spoken of, a distinct inflammatory zone or line of demarcation, dividing the blackened portion from the surrounding red skin. During all this time the patient had little or no constitutional disturbance. She was not at all sick, had no shiverings, and took her food fairly well. The temperatures noted throughout the illness have been, on an average, but very slightly above normal. The area of dulness over the spleen was enlarged, but this organ could not be felt projecting from beneath the ribs. The urine was of rather high specific gravity at first, but otherwise was quite normal.

On admission, the treatment adopted was the administration of salicylic acid in 15 gr. doses, twice daily, and the assiduous application of poultices to the neck. Milk diet and soup were ordered, and the patient was fed hourly. An improvement took place in the condition of patient from the time of her admission. The swelling gradually subsided, ulceration took place round the blackened portion before mentioned, and on 31st July the slough was removed and the part washed out every morning with carbolised water, the application of poultices being still continued. The salicylic acid was now stopped, a tonic mixture of iron and quinine being substituted, with 4 oz. of port wine. The favourable condition of patient has been maintained; but some burrowing having taken place in the neck, it was found necessary, on 7th August, to make a counter opening to allow of the escape of the pus. Practically, however, the patient may be said to have recovered from the effects of the serious complaint for which she was admitted.

The second case was much slighter and need not be so fully related. The patient is aged 17, and is, as already stated, a sister of the former patient. The pustule had the same situation as in the first case. The swelling of the face and neck was never so great as in the other. The pimple broke spontaneously two days after it was first observed; a considerable fall in the swelling then took place, and a small open sore was left. When admitted on 18th July there was still some swelling of the face and neck. The treatment was quite the same as in the former case, and the patient was dismissed well on 6th August.

A specimen of the blood has been obtained and preserved by Dr. Coats. At first nothing abnormal was observed on microscopical examination, but in the course of a day or two numerous motionless rod-like bodies were found in the preserved specimens. In the second case a microscopical examin

ation of the blood was made, but nothing abnormal was discovered, either when the blood was newly drawn, or four days after.

CASE OF PERICARDIAL EFFUSION-FLUID WITHDRAWN BY

ASPIRATOR.-H. H., aged 17, millworker, was admitted 22nd July, 1879, complaining of severe cough and general dropsy, most marked in the legs. The cough has troubled him for some years, and is always worst in winter; during the last four winters he has had several very severe attacks of hæmoptysis.

When admitted, he breathed with difficulty, his face had a livid hue, and the attacks of coughing were frequent and violent. On examining the chest there was found to be marked dulness of the left side anteriorly. The dulness extended 2 inches to the right of the middle line, and round into the left lateral region; it reached upwards nearly to the clavicle, beneath which, however, there was a limited area of clear percussion. The lateral limits of the dulness were much less at the upper than at the lower part of the chest. Behind, percussion was clear, except towards the base where there was some dulness. The left side of the chest was decidedly fuller than the right, and over the area of dulness there was a bulging of the intercostal spaces. Harsh sonorous râles were heard all over the chest on both sides. The heart sounds were normal, but seemed distant and muffled. The exact position of the heart could not be made out, and the apex-beat could not be felt. The pulse was rapid, very small, and thready.

Urine contained a trace of albumen and bile. Patient was ordered a cough mixture and a diuretic.

The diagnosis made was pericardial effusion, with probably slight pleuritic effusion at the left base.

As patient was not improving, a consultation was held on 30th July, at which the diagnosis made was confirmed, and it was resolved to remove the fluid by means of the aspirator. The spot selected for puncture was in the fifth intercostal space and about an inch to the right of the nipple line. A medium sized trocar and canula connected with the aspirator was used, and 38 oz. of a light straw coloured fluid withdrawn. When the instrument was first introduced, it was evidently not in contact with the heart, but during the latter part of the operation the cardiac impulses distinctly affected the canula. Immediately after the operation patient's breathing became decidedly less laboured, and very soon after there was a marked

improvement in his appearance, which, previous to the operation, was characteristically cyanotic.* On examining the chest on the following day, the area of dulness was found to be considerably diminished, the diminution being most marked at the upper part, and to the right. The heart sounds were now very distinct and nearer the surface. The pulse was much stronger and more regular, though still frequent.

What the final result in this case may be it is impossible to state, though no doubt can exist as to the great improvement which has resulted from the operation.

PRIVATE PRACTICE.

FROM EBEN. EVANS, M.B., Beaumaris.

THE USE OF IODOFORM IN THE TREATMENT OF CHRONIC ULCER.

