drainage. Kehr has gone further and has opened the cystic duct and also drained the hepatic ducts. In cases of severe infection, where we have a general cholangitis or even stones in the hepatic ducts and in the liver, certainly no operation promises much.

As a point of historical interest I will add that, in 1795, Sömmering proposed opening the gall-bladder if it was adherent to the abdominal walls. Richter, in 1795, also proposed-and he had a very good knowledge of the disease that the operation should be done in two steps, opening the abdomen down to the peritoneum, then applying substances which would cause inflammatory adhesions, and a few days afterward opening the gall-bladder, as was done by Köenig in 1892.

BIBLIOGRAPHY.

1. Frerich's Clinical Diseases of the Liver.

2. Riedel-Die Gallensteine-Berl. Klin. Wochenschrift, No. 1, 1901.

3. Ziegler's Pathology.

4. Berl. Klin. Woch., Nos. 1, 2, 3, 1901.

5. American Journal Medical Sciences, January, 1900.

6. American Journal Medical Sciences, August, 1899.

7. Medical News, page 35, page 965, 1901.

8. Medical News, February, 1901.

9. Musser, Medical Diagnosis.

10. Reference Hand-book.

11. American Journal Medical Sciences, October, 1900.

LOUISVILLE.

Reports of Societies.

THE KENTUCKY SCHOOL AND HOSPITAL MEDICAL SOCIETY.*

Stated Meeting, January 23, 1902, the President, William A. Jenkins, M. D., in the Chair.

Sebaceous Cyst. Dr. M. F. Coomes: I present this specimen more as a curiosity than any thing else. It is a sebaceous cyst which was removed from the sublingual region. The patient was a man about twenty-five years of age. The peculiar feature about the case is the unusual size of the cyst; it measures one and a half inches in diameter. It occupied all the space between the tongue and skin in the sublingual region. An opening was made underneath the chin, and after evacuating the cyst the sac was easily removed. I think that, like all tumors of this class, it came originally from the skin.

* Stenographically reported for this journal by C. C. Mapes, Louisville, Ky.

A New Apparatus for Preventing X-Ray Burns. Dr. J. T. Dunn: On account of the danger of burns from the X-ray, which we have heard of and which we all fear since we have been using the X-ray for therapeutic purposes, it has become necessary to encase the Crookes tube in a box and enclose it entirely, except as stated, so that you are able to direct the light upon that portion of the body to which it is intended to apply the treatment. If only a portion of the body the size of a silver dime is to be acted upon by the X-ray, as is sometimes the case in removing superfluous hairs, for instance, the X-ray, by this device, may be directed to this portion without other portions of the body beneath the Crookes tube being in the least subjected to the influence of the rays.

For this purpose I have devised the wooden box herewith exhibited, which retains the light, only allowing the escape of a ray of such size as may be desired to play upon the part to be treated. The outside of the box, as you will see, is simply plain wood, but of course the X-ray will go through this wood just as though there were no substance between the ray and the part to be treated, therefore the box is lined with the heaviest grade of roofing tin; not only that, but I have reinforced it by slipping in an extra plate on the side of the box which is next to me, for my own protection. The side next the patient is fitted with two heavy pieces of tin in the same way. You see in the center of the bottom of this box I have made several holes, simply for the purpose of ventilation, as the tube would otherwise make the box very hot. Through the center of these two pieces of tin I have a two-inch hole, which is the largest sized ray that passes from the inside of the box to the patient; it is seldom that we need a larger size than a twoinch funnel of light going toward the patient. I can regulate the size of the ray passing through this two-inch opening by a diaphragm, also made of thick tin, in which I have made holes varying in size from one and three quarter inches down to one quarter of an inch. By turning this diaphragm upon its center the desired size of opening can be brought over the two-inch hole, and thus the size of the ray regulated. Lastly, this aluminium slide fits into a groove in the sides of the box, and covers the opening through which the light passes toward the patient. This acts as a filter, and keeps from the patient all the rays which are supposed to burn. This piece of aluminium is grounded by a small wire running from it to the gas-pipe; the aluminium filters the light so that no electric discharge will reach the patient.

In this connection I desire to report two cases of superfluous hair and two cases of lupus, which I am treating by means of the X-ray and the device which I have just shown. This is a new treatment for the removal of superfluous hair, or hypertrichosis, as it is called. They are doing considerable work of this kind in the East, but, so far as I am aware, I am the first to adopt this line of treatment here. I have been treating two cases of superfluous hair by this method since the first of this month. I have looked over my history-book and jotted down a few points of interest.

CASE 1. Miss L. has had eighteen treatments, varying from five to ten minutes each; these eighteen treatments have covered a space of one hundred and twenty-nine minutes, or two hours and nine minutes altogether. The hairs on her chin, which was the point nearest the Crookes tube at the time of the exposure, where the rays were most effective, began to drop out after the eleventh exposure. Soon after that, all the balance of the hair on her face dropped out, leaving no scar; she suffered no pain, no irritation, and no dermatitis, as is frequently the case after a number of continuous exposures.

