cially production of tubercular peritonitis by injecting lupus material. It was with the idea that lupus was caused by tubercular bacilli and the known affinity existing between them and pyoktanin that caused Dr. Coomes, of Louisville, Ky., to first conceive the idea that pyoktanin would probably have a curative effect in lupus, and to Dr. Coomes I am indebted for the suggestion that pyoktanin would cure or benefit lupus, as he had succeeded in curing one or two cases with it and had benefited some others. With this brief introduction I will proceed to give in detail a history of three cases of lupus that I have cured in the last two years. In September, 1895, case No. 1, a boy ten years old, and in every way a healthy subject, came to my office with an extensive and well-developed lupus of the nose and upper lip extending on either side to the cheeks. The whole area was covered over with a thick crust, and upon removing the crust I found an extensive granular surface bathed in pus. Of course the territory involved rendered an operation impossible, and I went to work to try to cure the trouble. I first used stick nitrate of silver. I would sharpen a stick and bore into the exuberant granulations, but the amount of good accomplished by this treatment was very nearly none at all. I then tried electro-cautery with a similar result. I then used several chemical cauteries, but these seemed to produce so much irritation that, by the time the inflammation caused by their application subsided, the parts were about as before the treatment. I then tried proto-nuclein, and for a while it seemed to benefit the trouble, but after a while it came to a standstill, and under its use, though I used it for some time very faithfully, no further improvement occurred. I then began the use of pyoktanin or methyl violet, and almost from the first day of its use improvement was per ceptible, especially around the margin of diseased surface. The improvement was without an interruption until the process of repair formed the coating on the surface, and at this stage it came to a standstill and I began to think that I had again failed. After applying the solution of pyoktanin on the surface for some time and observing no further improvement, a thought occurred to me that the germs, whether tubercle bacilli or not, were protected by the thin membrane covering the surface, and I concluded to inject the solution into the tissues with a hypodermic syringe. I accordingly selected a small place near the center to make a trial upon. The result was most gratifying, and from this time on the cure was without any interruption until it was completed. I found in using the treatment that it was necessary to curette a few bad places, and I also found it was an advantage to use silver nitrate to smooth off the most elevated places, and I found that the irritation and inflammatory reaction resulting from the electro-cautery, or a chemical cautery, was lessened very much by the use at the same time of the pyoktanin solution. The last place to heal in this case was the ala of the nose, and on one side a very slight loss of tissue resulted in an almost imperceptible deformity. The treatment in trying various remedies occupied five or six months and the cure with the pyoktanin covered about seven or eight months. Case No. 2.-A child about two years of age. Lupus of the nose, covering the tip of the nose and also one ala of six months' standing. I had the former experience to guide me, and succeeded in curing this case in about four and one-half months. I used silver nitrate a few times, but not as much as in the former case. The cure in this case was completed without any resulting deformity. Case No. 3.-A healthy negro child, four years of age. Lupus of the external ear and the external auditory meatus were well developed and about seven months' standing. In this case I used nothing but peroxide of hydrogen and pyoktanin. Slight deformity resulted in this case, the ear being somewhat warped and drawn, especially the lobule of the ear. In all of the cases I am fully convinced that to the pyoktanin all of the credit is due. I will now in a brief way describe my method of using it: In the first place I remove the crust, but it will not do to remove the crust too frequently; as soon as the pus under it will exude through the various holes and crevices when pressure is made upon it, it shows that the crust is loose and can be removed without irritation resulting from its removal. After the crust is removed, then apply peroxide of hydrogen to thoroughly cleanse it from the pus. After cleansing thoroughly with the peroxide on cotton, I then apply a freshly prepared 2 per cent. solution of pyoktanin, and then wait ten minutes to let it dry, and then apply it again, and as the case goes on, as I find an elevated place I apply silver nitrate to smooth it down, but I am always careful to apply pyoktanin solution afterwards. I know that in many instances pet remedies are introduced by physicians, and that afterwards they are tried by the profession, and that no one ever gets the brilliant results reported by the enthusiasts who introduce them; but nevertheless I am fully persuaded that any one who will give the treatment I have described a thorough trial will not be disappointed in the results. I am sure that thorough cleansing with peroxide hydrogen, followed by two or three coatings of 2 per cent. solution of pyoktanin every two or three days, or at least as often as the crust can be removed without irritation, together with a small amount of cautery and the subcutaneous injections of pyoktanin will either cure almost any lupus, or so limit it that we can almost eradicate it by a slight surgical operation. DISCUSSION ON DR. HORINE'S PAPER. Dr. J. M. Crawford, Atlanta, was asked to open the discussion. He said: I have never seen a case of lupus. I wish I had. I can add therefore very little to this subject. With reference to the use of peroxide of hydrogen, I have noticed that a great many physicians favor it. Personally, I prefer hydrogen dioxide, instead of the peroxide, because it is not quite so irritating in its effects. Dr. J. L. Hiers, Savannah: My experience with lupus of the nose has been quite limited. I have seen only one case that I recall at present. I have listened to the doctor's paper with profound interest. I am sure many general practitioners will be benefited by it, and I am glad I was present when he read it. This Dr. M. L. Currie, Ailey: I saw one case that I diagnosed as lupus. It is a difficult disease to relieve. case occurred in a boy about ten years old, and his parents objected to any heroic treatment. They would not let me use the curette or anything of that kind. I had to use a caustic preparation in a rather secret way in the treatment of this case, and after a long time I succeeded in euring the patient. It was a small lupus growth, involving the cheek in front of one of the ears. I forget now on which side of the face it was. I used resorcin with a preparation of earbolic salve and cured the case after a long time. WASH-DRAWINGS ILLUSTRATING A CASE OF WITH COMPLETE EVERSION OF VAGINA FROM FIBROID TUMOR OF THE CERVIX. RESTORATION BY SUPRAVAGINAL AMPUTATION OF THE CERVIX AND INVERSION OF THE VAGINA. BY GEO. H. NOBLE, M.D. Mrs. H., a tall countrywoman, came to me from the mountainous region of Georgia on January 25, 1894. She stated that shortly after her first confinement, which occurred eight and a half years ago, she discovered a tumor, about the size of an ordinary marble, growing upon the neck of her womb, which, after a subsequent childbirth two and a half years later, had grown to the size of a hen's egg. From this time she dates the prolapsus, the tumor having escaped from the vagina. She had not suffered much except from the discomfort of aching, dragging, etc. Six years ago the lower extremity of the tumor ulcerated, but afterward healed, and, two months before admission, ulcerated again, from which she suffered the effects of absorption-accelerated pulse, elevated temperature, chills, profuse diaphoresis, etc.-until she became anemic and more or less emaciated. The family history was good. The condition on admission was as follows: temperature 102 2-5 degrees; pulse 116, weak and compressible; respiration 22 per minute; menstruation normal; bowels recently constipated; painful and frequent urination, and at |