disappeared. The pulse, instead of being rapid, has become slow, and instead of being irregular, it has become regular, and the child gives every indication of complete recovery. It has become too much of a habit to listen to the heart, and if we find no murmur there let it go. We should all take the lessons to heart that have been given us today, and remember that any heart or the muscle of the heart is amenable to treatment. We cannot do anything of more value than to treat the heart muscle.

DR. GEO. DOUGLAS HEAD (Minneapolis): I wish to speak of one phase not touched upon in the papers on myocarditis, and that is the persistently slow pulse. I have seen two cases, one in Osler's clinic at Johns Hopkins and the other in Vienna, in which the patients complained of fainting attacks, which lasted for some minutes, associated with extreme slowness of the pulse, the pulse going sometimes as slow as 15 to the minute. Such cases are described as Adams-Skokes' syndrome, and are a true myocardial degeneration or a coronary arteriosclerosis. It is important to recognize these cases when they come under our observation.

NECROSIS OF SOFT PARTS FOLLOWING ENORMOUS SUBCUTANEOUS INJECTIONS

OF ADRENALIN

F. A. DUNSMOOR, M. D.

Minneapolis

March 2, 1904, Mrs. F. A. P——, aged 18, was delivered of her first child by Dr. N. M. Cook of this city. Nothing unusual occurred at the confinement, and Dr. Cook reports no septic case seen by him at any time, and that he has never seen a fatal case in midwifery, and was certain he was surgically clean in the case. Four days later the grandmother, acting as nurse, reports that a piece of after-birth, large as a goose egg, came away, and the patient was very shortly in high fever with the usual symptoms of puerperal infection.

I saw the case in consultation the next evening, when the temperature was 105°, pulse 130, abdomen' distended, tympanites, face anxious, lochia diminished, and general condition bad. I recommended intra-uterine irrigation, strychnia, and calomel, and that the patient be sent to the hospital that a pan hysterectomy might be made. There was some delay, so the patient was not admitted to the hospital until 6 p. m., March 8th, much prostrated, temperature 104.5°, and pulse 124. Hoping to get patient in condition for operation next morning, I ordered stimulants, strychnine, ice-pack to head, intra-uterine douche, and hypodermoclysis, normal saline solution Oii, sol. adrenalin 5ss, to be given every six hours, first under breasts, next in the thighs. The interne misread the directions and made the solution 3 per cent adrenalin solution, thus giving an ounce of the 1-1000 solution in one quart. It is not probable that after the first the entire quart was given in the three fol

lowing injections. The mistake was not discovered until my attention was called to the necrosis, which included the skin, fascia, adipose and all tissues down to muscle over an area of thirty square inches below left breast in the first instance, with lesser destruction in each of the other points of administration.

The case was seen by Drs. J. H. Dunn, J. W. Little, A. A. Law, and other physicians about the hospital, and their opinions was that she would not survive hysterectomy. The house officer reported that "she had a pulse like a horse" after a hypodermoclysis, and the temperature fell to 100° and the pulse to 120,immediately rising to 105°, pulse 135 to 150, and making the usual zigzag between 105° to 100° daily. Involuntary dejections, tremor, sweating, and diarrhea continued until complete separation of the slough of breast and thigh on the 23d of March. There was irritating cough, neuralgia of face and head, and mental disturbance for complications during the first fifteen days. The temperature varied from 98.5° to 101° from March 23 to April 17, when she was discharged.

On April 2d, with the assistance of Dr. J. W. Little and Dr. Cook, I re-covered the exposed muscle on the chest with Tiersche's skin grafts (removed from her husband), which made immediate union, and produced as good results as if on a patient in perfect health.

April 16th, under cocain anesthesia, margins of skin wound about the slough in the left thigh were freshened, and skin and fascia separated from the muscles and drawn together by sutures.

