solution treated with an alcoholic solution of mercuric chloride. This precipitates the ptomaine us a double salt.

This salt is suspended in water and decomposed with hydrogen sulphide, and filtered; the solution of chloride of ptomaine evaporated to dryness, redissolved in water, and the excess of acid neutralized with a drop of solution of caustic soda; the neutral solution treated with alcohol, filtered, and then treated with platinic chloride. The double salt is soluble; for that reason the solution of double salt was evaporated to dryness and then treated with ether-alcohol to remove the excess of platinic chloride; 0.471 gram of this double salt left after incineration 0.168 gram of metallic platinum: 0.168: 0.471 :: 198: x = 555 molecular weight. 555 (340+78) = 142 (Rep. 2 molecules of base.) Calculated for CH, ON 2HCl Pt Cl1 = 555. 35.67 per cent of Platinum.

Oxygen. Nitrogen.

Found 0.168 0.471 34.18 per cent Platinum. 0.2040 gram of substance gave 0.1300 gram CO2= 17.38 per cent Carbon,

and 0.507 gram of HO-2.76 per cent of Hydrogen Nitrogen by Kjeldahl's process, but weighed as Ammonia Platinic Chloride 2.85 per cent Nitrogen.

0.2040 gram of substance was heated with concentrated sulphuric acid according to Kjeldahl's process. This gave 0.0455 milligram of ammonia platinic chloride. (NH 3HC)) PtCl 447. 447: 0.0455:: 28: x =2.85 per cent Nit. 0.2040 gram of substance gave 0.1300 gram of CO,. Equivalent of CO=44; amount of Co2 found 0.1300; Equivalent of C12.

Now as 44:0.1300 :: 12: x

.03545 C

.05633H .05814N

(354545633+5814) ==..... .05408 O

17.38 per cent Carbon. 0.2040

2.76

66

.05408 0.2040

2.85 2.65

Hydrogen. Nitrogen. Oxygen.

This alkaloid is identical with a base that I isolated from the evacuations of patients suffering with typhoid fever. I am satisfied that this alkaloid is produced by the action of typhoid bacillus upon nitrogenous

The blackest bete noir, which probably more frequently than any other lesion darkens the success of the general practitioner's daily work, is the "old, indolent, gray, or weeping ulcer," the ulcus non exedens of the older writers.

All doctors have had them in practice, and all have wished more than once that either himself or the patient had never crossed over into this vale of tears. In the course of time, as you call to mind the many times you have dressed the sore, the many times you have met with almost success, and then "thus far shalt thou go and no farther." Even when you recall complete success, and then a breaking down of the skin and a re-establishment of the old trouble in all of its malignant deviltry-in the course of time you become possessed of a peculiar illusion. You confound man with ulcer; when you look on him you do not see eyes, nose, mouth, etc., which go to make up a face, but you see a glistening, smooth surface, glassy in aspect, over which thin and watery tears course down as though weeping for its own unsightliness. Here and there, perhaps, you find this surface covered with green, fetid, and turbid tears, shed at the deaths of countless infant granulations, too weak and marasmic to live beyond the

*Read before the Owensboro Medical Society, November 19, 1889.

moment of their inception. When the sore is large, this appearance is generally found near its lower margin. The indolent ulcer is ever ready to slough. Some constitutional cause or disturbance, any general derangement of the health, or the part affected held for any length of time in a dependent position will produce sloughing. But not a healthy slough; not a slough through inflammation, but through lack of vitality in the granulations themselves. There are as many ways of treating indolent ulcer as there are names to the sore itself. But I believe (and my belief is based on both bitter and pleasing experience) there is but one correct method of treating these ulcers and that is by Tiersch's method of skin-grafting. I have caused to heal many ulcers by the use of pressure, and at one time I thought the rubber bandage was all that these cases required.

