was retained.

That night there came away a bolus of hair six inches long, three inches in circumference, and coated with hard fæcal matter. Two years afterward, the child was treated for threatened obstruction. injections of castor oil brought away the bolus.

Copious

Dr. J. W. Henson reported a case of obstruction in a girl of 14 years. She had typhoid, and on the twenty-first day, there was intestinal hemorrhage. He was afraid to give purgatives. For two weeks from the time of hemorrhage, fever continued. However, in a few days, there were frequent passages of masses as large as a fist. Oil was then administered, and the character of the operations remained the same for three days. The oil was then stopped and improvement followed rapidly.

Dr. J. A. Hodges said he listened to the paper with interest; that it covered well the whole ground, but there was one remedy to which no reference was made. Belladonna pushed till its physiological action is manifest, is indicated in any kind of obstruction. In one case, operation was about to be performed when the belladonna, which had been administered previously, produced a movement. Enemata, said the doctor, are never properly administered except by the physician himself. They should always be used before operation is decided upon. The best is of kereosene oil of which he

It is a lubricant and irritant. During

has used as much as a pint at a time. the injections, the buttocks are held up for half an hour if need be, and it is wonderful to find how far the oil penetrates. If there is no tympanitis, taxis or massage may be employed to hasten its action. In the case of a brakeman who had no diarrhoea there occurred white attending to his duties, a sudden pain like that of hernia; but on examination nothing much was found. An enema brought nothing; when a coal-oil enema produced a small movement. On opening the abdomen, a commencing hermia was found. The strangulation was removed and the patient recovered. Soon after, ob struction recurred. This time, the oil gave relief. The doctor has never observed any bad effect from the oil.

Dr. W. W. Parker reported two cases of impaction, both in aged women, both requiring two days for their removal. One began in October and was not removed till the February following. In making post-mortems, the doctor had often found scybalae where they were never suspected.

Dr. Henson reported that in the case of a girl of 7 years, he had used for five days purgatives and enemata without result. The contents of the abdomen could be felt, but no lumps were revealed. It was decided to remove her to the hospital for operation. Before doing so, belladonna was administered and the operation deferred, and for two days the use of the drug was contined producing movements which become regular. Enemata were also continued.

The President: Experiments show that the carbonate of sodium dissolves scybalae. The hint is worth remembering. Alkaline remedies are solvents

and there is no reason why they should not be given for that action by the mouth. They act on the centre and sides of the mass at the same time.

Dr. J. S. Wellford finds enemata of strong solutions of salt very efficacious. He follows this administration by salts, senna and manna. He thinks we err in giving the solid extracts as they are of small bulk.

Dr. Edwards thinks ox gall injections efficacious. It acts better than all other remedies, combining a natural purgative and solvent. He uses a bladder for each injection.

Selected Papers.

IODOFORM-OINTMENT INJECTIONS IN THE TREATMENT OF SUPPURATIVE ADENITIS OF THE GROIN.

BY JAMES R. HAYDEN, M.D.

The chief objects to be obtained in the treatment of suppurating inguinal buboes are their rapid disappearance, an amelioration of pair, and the absence of a compromising scar in the groin.

To this end various surgical procedures have been suggested from time to time, but it was not until 1856, when Broca, Roux, Marchal, Abeille, and others advocated aspiration of the pus and injection of diluted tincture of iodine into the abscess cavity, that such favorable results were in a degree obtained.

1857 Lebert reported a number of successful cases treated in a similar manner, except that he evacuated the pus through a small incision and injected the pure tincture of iodine.

Again, in 1861, Teackle, speaks of this method as being remarkably successful, and quotes several cases in which he has employed it.

Scott Helm, in 1886, was, I believe, the first to substitute iodoform for tincture of iodine, and used it in the following manner:

The parts were cleansed and anæsthetized by means of ether spray, the pus was drawn off with a hypodermic, and the abscess cavity washed out with a weak solution of carbolic acid. Iodoform suspended in glyce in was then injected, the needle withdrawn and the puncture closed with collodion; over this an ordinary dressing and spica bandage were applied. Twenty-one cases were treated in this manner with but one failure.

