from the left side of the growth, the incision on the right side being made close to the pubes. A wire ecraseur was then applied, and tightened until the soldering of the end of the wire gave way. A chain ecraseur also broke but was adjusted so as to last during the operation. The instrument was slowly worked and about twenty minutes occupied in dividing the pedicle.

There was very little hemorrhage from the stump; the bleeding from two points in the corpora cavernosa was stopped by a touch with the Paquelin cautery. The flap was now brought over the stump and a drainage tube, to the right side, and stitched in place with silver wire. Iodoform was dusted on and absorbent cotton applied under a T bandage. The growth is in the Johns Hopkins collection.

March 15th. There has been no fever or pain since the operation Drainage tube and stitches removed.

March 31st. The patient has gained in flesh and has a good color. At the site of operation is a small oval granulating spot inch long Patient is practically well.

Such an hypertrophy as is here mentioned, is very unusual in this country.

Little is known of the causes of such a growth. It is however very frequently associated with syphilis.

Schroeder* speaks of it as very uncommon in Germany.

Emmett mentions but one case. The common opinion that it is due to self-abuse or to sexual irritation is quite unfounded. Parent Duchatelet is quoted as stating that among 6,000 registered prostitutes in Paris he met with but three cases.

Dr. Ashwell has been struck with the integrity of the external genitals in prostitutes while the uterus and ovaries have been bound in all directions by false membrane.

The largest museum specimen of which I have accurate record is that belonging to the University of Rouen, which weighs eight pounds, and is fourteen inches in circumference.

The specimen exhibited before this Faculty by Dr. Wm. T. Howard of this city, ten years since, was exactly the size of the one removed by the writer.

Cases of this kind are often associated with hypertrophy of one or both labia majora or of the nymphæ. The most probable cause

*Schroeder, Krankh. d. Weibl. Geschlechtsorg.

+Emmet, Gynæcology.

I believe to be some long continued chronic inflammation in the immediate neighborhood of the clitoris, as a chancre compressing the veins and lymphatics going from the clitoris, while at the same time it causes increased arterial supply, by irritation of the nerves leading to the part.

The following references are made to the Army Medical Museum catalogue.

BIBLIOGRAPHY OF HYPERTROPHY OF CLITORIS.

L. Appia. Hyp. d. clit. guer. par. etrangl. T. de Med. Chir. et Pharmac. Brux. 1861, xxxiii, 149-155.

Archincloss (W.) Extirp. of ent. clit. and nymph. Glos. M. T. 1858, ii, 165-167.

Bainbridge (W.) Case of enl. clit. Med. Times and Gazette, Lond. 1860, i, 45-50.

Baekel (V.) Elephantiasis, du Clitoris. amp. galv. caustic, Gaz. Med de Strasb. 1875 3. S., iv, 133-137.

Buck (W. P.) Hyp. of clit. Phot. Rev. Med. and Surg. Phila. 18712, ii, 22, I pl.

Bumstead (F. J.) Hyper. clit. fibro cell. outgrowth. Ibid 1870-71, i, II, I Pl.

Canton. Hypertroph. clit. and areal. tissue, etc., 3 years' growth; removal. Lancet, Lond., 1856, ii, 650.

Caradic (T.) Cas curieux de tumeur fibro-plastique d. clit. etc., Union Med. Par., 1861, 2, S, xii, 115-122.

Case Hypt. d. clit. etc., Med. Ztg, Russland St. Petersb. 1858, xv, 363.

Clemens (A.) Extirp. ein. Monst. Clit. Deutsch. Klinik, Berl. 1863, XV, 344.

Dawson (W. W.) Hyp. d. clit. Cincin. Lancet and Obs., 1868, xi,

95-97.

Hergott. De la degen. hypertroph. d. part. gen. esp. ch. la femme. Mem. Soc. de Med. de Strasburg, 1872, ix, 177-187.

De l'Isère. (C.) Dis. of clit. case of excess. enlar. Proc. Am. Phil. Soc. Phila. 1844, iv, 129.

Jamieson. (A.) Enorm. hyp. clit., etc. Med. Rep. Shanghai, 1879-80. No. xix, 23.

Jones (S.) Spec. enlar. clit. Tr. Path. Soc. Lond. 1857-8, ix, 305, Lewis (W. M.) Case of morbid enlarg. of clit. Med. and Phys. J. Lond. 1811, xxv, 236-238.

Marsden (A.) Case of elephan. of clit., etc., Lancet, Lond., 1857, ii, 196.

Maury (F. F.) Tumor of clit, Phil. M. Times, 1871, ii, 33.

Masi. Elephan. d. clit., Spallanz. Modena, 1874, xii, 79. Pluchkel (F. S.) Monstros. Clit. Obst. Med. Woch. Wien, 1843.

703.

Raumeshur Awasthee. Tumur of clit. India J. M. & Phys. Soc. Calcutta, 1839, N. S., iv, 534.

Rheins. Wegnahme eines Monst. Clit. Gen. Ber. d. k. Rhein Med. Coll. 1838, Coblenz 1840, 136.

Ricken. Cas. d augment, etc., du clitoris. J. de Med. et Chir. et Pharmacol. Brux. 1865, xii, 218-223.

