bandage around the penis, as I usually do. As soon as bleeding commenced I placed an elastic bandage around the penis, but hemorrhage continued. The dressings were then removed and we began to pick up the bleeding points, and not only did we tie the five small arteries already mentioned, but oozing continued from the mucous membrane and under the skin. At one or two points I put a ligature from the outside of the skin through en masse and constricted the vessel in that way. No sooner was oozing controlled in one place than it would break out in another. It took fully two hours to completely check the hemorrhage.

I inquired of the patient if he had ever bled seriously before, and he said that he had not, that he had never been cut before. I then asked if he had never cut himself on the hands or elsewhere, and if so, had bleeding been unusual? He said that he had frequeutly cut himself and bleeding was always excessive; that he was full-blooded; that he "had lots of blood in him"; that his father was the same way. The interesting points in the case are that the man was an hemophilia, and second, the anomaly in location of the blood-vessels around the glans penis. When the dressing was taken off and an effort made to check the hemorrhage we found several veins as large as the radial vein of a child under the fascia, almost like a neveus.

Once before after a circumcision I had alarming hemorrhage from the artery of the frenum; a ligature was applied which did not hold, and there occurred secondary hemorrhage. On another occasion, six or seven years ago, I had some difficulty in controlling hemorrhage after circumcision.

In the present case it was not thought the patient was a bleeder, and no questions were asked. After this experience, at least until the lesson is forgotten, I shall not operate upon anybody until I inquire about the history of hemophilia. Ether was used in this case for general anesthesia.

In most cases of this kind I have been able to control oozing by means of an astringent composed of an alcoholic solution, equal parts of tannin and antipyrine, but it had no effect in this instance.

Dr. Krim just suggested that adrenalin solution might be useful in these cases. I have never tried it.

Discussion. Dr. S. G. Dabney: There is some little difference of opinion about the propriety of using adrenalin solution under these

Of

circumstances, because of the danger of secondary hemorrhage. course adrenalin is used more extensively about the nose and throat than elsewhere. A good many men are of the opinion that it is unwise to use it and have the patient go out without taking some especial precautions to prevent after-hemorrhage. It has not been my experience, however, to have seen secondary hemorrhage following the use of this agent. I use it frequently in nose work, and so far I have never seen secondary hemorrhage; that is, secondary hemorrhage has been no more frequent than before I used adrenalin solution. The styptic mentioned by Dr. Young, tanno-pyrin, is an exceedingly useful one, as is also ferro-pyrin.

Foreign Bodies in the Throat and Eye. Dr. William Cheatham : CASE 1. A man recently came to my office in quite a hurry, very much excited; could not wait for me to finish with a patient who was already in the consulting-room, as he was suffering very much with dyspnea, and gave this history: That he had been in a bar-room to get a drink and had stepped over to the lunch-counter and took a piece of meat with something on it, the nature of which he did not know, and had gotten something lodged in his throat.

I cocainized his throat, which was very sensitive, and could see a foreign body in the larynx. After getting the throat thoroughly anesthetized, by careful manipulation I removed from the larynx an olive leaf fully as broad as the end of my thumb. I suppose in making some hash or dressing they had chopped up some olives and this leaf happened to get in with the mixture. The man had suffered intensely from its presence in the larynx. It was very sharp and looked like metal; in fact, when I first saw it I thought it was a piece of metal that had by some means gotten into his throat.

CASE 2. A gentleman went out to trim away some briar bushes; a briar struck him in the left eye. The briar when I saw him was pushed through the cornea, with its point in the anterior chamber, but the anterior chamber was full. I sent him home and advised a compress, the use of atropia, cold cloths, etc. He returned the next day with the anterior chamber entirely empty, the briar having passed backward into the lens. He now has a small crescent-shaped spot on the lens, represented by the foreign body, and there is a slight injury to the cornea, but I hardly think there will be developed cataract, although my experience has been that cataract follows wounds of the capsule.

Of course the briar may work its way through the lens and give him some trouble in the future. There is no question, however, that the lens is the best part of the eye for the foreign body to remain in if it is to be left there, and as long as the foreign body remains where it is I do not believe it will cause him any trouble unless cataract follows.