CASE 2. The second is very much like the first case. Miss R. has had fourteen treatments, varying from five to ten minutes each, making one hundred and twenty-nine minutes. The hairs became loose after the tenth treatment. The roots seemed perfectly dry, and the hairs could be easily removed with but little traction and no pain. In neither of these cases has there been any dermatitis.

I am treating at the same time two cases of lupus by this method. One has been under treatment two days, the other about ten days. In one case (lupus of the nose), which has been under treatment ten days, after the fifth sitting, each consisting of ten minutes, the sharp outline of the ulceration was flattening out. There is now a healthy line of skin all the way around the ulcer, and it is closing in toward the center; patches of skin are also appearing in the middle of the abrasion.

I am very much encouraged in the treatment of these cases-both the lupus and hypertrichosis-by means of the X-ray, especially since devising the box or protector shown you. If the treatments were stopped at this point in the cases of superfluous hair they would return, but by making ten to twenty additional exposures the hair follicles will be permanently destroyed and the hairs will not return. Close watch is kept upon the condition of the tube, keeping the vacuum as near one point as possible. This is determined by the fleuroscope.

The essay of the evening, "Report of a Case of Cancer of the Stomach," was read by William A Jenkins, M. D. [See p. 161.]

Discussion. Dr. W. F. Boggess: I had the pleasure of seeing this case ante-mortemly with Dr. Jenkins, and at that time he had made a very clear diagnosis from the subjective and objective symptoms without any clinical test of the stomach contents. The case at that time was so positively evident to me of cancer of the stomach that, without examination of the stomach contents, there was no question about the diagnosis.

In

The case post-mortemly offers some very interesting features. the first place, cancer of the cardiac end of the stomach is comparatively rare when compared with the pyloric end. In the next place, the whole stomach wall seems to be infiltrated with cancerous tissue, with involvement of the surrounding organs, especially the kidneys and spleen, the amount of adhesions to the aorta and diaphragm, and the glandular involvement; and in addition to that, one of the most interesting features of the case is the fact that the liver shows neither adhesions nor cancerous involvement. In the great majority of cases cancers of the stomach, whether of the cardiac end or the greater or lesser curvature, or near the pyloric end, show involvement of the liver. Atrophy of the stomach is what we do not ordinarily find in cancer of this organ, in that in the majority of cases the disease attacks the pyloric end, and you have stenosis with dilatation of the stomach walls. This makes the case and specimen interesting from a clinical standpoint as well as from a pathologic view.

Cancer of the stomach is not an infrequent trouble; it may be either primary or secondary-a great majority of them being primary cancers involving principally the pyloric end-often very easy to diagnose, at other times the diagnosis being attended with a great difficulty. When the patient is so emaciated and the cancerous infiltration so marked as to allow you to palpate a hard tumor in the region of the stomach, or connecting directly with that organ, the diagnosis ordinarily is comparatively easy; but sometimes, even with the palpation of tumors in the ordinary regions that cancers are found, with the subjective and objective symptoms, we can not say positively that the patient has a cancer without the further clinical examination of the stomach contents, and in this we have one of the best diagnostic points. In the great majority of cases of cancer of the stomach we find an

absence of free hydrochloric acid and the presence of an excess of lactic acid; I say in the great majority of cases, because numbers of cases have been found where the post-mortem examinations have proven cancer of the stomach where hydrochloric acid was found present, even in excess, at some time during the course of the disease; but it is only a temporary presence of HCl, and sooner or later it will disappear entirely from the stomach contents. Not only is the absence of HC1 of great diagnostic value-and the test is easily and simply made-but a test of equal value is the presence of lactic acid after a properly-given meal.

Boaz called our attention a number of years ago to the fact that the test-meal, as ordinarily given with baker's bread, was of little or no value, because the stomach contents under these circumstances will always show the presence of lactic acid after one or two hours; in other words, that there was a certain amount of predigested or pre-prepared lactic acid in the bread before being taken into the stomach. But if you will give a test-meal of substances where there can possibly be no lactic acid fermentation, and you find lactic acid in the stomach contents after the withdrawal of the test-meal, it is one of the best diagnostic points we have at our command at present. The presence of bacteria is of great value also. But if you have typical subjective and objective symptoms of cancer of the stomach, the test-meal should be given of proper substances and with ordinary precautions, and under these circumstances the absence of HCl and the presence of lactic acid. are always absolutely confirmatory.

The cancers of the stomach that we see in our practice being almost always pyloric, in addition to examination of the stomach contents, hypertrophy or dilatation of the stomach coming on rather acutely in the course of a few months, with stenosis and stagnation of food, is another very suspicious point, and should lead us to suspect cancer even without marked objective and subjective symptoms.

It is rare that you find cancer involving the cardiac end involving all the stomach wall, giving rise to atrophy and contraction of the stomach rather than dilatation, and when you have this condition, owing to the fact that the colon is in front of it you do not have the same ability to detect a tumor by palpation that you have when the cancer occurs at the pyloric end.

The treatment as outlined by Dr. Jenkins is possibly about all that we know at present. There is, of course, no treatment for these cases