'T+r\, 9 rv h t_ in • n«-** *'- v^ A. *. y. ! .: >; -: ?*SSi^ ON HOW TO PRESERVE I ' iiilllllllllliilUIIIIKIII mdml mm NATIONAL LIBRARY Of MEDICINE NLM DDlBTni 5 c. y ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C NLM001391915 WBJ 1868 The New Medical Epoch of H^ematherapy. The closing decade of the Nineteenth Century has been signal- ized by probably the most potential and far-reaching development of Therapeutics in the history of Medicine ; and this is the subject of our brochure. It is true that about the same period had brought to light a group of therapeutic methods of exceeding promise on special lines, the true scope and efficacy of which must yet be determined by long and critical trial. This group of remedial methods—which may be termed the isopathic group, including its great archetype, vaccina- tion—aims to make the diseased human system at once the seat and che beneficiary of the warfare of diseases, toxines and microbes against themselves and each other; but it is yet far from the full development of the residual consequences, the status quo post bellum, for which we must watch with solicitous caution. This group is therefore not the crowning therapeutic evolution that we celebrate, whatever balance of true unalloyed beneficence it may be destined to strikt in its perfected maturity ; nor is it analogous, or even harmo- nious, with the great principle of cure here asserted and vindi- cated by its unequivocal and invariable triumphs. The antithetical relation of the two principles may be tersely stated as that of casting out disease by disease or its products and reactions, on the one hand, as opposed to the expulsion of disease by the pure principle of health or vitality, on the other, through its universal depositary—living blood. Nothing has been more indisputably settled by the modern sci- ence of biology than that health, or vitality, is as truly and practi- cally the antagonist as it is logically the antithesis, of disease, of every form of disease, and of every cause of disease. And again, it is one of the most brilliant, and by far the most practical, of all the demonstrations of modern biology, that the principle we call health 2 or vitality is not only seated, as mankind have always blindly be- lieved, in the Blood, but also, that perfect blood is its impregnable citadel, carrying an armament against which the assaults of disease, whether by its antecedent germs or its consequent toxines, are forever impotent. Upon this great truth, it is clear that an infallible hsematherapy might be founded, if only man could find means to realize the con- dition, perfect blood. Wanting this, the question yet remains : Can perfect blood be borrowed for man ? On certain occasions, vital, if not absolutely perfect blood has been borrowed for the dying, by transfusion, and they have been saved. That was to supply deficient quantity of blood, and the means were obviously appropriate ; but it was not understood, as it is now in the light of recent science, that blood of superior quality, or vital energy, if thus borrowed and intro- duced, reinforcing the weak or morbid circulation of the patient, would have power to antagonize, master and expel disease with all its hosts, microbial or toxic, from either tissues, organs, or enervated functions. But this is a strict logical consequence of what we now know of the remedial qualities and resistant forces of the blood. Can this logical truth be made practical? and if so, in what manner, and to what extent ? In a measure sufficient to make a great medical epoch, these questions are answered in favor of man by the actual applications of borrowed blood that will be clinically described in these pages. It has now been abundantly demonstrated in practice, and only remains to be put into words and remembrance, that blood can be borrowed for us from the most vigorous animals, and supplied to our deficiency either of quantity or of vital power, by either of three modes of conveyance according to convenience or necessity, viz: by subcutaneous injection into the circulation; by direct absorption into the system through the sides of the alimentaiy canal, upper or lower; or by topical application to any exposed or denuded tissue whatever, to which the native circulation of the patient fails to afford healthy sustenance and protection whether through insufficiency, paucity and sickliness of organic cells, or lack of vital and vitalizing energy. That this is literally borrowing life, is ^"ly another and 3 more startling way of stating the fact! a fact emphasized in a most remarkable way by the observations of Dr. Brakenridge of Edin- burgh, who found that the vital cells of injected blood not only re- inforced the circulation by their own quantity and quality, but also revitalized and enlarged the debilitated cells of the patient, and excited an immediate proliferation of new cells. But a last practical question still remains : How to get the blood we desiderate, in its pure incorruptible essence and vitality, on such terms as will be practicable for the general use of mankind, and of the medical profession in particular ? The only solution of this problem so far attained—and one that seems as far satisfactory as can now be imagined—happened almost by accident to Dr. W. H. May of New York, in 1888. Baffled, like all his professional brethren, by an in- curable ulcer, he tried the venturesome experiment of injecting around the sore a preparation of raw ox blood which had been up to that time known as a valuable invalid food only—'' Bovinine.'' Astonished as if he had called up a spirit from the vasty deep, he belield the Power he had invoked, charging from all sides upon the noxious area of disease with serried columns of vital corpuscles linked in tissue with the flesh behind, and weaving their encroaching par- allels against the receding masses of the foe, until an absolute victory was won, and the ruddy flag of Life waved over the long-undisputed territory of death and corruption. The discovery of this Power was afterwards seized upon by Dr. T. J. Biggs, an assistant surgeon in the New York Polyclinic, a man of ripe accomplishments and experi- ence, and of rare professional enthusiasm, who developed new methods and applications from the germinal discovery of Dr. May, up to the marvellous therapeutic scope and efficacy now exhibited by his clini- cal reports, which make the marrow of the pages to which the atten- tion of the profession is herewith invited, but which are evidently a bare earnest of vastly greater things to come. 4 Nutrition and Health. BY DR. T. J. BIGGS. Nutrition is the '' ne plus ultra'' or ultimate purpose of the various functions of the animal organism. It is the consummation of physiological action and is