mouth, pharynx, and lower extremities. The ulcerations on the extremities were surrounded with deep pigmentation. Cavities existed in both lungs.

November 16th.-Four ounces of non-defibrinated blood mixed with ammonia were injected into the median basilic vein. Four days afterward the ulcers on the legs healed over, and the pigmentation became less distinct. The strength and appetite improved.

30th.-Transfusion repeated with defibrinated blood. Three days subsequently hæmorrhage occurred from the legs.

December 10th.-Condition of the patient improving.

CASE III.-A man, aged forty-six, suffered from phthisis in the third stage.

November 16th.-He was transfused with four and a half ounces of defibrinated blood mixed with ammonia. His condition was so much improved that he was enabled to leave his bed and walk about the ward.

23d.-Again transfused-improvement continued.

December 10th.-Is returning to the condition he was in when transfusion was first practiced.

CASE IV.-A woman, aged twenty-four, in the last stages of phthisis, was transfused with Aveling's instrument.

November 23d.-After two and a half ounces of defibrinated blood were injected, the tube clogged up and the operation had to be suspended. The patient said she felt better after transfusion, but there were no external signs of it.

CASE V.-A man, aged forty-eight, suffering from tertiary syphilis, waxy kidneys, liver, and spleen, as well as phthisis in the third stage, was selected for operation..

November 30th.-Transfusion of defibrinated blood practiced. The patient said he felt better, but, as in the former case, no signs of improvement were manifest. Death took place three days after the operation. The condition of the viscera was found as diagnosticated; no signs of thrombosis or embolism existed anywhere.

CASE VI.-A woman, aged twenty-seven, a subject of tertiary syphilis, and phthisis in the stage of excavation, was

transfused with an instrument consisting of a glass funnel with rubber tube and canula attached.

December 3d.-Four ounces of blood were introduced into the basilic vein without difficulty. The transfusion improved her general condition. She requested that it be repeated.

CASE VII.-It was proposed to try the effect of transfusion on a man aged forty-six, who was in a moribund condition, suffering from syphilis, and phthisis in the third stage.

December 10th.-At the time of operation the patient was insensible. Two ounces and a half of defibrinated blood with ammonia were introduced. After the operation there was a marked improvement in the pulse and respiration, and the insensibility was partially relieved. At the time of report, December 11th, the patient was living.

The operation for transfusion of milk or blood is the same, and consists in opening either the internal saphenous, median basilic, or cephalic vein. The skin is pinched up and incised with a curved bistoury; the exposed vein is then secured with the forceps and opened for a fourth of an inch, and the canula inserted. The canula may be secured either by a ligature or the fingers of an assistant. In Case No. I., where milk was transfused, a goat was brought to the side of the patient and milked into a glass vessel placed in water of a temperature of 107°. In order to avoid the risk of introducing any foreign matter, carbolized gauze was used to strain the milk before passing into the receptacle.

The effect of the transfusion at first is to increase the respiration, and sometimes to stop it for a few moments, but within half an hour the immediate effect has usually passed away and the more lasting benefit ensues.

The cases operated on by Dr. Howe show, in a very satisfactory manner, what that benefit is, and it would be markedly interesting to have the records of a series of weekly transfusions extending over a lengthened period, in order to thoroughly test the procedure in cases of such a chronic nature as tertiary syphilis and the third stage of phthisis.

Inflamed Bursæ over the Ball of the Great Toe.-A female patient, aged twenty, complained of corns or bunions which, during a period of four years, rendered her unable without great

pain to perform any duty requiring the use of her feet. An examination showed that the cause was inflammation of the burse on the outer side of the ball of either great toe. The burse were dissected out, and after the wound had thoroughly healed the distress was completely relieved.

In another case of a patient, of the same sex and age, it was found that the bursa had suppurated, but no improvement occurred. It was completely dissected out, and the same relief occurred as in the former case. After a period of a year no return had occurred in the second case.

PRESBYTERIAN HOSPITAL, NEW YORK.