Strips of linen sheeting moistened in water and applied to the ulcer, and over this the flannel roller, is a very efficacious dressing, especially where the ulcer is due to malnutrition or varicose veins. Dusting the sore with iodoform, and then applying the common cotton or calico roller, answers admirably sometimes. But, after you have healed the sore, what can you promise the patient? Afier days of toil and trouble, after alternations of hope and despair, after great care and vexation of spirit, you have brought the case to a successful termination. Can you promise the patient immunity? No! for in eight cases out of a dozen, where the sore has been of long standing and is due to varicosity, alcoholism, or malnutrition, the ulcer will return. Where Tiersch's method of skin grafting is done, the sore rarely if ever returns. The reason for this is self-evident. Wo cover the sore at once with strong, healthy, and old skin, and when the operation is a success there can be no breaking down of the tissues. Then, too, this method of treating ulcers saves time, suffering, and money. The first desideratum one must possess to perform Tiersch's method successfully is to secure a healthy field on which to plant the grafts. This is done

by securing a slough. Where the base of the ulcer is not indurated, you can get this artificially by scraping out the ulcer with Volkmann's spoon. Where the base is indurated, there are several ways of securing a slough. The favorite method is to cut completely around the margin of the ulcer, and then make a crucial incision through its base. A poultice should then be applied, and renewed daily until the slough comes away. On the fifth or sixth day a healthy granulating surface on which to plant the grafts will present itself. En parenthesi, let me say that last winter I resorted to an original method to procure a slough. The ulcer was on the calf of the leg, some four inches long by two inches broad. I introduced setons of silkworm gut, not catgut, through its base, from side to side, at intervals of one quarter of an inch. I directed that these should be moved backward and forward night and morning. In five days' time I had a beautiful granulating bed, and, strange to say, without having given very much pain to the patient. I have performed skin grafting (Tiersch's method) twice. Both cases were successful; the first case only after the second attempt. This result was due, probably, to my inexperience and to the lack of antiseptic precautions. The second patient was a colored sleeping-car porter who had an indolent ulcer of several years' standing on his shin. This operation was remarkably successful. The dressings were removed on the fourth day. The grafts had adhered firmly, with the exception of a place at the lower margin, about the size of a silver five-cent piece, where the graft had sloughed away. This operation was done in Knoxville last March. I had a letter from the man a week or two since, consulting me about something else, in which he incidentally remarked that he had had no further trouble with his leg. Some of you may not have had an opportunity of seeing this operation, so I will take the liberty of describing it: We will presume that the ulcer has been made ready for the grafts; that a pan of salt water (moderately salt), temperature, 100° F., is sitting on a table by your side, and that the patient has been

anesthetized. The thigh is bared-if you select it as the point from which you wish to get the grafts--then thoroughly soaped and shaved. Then the skin should be washed with a bichloride-of-mercury solution, 1 in 5,000, and afterward cleansed with ether sulph. Your assistant, standing at the side of the patient and fronting you, places a band on each side of the thigh, and stretches the skin. You then take a sharp, thin razor, and cut the grafts an inch broad, and as long as necessary, dropping them as fast as cut into the basin of salt water. You may take two or more, if necessary, to cover the sore. They are to be applied to the surface of ulcer, straightened out (for the skin has a tendency to roll together) and then dusted over with iodoform. Then comes the dressing of iodoform gauze, bichlorideof-mercury gauze, rubber protective, and finally the bandage. The surface from which the skin has been taken should be dusted with iodoform, and dressed with a dry dressing. It heals in a day or so without a scar. I should state that all bleeding must have ceased, and the blood removed with a soft sponge, when scraping with the spoon is resorted to before applying the grafts. In a healthy, granulating sore, I merely wash off the surface with a bichloride douche, 1 in 5,000. In conclusion, let me say that this is an operation that calls for the strictest antiseptic precautions, and the surgeon often meets with failure where success is due, on account of neglecting the simple rules laid down for the warding off of sepsis.

OWENSBORO, KY.

TWO CASES OF ABSCESS.

BY A. S. M'CLANAHAN, M. D.

Having recently treated two cases of deepseated abscess, I beg leave to call attention to some points in the management of them:

CASE 1. Male, aged thirty, had been strong and healthy until within a few months of taking his bed. When first seen he was suffering with a distended bladder, supposed to have been due to enlarged prostate. The retention of urine was relieved by the soft catheter.

At this time he called attention to his legs, and complained that they felt weak and benumbed; when told to draw them up, he did so with great difficulty. The bladder trouble persisted for several days, which necessitated the use of the catheter frequently.