On entering the room occupied by an old man, whom I was one night called to see for a sudden illness, I was quite overcome by a most offensive and fœtid odour, which, I found on enquiry, was caused by "a bad leg" of 30 years' standing. On asking to see it, I was shown a large irregular sloughing ulcer in a most horrible condition. I washed it with a solution of carbolic acid (1-20), then dressed with a solution (1-40.) This I did daily for about a fortnight, and the ulcer became perfectly sweet and healthy looking; but if left for a single day without dressing, the granulations became greenish, and the fœtid odour returned. I then tried an ointment of iodoform, according to the formula used by Dr. Tantum for prurigo, i. e., iodoform zi,

* Dr. Newman made an examination of the fluid, and reports as follows:-"A pale straw-coloured fluid, sp. gr. 1020, neutral, without any sediment when examined three hours after having been drawn off, but throwing down a slight deposit when allowed to stand for twenty-four hours. This deposit was found, on microscopic examination, to consist of red blood-corpuscles and leucocytes. On analysis, the fluid is found to contain :

Water,

92.26

5.1

*69

1.8

•15

7.74

100.00

to zi of ointment. I spread a thin layer of the ointment on a piece of lint cut to the size and shape of the ulcer; this I placed on the ulcer, and over it a layer of carbolised tow-as an antiseptic precaution-then bandaged the leg firmly, and left my patient for a week without re-dressing, and to my satisfaction, at the end of the week found the ulcer in a nice healing condition. Since then, I have continued the treatment with very satisfactory results. I have also tried it in other cases with like results.

MEETINGS OF SOCIETIES.

GLASGOW MEDICO-CHIRURGICAL SOCIETY.

SESSION 1878-79.

MEETING XIV.-2ND MAY, 1879.

MR. JOHN REID in the Chair.

DR. MACEWEN read a paper ON THE INTRODUCTION OF TUBES INTO THE LARYNX THROUGH THE MOUTH INSTEAD OF TRACHEOTOMY OR LARYNGOTOMY. He detailed three cases in which this was done successfully. The first was a case in which chloroform was administered through the tube during the removal of cancer from the pharynx. The anaesthetic was easily administered in this way, and the tube at the same time prevented the blood from getting into the trachea. The two other cases were laryngeal affections requiring immediate assistance. The one was acute cedema glottidis, the other oedema ensuing on an old-standing laryngeal stenosis. Both were cases in which tracheotomy would have been performed if the tubes had not been used. The tubes were inserted easily, and borne with no great discomfort by the patients; they were withdrawn at the end of thirty-six hours, the patients being then cured. Two of these patients were then presented to the Society, Dr. Macewen stating that the third had some time previously been shown to the Pathological Society of Glasgow. The instruments used were shown, and an improved form also exhibited.

Dr. Hugh Thomson said that the procedure adopted by Dr. Macewen appeared to be essentially new, notwithstanding that

some French medical men had tried it in modified forms, and on a less methodical plan. There was no doubt that in many cases of œdema glottidis, for which tracheotomy was resorted to, the introduction of a temporary tube would be quite sufficient for the purpose aimed at, and would give permanent relief. The application of the procedure to the cases of children was more doubtful than on the adult.

Dr. Allan, Belvidere Hospital, related the treatment in a case of loud and difficult respiration occurring in a man after a severe attack of typhoid fever. There was a hacking cough, and a peculiarly loud respiration which could be heard in the neighbouring wards. The symptoms increased in severity. Tracheotomy or tubage of the larynx on Dr. Macewen's method appeared to be the only alternatives. The latter method was resolved on. A gum elastic catheter, previously softened in warm water and lubricated, was attempted to be introduced. The first attempt failed, but the second was successful, the tube being thrust down the trachea several inches. The patient breathed through the tube as freely as its size would permit, but it got blocked up with mucus, and there was no means of clearing it in situ. It was evident, however, that the tube (he thought it was a No. 12), was too small, and after some minutes it was withdrawn. There appeared then a little blood in the sputum ; and there existing a suspicion of laryngeal phthisis, he did not introduce another tube. But from that time there was a marked improvement in the symptoms, and the breathing in a day or two became noiseless.

Mr. H. E. Clark said that having been present at the death by chloroform to which Dr. Macewen had referred, he could corroborate what he had said, that the death was in no way due to impeded respiration, as the tube was not in at the time. But he was not so sure that the fatal effect might not have been due to ulceration, from the repeated introduction of the tube.

Dr. Alexander Robertson said that if this plan obviated, in a certain class of cases, the necessity of cutting operations, a good deal was gained. When Dr. Macewen, some months ago in the Pathological Society, submitted his method of tubage, it was received rather doubtfully and critically. Many difficulties and disadvantages were hinted at, such as the blocking of the tube, ulceration of the vocal cords, paralysis of these cords, &c. But Dr. Macewen's further experience in the treatment went far to remove these objections. If Dr. Macewen found that the long tube could be dispensed with, it would be a point gained; and the range of