strength of the current being increased until we can use as much as forty or fifty millidmperes. Gradual reduction of the growth takes place under this treatment, and a number of cures are recorded as its result. It is of very little service, however, in cystic goitre, because we can't get the effect of the negative pole in the alteration of the tissue of the growth as we do in the more solid tumors. It has been suggested to tap the cyst, wash it out, fill it to distension with chloride of sodium solution, and by this means, receive the full effects. With electrolysis, four or five to a dozen or more sittings are required. CATAPHORESIS-The third method, that of cataphoresis or the introduction of remedies by the direction of the electric current, has been in my hand a very satisfactory treatment, particularly in follicular goitre. I can record two or three cases in the last eighteen months where I have had the most satisfactory results from the use of iodide of potash by this method. I use, attached to the positive pole, a metal disc which is covered with wet chamois of cotton upon which is packed as much powdered iodide of potash as it will hold. This is covered over with a thin pledget of wet cotton and applied to the growth. The negative pole is held in the hand, or applied to the back of the neck, or between the shoulder blades. I have seen very little notice of this method of treatment. The only case that I know of recorded, was one reported by Dr. McGuire two or three years ago, in the Virginia Medical Monthly. In the goitrous enlargement or bronchocele, which one observes in young people, young girls especially, about the time of puberty, I don't know any more satisfactory treatment. It is true that this form of bronchocele occasionally manifests itself unless at the time, or during the period of, menstruation and very frequently gets well of itself. I am not, however, referring to this form, but to those cases of persistent enlargement of the gland, which not only is seen during the menstrual period, but is present more or less all the time until active measures are instituted for its relief. I have seen cases of follicular bronchocele that have become very large in women because no attention was paid to it in the stage where it would swell up and go down as it were, on the theory that it would get well of itself. One of these was very large, and persisted for several years, and was cured by the application of iodide of potash by cataphoresis. This case I have already mentioned, and it is one known to most of you. I am satisfied that further investigation into this method of applying remedies, will show it to be of great value. In regard to operation, I am satisfied that in cutting open the cysts, as I did in the case above recorded, that I was exposing this pa tient to as great danger as if I had removed part of the gland. evidenced by the symptoms that developed. This was Partial thyroidectomy, or strumectomy as some call it, is recommended by many authors for follicular and fibrous goitre. Storm of Christiana, has re ported quite a number of operations with success. He also advises enucleation of the cyst for cystic goitre. Morris, in the Lancet, January 25, 1895, reports five cases of bronchocele operated on for urgent pressure symptoms, (all the cases being of comparatively short duration) in which he had good results, and he advises removal of the isthmus and as much of the lateral lobes as may be needed to relieve pressure which is followed by atrophy of the rest of the gland. Brooks reports two cases of partial thyroidectomy followed by success. Operation has also been suggested and porformed by quite a number of authors for exophthalmic goitre on the ground that it is a hyperplasia of the gland structure, and that the nervous symptoms are due to the toxic effects of the altered secretions, and a number of cures are reported. Greenfield's article in the British Medical Journal, December 1893, is probably the best of these contributions. All operators, however, have come to one conclusionthat complete removal of the gland is unjustifiable, and that all operations are more or less dangerous, death on the table having resulted in a number of cases from collapse. It is doubtful that any deaths have resulted from hemorrhage, although in some cases the bleeding is hard to control because of the difficulty of applying ligatures to the vessels whose walls are in such a condition that ligatures will tear loose. To arrest the bleeding by packing is not satisfactory and may be dangerous. If proper care is taken in performing the operation, the bleeding arrested as the operation proceeds, and the field kept as aseptic as possible, I believe the operation of partial thyroidectomy would be comparatively safe. Care must also be taken not to injure the recurrent laryngeal nerve. This operation has been successful in a great many instances, but there have been some failures, as is the case with all operations in surgery. DISCUSSION. Dr. Chas. N. Shields remarked that up to five or six years ago he had been treating goitre with electrolysis by the labile method-a pole on either side of the tumor. In two cases a cure was permanent. Three-quarters of the cases in girls occur at puberty and as these cases get well anyway, it is doubtful that the cure was the result of electrolysis. For the last four or five years, the doctor has been treating goitre by cataphoresis as described by Dr. White. In three cases, the results were good. one and one-half inches to normal. provement, but reduction was not complete. viously and reduced one and one-half inches. Under Dr. Shields' treatment reduction was permanent. Another case was that of a young Italian affected In the first case, the neck was reduced by goitre for eight years. He had been treated in Italy by injection and electrolysis. The growth was cystic and looked suppurative. Counter puncture was done and the tumor washed out every other day with peroxide of hydrogen. It was larger than a hen's egg, but now, there is no perceptible enlargement. Results, as a whole, however, are such as never to make him promise permanent cure. Dr, Jacob Michaux said that in doing a tracheotomy in a child with diphtheria, he was obliged to go through the isthmus of the thyroid gland; and the amount of hemorrhage ensuing made him fear greatly for the safety of the child. Dr, W. W. Parker never fails to stop goitre in the formative stage, by a blister applied every ten days. Dr. J. W. Henson spoke of the operation of opening the deep fascia and stitching it to the integument. Dr. White, in closing the discussion, stated that he had listened to the remarks with interest; that he had only known the evening before that he was to be called on to open the discussion on goitre; and that he regretted the brevity and necessary incompleteness of his remarks, limited as they were mainly to his own experiences and his recollections of what others had said and written in