Hæmatocele; Sloughing of the Walls of the Sac.--A man entered the service of Dr. George F. Shrady, in the Presbyterian Hospital, with an oblong scrotal tumor measuring twenty-six inches in its lateral diameter by twenty-two inches in its antero-posterior. The patient was a baker, fifty-three years of age. He noticed, four years previously, a hard and painless swelling in the right scrotum, which increased slowly till three months before admission, at which time it began to grow rapidly. He presented himself at a dispensary and had the tumor tapped, five or six quarts of a bloody fluid being removed. Five weeks after this operation he entered hospital. The tumor was as has been described. A careful examination showed that there was a double hernia as well as gas and fluid in the scrotum. The presence of gas independent of the hernia was obvious from the fact that the succussion sound was obtained, and, moreover, the air and fluid adapted themselves on a change of position of the tumor in a manner much more rapidly than if fluid and floating intestine had been present. Aspiration was performed, and there was obtained a fluid of a very offensive odor and of a brown color. An incision six inches in length was then made, and six quarts of extremely fetid pus were withdrawn. The right testicle was enlarged and incorporated with a mass of fibrous material; the left was normal. The inside of the sac was lined with concentric layers of organized fibrine which were in a sloughing condition. A counter-incision was made in the scrotum

and a drainage-tube inserted. After evacuation of the fluid, the scrotum was sufficiently large to fill a wash-basin in which it was supported. Two months after operation the scrotum was five or six inches in diameter.

The case illustrated in a very striking manner the necessity of an early diagnosis and prompt treatment. The patient could not give a very intelligent account of the origin and progress of his trouble, and the diagnosis was arrived at from an objective rather than a subjective point of view. The suspicions were very strong toward hæmatocele from the start. In the first place, the tumor seemed to enlarge too rapidly for a return of simple hydrocele; secondly, there was the history of considerable pain; thirdly, there were want of translucency and a peculiar hardness of feel of the scrotum; and fourthly, there were cedema of the scrotum and the presence of gas in the tunica vaginalis. All these symptoms looked toward hæmatocele which was in a state of decomposition. Aspiration and the escape of an intolerably fetid fluid confirmed the latter suspicion, and left no other course to be pursued than the freest possible evacuation of the contents of the sac. It is doubtful whether the patient could have tolerated much longer the presence of six quarts of decomposing fluid in the tunica vaginalis. As it is, he had a narrow escape from septic poisoning, and was fortunate in being able to withstand the depressing effects of the exposure of such a large sloughing surface and the protracted and profuse discharges which were the necessary consequences of granulation and final closure of the wound. Strange to say, however, the patient went on to recovery without a bad symptom. The hydrocele is of course radically cured by the complete obliteration of the sac.

Proceedings of Societies.

AMERICAN DERMATOLOGICAL ASSOCIATION.

(Continued from December number.)

He was formerly disposed to think, from the writings of Geber and Kaposi, that the tumors were really epithelioma,

or of a malignant character. But, from the investigations of his friend Dr. Heinemann, a microscopist of high reputation, he had come to understand that they were simply inflammatory growths of the skin, caused by the augmented vascularity of the part, and largely made up of the increased number of blood-vessels. This point, he considered, had a very important bearing on the prognosis.

We come next, he continued, to the later developments of the disease. The case which Dr. Heitzmann had reported was, he thought, older than any of his, and he was inclined to believe from it that this affection, in its severe form, really predisposes patients to malignant growths about the face. This, however, was only a suggestion, and he thought that the matter must remain sub judice for the present.

Such was the clinical history of the disease, and he would now say a word as to its course, as it had been observed in different individuals. It seemed to be an affection which might end in early life without any great disfigurement (except a certain amount of permanent pigmentation), or it might be of an inveterate character. The disfigurement might make the patient hideous for life, or, on the other hand, it might be very slight.

Finally, as to the proper title by which to designate it. It had been seen that the disease was certainly not a xeroderma, since only when the atrophy is very well marked do we find anything like parchment-skin. (When this was present, the sebaceous glands of the part had probably been entirely destroyed.) It certainly seemed very improper, then, to call it xeroderma, which name was only applicable to a feature of the atrophic form. Besides, the name xeroderma had been already employed for years to designate another affection. He contended, therefore, that we should not any longer attempt to bolster up this inappropriate title. The whole disease, as he thought he had conclusively shown, was really an affection of the blood-vessels, and we had a term which would exactly express the condition met with in it, viz., angioma. Then, in order that its secondary results might be indicated, he would suggest that the adjectives pigmentosum and atrophicum