Discussion. Dr. S. G. Dabney: If I understood Dr. Cheatham correctly, when he first saw this patient the foreign body was in the anterior chamber. Of course I know this is a delicate question, but I would suppose it would have been indicated to have gone into the anterior chamber and removed the foreign body. A foreign body in the eye is always such a dangerous object that if its removal is possible it should be accomplished. It is also interesting to note that in this case the foreign body of itself penetrated further and entered the lens. The man will be exceedingly fortunate if it does not produce traumatic cataract. A foreign body may be retained in the lens without the whole lens becoming opaque, but such instances are certainly of the greatest rarity. I think in this case the lens, including the foreign body, will have to be removed at some future time.

Peculiar Injury to the Knee. Dr. Ewing Marshall: I would like to report a case that has been giving me some trouble lately and get the judgment of the members as to treatment. A young man, who is a stenographer and typewriter, in sitting at his machine places his knee under the table to steady it while he is working at his machine. He takes the work mostly by dictation directly on the machine instead of writing it in shorthand and then transcribing, consequently his work is extremely rapid and he holds the table steady with his knee.

Six weeks ago he did not know there was anything the matter with his knee, but in buttoning or tying his shoe he placed his foot on the edge of the bed and thinks he twisted his knee-joint, and said he thought he heard something crack in his knee. The next morning the knee was painful and before night it became swollen, and he sent for me. It was Wednesday night when he put his foot up on the edge of the bed; Thursday the knee was painful, and he sent for me Friday morning, but being out of town I did not see him until Saturday, when the knee around the patella was over two inches larger than the knee of the opposite side at a corresponding point, and there was an inch and a half difference in favor of the injured side above and below the

knee; the swelling extended above and below the knee, and seemed to be fluid.

I kept the patient quiet for ten days or two weeks, thinking probably an operation would have to be done to liberate the fluid, but before doing that I suggested to the family that a consultation would be desirable, and they asked to have Dr. Vance see the case with me. Dr. Vance was called and said he did not think it would amount to anything, and advised putting the leg in plaster, to be kept on for three weeks. I put it in plaster and kept it there for three weeks, and when the plaster was removed the knee was in practically the same condition as before. I would be glad for any suggestions that the members can offer as to the further treatment of this case.

Discussion. Dr. H. N. Leavell: The case reported by Dr. Marshall is one of considerable interest. I would suggest that possibly a jointmouse is keeping up the irritation.

Dr. G. B. Young: If there is any one thing harder than another, it is to tell what is the matter with a knee-joint. Personally, as the result of a football injury received a number of years ago, I have a pet knee, which gives me more or less trouble periodically. There is possibly a loose cartilage, and occasionally in tying my shoe I can feel something crack, and I will limp around for a hour or two with pain. Every now and then suffering is so intense that I will be compelled to go about on crutches for a month or six weeks. I have a cousin who is afflicted the same way. Nobody has ever been able to tell me what happened in this knee-joint, and I do not believe Dr. Marshall will ever know what happened in his case.

Dr. Ewing Marshall: After having this case under my care I read a very able article from the pen of an English writer, Herbert W. Allingham, on disturbances of the knee-joint, and he reports over fifty cases that have come under his observation in the last twelve years. He advises in these cases to open the knee-joint and drain thoroughly, even washing it out and feeling around in the joint with the fingers to see if there is a piece of loose cartilage or anything else present, and then closing the wound tightly. He says he has gotten perfect results in such cases by this method of procedure. In the case I have reported the only abnormality I have been able to discover is the presence of fluid.

P. F. BARBOUR, M. D., Secretary.

VOL. 34.

"NEC TENUI PENNÂ.”

JULY 15, 1902.

No. 2.

H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid.

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DO NOT IRRIGATE THE PERITONEAL CAVITY WHEN
IT CONTAINS PUS.

This is a question of vital importance and one that every practitioner and surgeon should thoroughly understand. It has been a live topic in many of the medical societies during the past few months, and the reason for irrigating an infected peritoneal cavity was certainly not understood by many even after what appeared to be satisfactory explanations had been made. First of all, it should be remembered that the whole peritoneal sac is one vast absorbing membrane; that it abounds in lymphatics and blood-vessels, and that in many cases the patients have consumed but little water for hours and possibly days before the abdomen is opened; the general thirst existing in disease or from the use of some drug, such as opium in any form, which might prevent the patient craving water or calling for it even if the system needed it badly, because of the obtunded sensation due to the action of the opium or to exhaustion from the disease; and even without any of these extreme conditions existing, the peritoneum is at all times an active, absorbing membrane, and the diffusion of a large or small quantity over its surface laden with poisonous germs can only hasten general infection of the entire economy by rapidly disseminating them over the whole system. In short, by vitiating the blood-stream, which after all is the great avenue through which the system is contaminated,