accomplished through the agency of all functions combined. In other words nutrition is life itself. Alimentation, digestion, absorption, secretion, respiration and cir- culation are all directed toward the same end—nutrition—and if any of these functions fail, nutrition becomes impaired or is discontinued, and without nutrition the body is without life. The bond of union between these functions is the blood, the vital fluid in which all the elements of perfect nutrition are combined and endowed with the mysterious potency of supporting life. The two classes of elements necessary for the sustenance of nutrition, the nitrogenous and carbonaceous, are found in the blood in abundance, the former to supply muscular force, the latter bodily heat. Ferfect nutrition demands an adequate supply of these sub- stances, which the blood obtains from without, in the various articles of food, and, through the function of respiration, from the atmos- phere. When the supply of either of these nutritive principles is not equal to the demand, nutrition becomes impaired and the functions dependent on the supply, as well as those on which it depends, become weakened accordingly. MAI,-NUTRITION. Mal-nutrition results from any of the following causes:—ist. An inherent defectiveness of the nutritive functions; 2nd. The existence of some acute disease; 3rd. A constant lack of proper digestion and assimilation of food. ist. An inherent tendency may be derived from one or both parents. The offspring thus endowed exhibits marked outward 5 manifestations of mal-nutrition. He is apt to be small of stature and light of frame, easily overcome by fatigue and readily prone to disease. He has inherited from his parents a constitutional taint, which creates a soil well manured for the reception and growth of noxious germs and specific micro-organisms. Here is a child who is destined by nature to be a chronic invalid; one who goes through the period of childhood without missing one of the diseases which commonly attack the tender age, and all these maladies seem to assume the virulent or malignant type. Such a child, if it has not already inherited the fatal germs of tuberculosis, will be likely soon to acquire the bacilli of this dire disease from some outward source. Unless such a case as this be taken in hand early and afforded proper treatment, it would seem a dispensation from Providence that the inherited and diseased organism, lacking sufficient power of resistance against the various diseases, the seeds of which it is bound to come in contact with, should succumb early in life and thus destroy a dangerous focus of disease in one whose existence can but incite pity in others, with scant happiness for itself. 2nd. Defective Nutrition as a Result of Acute Disease is of course of a less serious nature, and apt to be of only temporary duration; but it is during this period of mal-nutrition in acute diseases, as a result of the exacting demands which the com- bustion of fever has made upon the residuary supply of nutrient material in the system, that the patient is prone to various complica- tions and liable to die. 3d. There are various causes responsible for the existence of mal-nutrition as a result of imperfect digestion and assimilation: namely: 1. An insufficient or improper supply of food; 2. An excessive supply of food; 3. Habitual indulgence in alcoholic stimulants, opiates, &c; and,—4. Various chronic and functional diseases. 1. As already stated, the two principal classes of nutrient principles demanded by an animal organism for its sustenance are the nitrogenous and carbonaceous. When the nitrogenous is de- ficient and the carbonaceous abundant, the natural wear-and-tear of the tissues is, through lack of the proper material, improperly 6 repaired, and hence debility ensues. Of that description is the individual who to outward appearance is well nourished and his body well rounded with fat, yet lacks ability to resist fatigue. His muscles are not muscular but fatty, and the apparent muscular development is largely due to the interposition of adipose tissue. If on the other hand the carbonaceous principles are wanting, though the nitrogenous may be sufficient in quantity, those elements which are intended for combustion and the production of heat are so deficient that a great tendency to chilliness and sensi- tiveness to cold is experienced. In this case there is generally a deficiency of fatty tissue, and emaciation results, as the system tends to burn up the fat in the absence of carbonaceous materials supplied from without. This condition leads to pernicious results, as the fatty element in the system is a very important one. It is on this account that the emaciated subjects of scrofula and •tuberculosis derive temporary benefit from cod-liver oil and olea- ginous preparations until this deficiency is supplied. 2. Mal-assimilation as a result of over-indulgence in food is a not uncommon condition, and is more apt to be found among those who lead a sedentary life and eat for pleasure alone. Dyspepsia, that common ailment of the overfed, is a functional disorder of the stomach and intestines, brought on by too rapid eating and overfeeding. It has been stated that the indolent dyspeptic, well clothed and well protected by woolen and silk, consumes more food than the hardy agricultural laborer. Such overfed individuals generally take too little exercise—and exercise is absolutely necessary for the proper assimilation of nitrogenous food and its proper adaptation to produce muscular vigor. Therefore the excess of nitrogenous material ingested by overfeeding is eliminated by the bowels and kidneys, while at the same time excess of carbonaceous material is deposited in the form of adipose tissue all over the body. Such an excessive deposit of fat, either generally or locally, is as a rule the result of overfeeding, but may be constitutional and hereditary. In either case it is not devoid of danger, as such an individual becomes more and more sedentary in his habits and less likely to 7 resort to the safety valve and all-necessary practice of muscular exercise. 