whose external is compact, over considerable cancellous structure- -as the head of the tibia-the explosive effect is more marked, especially at the longer ranges. In wounds of the shaft of the larger long bones the fractures are terrific, particularly at the longer ranges; but in the smaller bones which are comparatively solid the holes look as though they had been made with a punch. In the brain, lungs, heart, spleen, kidneys, liver, intestines, and bladder, especially if the organs are full, the explosive or lateral effects of the bullet are simply terrific, tearing every thing around. In some of these experiments it was shown that the whole viscera was almost disintegrated by a single shot. All wounds will be more or less septic, for, as before stated, it has been proven by careful experiments that the heat of firing does not sterilize the projectile. The degree of infection will depend on the amount of handling and condition of the missile before firing, as well as of the bits of clothing and other foreign bodies carried into the wound. As the result of these experiments, which were in every instance conducted by men of the highest scientific character, it has been proven that in future wars the medical and hospital departments must be equal to at least four per cent of the whole force of the army in order to handle the wounded promptly, and thereby free the army of the impediment of those who are disabled, whose presence will detain and demoralize the troops. In view of these facts Dr. Demosthen was undoubtedly correct when he wrote to the Paris Academy "that humanity will gain nothing from the modern missile in warfare." NOTE. The writer acknowledges his indebtedness to Col. J. D. Griffith, President of the Association of Military Surgeons, for the use of the accompanying cuts. LOUISVILLE. TANNOCHLORAL IN SEBORRHEA.-Captol, a combination of chloral and tannin, is an hygroscopic powder, of a dark-brown color, slightly soluble in cold water, more soluble In hot water and alcohol, and decomposed by alkalies. According to La Medecine Moderne this combination is valuable in seborrhea. It is employed in the form of a two.per-cent alcoholic solution, of which a few drops are added morning and evening to the water with which the scalp is washed. Generally at the end of eight to twelve days the crusts fall, the secretion of the sebaceous glands diminishes, and the hair ceases to fall.-The Medical Bulletin. Reports of Societies. LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.* Stated Meeting, February 25, 1898, the President, F. C. Wilson, M. D., in the chair. Extrophy of the Bladder. Dr. A. M. Vance: This young man, aged seventeen years, has a typical extrophy of the bladder. When a baby he was taken to a surgeon in St. Louis, Mo., who said that nothing could be done in an operative way which would be of benefit. I first saw him five months ago, and operated upon him at that time, and have performed one operation since, a failure resulting in each case so far as marked improvement in his condition is concerned. I expect to make another attempt next Monday, and shall hope for a better result. Since operating upon this patient the first time I have gotten the same result in a similar case in a boy six years old, and I take it this is probably the best age in which to do this work. I operated twice upon this little patient at the Children's Hospital with benefit each time. It may take several more operations to close the opening, but I am much encouraged. In the patient before you you can see the prostate gland, you can see the ducts of the seminal vesicles, you can see the ureters discharging urine almost constantly, the posterior bladder wall being exposed to the world. In the two operations already performed I have piled up tissue upon each side, which makes success in the case later more probable. When he lies down, as you will observe, the bladder wall forms a concavity. None of these cases have umbilici, and few of them have any pubic bone. The umbilical cord is evidently attached to some part of the tissue about the extrophy at birth. Operation in these cases is attended with numerous difficulties. The surroundings are septic and conditions develop which are antagonistic to perfect surgical work. The tissues of the abdominal wall beneath this condition of extrophy are extremely thin, and it is therefore necessary to bring flaps from each side in order to build up tissue sufficient for the purpose. A question of considerable importance is the suture material which shall be used in operating upon such cases, and the manner in which Stenographically reported for this journal by C. C. Mapes, Louisville, Ky. the sutures shall be introduced and fastened. In the case operated upon at the Children's Hospital I used silkworm gut, secured by means of shot, which were easily removed afterward, that is, two continuous sutures. It seems to me that the only procedure indicated in the case before us is to endeavor to bring together these pillars of tissue, in such a manner that the patient can lead a comfortable urinal life. It is possible by a series of operations that this can be done. One of the great drawbacks to operative interference, or success attending it, is erection of the penis which occurs afterward, preventing proper healing of the parts. This feature is especially marked in a patient of this age, and is one reason for failure in the operations already performed. I hope to overcome this by the administration of large doses of bromides when operation is again undertaken. Discussion. Dr. W. L. Rodman: I think the doctor's idea is the correct one, he should build up the tissues in the way he has begun, and he has already accomplished a great deal toward the betterment of a most unfortunate condition. I would advise proceeding in the line he has proposed. Dr. T. S. Bullock: I had the privilege of seeing the first operation performed upon this young man, and certainly thought when Dr. Vance had finished that he had some chances of obtaining a favorable result. Unfortunately, however, this seems to have been defeated by some untoward circumstances, although he has gained considerable since that time in building up tissues from which to work. Dr. A. M. Vance: As already shown, in the majority of these cases there is no pubic bone, and there is always a certain defect in the power of the rectum to retain its contents which constitutes a very annoying complication. With the bowels constipated we have little trouble, but when diarrhea exists the condition is extremely disagreeable. In my entire experience I have had under my care but three of these cases. The first one, a little girl, had prolapse of the rectum, which upon being excised measured something like six inches; it was an immense prolapse, it hung down between the child's legs, was excoriated aud caused a great deal of suffering. The infantile uterus was exposed, as was also the posterior wall of the bladder; the ureters could be seen discharging urine upon the excoriated surface as in the case before us. |