ment, it becomes an economic necessity, if not a surgical one. In regard to the second objection, that the inflammation is likely to be increased, this result has not been found to follow the use of the curette. That there may be an undesirable loss of blood from the primary incision we admit may be true in some cases. By limiting the length of the incision, however, in cases where, from anatomical relations, free hæmorrhage would be likely to follow the incision, and making the cut only long enough to allow of the satisfactory use of the curette, the amount of blood lost will hardly exceed that from an ordinary free incision. The oozing from the capillaries in the wall of the abscess has not been found in any case troublesome. With reference to the scar deformity, in parts of the body covered by the clothing it makes little difference whether the cicatrix be an inch or two longer or shorter; in the exposed parts of the body, for cosmetic purposes it may be made as short as is consistent with the free use of the curette, and shows little if any more than the scar after an ordinary incision.

There are some cases where the curette should be used with much caution, if not entirely avoided; such as perityphlitic abscess, deep-seated abscess of the abdominal wall or of the neck, or periarticular abscess especially, when these are acute. In such cases there might be danger of making an opening into important cavities, and giving rise to dangerous and fatal results, where otherwise a cure would have taken place.

The following cases will serve as illustrations of the preceding remarks:

A male, thirty years of age, with a chronic abscess on left side of neck for three months, presented himself to me. I opened and treated as above described. It healed in five days. I also saw two cases of acute glandular abscess on neck in children. Same treatment as above. They were cured in four days.

There came under my care a female with large subacute abscess of two months duration on outer aspect of left thigh, occurring after childbirth. Patient very anæmic, weak. Aspiration had already been practiced, but the cavity refilled. I opened it and curetted it. She was completely cured at the end of a week.

Still another, a case of child with morbus coxarius and cold abscess over inner aspect of right femur. After incision, bone was found bare over a spot as large as a five-cent piece, but not rough or softened. No hectic symptoms followed the operation. Indeed, the irritative symptoms of pain, sleeplessness, and fever were relieved by the procedure. A sinus was left after the immediate healing, and continued to discharge for about four weeks. It is possible in this case that if the parts had been kept more perfectly at rest a more prompt recovery might have taken place; but in other respects it could not have been more satisfactory.

I likewise saw a female with acute periosteal abscess of traumatic origin over the inner aspect of right tibia. I treated her as above. Two dressings; cured at end of fourth day.

A child with a "cold" abscess in Scarpa's space, right side, confining patient to house, causing much pain and general irritability. I opened as above, with no unpleasant symptoms following. The patient was soon able to be out of doors, with a decided improvement in general condition. A sinus was left, which discharged for several weeks.

Finally, I recall the case of a female with large acute traumatic abscess of anterior abdominal wall. The symptoms were acute, but pus formed very slowly. I opened and curetted cautiously, and, as the event proved, insufficiently; there were discharged small masses of sloughy tissue for a week with each irrigation of the cavity; but finally, after about four weeks, it healed perfectly. It is possible, and even probable, that the curette might have been safely used more freely here with benefit to the patient.

These cases, so very briefly reported, may suffice to emphasize the points suggested in the foregoing remarks, and may encourage the employment of more radical measures than we are accustomed to use in the treatment of abscess in suitable cases.

A NEW DRAINAGE DEVICE.

In several of the cases treated by the method suggested in this paper, a drainage tube, or, more properly speaking, a drain

age groove was used, and seemed to answer its purpose in some respects better than the usual tube. It consists of an ordinary Jacques's catheter without any side openings, the central canal open at both ends, and the wall of the catheter so compressed as to give three moderately deep longitudinal grooves extending from what may be called the free end to within a line or two of the point of the instrument; of course, the lumen of the tube is encroached upon by the grooves, but sufficient space is left to allow of the use of the central canal for injection or irrigation. The drainage takes place almost altogether through the external grooves, and to a very slight extent by the central canal. It has acted well in the cases in which it was used, presenting three continuous grooves for drainage, which would be equivalent to three fenestræ for every few lines of the tube, thus securing a more constant and complete evacuation of the fluid contained in the abscess cavity. The grooves have not, as was feared at first, been occluded by granulations pressing into them. If irrigation be employed, the grooves allow of the ready escape of fluids injected through the central canal, without distending the walls of the abscess, and so interfering with the healing process. These drainage grooves were made by Tiemann & Co., of New York.