3. It is not necessary to dwell on mal-nutrition as a con- sequence of over-indulgence in alcoholic stimulants, opiates, &c, further than to state that it is the result of impaired digestion from constant stimulation and irritation to the whole digestive tract and from a reflex irritation of this system as a result of over-stimulation of the brain and spinal cord. 4. Lastly, mal-assimilation is to be considered as a result of various chronic diseases and functional disorders. This form of defective nutrition is probably the most common which the physi- cian is called upon to treat. It appears in various modes or degrees according to the malady upon which it is dependent. Diseases of the stomach, liver and intestines, lungs and kidneys, are all accompanied by impoverishment of the blood, on account of which the processes of digestion are improperly performed and nutrition necessarily becomes impaired. The various functional disorders which produce mal-assimila- tion are of a reflex nature, acting through the nervous system, and are due to defective innervation. Defective nutrition dependent upon some mild form of chronic disease or functional disorder, when slighted and left untreated may of itself be the cause of further disease of a structural nature, especially of the excretory organs, the kidneys and liver. Deficient nutrition is often responsible for the contracting of various contagious maladies, and it may be stated that other things being equal, of two individuals coming in contact with some form of contagion, the one properly and the other improperly nourished, the latter is always more apt to contract the disease. In regard to the acquiring of contagious diseases generally it may be said that there is a certain power of "resistance" which everyone possesses to a greater or less extent, which explains the reason why some during an epidemic fail to become infected while others contract the disease. Nutrition undoubtedly has more or less to do with this susceptibility or resistance to contagion in different individuals, for we all of us daily come in contact in the 8 atmosphere and in our food, with various forms of noxious germs, and under certain conditions we fall victims to the various diseases of which they are the seeds, while more often they pass out of the system or are destroyed, having fallen on barren soil. The study of bacteriology teaches us that micro-organisms exist everywhere. Everything we touch, eat and drink, and the atmosphere we breathe, may contain noxious germs, which pro- pagate with inconceivable rapidity in the system when they find a proper soil. This we can readily demonstrate by cultures in our laboratories. Recent examinations in the dissecting room have shown the existence of tubercle bacilli in a large number of lungs, which apparently during life had produced no outward symptoms and left no evidences in the post mortem examination of pathological changes, or else left the marks of tubercular lesions, which under favorable conditions had spontaneously healed. We all then, probably, in any large city replete with tuber- culous subjects, at one time or another inhale into our lungs the germs of this dire disease. Why is it, then, that there are so many previously healthy individuals, with no family history of con- sumption, who acquire this malady, while on the other hand there is a still greater number who are fortunate enough to have resisted the invasion of the bacilli? There is but one positive answer to this question and that is that defective, improper or perverted nutrition must play a most important part in the etiology of all such diseases. To recapitulate the different causes upon which mal-nutrition ia dependent we make the following summary: i. Defective nutrition in the young, an inherited condition from one or both parents. 2. Mal-nutrition the result of acute dis- ease. 3. Defective nutrition as a result of improper assimilation and digestion, which may be brought on by an insufficient amount of food, over-indulgence in alcoholic or other stimulants, an ex- cessive supply of food, and various chronic and functional diseases. In all of the above forms we have an impoverished condition of the blood, which is dependent upon different causes, and we have already shown in the foregoing statement that our subjects are not necessarily lean and spare, but on the contrary may be corpulent. 9 The; Question of Treatment. The blood plays the ' 'title role'' in the causation of all forms of mal-nutrition, and as the blood is responsible for the proper per- formance of all those functions which go to produce perfect nutri- tion, if in defective nutrition the blood is lacking in one or all of these elements, it becomes incumbent upon a physician under these circumstances to supply in some manner this deficiency by such proper means as are at his disposal. The question of treatment is a most important one. There are various remedies which are used and spoken well of, all directed toward the same end, namely: that of supplying to the blood those materials in which it is deficient. But the nearer we come toward supplying these materials in the form in which they naturally exist in the blood itself, the more perfectly do we accomplish our object, and the less work we give the system in so doing, the better. What could more perfectly fill these require- ments than blood itself, and what could be more rational than sup- plying to a system in which the blood is lacking in natural con- stituents, new blood from a healthy animal, which will contain in abundance all the elements necessary to healthy nutrition, and these already organized for direct incorporation in the tissues? It was often the practice in olden times for sickly individuals to visit the slaughter houses and obtain the freshly caught blood of a healthy animal, which was taken raw into the system. This procedure was followed by most beneficial results. L,ike treatment has been in use for poorly nourished children, whose lives were despaired of, with equally good results, and at the present day we often hear of invalids pursuing the same practice. Hence the saying "strong as an ox," which has undoubtedly derived its origin from this source. In the light of past experience and as a result of many practical demonstra- tions which have been presented, I wish to lay special stress upon the treatment of mal-nutrition by the use of bullock's blood, and I especially desire to emphasize the great value of its employment in all forms of cases as classified in the foregoing pages. For- tunately it is not necessary at the present day to send our patients to the slaughter house, as we can obtain our ox's blood fresh from the arteries of healthy animals, preserved in all its vitality in the preparation known as Bovinine. ir: General Outlines of Treatment. Defective nutrition in childhood may not be recognized in the nursery, and being consequently neglected, such children, though apparently healthy, may sicken and die of phthisis before coming to maturity. If close observation is made, defective nutrition may be discovered before it becomes too late, and by proper treatment the child can be restored to a condition of health and acquire a necessary power of resistance against the various diseases which threaten the life of so many. In many young children the use of blood is especially to be recommended and the preparation known