Rogers. Elephantine devel. of clit., Trans. Obst. Soc. Lond. 1869 xi, 84-86.

Satterup. Hypt. Clit. Mitt. a. d. Geb. d. Heil. Leip. 1845 1-210. Shaw. Excess. enlarg. of clit. Tr. Path. soc. London 1852-3, iv, 207209, also Lancet, Lond. 1852, ii, 468.

Simmons (R). Case of ext. enlarg. of clit. Med. & Phys. Jour. Lond. 1801, V, I-4.

Stamilaud (S). Lond. 1849, ii, 89, Superab. devel. of clit.
Tutum. Elephan. of clit. Lancet, Lond, 1859, ii, 662.

Verrier (E.) Elephan. d. clit. Gazett. Obst. Par. 1879, viii, 369-375 Also, Ann. de. Gynæc. Par. 1879, xii, 275-278.

Vigorito (N.) Mem......... elephant.........Clitoris Rendic. Accad. Med. Chir. di. Napol.

Watts (R.) Removal of clit. and left lab. maj. for hypertrophy. Arch. Clin. Surg. N. Y. 1876, i, 75.

Wimmer. Polyp. d. Klit. Beit. z. Prac. Heil. Leip. 1836, iii, 166

168.

Wylie (W. G.) Syph. hypert. of the clit. Am. Journ. of Obstet. 1873-4, vi, 43-45.

Ziembicki. Elephant. d. cap. d. clit. Bull. Soc. Anat d. Par. 1873, xlviii, 343.

Report of Section on Practice of Medicine.

JOHN S. LYNCH, M.D., Chairman.

ANTIPYRINE.

The addition of this substance to our armamentarium against the febrile state, by Knorr, of Germany, during the past year, is a fact of most transcendent importance to the profession and to the world. Furnishing us, as it does, with a weapon by which we can absolutely control febrile temperatures in all diseases in which they are present, its discovery can scarcely be ranked as less important even than that of quinine itself. I feel, therefore, that I cannot do a greater service to the profession in this city (where it has not yet come into general use) than to call attention to it by relating my own experience, which has been considerable, in its use.

I believe that none of this medicine had been introduced into Baltimore until about the 1st of November last, when one ounce of it was obtained at my request, and after much difficulty in finding it, by Mr. John F. Hancock. My first essay in its use was in a case of pulmonary consumption, the patient being our lamented fellow member, Dr. George S. Kinnemon. I found that in doses of three to four grammes daily I could perfectly control the temperature, which had been running up to 103-4 every evening in spite of large doses (gram. 1.5 to 2) of quinine. Could I have obtained constant supplies of the drug, I am confident that his life might have been greatly prolonged. But as long intervals occurred in which it could not be had, and as the disease had already made serious ravages, he succumbed.

The next case in which the medicine was tried was one of enteric fever in a girl seven years old, in which I had been trying to control the temperature with quinine and sodium salicylate. Her stomach, however, had revolted against each of these in succession, and the case had assumed a very threatening aspect. The afternoon temperature was 105.5°; diarrhoea set in; the tongue became dry, and delirium was almost constantly present. At this time I received the first supply of antipyrine, and .39 grams. were given every third hour. The change for the better was immediate and most satisfac

tory; the temperature fell to the normal; the delirium disappeared; the diarrhoea ceased; food was taken without difficulty, and the patient rapidly recovered.

I will not engross your time by relating other cases, but will merely say that Mr. Hancock tells me I have prescribed since November over 15 ounces of the drug, and that I have used it in croupous and catarrhal pneumonias, in numerous cases of phthisis while fever existed, in rheumatism, malarial fevers, and in short in all forms of disease attended with pyrexia, and, with two exceptions, have found it to be a certain, safe and reliable antipyretic.

In rheumatic fever I have found it quite as curative as salicylic acid and its compounds. In malarial fever it has no curative power, but it can be used with great benefit in hastening the defervescence, and thus converting a remittent into an intermittent, and enabling us to use quinine far more effectually and in smaller doses to arrest the paroxysms. In all forms of inflammatory fever I have found it extremely useful by arresting fever, to obviate that reactive influence which fever always exerts upon inflammatory processes.

In only two cases have I found that it produced any disorder of the stomach. In these, vomiting seemed to result from its use, but this was quickly relieved by suspending the medicine and giving the patient lime-water and creasote.

It produces none of the disagreeable nervous effects experienced from quinine and salicylic acid. No giddiness; no headache; no tinnitus aurium. As to the dose, I have found that grms. 1 to 1.5, repeated every two or three hours, is amply sufficient for all the ordinary purposes of an antipyretic; but it can be given in much larger doses if found necessary. Its effects are rapidly producedeven in an hour or less, and in this respect it possesses a great advantage over quinine, which is much slower in its action. On the other hand, its effect is very much less permanent than quinine, and it must, therefore, be continued longer and given more frequently than that drug. The first dose usually produces sweating-in some cases. quite copiously-but subsequent doses fail to produce this effect unless an interval of 24 to 48 hours intervenes between the doses. In no case, however, have I seen it produce the exhaustive sweats generally produced by sodium salicylate and frequently by quinine. In intermittent fevers-especially the fevers of phthisis, if given during the period of pyrexia—as in the afternoon-it always seems to prolong the morning intermission.