action can be controlled by acetic acid if the burning is too great. I have used the pyoktanin in one case of cancer of the womb that was not suitable for operation, but failed to get the good results from it claimed by some of its advocates. An adverse opinion in a single case is not worth much, however. The question of relieving pain is an important one. The local application of carbolic acid, laudanum and cocaine to the ulcerated surfaces is important. Opii grs. i, ext. bellad. gr. }, makes the best analgesic pill, its effects being a little slower but much more lasting than the alkaloids of the same preparations.

We come now to the use of the knife, which is such a scare to so many patients, yet far more humane and devoid of pain. than the application of the various pastes first enumerated. By injecting twenty to thirty minims of a four per cent. solution of cocaine into the surrounding tissue, there is hardly any pain connected with the extirpation of these small ulcers and tumors. The resulting wound heals much more promptly, and there is less liability for it to return; and, altogether, it is much preferable to other methods of treatment.

Case 1. In 1882 Mr. L. consulted me in regard to an epithelioma on the lip, produced by excessive pipe smoking. It had been a running, unhealed sore for six months. I made a V-shaped incision through the lip, cutting wide from the infected margin of the tumor; brought the parts together with silk sutures extending entirely through the lip, relieving the tension on the sutures by adhesive plaster across the wound, dressed the part with bismuth and iodoform, and in a week ulcer was entirely well, and though ten years have elapsed there has been no return.

Case 2. I was consulted by Mr. B. the same year for an epithelioma of the first phalanx of the finger, which had resisted the usual ointments, and possessed all the earmarks of skin cancer. I suggested the advisability of an amputation of the offending member. The treatment seemed to him out of proportion to the gravity of the case. He consulted another physician, received the usual cancer salves and paste treatment. The disease spread rapidly through the lymphat

ics, finally involving those in the axillary space, breaking them down rapidly,opening the pleural cavity, and resulting in death in less than a year's time.

Case 3. Mrs. M. was affected with a hardened nodular mass upon the tip of the nose, which continued gradually to break down and enlarge until about the size of a quarter. It resisted every known means of healing cleanliness, ointments, powders, and poultices, remaining an ulcerating sore for three years. Chloroform was used in this case, and the entire end of the nose removed down to the ale; the parts were approximated by silk sutures upon which there was considerable strain; adhesive plaster was applied so as to draw each cheek forward, thus relieving the strain upon the tightened sutures. The case was dressed with aristol, afterward with iodoform and boracic acid. On the third day, alternate sutures were removed, and on the sixth day the remaining ones were taken out. On the tenth day the patient was discharged cured, and has had no relapse of the disease since, though three years time has intervened.

Case 4. Capt. W. had been troubled with a warty excrescence on the right cheek for four years; it was dotted with black pigment, with a tendency to bleed. I injected a four per cent. cocaine solution in the base of the tumor, and removed it by making a funnel-shaped incision deep into the tissue, cutting away from the diseased surface. I dusted the parts with a dry dressing, applied a small piece of absorbent cotton over the cut, then adhesive plaster over this. Removing the dressing after five days, found the parts entirely healed, with no tendency to return, though two years have elapsed.

I have two other cases, recently operated on, that have made fine recoveries: one of the breast, and one of the cheek. They are too recent, however, to report as to what the final outcome will be.

From the foregoing cases I am led to believe that epithelioma is an entirely local disease at first, and susceptible of a cure if taken in hand at once; that no time ought to be lost fooling with cancer cures and salves, but that the knife, and it applied wide of the mark, is the panacea for all such ulcers.

SOME UNUSUAL CASES IN RECENT ABDOMINAL WORK.

T. J. CROFFORD, M.D., MEMPHIS, TENN.

Gynecologist to St. Joseph's Hospital, Memphis Sanitarium, &c.

Case 1 was in the person of a virgin, aged 35, who had been a great sufferer for fifteen years. She was examined one year ago by myself, and pronounced incurable except by Tait's operation. She fought this one year longer, but was forced by her constantly increasing invalidism to yield. In this day of a justifiable revolt against so many and such reckless abdominal operations, some go too far in the revolt. This case illustrates the fact that there arise diseases of the appendages, even in the virgin, which cannot be cured by other means than the removal of the diseased structures by abdominal section. The recovery was prompt.

Case 2. Mrs. A., aged 27, married, two children. Like the first case, was examined one year ago, and pronounced incurable except by Tait's operation, so enlarged and adhered were the tubes and ovaries. She declined the operation and resorted to the use of electricity; there was no permanent benefit. On last January an attack of peritonitis came near ending her life and determined her to have the operation performed as soon as practicable, notwithstanding more formidable adhesions which had now taken place rendered the operation more difficult and hazardous. This case illustrates the delusion of electricity and the dangers of delay when an operation is inevitable. There is more danger from one of these attacks of peritonitis to which these cases are prone, than from the operation when skillfully done under modern methods. She got well.

Case 3 was an ovarian tumor weighing fifteen pounds, of interest in being of six years' growth, and so closely simulating a fibroid as to make a diagnosis impossible. It was quite tense and filled with a fluid looking like pus. The case is interesting also on account of the almost universal adhesions: those of the anterior abdominal wall were quite strong. The omentum was spread out like a fan upon its surface, and the small intestines were so strongly attached as to require an

enterorrhaphy after their separation from the tumor. But the point of greatest interest in the case is the unorthodox method of conducting the operation. Instead of tapping the cyst, as is the custom, the incision was extended up to the ensiform cartilage, preferring to separate the adhesions on all

Fig. 1

sides of the tumor in its distended, rather than its collapsed condition. Also by this means the danger of liberating the septic fluid in the peritoneal cavity was obviated. 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.

Case 4. Mrs. H. of Arkansas, aged 62 years, was the subject of a very large polycystic ovarian tumor (figs. 1 and 2) of six years' duration. It had been tapped seven times, and she was proposing to have it again emptied, when her husband came over to consult me upon the subject of its removal. I advised him to bring her at once to the Sanitarium without drawing off any of the fluid, preferring to operate as it was. The patient was much withered and exhausted from lugging

around the enormous growth. The adhesions, as expected, were firm to the abdominal wall in front, so dense as to pull off the parietal peritoneum and cause free hemorrhage from many places. The fluid was rapidly evacuated through the trocar and through openings torn into the sac from separated

Fig.2.

adhesions. The small pedicle was secured in the usual way. The tumor unquestionably received most of its nourishment through the adhesions, as the vessels entering through these were much larger than those of the pedicle. It will be remembered as the reason given for the occasional absence of a true pedicle in these tumors being a rotation or twisting, causing an atrophy and severing of the pedicle, the nourishment coming readily through the adhesions. The fluid filled three ordinary water buckets-the colloid material and sac added to this making altogether seventy-five pounds in weight. The operation was done on the 28th December last. She made an excellent recovery and is since in all respects well.

The points of interest in this case were:

1. The size of the tumor.

2. The extent and density of the adhesions.

3. The smallness of the pedicle.

4.

The length of time in existence and number of tappings. 5. The age and feebleness of the patient.