as Bovinine is a most eligible form in which to administer it and is, in fact, the only one that is readily to be obtained. It is perfectly reliable and stable, a pure defibrinated ox's blood free from all insoluble material. In children the proper quantity to give is 10 to 20 drops at each feeding, in milk or water, with salt added to suit the taste. It is hardly necessary to say any more in regard to building up the young by this natural method. The intelligent attendant must see the wisdom of this mode of treatment and will follow it up according to his own ideas. The next class of cases we have discussed are those dependent upon some acute disease. Here in the so-called convalescing stage, when the patient is worn out and weak, some powerful means of rebuilding the system is demanded. Here the value of the blood treatment will be readily appreciated and especially recommend itself to those who object to the employment of alcoholic stimulants, while it may be also used in combination with them. In the adult I would recommend from a tablespoonful to a wineglass of the Bovinine to be given in milk or light wine every two, four or six hours. It is astonishing to see the marked improvement resulting from such a course of treatment, the response following so rapidly and surely. Under the phase of mal-nutrition last described, viz.; that resulting from constant lack of proper digestion and assimilation, there is no end to the variety of ailments which are amenable to treatment by the means here suggested. Where the supply of food II has been insufficient or improper, the introduction of aliment already perfected and vitalized instantly supplies the wants of the system without exacting of it any functional effort. It is a direct supply to the system of all that constitutes healthy blood, both in its vital energy and in the nutritive elements for want of which the broken- down organism is languishing. This course of treatment, if there is any vitality left in the patient, will probably enable him to shake off his disease and regain sufficient vigor for a long and useful life. Under this class also will come the habitual drinker or opium eater, who has ruined his digestion and powers of assimilation by such vicious indulgence. Abstinence from the alcoholic or other habit will give the blood treatment a chance to show its power in healing and reinvigorating his outraged system and enable him to experience the pleasure of good health. In the case of those who suffer from over-eating it is especially necessary that in conjunction with treatment a proper and regular amount of physical exercise be taken. The diet must also be regulated and may be cut down to nil, as in its place we shall supply in small bulk all that is necessary to the system, concentrated in the ox blood. I can personally state that physical exercise, properly pursued, in conjunction with the intelligent use of Bovinine, may produce a condition of physical health and well-being that is only exampled in those athletes with whom physical development is the principal pursuit of life. In confirmation of this I may quote the experience of several who have followed this mode of training, and especially the remarkable case of one who in a recent bicycle race used no other mode of nourishment except the daily ingestion of Bovinine. Many athletes in training find it beneficial to confine themselves almost entirely to Bovinine as the means of nourishment. Of course its use in such cases must be regulated in quantity according to individual physique and the effect experienced. Furthermore, some systems require a greater amount of one or another element of food, and such.elements must be supplied as the demand for them becomes apparent. It will, of course, be understood, that under conditions of normal health, something of the substantial filling ma- terial provided in natural food is not to be omitted. 12 In chronic diseases the indications are well marked. These are always the condition and effects of mal-nutrition fostered by the disease, while the process of the disease is in turn accelerated by the want of nutrition. Such a means as the life-giving animal blood affords for rapidly building up a disabled system forcibly appeals to us in such cases and it is only necessary to state that the preparation Bovinine is to be used in the same manner as already prescribed. Even if it fails to exert a direct curative action on the malady itself, it will at least prolong life by supplying those vital elements which the various functions of the organs in their diseased condition are making unsatisfactory efforts to produce for themselves. In conclusion I might mention a few of the special indications for the adoption of the blood treatment:— i. That condition of extreme collapse and shock, the result of severe haemorrhage. Here we are called upon to supply at once something to replace the great loss of a large quantity of the vital fluid with all its nutrient principles. Hence we proceed at once to inject subcutaneously into the soft parts a half a pint or more of the sterilized bullock's blood or Bovinine, (with the proper administra- tion of one-third salt water), and the effect we produce is instantane- ous. This process may be repeated, or followed up by the internal administration of the Bovinine. The Bovinine may also be admin- istered per rectum in the above condition with most satisfactory results. Its use in this manner in that alarming condition—post- partum haemorrhage—will be spoken of in a subsequent article. 2. In extremely irritable conditions of the stomach we have another special indication for the use of Bovinine, which can be given internally oftentimes when nothing else will be retained. Or in those cases where even the Bovinine is ejected and rectal feeding has to be resorted to, enemata composed of Bovinine and peptonized milk will contain all that is necessary to sustain the system until stomach feeding can be resumed. In such a case two or three ounces each of Bovinine and peptonized milk should be given per rectum every three or four hours, and should be introduced through a tube which will reach at least as high as the sigmoid flexure of the colon—eight inches. 13 This mode of treatment is adaptable to all cases where it is desirable to give the stomach a rest, where it is the seat of some disease or growth or is unduly irritable, as after the various febrile diseases and especially typhoid fever, when the local application of Bovinine to the ulcerated surface of the intestines finds a special efficacy. 