At each visit paraplegic symptoms were noticeably increasing, and in time he lost entirely the use of his legs, but no symptoms had yet appeared to account for it. On a subsequent visit, however, while emptying his bladder with the catheter, I noticed that the urine, hitherto clean, had changed to a milky color, and that the last coming out was of a creamy consistency, which was evidently pus.

This discharge of pus increased in quantity and continued for several days. There was absolutely no evidence of caries of the spine, and so I supposed the case to be one of ordinary psoas abscess emptying itself through the walls of the bladder.

The patient had daily exacerbations of temperature, and the general symptoms soon assumed a typhoid character.

The treatment consisted in daily irrigation of the bladder through a double-current catheter with a solution of cor. chloride mercury; tonics and restorative remedies were given internally.

Under the treatment the pus perceptibly decreased daily, and finally ceased. The temperature became normal, appetite improved, and though convalescence was very slow the patient recovered, with the perfect use of his legs restored.

CASE 2. A young girl had a large tumor on the outer aspect of the thigh, extending from the great trochanter down to the upper portion of the lower third; it was soft and fluctuating, and had first been noticed three years before, since which time it had gradually increased in size.

The patient was of strumous diathesis, with glandular enlargement about the neck, blepharitis and ulcers upon the cornea. Her general

health was feeble.

In this case there was no curvature of the spine, but tenderness about the middle of the dorsal region.

Treatment consisted in emptying the abscess by the aspirator, great care being used to prevent

air entering the cavity. After this it was thoroughly washed out with a weak solution of bichloride of mercury; later a solution of carbolic acid was used, and finally sweet oil was thrown into the now perfectly clean cavity.

This treatment was carried out three times, at intervals of about three weeks; at the end of about six or seven weeks all fluctuation had disappeared, and no enlargement remained except the induration due to adhesive inflammation, which gradually subsided.

of twenty-four years, had pain in the bladder with frequent micturition. This gradually changed until the rectum became the seat of the pain. This pain is not aggravated by defecation, and it may come on at any time or at any place. She is compelled to empty her bladder five or six times during the night. Her physician had used nitrate of silver, carbolic acid, and nitric acid locally without benefit. The patient had used cold applications with benefit. Another phy

Believing that spinal symptoms would eventually appear, I applied the "paper jacket," under the use of which and of tonics all strumous symptoms subsided, the spine regained its strength, and now the patient is perfectly recovered.

I believe that in these large abscesses it is unwise to admit air into the cavity, since its presence seems to set up in the walls a condition which favors the absorption of purulent matter. By the exclusion of air and by the use of antiseptics the danger of pyemia is reduced to the minimum.

MCKENZIE, TENN.

Societies.

LOUISVILLE SURGICAL SOCIETY. Stated Meeting, January 13, 1890, J. M. Mathews, M. D., Vice-President, in the chair.

Dr. Mathews presented an anomalous case of rectal trouble. At a meeting of the American Medical Association Dr. Goodell reported a series of cases of nervous or hysterical rectum. The speaker had himself read a paper on this topic before the Mississippi Valley Medical Association in 1889. Besides the cases reported in these two papers Dr. Mathews had seen six cases that did not strictly come under this head. He read passages from Goodell's article, an important point being that during and after defecation the patient has severe pain in the rectum. Rectal diseases may be classed under three heads: (1) Hysteria. (2) Reflexes. (3) Lesion or pathological change at seat of trouble.

About four years ago the patient, a lady

efit. The patient came here for treatment seven weeks ago. Dr. Mathews divulsed the sphincter and waited. No good resulted. The bowel looked healthy -seemed to be absolutely normal. Thinking the trouble might be reflex, he dilated the cervix uteri, and later the urethra. No good resulted. The bladder was searched for stone. No stone was found. Five days ago he prescribed a suppository composed of grain morphine, grain of cocaine, and grain of belladonna. For forty-eight hours she has had no pain at all, except that on her way to this meeting she was frightened and had the pain until she arrived here. Dr. Mathews' diagnosis is neuralgia of the rectum. The lady has come one thousand miles for help. What shall be done?

