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 |   Related post: PITH OF PROGRESSIVE LITERATURE. 209 tient. After extensive inquiries he finds that ap- proximately only forty per cent, of breast carcino- mata showed positive, microscopical metastasis to the axillary lymphatic nodes, and that eighty-five per cent, of recurrences in cancer of the breast are in the chest wall and only fifteen per cent, in the axilla. He is impressed by the fact that recurrence after operation for cancer of the breast is almost invariably in the line of incision, and believes the knife must sever the continuity of the fluids as well as the tissues holding them, hence infection is al- most inevitable because of the manner of trauma- tism. He reports seven cases successfully operated in by the chemical method, which he describes as follows: 1. Cocaine, forty per cent, solution, is driven into the segregated area by phoresis and as high as 200 milliamperes of current may be used, varying with the susceptibility of the patient. 2. The cuticle is then destroyed with caustic potash. 3. Tis- sues outside of the condemned area are properly protected from accidental chemical contact by means of strips of cotton flannel saturated with dour paste. 4. A mixture of zinc chloride, with powdered sanguinaria plus water, to the point of proper working consistence, is applied and protect- ed with dressings. 5. In twenty-four or forty- eight hours a layer of devitalized tissue is asepti- cally removed and a fresh application is made, re- peating the process each twenty-four hours until the entire breast has been removed. 6. Nature is .allowed to complete the operation in her own way by granulation. Strict asepsis should be main- tained throughout. 7. Skin grafting after Ochs- ner's method is done under cocaine cataphoresis safely and painlessly. Gonococcus Vaccine as a Guide in Diagnosis and Treatment. — J. London injects gonococci, suspended in normal saline solution, into the endo- dermal layer of the skin with a hypodermic syringe and fine needle and obtains a local reaction,' be- lieving, in obscure cases, where the gonococcus is a possible infecting agent, as in a joint, tendon, en- docardial and peritoneal or pleural infection, as well as in involvements of the genitourinary an- nexa. both male and female, a means of diagnosis not dependent upon the discovery of the gonococ- cus itself is of decided value. To obtain this re- action the skin on the inner surface of the arm or forearm is cleansed with alcohol or ether, which is allowed to evaporate ; then a saline suspension of dead gonococci in a strength of 50,000,000 to 100,000,000 to the c. c. is injected into the skin un- til a slight weal is formed. A positive reaction oc- curs in about twenty-four hours, a central papule, red in color, surrounded by a lighter red areola, two to three inches in diameter. A previous injec- tion, within ten to fourteen days in negative cases, may cause a positive reaction on secondary injec- tion. The writer reports that of eighteen cases in which the gonococcus was found, sixteen gave a positive reaction. Of fourteen control cases, non- gonorrheal, twelve gave no reaction, two gave a slight reaction. Of three cases of gonorrheal arthritis, two gave a positive reaction. In a case giving a negative reaction, staphylococci were found in the prostate, but no gonococci. In three cases in which the complement deviation test was performed, two were positive and one negative to the blood test, but all three were positive to the skin test. In two cases of stricture, one was posi- tive and one negative. Of eighteen cases which were clinically gonorrheal, but where no gonococci were found, in thirteen the skin test was positive, in two negative, and in three doubtful. Cured cases give negative reactions. ANNALS OF SURGERY. November, IQI2. Tetany Following Extirpation of the Thyroid. — Francis J. Shepherd, reviewing the literature on the subject, says the weight of opinion tends to prove that postoperative tetany is dependent on the removal or destruction or injury of the parathy- roids. As to the functions of the parathyroids there are at present two theories: 1. An antitox- ine is developed by the parathyroids which neu- tralizes certain Buy Aerovent waste products of tissue metabol- ism; and, 2, the calcium metabolism of the cells of the body is controlled by the parathyroids, and their removal causes a rapid disappearance of the soluble salts of calcium from the blood. The glands are difficult to distinguish without micro- scopical examination, but as a rule their yellowish brown color distinguishes them from the deep red color of the thyroid. For treatment various meas- ure? have been adopted, transfusion, parathyroid feeding, injection of the nucleoproteid principle, calcium lactate, and transplantation from other sub- jects. The writer had always been a little scepti- cal regarding the danger of tetany or cachexia strumapriva following total thyroidectomy until last winter, when a severe tetany followed thyroid- ectomy in one of his cases. On the third day after operation the patient complained of a feeling of general formication and of a great weight which pressed on his brain. On the fifth day, in addition to formication and numbness of her legs and face, she began to have cramps in both hands, pains in the joints, and stiffness of the fingers and flexion of the toes. On the appearance of typical tetany the writer put her on one drachm doses of calcium lactate and one half grain of parathyroid extract, every four hours, which controlled all her symp- toms. Six months later she had gained twentv pounds, and the only symptom at present is oppres- sion in the head, which is corrected by lactate of calcium of which she now takes only twenty grains, twice daily. Surgical Treatment of Aortic Aneurysm. — J. A. C. Macewen, with a view to obviating many of the dangers attendant upon the surgical treatment of aortic aneurysms, namely, anesthesia, ligation of diseased sclerotic vessels, and embolus, follow- ing the detachment of a red blood thrombus, pro- poses a method for inducing the production of a strong, enduring white thrombus, which was put forward many years ago by Sir William Macewen A fine, highly polished steel needle is introduced into the interior of the aneurysmal sac or dilatation, and the inner surface of the opposite wall is scratched very lightly so as to produce a series of slight abrasions on that surface. In this manner there is produced a white thrombus by the action of fibrin and leucocytes. 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