3. In anaemia and chlorosis in young girls, especially those who suffer from menorrhagia, Bovinine will render invaluable aid. 4. Lastly, as a local application to all forms of ulceration, unhealthy sloughing surfaces, and as a means of preserving locally perfect nutrition during a process of skin grafting, Bovinine has proved its value by a most practical showing of cases which will be reported from carefully taken notes, in subsequent pages. The use of Bovinine as a local application is based on the same grounds as its internal administration, and upon the fact that by this method the pure animal blood is brought directly in contact with the tissues, which is the ultimate purpose of the circulatory function. M Local Nutrition in Chronic Ulceration. Is the Topical Application of Nutrition Available in the cure of Chronic Ulceration ? By T. J. BIGGS, M. D. Assistant Surgeon New York Polyclinic. The question of curing chronic ulceration has been one of the most profound and one we might say that has puzzled the surgeons of the world for centuries past, who in spite of all the skill and with ;all the remedies at their disposal, have in many cases failed to pro- cure complete repair. The question then is: What is the cause of ■ulceration, and what is the pathological factor in its production ? . Wyeth's Text Book on Surgery describes an ulcer as "the result of the molecular death in the integument or mucous membrane and the underlying areolar or sub-mucous tissue.'' The process of necrobiosis may at times extend below the deep fascia. Of whatever variety, an ulcer is caused by a failure of nutrition in the part affected. The arrest of nutrition may be from a specific cause, as in the ulcer of chancroid or from a varicose condition of the veins, or constitutional, as in the late manifestations of syphilis, in scorbutus, etc. Where there is dyscrasia, ulcers are more liable to occur, notably in parts of the body subjected to undue irritation, or where an abnormal interference with the circulation exists. Ulcers may be divided into two clinical groups —the active and indolent. In the one, the material for repair is in excess ; in the other it is deficient. The most frequent seat of ulcer is upon the anterior aspect of the tibia at its middle or lower portions. The indolent form occurs almost always in the aged, and chiefly among the poorly fed and laboring classes, where the erect posture is of necessity maintained for many successive hours. An indolent ulcer demands stimulation. 15 From the foregoing statement, the treatment of indolent ulcer- ation must of necessity be directed to the cause of tissue destruction, and the application of such available nutrition as shall prevent further destruction and decomposition, to assist nature in repairing her loss. With the view of ascertaining precisely how far the topical use of nutrition was applicable, a series of experiments were con- ducted and various forms of nutrition were applied to ulcerated surfaces. Dilute solutions of sugar, starch, predigested starch, malt extracts, peptone broth, beef tea, extracts of beef, dissolved Pepsin, Papoid, Ichthyol, milk, blood clot, ordinary defibrinated blood, andde- fibrinated ox-blood available in the preparation known as. Bovinine. Ten consecutive cases were tried with each substance and the effect observed, care being taken to note any existing diathesis in each particular patient, which, if discovered was promptly treated. In most of the experiments three or more substances were used on the same patient at the same time, according to the number of the ulcers, and while all rendered more or less benefit, milk, blood clot, defibrinated blood or Bovinine were more prompt in their action than the rest. Further experiments proved that milk turned rapidly sour and pro- duced irritation, blood clot and ordinary defibrinated blood acted very nicely when the dressings were changed every four hours, but when left longer were found to be decomposed, and thereby retarded the pro- cess of healing, which was slow compared with that of the Bovinine cases, the ratio being about three to one in favor of the latter. A series of experiments were also conducted with Bovinine and Iodo- form on the same patient; here the ratio was found to be about ten to one in favor of the former. The explanation of this process will be evident to all who are familiar with the cell theory of Virchow, or the study of embryology, which shows conclusively that all living bodies are composed of one or more cells, each cell being peculiarly adapted to perform the function ascribed to it. Among the lower orders of cell life, the Amoeba probably are the most common. These closely resemble the Leucocytes or white corpuscles of vertebrate blood, and are almost entirely composed of undifferentiated protoplasm. On close examination, they will be found to consist of small, oval-shaped masses, which by means of i6 a continually occurring flux in their protoplasmic substance, are able to change their form and also their position ; each one is capable of living, moving, absorbing, growing and finally dying. Furthermore, each one of these little bodies will be found to be contractile, just as the muscle-fibres are under the action of an elec- tric current, with this exception, that, while the muscular contraction is regular, the cell contraction is spontaneous. When irritated they will contract and produce heat which is relative to inflammation. They are receptive and assimilative, fragments of foreign matter are laid hold of by a well-defined movement, which is quite character- istic and often repeated, and the observer can often see dead spores and pieces of undigested matter imbedded in their interior, which are subsequently ejected from their bodies. They are meta- bolic and secretory, for the increase of the Amoeba is incessant, and the protoplasm is continuaUy undergoing chemical changes, room being made for new protoplasm by the breaking down of the old into products which are ejected. They are also respiratory and reproductive, oxygen being absorbed and the production (complete or partial) of carbonic-acid gas ensues. The original cells increase their number by cell division. These individual cells by aggregation into colonies, reach their maturity and subsequent development in the matrix or mother ele- ment, in the higher order of animals and plants. Each colony or tissue corresponds to one or more of the fundamental qualities of protoplasm, for the development of which it is devoted by the special division of labor. Chemical change—including the assumption of oxygen, and the production, complete or partial, of carbonic gas, and above all, that of assimilation, secretion, excretion and reproduction- is retained by every tissue to a greater or less extent, and while some of its processes are held in abeyance for mechanical reasons, yet, it is never totaUy arrested while life exists. Plants acquire their nutriment from the inorganic kingdom and from decomposing organic matter; animals, chiefly from organic matters, whether animal or vegetable. Both possess the wonderful power of re- arranging the constituents of these substances into forms identical with those of the elements of their various tissues, and of thus making them part and parcel of themselves. 