Later, Helm substituted oleic acid for glycerin, and finally iodol for iodoform.

In 1889, Von Eichstoff reported a series of cases treated by injections of iodoform and ether which he employed in two different ways as follows: First method. The pus was withdrawn and the cavity irrigated with boric acid solution, and then injected with the iodoform and ether mixture, the

puncture being covered with an ordinary dressing, which was left in place for three days. In some cases he had to make a second injection, but never a third.

A cure was accomplished in from three to eight days. Second method. The parts were cleansed and the iodoform-ether mixture injected directly into the abscess cavity without evacuating the pus. As a rule, two injections had to be employed before a cure was accomplished, which on an average took about twelve days.

In the same year Fontan described very minutely the treatment of suppurating buboes by injections of 10doform vaseline. He gives a total of forty-one cases so treated, the average time for cure being six to seven days. His method of procedure is as follows: The parts are shaved and cleaned; the bubo opened with a lancet and all the pus forced out; the abscess sac is then irrigated with diluted Van Swieten's fluid, and iodoform-vaseline injected with a glass syringe, previously warmed in hot water. A cold wet dressing is applied in order to congeal the ointment at the opening. In some cases it was necessary to resort to an injection a second time.

In 1893, W. K. Otis reported very favorable results in sixteen cases in which he used injections of iodoform ointment in a similar manner.

Having employed this plan of treatment with such satisfactory results, I feel justified in reporting the few cases so operated on; these were not selected, but taken at random as they entered the hospital and clinic. The steps in the procedure are similar to those advocated by Fontan, with the addition of the peroxide of hydrogen, and are as follows:

1. The operative field is shaved and rendered surgically clean in the usual

manner.

2. A few drops of a 4 per cent. solution of cocaine are injected beneath the skin where the puncture is to be made.

3. A straight sharp-pointed bistoury is then thrust well into the most prominen: part of the tumor until pus flows.

4. All of the pus is forced out through this opening by firm but gentle pressure, as this procedure is, as a rule, very painful.

5. The abscess cavity is irrigated with pure peroxide of hydrogen until it returns particularly clear.

6. It is then irrigated with 1:5000 bichloride of mercury solution, all of which is carefully squeezed out.

7. The now thoroughly cleansed abscess cavity is completely filled, but not painfully distended, with 10 per cent. iodoform ointment by means of an ordinary conical glass syringe, previously warmed in hot water.

8. A cold wet bichloride dressing is applied with a fairly firm spica bandage, the cold congealing the ointment at the wound, and thus preventing its escape into the dressing.

The patient should be kept very quiet for the first twenty-four to fortyeight hours, rest in bed being preferable, although not absolutely necessary.

The dressing is removed at the end of the third or fourth day and the parts examined; if pus has reaccumulated or the ointment escaped into the dressing, a second injection may be made. If, on the other hand, all looks well, the first dressing is replaced by a gauze pad and spica bandage, and the patient told to report in two or three days for examination.

In a few of the above series of cases several drops of an oily serous fluid were observed at the first dressing escaping from the puncture; this fluid was carefully wiped off and a sterilized gauze dressing applied, recovery being in no way retarded by the exudation.

The following table gives the etiology, amount of pus evacuated, number of injections employed, and time for cure in each case:

Suppurative action and pain ceased atter one injection of the iodoform ointment, except in two cases; in these the injection had to be repeated on account of a slight reaccumulation of pus.

None of the above cases were pronounce cured until firm pressure in the groin elicited neither pain nor fluctuation, and the overlying skin had resumed its normal appearance.

In order to secure the most favorable results from this method, it should only be employed when the glands are quite thoroughly broken down, so that the iodoform may come in direct contact with all of the infected tissues.

It is not, of course claimed that this method will succeed in every case of suppurative adenitis, but its many advantages over the more radical procedure render it, in my judgment, worthy of a trial. There is no necessity for the patient to remain in bed, or undergo anesthesia; the little scar in the groin is soon covered by hair, and he or she is spared a more or less painful and tedious convalescence. If after one, two, or even three injections, this method fails to produce the desired result, an incision may then be made and the contents of the bubo removed; the previous treatment not having interfered in any way with this operation.

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Editorial.