoms of fibrinoids that were many times attributed to other trivial causes by a superficial examination, and insisted that the patient be examined under an anesthetic and curretted at the same time, if necessary. He pointed out that most of the literature dealt exclusively with the operative views and nothing was said about preventive measures. The early practice of such treatment often obviated the necessity for hysterectomy later on.

TREATMENT OF FRACTURES OF THE PATELLA.

Dr. David C. Peyton, of Jeffersonville, Ind., discussed the relative frequency of these fractures; the contractions of the quadriceps as an efficient agent in the etiology; the displacement of the fragments and the associated injuries to the soft parts; the diagnosis, and then outlined the advantages of treatment by open arthrotomy as compared with non-operative procedures.

Dr. Truman W. Brophy, of Chicago, gave a lantern demonstration of his method of operating on cases of cleft plate. He also exhibited patients upon whom he operated, showing excellent results. The patients were able to articulate remarkably well.