17 Experiments have been made with these individual cells and isolated colonies of simple structures by supplying nutrition artificially, by which they have been kept alive for days independent of the influence of the nervous system, each cell assimilating by contact with the proper nutritive medium, the material necessary for the preservation of its growth and integrity. The food or aliment which is necessary for the sustenance of these cells and colonies must be in a state of solution and contain the elements of Carbon, Hydrogen, Oxygen, Nitrogen and the various salts. It is therefore proven conclusively that each and every tissue is capable of absorb- ing and assimilating nutrition when presented in proper form. Upon these conditions is based the theory of topical feeding in chronic ulceration, and to this inherent power of life in each individual cell, do we owe the success attained by the topical application of nutrition as alluded to above. Granulating surfaces are non -absorbent if the substance presented be of an acrid, irritable nature or be incapable of sustaining the life of these individual cells, but, if on the other hand, the substance presented be of a neutral reaction, of a greater density than that of healthy blood, and be composed of substances capable of sustaining the life of those cells, not only will they absorb and assimilate such nourishment in large quantities, but they will live and thrive, and assist nature in repairing her loss, in such a way as to leave the surface of the part free from scar. The subjoined cases afford practical demonstration of the prin- ciples stated in the above disquisition. These cases are from among the first that were treated by this method. They have been followed so far (Oct. 10, 1894), by 348 other cases of like nature, without a single failure of perfect cure. CASE No. 1. Name.—Mrs. Crummey. Nativity.—Ireland. Age—Fifty- five years. Relation.—Married. Work.—Housework. Address. —No. 303 East 35th St., N. Y. City. Patient came to Demilt Clinic, Oct. 9th, 1893. Examination revealed a Traumatic Ulcer of right leg two inches in diameter over the gastrocnemius muscle. She gave a history of falling down i8 stairs, sustaining a severe contusion of right calf, which broke down in ulceration two weeks later, and in spite of all treatment applied, refused to heal. The ulcer was foul and covered with unhealthy granulations, exuding a thick viscid sanguineous pus; the edges were indurated and undermined; there was also considerable phlebitis. Its failure to heal and respond to ordinary means of treatment seemed to be on account of a local malnutrition. On these grounds it was decided to resort to a means of supplying the lack of nutrition by the local application of Bovinine. The method of treatment pur- sued was as follows : The leg was thoroughly scrubbed with hot water and bichloride of mercury soap, the unhealthy granulations removed with a curette, and the wound was then dressed with wet bichloride gauze 1-3000, and patient instructed to call at my office next day. Following this the daily use of Bovinine was adopted exclusively, it being applied topically as follows : After thoroughly cleansing the wound with peroxide of hydrogen, plain sterilized absorbent gauze was saturated with Bovinine and laid over entire surface of the ulcer, over this a piece of sheet lint large enough to overlap the edges of the gauze at least three inches in all directions, and over this a piece of oiled muslin (it is wise to use the oiled silk or muslin in all Bovinine dressings, as it promotes a more ready absorption and prevents evaporation of the volatile elements in the Bovinine) and a roller bandage firmly applied. The ulcer was dressed daily for ten days, then every other day until discharged. The ulcer healed in just three weeks from the first application of Bovinine, leaving only a slight pink cicatrix. T. J. BIGGS, M. D., Asst. Department Surgery, Demilt Clinic, New York City. Dec. 10th, 1893. CASE No. 2. Name.—Matilda Dukner. Nativity.—Germany. Age.- - Twenty-six years. Relation.—Married. Work.—Housework. Address.—No. 715 Seventh Ave., N. Y. City. Dr. U.---sent patient to me October 25th, 1893. On exam- ination I found a superficial necrosis of entire first phalanx of index finger of left hand, resulting from a periostitis, the consequence of a blow received four weeks previous. The wound was enlarged by an incision and necrosed tissue removed. After thorough irrigation the cavity was packed with sterilized absorbent gauze saturated with Bovinine, and dressed as in the previous case. The packing was renewed each day until the cavity had entirely filled up. The 19 wound was then strapped, and in twenty-one days from the first application of Bovinine the patient was discharged with the wound entirely healed. T. J. BIGGS, M. D., Demilt Clinic. CASE No. 3. Name.—John O'Brien. Nativity.—Ireland. Age.—Fifty-six years. Relation.—Married. Work.—Flagman, L,. I. R. R. Ad- dress.—No. 195 Mulberry St., N. Y. City. Dr. F.----sent patient to me October 3rd, 1893, suffering from a necrosis of right tibia, the result of a railroad injury. Examina- tion revealed deep necrosis on anterior surface of tibia, about three inches long, in the middle of the shaft. The wound was rendered antiseptic, and the necrosed tissue removed, leaving a mere shell of bone. It was decided on account of the size of the cavity to try sponge grafting, which was done as follows : A thin layer, cut from a laparatomy sponge (previously prepared by soaking for three hours in a 1-40 sol. of carbolic acid, and then sterilized) was soaked in Bovinine and laid in bottom of cavity, and the wound was then covered with wet Thiersch gauze. The wound was dressed in this manner daily for five days, at the end of which time the layer of sponge had become vitalized, granulations anastomosing all through its pores. A second layer of sponge soaked in Bovinine was again applied over this granulation mass and dressed as before: in seven days this also became vitalized, filling up almost the entire cavity. From this time on until the bone had entirely covered, the wound was dressed with nothing but Bovinine. After the bone had entirely covered, the wound was strapped and dressed with dry dressings, iodoform gauze, etc. December 10th, 1893, the patient was discharged, the wound having entirely healed. T. J. BIGGS, M. D., Demilt Clinic. CASE No. 4. Name.—Anna Battey, Nativity.