relation to bronchocele; but that he would try to reply to the gentlemen who had spoken on the subject he had introduced. In regard to Dr. Michaux's remarks as to the danger from cutting through the isthmus, he had learned from his experience that this was one of the tra ditions in the profession used to scare timid operators, like the nursery ghost stories to quiet refractory children. He had often, in doing tracheotomy in a hurry, to open the trachea without regarding the isthmus; and whilst he had seen considerable bleeding-which usually stopped on inserting the tube-he had never seen a dangerous hemorrhage. Once he was called at midnight to a man who had been apparently suffocated by the pressure of an enormous goitre, and was obliged to open the trachea by candle-light as quickly as possible. Dr. O'Brien of Alexandria, assisted him on that occasion, and he cut directly through the centre of a fibrous goitre three inches thick, without regard to hemorrhage, until he reached the trachea which was opened; and the man was resuscitated by artificial respiration. Even then the hemorrhage, whilst considerable, was not dangerous in amount. He was glad to know that Dr. Shields' experience with the cataphoratic action of electricity had been favorable, but did not think it necessary to put the remedy on both poles, as the positive pole was the active agent in inducting the remedies into the tissues. He thought also, that Dr. Shields' idea of electrolysis was rather different from the common acceptation of that term, inasmuch as he seemed to confound the passage of the constant current, or galvarism, through the growth, with the destructive actionof the negative pole introduced directly into the tumor-the term electrolysis referring only to the latter. Dr. Parker's experience with goitre was more favorable than his own; especially in the lucky circumstances that he always saw them just in their incipiency when counter-irritation with blisters was sufficient to cure. All the goitres he had ever seen were well developed tumors of long standing when the case applied to him. On one occasion, however, he had seen an enlargement of the thyroid cured by a blister. It was a case of non-suppurative thyroiditis, the only one he ever saw, which developed so rapidly in a very short time as to theaten suffocation. He, at once, applied an ointment of red iodide of mercury and iodide of potash all over the front of the neck, producing an enormous blister and in a few hours, promptly relieving the patient. Meanwhile, he sat by expecting at any time to be obliged to open the trachea. Dr. Henson was quite right in saying he had seen report of merely opening the deep fascia in goitre, as it was an operation suggested to relieve dyspnoea from pressure of the glands on the trachea, but Dr. White had never seen a case of cure recorded, from this method; although it was quite within the bounds of probability that after relieving the pressure of the fascia upon the gland, atrophy of the gland might have ensued; and, therefore, it is not at all improbable that he had seen a report of a case cured by this operation, although it was performed merely for the relief of suffocative symptoms and not to cure the goitre. ACUTE COCAINE-POISONING.* BY M. V. BALL, M.D., Philadelphia, Pa. In presenting this report of a case of acute cocaine-poisoning, I doubt whether I can offer anything new, and yet there are several interesting points to be noted. The literature on cocaine intoxication, though widely scattered, is, however, quite extensive. Mattison, of Brooklyn, and Germain Sée, of Paris, have each reported, in 1892, two hundred and more cases of poisoning, with twenty deaths. Since then quite a number of deaths have been recorded in medical journals. The dose at which fatal poisoning has occurred varied within marked limits. In five fatal cases reported by Manheim, the quantity of the alkaloid taken was over 15 grains. In two cases reported by Mattison, death occurred after the hypodermic injection of grain. Symptoms of poisoning has set in when the drug was administered by the *Read before Philadelphia Medical Association October 9, 1895. stomach, when thrown into urethera, nose, ear, rectum, or when injected under skin or into the gums; or when simply rubbed over the surface of the face. Absorption is very rapid, and in some of the cases reported the operator barely had time to withdraw the needle of his syringe before symptoms of intoxication set in. The symptoms described in each case differ greatly, and there are all stages, from slight incoherency in speech with dizziness and dilated pupils to excited hallucinatory delirium, thready uncountable pulse, convulsive breathing, or sudden collapse, or marked tetanic spasms. Cocaine-poisoning exhibits the symptoms of strychnine-poisoning in some cases, in others that of alcohol, and in some a mixture of both. I will now describe the case in question: Mrs. C., aged thirty-five years, white, a sufferer for ten years past from rectal stricture, accustomed to use cocaine locally on pledget of cotton in the rectum, being tired of her existence resolved to end her life by swallowing 25 c.cm. (6 drachms) of 5 per cent. solution of cocaine, equal to about 1 grammes (18 grains) of the alkaloid. The dryness in the throat was speedily produced, and in attempting to get up from her couch to ring for the servant she felt dizzy and fell to the floor. A young medical student living in the house, and summoned at once, found her in a raging delirum. She wanted to throw herself from the balcony. She talked loudly, incessantly and incoherently. She was restrained by physical means, and when the student endeavored to give her a hypodermic of morphine she resisted, and would not allow him to do so. He persuaded her to take the tablets by the mouth, and so grain was administered. It was about half an hour after that I saw the patient. She was held down on the bed by her friends, and was gesticulating wildly, yet was able to recognize me as soon as I entered the room, appealing to me for help. I suffered her to be released, when immediately rushing past me she made for the open window to fling herself out. This she was prevented from doing, remarking, as she was led back to her couch, that after all "she wanted to look pretty when she died." Her pupils were widely dilated, the pulse hardly perceptible and very frequent. The tongue would be protruded spasmodically, and teeth gritted together in a tetanoid manner. She talked incessantly. In a few minutes I was able to gain control over her without using physical restraint; and, though she talked irrationally at times, her delirium was less marked, and she told me that she was not going to get over the effects, nor would she allow me to give her an antidote; in the next breath she would ask me to listen to her singing or recitation. Frequently looking at her hands they appeared dirty to her, and she would rub them, Her tongue was much congested, bluish |