4 LOUIS A. DUHRING;
in the procedure. Drs. J. Solis Cohen, Van Harlingen, Praeger, and Benning were also present. The instrument was that manufac- tured by the New York Galvano-Faradic Company, three cells being employed ; the loop was of platinum wire. This was slipped over the tumor, the patient being under the influence of ether, and.a red- hot heat obtained, when the wire was slowly and gradually tight- ened. Thirteen minutes were occupied in traversing the base and in removing the growth. The operation proceeded without com- plication and absolutely without hemorrhage. A wound two and a half inches in diameter remained, which displayed the frontal bone. The tumor of the popliteal space was subsequently removed by the same means ; likewise without hemorrhage.
Feb. 28. — No unpleasant effects followed the operation. The wouncJs at once began to granulate abundantly and to close, but it was found that the periosteum upon the frontal bone had been de- stroyed and that repair would not go beyond a certain point. The general symptoms, however, did not improve. The gapes and hiccup still came on every afternoon, and the stomach rejected absolutely everything. Intense flushing of the whole body, especially of the back, also was present with regularity everyday.
March 7. — There have been repeated attacks in the course of the day of vomiting of dark bloody material. The flirshing continued until yesterday, when in its place cold extremities followed by heavy perspiration manifested itself. The nights are sleepless, even under the influence of morphia, which she has for some time been taking by the stomach in JE^-gr. and ^-gr. doses. The patient exhibits a marked disposition to be decidedly better or worse from day to day. For the past week a nasty, thick, tenacious, greenish, offensive ac- cumulation in the form of a plug has daily, and often twice daily, discharged itself with difficulty from the nasal passages. The arms are still helpless, and the hands oedematous ; the legs and feet are generally cold, swollen, and likewise cedematous. The urine for the past six weeks has been variable as to quantity, but generally thick and red, with an abundant brick-dust deposit. No albumen.
March 18. — She is entirely helpless, not being able to move her arms, and at times not even the lower extremities ; yet some days she possesses considerable motion of the arms, and is able even to carry one hand to her face. While she is failing rapidly from week to week, she nevertheless rallies most remarkably. The wounds are healed except over the forehead, where the bone was injured. The leg wound is entirely well. The nurse states that the disease has showed itself in the form of a swollen tumor about the size and shape of an olive, on one of the labia of the vulva. But the patient objects to an examination, stating that it is only one of many and like those elsewhere. Three days ago she was seized with a most voracious appetite, which lasted several days. Notwithstanding that absolutely nothing remained on the stomach — not even the smallest quantity of fluid — she craved both food and drink of any kind.
