the rectum, the dressings or gauze drainage in the abdomen would be stained with the permanganate. The flow is controlled by a pair of hemostatic forceps clamped on the rubber catheter. Seven infected abdominal casescame under my observation while there, and all recov ered under this plan of treatment. I was informed that since this method was adopted only three out of twentyfive cases had been lost.

Dr. W. A. Norton, Savannah: Dr. Westmoreland mentioned the fact that considerable difficulty is experienced in keeping the patients in the Fowler position. I have recently seen an article in the Journal of the American Medical Association by Dr. Maguire, of Richmond, in which he mentions a seat composed of two pieces of board with holes in the center and a pole run-ning from the topboard to the one at the foot of the bed. It can be adjusted to any position that may be required, and in that way the patient is prevented from sliding down in the bed. In this article Dr. Maguirealso calls attention to the fact that the psoas muscles cause a cavity on each side which allows an accumulation of pus and a tube drain deeply inserted is necessary to carry this off.

Dr. W. W. Battey, Jr., Augusta: I would like to suggest not using irrigations in any of the cavities of the abdomen that are walled off. Dr. Goldsmith mentions. dry sponging; that is very important.

Another point I would make is that we should never use peroxide in sponging in these areas.

Eserine sulphate, in one-fortieth grain doses, acts well to control peristalsis.

Dr. J. B. S. Holmes, Valdosta: Dr. Goldsmith's paper is very interesting, very instructive and very practical,

and in the main I agree most heartily with him. Years ago, when I first began doing abdominal work, I was taught always, when there was pus in the abdomen, to irrigate freely and thoroughly with normal salt solution. The result was that many of the patients died. For several years I have not used it at all, but have depended entirely upon dry sponging and my results have been very, very much better. Where pus is found in the abdomen, I always make a stab puncture in the loin for drainage-drain through this opening as well as the one in front. I use gauze, however, instead of rubber drainage tubes. The ends are brought out and carefully wrapped, though loosely, with sterile gauze that has been saturated with salt solution and wrung moderately dry. I have these changed at intervals of two to four hours, as occasion requires. I have adopted, with excellent results, Ochner's method of keeping the stomach empty, allowing the patient to go from three to five days frequently without food or water in the stomach, depending entirely upon throwing normal salt solution into the bowel, into which a certain quantity of peptonoids is poured.

I don't move the bowels under four to six days, and when I do, I always use castor oil, as I consider it the most satisfactory purgative in these cases.

Very many of my patients recover under this line of treatment that I am sure would have died under the old plan.

The Association is indebted to Dr. Goldsmith for his excellent paper.

Dr. Floyd W. McRae, Atlanta: I am always interested in anything about the abdomen, and especially about drainage. There are several points I would like to discuss. I would take issue with Dr. White that in

septic conditions about the abdomen I think drainage is underdone, not overdone, though in pelvic work I think it is sometimes overdone. There is a great difference in the type of infection. Wherever the gut has communicated with the peritoneal cavity it is easier to underdo than to overdo drainage. I use the rubber drainage tube, but I use gauze with far more confidence. because it is more effectual. I think a piece of gauze simply stuck in is not a good drain, but if you use gauze drain properly prepared, as the improved cigarette drain, you get the advantage of the rubber tube with the additional advantage of the gauze; the gauze acts by capillarity. The peritoneum rids itself of infection by secretion; the internal secretion, if I might use that expression. I think the Fowler position has come to stay.

Dr. W. F. Goldsmith, Atlanta (closing): A point that should be particularly emphasized is that of minimizing the amount of visceral manipulation, as Dr. White has just said. To look around for pockets of pus adds to the shock and increases the irritation. The matter of drains is largely one of personal equation. Those of us who have put strips of iodoform gauze down deep in the abdominal cavity have seen tremendous adhesions occur, the removal of which means the tearing of structures that should be left in place.

HEREDITARY MULTIPLE OSTEOMATA.

BY T. P. WARING, M.D., AND E. R. CORSON, M.D.

Current literature is fairly rich in the report of cases of multiple osteomata; there are a few articles describing osteomata occurring in families, but I believe that this is the first report of multiple osteomata distinctly traced through four generations (three now living), and appearing in individuals who followed the maternal type, while those who resemble the male line of the family (as distinct in physique as possible), have been also free of the disease. The interest also increases in the study of this case on account of the beautiful X-ray pictures taken by my colleague, Dr. E. R. Corson,

I have used one case, the most pronounced, the third in line, for the base of this report. The other cases consist of the mother, the grandmother, and the daughter, the last now three and a half years old.

Mrs. S., aged twenty-seven, weight 110 pounds, height five feet three inches, native Hebrew. Family history: Grandmother had a growth at the upper end of the left tibia. It is said to have come on after scarlet fever. If she had other growths, as she probably did have, they are not remembered, as she died when her daughter (the mother in this report) was five years old.

The mother, still living, has the same formation on lift tibia below the knee. She also has osseous growths at the right elbow and wrist, with shortening of forearm.

She also has a growth by right knee. The mother's brother has exostoses in upper end of humerus.

Patient's previous history: She has never had rheumatism, or any infectious disease, but was said to have been rather a delicate child, with, however, no severe illnesses. The first nodule was noticed on left leg, below the knee, shortly after birth; the next noticed was one near the left ankle. In the meanwhile, the growth at the knee seemed to have disappeared. The ankle growth attained good size, and deformed the ankle to such an extent that it was removed at the age of three and a half years. She can not remember the sequence of the other growths, but they kept forming until the age of fifteen, and then seemed to cease growing. She can not distinguish any change since that time, there has been none during the time of my observation, which is four years. She says that she could always tell when the nodules were coming by the pain felt; after they formed, there was no pain. The growths now consist of several above and below both knees, and above both ankles. Left hip one large mass, and a small one. The right hip is apparently healthy. The left shoulder is one large mass, right shoulder is apparently healthy. The left elbow is healthy, but the left lower radius has several small exostoses. The right elbow and forearm are much deformed by numerous growths, as shown in photographs. There is one small growth on the second metacarpal bone of the right hand. In all about twenty exostoses are apparent.

She has two sisters and one brother, who are of larger frame and perfectly healthy. They resemble the father in appearance and disposition.

My patient has one child, aged three years and three months.