At the present time the cavities in the buttocks have about closed, the one on the abdomen has completely repaired.. he is able to walk about the ward. The phimosis still exists and but little repair has gone on in the penis, so that there is still a question as to what the ultimate termination of this organ will be. One of two things seems to be indicated, either to repair the urethra and bring the scanty integument together to cover it, and at the same time remove the phimosis, or to make a complete amputation. In either event I would be pleased to report the result at some future time. I also wish to say that during your visit to the hospital this morning the specimens and patient will be presented at the clinic.

SYNOPSIS OF DISCUSSION ON REPORT OF A "CASE OF FOXTAIL POISONING."

By R. HARVEY REED, M.D.,

Rock Springs, Wyoming.

The case just reported by Dr. Chamberlain on foxtail poisoning is certainly unique. As the doctor has described the plant and the particulars of this case in his paper, I will not take up your time repeating it. But I wish to call your attention to the peculiar features of the case and the peculiar action of this infection as manifested in this particular case. From the party's own statement we are lead to believe that the foxtail was passed into the bladder through the urethera, and the spears having separated from the head of the foxtail, immediately commenced to penetrate the soft parts of the pelvis, a part of them escaping into the right iliac region, while the others escaped on each side of the urethra in the ischio-perineal region, destroying the soft parts until the ischium was exposed on either side.

Another "flock" of these barbs penetrated the scrotum, causing necrosis of not only the scrotum but of the testicles, all of which we were obliged to remove a few days after his admission to the hospital.

At this time we found about one and a half inch of the perineal portion of the urethra destroyed. It seems that wherever these little barbs, which are so arranged as to continue their course in a given direction, that direction depending upon the location of their point to a certain extent and also to the actions of the muscles through which they moved, that they continue to work their way onward until they meet some insurmount

able barrier or set up such a terrific inflammation, followed with suppuration and necrosis, until their escape is effected.

Dr. Solier-Doctor, to what do you attribute the toxic effect of the foxtail poisoning?

Dr. Reed-I am sure, doctor, I am not able at this time to fully answer your question. I am inclined, however, to believe that, like any other foreign body, it sets up an irritation of the parts penetrated by it, and at the same time it carries with it whatever germs may have clung to it. From what little experience I have had I am not inclined to believe there is any specific poisoning in the foxtail itself, but owing to its peculiar formation it is capable of retaining in its meshes, so to speak, germs which would infect the parts which are in a condition to be infected, owing to the inflammation induced by the presence of this strange foreign body.

The history of the case clearly shows that the destruction of the soft parts came from the introduction of the foxtail, as the man admitted that he had introduced it, and the two operations which were made subsequent to his admission to the Wyoming General Hospital found the barbs of the foxtail in the soft parts where the greatest amount of destruction was going on. The removal of these barbs and the aseptic treatment resulted in the repair of the parts, notwithstanding the patient was greatly reduced, and for some four or five days his temperature remained at 94 degrees. His teeth were covered with sordes, and while he was usually a strong, robust young man, he was emaciated to a mere skeleton, but as you will see him when you visit the hospital to-day, he has now become fleshy, all evidence of the general septic infection having disappeared, and now we are simply waiting the repair of the parts. We expect to make a circumcision, which has become necessary owing to the cicatricial contraction induced by the inflammatory change, and after the recovery from the circumcision we intend to make a plastic operation, and if possible restore the urethra. What the result will

be in this case remains to be seen.

We all know that this peculiar plant has a very hazardous effect upon stock that eats it, the barbs penetrating not only the soft tissues of the mouth, as well as the bone, but producing large ulcers, followed by necrosis of the bone, and at times when penetrating the intestines of the animal produces death from peritonitis, if not by septic infection when this does not occur. Whether or not this is due to the toxic effect of the plant itself or to its peculiar construction, which favors its passage through the soft and hard parts and carries germs, as has already been stated, I am unable to say, but one thing is certain, that its re

moval in the case which has just been reported by Dr. Chamberlain has been followed by a speedy and most remarkable recovery from a decicedly typhoid conditon with the lowest and longest continued low temperature that I have ever yet seen.

N. B.-Since the meeting of the Wyoming State Medical Society I beg to state that I performed the circumcision on the case, which healed by first intention, and a few days later restored the urethra by a plastic operation whereby we took the skin from either side of the perineal region, allowing the flaps to remain attached to the anterior portion of the pubes, bringing the two flaps together and making the line of suture along the natural position of the raphe. This required us to cut the flap from the ischial region, owing to the cicatricial tissue which we had to deal with in the region of the urethra, and after suturing the lateral edge of the flaps on either side to the cicatricial tissue, which was thoroughly denuded in the hope that we would get adhesions, we sutured the center along the line of the raphe, leaving the denuded surface to granulate. At present writing, a week after the last operation, the patient has not entirely recoverd, but the indications are favorable to a complete recovery.

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