The case is reported, not with any idea of depreciating the value of the adrenalin solution, but rather, to show its power as a hemostatic, as well as to consider if this drug should not have the credit of saving the patient's life in spite of the sloughing caused by the excessive dos solution was certainly absorbed even after it had c shut off the circulation to the superimposed evident that a 3 per cent solution injected artery the size of those supplying the ch

the vessel as if tied. At the same time its stimulating power of heart and general circulation will be markedly manifest. I have frequently applied the full strength of the 1 to 1000 solution to abraded surfaces within the abdominal cavity on torn intestine or meseentary with much benefit, and no bad symptoms have followed. The strength of the solution to be used hypodermically when confined in small space must be considered with care, since the fact is proven that a solution of 3 per cent is competent to so constrict the artery as to shut out nutrition of the area that is supplied by the artery with which the solution is in contact.

DISCUSSION

DR. L. F. SCHMAUSS (Mankato): About a year ago I had a little experience along this line. I had an old lady with a urethral caruncle, which I removed and in which adrenalin 1-1000 strength was applied to control the oozing. It was followed by necrosis. I should have ascribed it to the use of adrenalin if it had not been that the patient was burned on the thigh with a hot brick. This wound also was followed by gangrene. Both finally healed. The patient died about six months later of apoplexy, and it is my opinion. that the adrenalin had nothing to do with the necrosis following the operation. It was simply a case of "apoplectic diathesis," of marked susceptibility to gangrene.

DR. JAMES MCKEON (Montgomery): I have used adrenalin for almost two years in the treatment of asthma, not as a cure, but as pallative measure, and with good results. I have injected from five to fifteen minims hypodermically. I have never had cause to regret using it, I have never had any gangrene following its use, and my patients derived more benefit from it than from any other one remedy.

DR. O. W. ARCHIBALD (St. Paul): I used adrenalin in I-10CO solution in the case of amputation of the small toe. I had quite a large slough, I noticed afterward, on the other foot and hand. There was no actual gangrene at any other place. I used a very small quantity, probably a half ounce or quarter ounce of 1-3000 solution.

DR. F. A. DUNSMOOR (Essayist): I will say in explanation that the interne did not intend to use three ounces. I made the sign for a half dram, and the doctor in reading my figure for the dram thought it looked like the figure 3, and the 1⁄2 he took for %, so he made a three-per-cent solution, apparently following written orders. We got this woman in this distressing condition by giving her an injection of this solution four times in twenty-four hours. She had three ounces of the solution in her system. You need not be afraid that it will act as a poison. It will tie up the blood vessels, which show remedy for hemorrhage.

THE ETIOLOGY AND PATHOLOGY OF GASTRIC ULCER

W. D. SHELDEN, M. D.

Minneapolis

The frequency of gastric ulcer, including open and healed cicatrices, all cicatrices being considered healed ulcers, is about five per cent in the cases as they come to the autopsy table. Open ulcers are found in from one to two per cent.

In 607 autopsies collected by Welch, 226 occurred between the ages of 20 and 40, while 222 occurred between 40 and 60. Age is determined more accurately by clinical, than by post-mortem, records. In 252 clinical cases, Lebert found 68 per cent to occur between the ages of 20 and 40, and 20 per cent to occur between 40 and 60. Ulcer under ten years is rare.

Kundrat says that the millet-sized ulcers, developing, he believes, from hemorrhagic infiltrations in the gastric mucosa in children, never develop into typical ulcers because acid catarrh is uncommon.

In old age the frequency of ulcer diminishes, but, considering the number of individuals living at 60, the percentage still remains high. Welch's statistics show that out of 607 cases of open ulcer, 119 were found in persons over 60. The female sex is the more often affected, the ratio being 3 to 2. Usually ulcer appears in women between 20 and 30, and in men between 30 and 40.

Vocation cannot be said to have any great determining influence in the causation of ulcer. Nevertheless, servants, and more especially cooks, seem to be peculiarly prone to the affection. Bamberger laid considerable stress upon the susceptibility of cooks to this disease.