—England. Age.—50 Years. Relation.—Married. Work.—Housework. Address.— 178 Freeman Street, Greenpoint, L,. I. Patient came to Demilt Clinic, Oct. 9, 1893. An examination revealed a varicose ulcer of left leg over ankle, on the outer side, 2^ inches in diameter and of eleven years standing. The patient said that in spite of numerous treatments applied the ulcer had never entirely healed: it would improve for a while and then break down again. 20 After thoroughly cleansing the ulcer and surrounding tissues, the ulcer was curetted and a wet Thiersch dressing ordered for the first twenty-four hours, after which Bovinine topically applied as in the former cases, was the only treatment employed. The ulcer was dressed daily for the first ten days, then every other day until the patient was discharged cured. The ulcer healed in just twenty-eight days, leaving a pink cicatrix one-half inch in diameter. T. J. BIGGS, M. D., Asst. Department Surgery, Demilt Clinic, New York City. CASE No. 5. Name.—Mary Byrne. Nativity.—Ireland. Age.—40 Years. Relation.—Married. Work.—Housework. Address. — 205 East 40th Street, New York City. Patient was first seen at Demilt Clinic, Oct. 10th, 1893. On examination found a large varicose ulcer on left leg, above ankle on outer side, six inches long and two and one-half wide, also a smaller varicose ulcer of right leg, two inches in diameter. The large ulcer on left leg was of fourteen years standing, the small one of three months; neither of them from the time of their first appearance had ever healed although patient had been con- stantly treated at various clinics. The topical application of Bovinine was commenced and applied daily for the first two weeks, after that every other day. The small ulcer healed in twenty-five days and the large one in eight weeks, leaving in both instances pink, healthy scars. The patient has been seen twice a week since the ulcers healed, and up to date there is no indication of any return, but on the contrary the scars have grown less and the leg has assumed its normal size. T. J. BIGGS, M. D. Asst. Department Surgery, Demilt Clinic, New York City. CASE No. 6. Name.—Sam. Johnston. Nativity.—Ireland. Age.—35 Years. Relation.—Married. Work.—Machinist. Address.— 223 Avenue C, N. Y. Diagnosis.—Indolent Traumatic ulcer of left leg, two inches in diameter, over outer side of ankle joint; ulcer of two years standing and had never been healed. 21 Treatment.—Topical applications of Bovinine commenced Oct. 9th, 1893, patient was discharged completely cured November 4th, 1893. CASE No. 7. Name.—Mary Ann Callery. Nativity.—Ireland. Age.—60 Years. Relation.—Married. Work.—Housework. Address.— no Sanford Street, Brooklyn, N. Y.. Diagnosis.—Varicose ulcer of right leg, over ankle on outer side, iy2 inches in diameter, of three years standing: had never healed in spite of various treatments. Treatment.—Bovinine commenced topically Oct. 15th, 1893, patient was discharged cured Nov. 10th, 1893. CASE No. 8. Name. —Maggie Hanabery. Nativity.—Ireland. Age.— 39 Years. Relation.—Married. Work.—Housework. Address. —514 East 17th Street, N. Y. Diagnosis.—Large indolent ulcer 4^ inches in diameter, on right foot, dorsal surface, of 17 years standing, the result of burn. Treatment.—Topical application of Bovinine was commenced Nov. 10th, 1893, patient was discharged completely cured Jan. 15th, 1894. In this case the patient suffered severely and constantly until Bovinine was applied, after which she suffered absolutely no pain. CASE No. 9. Name.—Lizzie Ziskind. Nativity.—United States. Age.— 2 Years. Address.—411 Seventh Avenue, N. Y. Diagnosis.—Indolent ulcer 4 inches in diameter, of three months standing, on left nates, the result of a burn. Treatment.—Bovinine commenced topically Dec. 16th, 1893, discharged completely cured Jan. 25th, 1894. The patient was entirely relieved of pain after first application of Bovinine. CASE No. 10. Name.—Pat. Murray. Nativity.—Ireland. Age.—55 Years. Relation.—Married. Work.—Longshoreman. Address. — 25 Rutgers Street, New York. Diagnosis.—Ulcer on left side of the lower jaw with necrosis of bone, the result of a carious tooth; ulcer 2 inches in diameter and of two years standing. Treatment.—December 6th, 1893, necrosed bone was removed and wound packed with Bovinine; this was repeated every day for 2 weeks, then every other day until discharged cured February 22d, 1894. This wound in spite of three operations and all treatment employed, had refused to heal until Bovinine was used. 22 CASE No. n. Name.—Nellie Ravora. Nativity.—Ireland. Age.—25 Years. Relation.—Married. Work.—Housework. Address. —208 East 25th Street, New York. Diagnosis.—Indolent ulcer of right leg, above ankle joint on the outer side; ulcer 1^ inches in diameter. Treatment.—Bovinine applications were commenced January ist, 1894, and was discharged cured February 3rd, 1894. In this case the patient suffered severely from pains in and around the ulcer- ated surface, but was entirely relieved after the first application of Bovinine. CASE No. 12. Name.—Harry Rimanoczy. Nativity.—England. Age.— 25 Years. Relation.—Single. Work.—Artist. Address.— 831 3rd Avenue, New York. Diagnosis.—Ulcer on corona of penis ^ inch in diameter and of two years standing. Treatment.—Applications of Bovinine commenced October 20th, 1893, patient discharged cured November 28th, 1893. This little ulcer had resisted all treatments till Bovinine was used. CASE No. 13. Name.—Kate Keller. Nativity.—Ireland. Age.—55 Years. Relation.—Married. Work.—Housework. Address.—605 East 16th Street, New York. Diagnosis.—Varicose ulcer, outer side of knee, on right leg, ^ inch in diameter, of six months standing. Treatment.—Bovinine commenced topically October 31st, 1893, was discharged cured December 1st, 1893. CASE No. 14. Name.—Bridget Welsh. Nativity.—Ireland. Age.—65 Years. Relation.—Married. Work.—Housework. Address. —295 Delancy Street, New York. Diagnosis.—Varicose ulcer on right leg, -outer side, just above the ankle, 2x3 inches, of twenty years standing; had never been en- tirely healed. Treatment.—Commenced Bovinine November 8th, 1893 patient discharged December 25th, 1893, cured. In this case as in all the others the patient was entirely relieved of pain after the first p-oplieation of Bovinine. 23 CAc^i^ ino. 15. . Name.—Mat. McGray. Nativity.—Ireland. Age.—38 Years. Relation.—Married. Work.—Driver.' Address.— Yonkers, N. Y. Diagnosis.—Traumatic ulcer of right leg, outer side, just above ankle, 2 inches in diameter, of sixteen years standing and had never healed. Treatment.—Bovinine dressings begun November 9th, 1893, patient discharged cured December 16th, 1893. CASE No. 16. Name.—Margaret Donovan. Nativity.—Ireland. Age.— 50 Years. Relation.—Married. Work.