A word with reference to the use of these grooves in emptying the bladder, especially in the male, may not be out of place. They have been found of use in two or three cases where there was much muco-pus, or blood, that sometimes blocks up the eye of the ordinary catheter, and necessitates its removal and re-introduction. The patients have complained of no pain on the introduction of the instrument, and there can not be any occlusion of the grooves. If the urine does not flow freely, by pushing the instrument a little further into the bladder, practically three unobstructed fenestræ are presented for the purpose intended. The instrument is also equivalent to a double catheter, but, with the female, the instrument is manifestly not so satisfactory as the ordinary catheter, where, the drainage being central, allows the urine to be conducted into a vessel at some distance from the meatus.

CHRONIC CATARRHAL GASTRITIS: FATAL FROM COMPLICATION OF SUDDEN ENLARGE

MENT OF THYROID BODY.

By WM. HENRY THAYER, M. D., of Kings County.

Read by title, November 19, 1885.

June, 1883.-E. R., aged sixty-one, a native of Massachusetts, resident forty years in Brooklyn, married. A man of active habits, and engaged in an engrossing business, which takes him to New York daily at five o'clock in the morning. In good health till 1876, when he began to show symptoms of gastric disturbance, and had a succession of boils, with considerable prostration and emaciation, from the latter of which he never recovered. He became very sallow, and subject to neuralgic pains in his stomach and various parts of the body.

He first consulted me in August, 1878. He was thin, sallow, and feeble, suffering every night with neuralgia in both arms, preventing sleep; had a slightly tender node over the lower part of left tibia, which had existed for three months. Appetite good; bowels regular; pulse feeble, but regular; heart's action normal. Under tonic treatment, with a hypodermic injection of morphia and atropia at night, he gradually recovered. There have been occasional recurrences of the neuralgia, more or less severe in character; in fact, he has never been wholly free from pain. He has had a somewhat imperfect digestion.

In February, 1883, he had, with oppression at stomach after supper, much abdominal pain, which returned every night and prevented sleep. This condition of affairs was prominent for two weeks before he consulted me. His bowels were regular, but the evacuations were small; appetite good; urine normal. I directed that his supper should consist of bread and milk only, and that he should take pepsin with every meal; these to be followed by:

B Bismuthi subcarb., ss.; cerii oxalatis, gr. j. M.; also, a wineglass of Hunyadi Janos water every morning on rising, and cherry rum when in pain; and especially, that he should do less work. His pain lessened, and soon almost disappeared. In place of the bismuth and oxalate of cerium, he was given the following pill:

B Ferri sulphatis,

Extracti conii....

Extracti nucis vomicæ...
Quiniæ sulphatis

.ää gr. j.

gr..

gr. j. M. Ft. pil.

On the 28th of February, he was sent to Atlantic City, New Jersey, where he stayed a month, lost his pain, and gained three pounds in weight. He returned too soon to business, and, about May 1st, finding himself running behindhand, went again to Atlantic City for a few days, and in the latter part of May felt quite free from pain or any gastric trouble, and soon began to work too hard, and to be careless about his diet.

June 12.-I was called and found that he had much distress at epigastrium and under sternum, and had been vomiting-this since the evening of the 10th, when he had indulged in salmon at supper. He was given laxatives, pepsin and nitro-hydrochloric acid with each meal, sulphate of quinia three times a day, and, when in pain, whisky.

The pain, however, continued in paroxysms, sometimes severe, in the lower half of chest. There was no tenderness at the epigastrium; no tumor found anywhere; the abdomen was retracted; no fever; pulse normal. He can not retain food, and constantly raises a tough, tenacious mucus, partly after vomiting.

June 15, evening.-No change. He vomits everything taken, although food has been limited to milk, lime-water, and brandy, by the spoonful, at regular intervals. His medicines have been suspended, and carbolic acid administered, but without effect. An emetic of ipecac was followed by free vomiting of mucus. Then a hypodermic injection of solution of sulphate of morphia and sulphate of atropia.

June 16.-Every swallow of milk and lime-water still produces pain. From this date, all food by the mouth was discontinued, and he was sustained by enemata of strong beef-tea, yolk of egg, brandy and laudanum-of which he took three a day. Pain