Dr. Ap Morgan Vance thinks it possible that it is a spinal trouble (congestion). Similar cases affecting other parts occur in general surgical practice. He has seen a patient wearing a splint for supposed hip disease who had simply congestion of the lower part of the spinal cord. Under proper treatment the fancied hip trouble disappeared. In another case a boy was relieved of symptoms of hip-joint disease, osteo-myelitis, etc., by a fly blister over the lumbar region. Such cases are common enough. He would advise a very hot spinal douche.

Dr. A. M. Cartlege agreed with Dr. Vance as to the probable origin of the trouble. Another hypothesis is simple neuralgia. He would try quinine and arsenic, galvanism, and later faradism, along with counter-irritation over the spine.

Dr. John G. Cecil thinks the symptoms

point to the bladder rather than to the rectum; thinks it possible that there may be a bladder trouble without its being located. There might be villous growth in the bladder.

Dr. I. N. Bloom believes that the symp. toms showed that the nerves going to the bladder are those chiefly involved. This points either to inflammation or congestion of a ganglion or several ganglia of the sympathetic, from which filaments go to the bladder and rectum; but, as suggested by Dr. Vance, a congestion of the lower spine should be considered in treatment.

Dr. W. L. Rodman thinks with Dr. Vance and advises actual cauterization of the spine. Dr. Rodman would advise in addition that the bladder be examined by the cystoscope, and the urine examined. If nothing was discovered, he would say the trouble was spinal.

Dr. Mathews, closing discussion, said he had seen six such cases. His second case was the wife of a planter, who came here for treatment. He promised relief by stretching the sphincter. Dr. Marvin cauterized her back for two weeks without any result. Dr. Mathews related the fact that Dr. Bloom had chloroformed a patient for him in fifteen seconds-patient a full-grown man who weighed 220 pounds.

Dr. Cheatham exhibited the use of the electrical light, in demonstration of fluid in the antrum, upon a patient present. The left side of the face lighted up, while only the floor of the antrum lighted up on the right side, showing fluid in cavity of right side.

E. R. PALMER, M. D.,
Secretary.

Reviews and Bibliography.

Transactions of the Gynecological Society of Boston. New Series. Vol. I. 396 pp. Boston: Cupples & Hurd. 1889.

The Gynecological Society of Boston has for many years done work in which the whole country takes pride. The volume before us is not likely to take rank below those that have gone before.

The introduction is supplied by a thoughtful address by the president, Dr. Horace C. White, and is followed by a radical plea

against the production of abortion, by Dr. Kelly, under any circumstances. The argument exhibits the special pleadings characteristic of middle-age scholasticism, and might have been made shorter by the averment of an infallible mandate from the See of Rome, as that idea evidently underlies the whole question in the mind of Dr. Kelly. Drs. Symington Brown and E. W. Cushing, in the discussion which follows, sustain very properly the dignity of the profession, and its right, infinitely greater than any church authority, to decide upon the ethics of medical questions.

Dr. Cushing, however, admits that the Catholics will have the majority in a generation or two, as far as New England is concerned, since the Catholic birth-rate is about six to one of the Protestant.

Next follows an orthodox article on the treatment of constipation. The only criticism to make is that the author divides treatment into three parts-(1) attention to the regular evacuation of the bowels, (2) purgatives, (3) enemata-instead of having the treatment to correspond to Demosthenes' notion of eloquence, in giving " first action, second action, third action." The others are of course not to be dispensed with, but they are a comparative by-play.

Dr. Cushing follows with an article on the relation of bacteria to puerperal inflammations, commending cleanliness and non-interference in the treatment of healthy puerpera, and vigorous antiseptic irrigation of vagina and womb in cases of inflammation. Dr. Cushing, however, commends the washing out of the vagina with antiseptic solutions immediately after labor, and the uterus also if an operation has been performed. In ordinary practice, however, the propriety even of this is to us more than doubtful. Strict cleanliness during the labor and the careful removal of every particle of membranes, and then the constant removal of all discharges as soon as they have passed the vulva, we can not but think the fulfillment of the attendant's duty unless inflammation sets in. If pus forms, it of course must be removed.