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conducting the operation. Instead of tapping the cyst, as is the custom, the speaker extended the incision up to the ensiform cartilage, preferring to separate the adhesions on all sides of the tumor in its distended, rather than its collapsed condition. He also by this means avoided the danger of liberating some of the septic fluid in the peritoneal cavity. The advantages of these points in gaining time and safety are very great, much more than the dangers incurred by an extension of the incision to the ensiform cartilage. It is now one week since the operation, and the woman is progressing quite favorably, and is out of danger.

Dr. Sale, as germain to Dr. Crofford's cases, reports two cases seen since last meeting of the society, one showing a peculiar mistake of diagnosis on the part of a most excellent general practitioner. The patient was an unmarried woman 40 years of age, and was sent to Dr. Sale with a diagnosis of cancer to determine whether it would be worth her while to go to New York for treatment, or to die at home without it. Three years ago menses became abundant and frequent, and the flow became fetid. The uterus was examined and cancer diagnosed. On introducing his finger, Dr. Sale felt a globular elastic mass, not however having the feel of a cancer; moreover, after three years of progress, there was not the glandular enlargement and lancinating pain of cancer. He forcibly dilated the cervix, discovered a fibro-cellular polypus, ulcerating, giving pus, and cancerous appearance. It was readily removed with snare and curette under antiseptic precautions without assistance, and with perfect relief for the patient. Another case was rare and interesting. Many claim abscesses do not originate in the uterine wall; that when found there, they come from extension of a tube abscess. In this case a pregnant woman fell, a stob striking her in the belly causing miscarriage. Dr. Sale saw her and supposed all the debris had been removed; yet hemorrhages followed, not checked by styptics. Intending to cleanse the uterus, Dr. Sale introduced an irrigating curette, pressing it not very heavily against the wall of the uterus. Over about the point injured by the fall the wall yielded, the instrument entered some distance, and out gushed nearly a half pint of fetid pus. VOL. XII-11

The cavity was swabbed with creoline and tamponed with iodoform, the flow stopped, the uterus involuted, and the patient is well.

Dr. Krauss reported a case of epithelioma of the face successfully treated by injection of methyl violet solution. The cancer, beginning at the outer edge of the orbit, occupied a considerable portion of that side of the face, denuding the bone, of which several pieces were removed in the course of the treatment. The diagnosis was confirmed by microscopic examination. The treatment consisted in the injection with a hypodermic syringe into the substance of the tumor, two or three times weekly of one dram of a 1-400 gradually increased to 1-250 solution of methyl violet. The treatment was begun in June of last year and discontinued in January of this, at which time there was complete cicatrization and apparent cure, which condition exists at the present time. Drs. Willett and Williams saw the case before, during, and since treatment, and confirmed the statements of Dr. Krauss as to treatment and results.

Dr. Marshall saw in an old woman a cancer of several years growth involving the brow, which had been removed by the roots by a cancer doctor with a salve, the wound healing completely. Dr. Saunders saw the same sore some years ago healed under the use of iodoform.

Dr. Krauss also reported a case of cocaine poisoning. He injected into a young man's urethra about a dram of an 8 per cent. solution of cocaine, one-fourth of which was possibly absorbed. He introduced an instrument, when presently the patient proclaimed a dizziness, threw his head about, and yelled. An injection of morphine secured comparative quiet. In an hour the Doctor was sent for again, and found the patient partly delirious, walking the floor and reciting poetry. Two drams of chloral and some other remedies were administered, and he again became more quiet. Three-quarters of an hour later the Doctor was again hurriedly called; found the patient violent, barricaded in a room, and flourishing a pistol which he had obtained. Being unable to influence the patient in any way, or reach him with safety, Dr. Krauss had Dr. Saunders summoned, the latter having formerly been the

family physician. Dr. Saunders advised non-interference as being the safest measure, for the doctors at least, and suggested that the patient probably would soon exhaust himself and fall asleep. This he did a few hours later, and awoke well. It may be observed that the patient had previously had attacks of acute mania. Dr. Saunders substantiated Dr. Krauss's statement. He found one door barricaded, another slightly ajar, through which could be seen the patient, flourishing a revolver, and defying entrance, declaring the doctors had poisoned him, and that he would have no more to do with them. The Doctor decided not to press his services and withdrew. Dr. Saunders saw in another man of the same family, who had a toe nail removed under the influence of cocaine, convulsions and mania followed, showing family peculiarity.

Dr. Sale thought this matter of cocaine poisoning was important to all doing minor operations. The use of cocaine is universally recommended by recent books on Surgery, and few speak of untoward effects. He received his warning early. Soon after the introduction of cocaine, a dentist in his town. used it in the extraction of a tooth. Eight or ten drops of a four per cent. solution were placed in a gum, the forceps applied, and the dentist was surprised that the patient, his wife, made no complaint. Glancing at her he observed the face blanched, the pupils dilated, and the heart not pulsating. Dr. Sale and other medical gentlemen were called; there was no radial pulse and every appearance of death, yet the heart still beat, and with the use of nitro-glycerine, the battery, and other remedies the patient, after lingering six hours between life and death, rallied and recovered. In her case, the tongue and muscles supplied by the glosso-pharangeal nerve were paralyzed; she was fed for two days through a nasal tube and the urine drawn. He has observed also that after using cocaine tissues are more liable to slough, either from its dynamic or specific effect.

Dr. Hill has in his own practice seen two mild cases of poisoning. After a few drops of a four per cent. solution had been introduced into the tonsils of a young lady patient, she grew pale, the pupils dilated, there was a good deal of heart

excitement. The tonsils were removed, the patient sent to her room, but remained somewhat delirious and stupid during the night.

Dr. Krauss said numerous cases had been reported of heart excitement due to cocaine, but he had been unable to find cases of well-marked mania or delirium. In a case reported by a German specialist, after a twenty per cent. solution had been brushed upon the raw surface in the nose, the patient (a lady) went home, and some hours after was found intoxicated, and took some weeks to recover.

Dr. Williams in a case in which he used a small quantity of cocaine for opening an abscess of the hand, found the patient half an hour later in a condition which could only be described as " gloriously drunk."

Dr. Sale thinks the canabis indica and other ingredients of the bromidia might have aided in producing the mania in Dr. Krauss' case.

Dr. Heber Jones has made the same observations as to the effect of cocaine on the healing of tissues. In injecting under the mucous membrane for circumcision, he never gets union by first intention, as he constantly did before the introduction of cocaine, and as he now gets when operating without cocaine, and he does not attribute this effect to the mechanical separation of the tissues by cocaine.

Dr. Krauss considered the delayed union due to paralysis of the trophic nerve. A. B. HOLDER, M.D., Sec'y.

CLINICAL SOCIETY OF MARYLAND.

WM. T. WATSON, M.D., SECRETARY.

BALTIMORE, MD., March 18, 1892.—The 264th regular meeting was called to order by the President, Dr. Robert W. Johnson.

Dr. W. S. Thayer reported a case of leukæmia and exhibited the patient. The patient, a colored man of about 30 years of age, first reported to the Johns Hopkins Hospital Sept. 15, 1890. Complained of shortness of breath, swelling of feet, and great swelling of abdomen. The spleen was found to be enormously enlarged, filling up the whole of the

left side of the abdomen and reaching beyond median line. Examination of the blood showed one white to four red corpuscles. There was no history of malaria. He was placed upon Fowler's solution, three minims ter in die, increased by one minim every other day until physiological effects appeared. In about four weeks the proportion of white to red corpuscles was one to seventeen. He then returned home to Virginia and ceased to take medicine. He came back again Jan. 29, 1891, his blood at that time showing a proportion of one white to three red corpuscles. He was put upon arsenic, and within nineteen days the leucocytosis had entirely disappeared. May 27th he went away feeling very much better. His white corpuscles were normal, and his red corpuscles numbered 4,000,000 in the cubic millimeter. His spleen, which had touched on the right Poupart's ligament, was reduced in size, extending only a hand's breadth below the costal margin. He took arsenic in increasing doses until the dose reached 12 or 13 minims ter in die; when physiological symptoms appeared the dose was reduced, and he started up again. He took 12 minims regularly for a matter of two months without any symptoms. Nothing was heard of the patient for eight and a half months. On Feb. 9th of this year he returned. He said he had felt perfectly well until last Christmas. An examination revealed that his spleen was larger than ever before, legs oedematous, and a proportion of one white to every nine red corpuscles. After a week's treatment in the dispensary he was admitted to the hospital, where he has been for four weeks. During this time the red corpuscles have increased from 2,700,000 to 3,400,000, and the white have diminished, so that the proportion instead of being one to nine is now one to thirty-five. He has gained ten pounds, his spleen somewhat diminished in size, and his general condition has improved very much. His reaction to arsenic each time has been very striking. It is in this condition, with enlarged spleen, that treatment seems to do most good. Some cases are reported where there seems to have been a definite recovery.

Dr. J. E. Michael: Only a few years ago this case would have passed for a malarial one in the hands of the general practi

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