—Housework. Address. 7 Oak Street, New York. Diagnosis.—Varicose ulcer of right leg, 2 inches in diameter, of two years standing, had never healed. Treatment—Applications of Bovinine were commenced Novem- ber 13th, 1893, patient discharged cured December 19th, 1893. CASE No, 17. Name.—Hannah Kirwin. Nativity.—Ireland. Age.—65 Years. Relation.—Married. Work.—Housework. Address. —1499 Lexington Avenue, New York. Diagnosis,—Indolent ulcer on right leg, of two years standing, 2 x 1^2 inches; had never been healed. Treatment.—Bovinine applications were commenced December 7th, 1893, patient discharged cured January 28th 1894. CASE No. 18. Name.—Louise Gobeley. Nativity.—Germany. Age.—24 Years. Relation.—Married. Work.—Housework. Address. —27 Broome Street, Newark, N. J. Diagnosis.—Tubercular ulcer three by two and one-half inches in diameter, on right leg over tibia, of six years standing, had never healed in spite of various treatments applied. Treatment.—March 15th, the ulcer was curetted, and then injected subcutaneously with the mixture of Bovinine and Iodoform at the line of demarcation between healthy and unhealthy tissue, thirty minims of the mixture were injected in six different places, the wound was then cleansed and dressed with Bovinine as in the other cases. The dressings were renewed daily for the first eight days, then every other day, until the patient was discharged entirely well April 10th, 1894. 24 CASE No. 19. Name.—Emma Robbins. Nativity.—United States. Age. .30 Years. Relation.—Single. Work.—Dressmaker. Address. —441 W. 47th Street. Diagnosis.—Patient came to Polyclinic December 2nd, 1893. An examination revealed a necrosis of the first phalanx of the index finger, the result of an injury. The necrosis involved almost the entire anterior surface of the phalanx, the bone being com- pletely denuded of its periosteum. Treatment.—After'the necrosis had been removed, the wound was packed with Bovinine; the wound was re-dressed daily for the first seven days, then every other day until healed, Jan. 6th, 1894. CASE No. 20. Name.—Henry Coligan. Nativity.—Ireland. Age.--76 Years. Relation.—Married. Work.—Machinist. Address.—324^ East 8th Street. Diagnosis.—Traumatic indolent ulcer of right leg, over outer side of ankle joint, about the size of a twenty-five cent piece. In spite of all treatments applied it would not heal; the ulcer was of. six years standing. Treatment.—Hypodermic injection of Bovinine and salt water (one-fourth salt water, three-fourths Bovinine) was commenced May 10th, 1894, and employed twice a week for the first fourteen days, then discontinued, the ulcer having almost healed; besides the injections the ulcer was dressed topically with Bovinine, as in the other cases described. The patient was discharged cured June 3rd, 1894. CASE No. 21. Name.—Eddie Garrison. Nativity.—United States. Age.— 3 Years. Address.—217 East 47th Street. Diagnosis.—Traumatic ulcer on back of right hand, about one and three-quarter inches in diameter, of four months standing, had resisted all treatment employed. Treatment.—Bovinine commenced topically June 3rd, 1894, patient discharged cured July 7th, 1894. CASE No. 22. Name.—Edward Miller. Nativity.—United States (Negro). Age.—22 Years. Relation.—Single. Work.—Hall-boy. Ad- dress.—217 West 27th Street. Diagnosis.—Syphilitic ulcer of right leg, two and one-half by three inches, of two years standing, resisted all treatment. 25 Treatment.—The ulcer was curetted, and dressed with * wet bi-chloride of mercury dressing for the first twenty-four hours, after which nothing but Bovinine dressings were employed; the first dressing was applied May 4th, 1894, and the patient discharged cured June 12th, 1894. CASE No. 23. Name.—James O'Connor. Nativity.—Ireland. Age.—55 Years. Relation.—Married. Work.—Cigar Maker. Address. —195 Third Avenue. Diagnosis.—Indolent ulcer of right leg, two by three inches in diameter, of five years standing, had never healed. Treatment.1—Topical applications of Bovinine were com- menced June 4th, 1894, patient discharged cured July 16th, 1894. CASE No. 24. Name.—Chas. McGinnis. Nativity.—United States. Age. 15 Years. Work.—School. Address.—306 East 49th Street. Diagnosis.—Traumatic ulcer, right side of head over temporal bone, one by one and one-half inches in diameter, of six months standing. Treatment.—Bovinine dressings commenced May 4th, 1894, discharged cured May 29th, 1894. CASE No. 25. Name.—Dan Burk. Nativity.—Ireland. Age.—35 Years. Relation.—Single. Work.—Laborer. Address.—Washington House, 23rd Street. Diagnosis.—An ulcer the size of a twenty-five cent piece over joint of great toe, on right foot, the result of a burn. The ulcer was very painful and of eight months standing. Treatment.—Bovinine commenced topically April 6th, patient discharged cured May 2nd, 1894; after the first application of Bovinine the patient was relieved of all pain. CASE No. 26. Name.—Arthur Thomas. Nativity.—France. Age.—38 Years. Relation.—Single. Work.—Cook. Address.—70 Bowery. Diagnosis.—Ulcer of hand, two and one-half by three and three-quarter inches, the result of a burn, patient suffered constantly. Treatment.—Bovinine dressings commenced Jan. 12th, 1894, patient discharged cured Jan. 30th, 1894. Patient was relieved of all pain after first dressing of Bovinine. CASE No. 27. Name.—Mary Breitfuld. Nativity.—Germany. Age.—48 Years. Relation.—Married. Work.—Housework. Address. —644 Third Avenue. 26 Diagnosis.—Varicose ulcer of left leg, over tibia, three and one- half by two and one-half inches, of six years standing. Treatment.—Bovinine dressings commenced Feb. 20th, 1894, patient discharged cured April 2nd, 1894. Remarks.—Patient suffered so much in this case, that she wanted the leg amputated. After second dressing of Bovinine she was entirely relieved of pain. Salem, Mass., June ist, 1894. The Bovinine Company, Gentlemen:— In regard to the external use of Bovinine by me, and as a local nutrient, I may say that it proved very satisfactory. In some cases of multiple chronic ulcers of the leg, the rapidity of healing under its use was really remarkable. Compresses soaked with Bovinine were applied, and it was also used subcutaneously. Its use was continued in various forms of ulcers, old and recent; wounds of all kinds; compound fractures; sinuses; after operations for fistula, etc., etc. In one case only some irritation was caused by its use subcutaneously; in all others it was satisfactory and successful Yours truly, Lawrence G. Kemble, M. D. Camden, N. J., January 4th, 1894. Bovinine Company, New York. Gentlemen : I consider it my duty to again inform you of the great value of Bovinine. I am highly gratified over one case in particular. This case of which I am about to speak is one of a lady that suffered a traumatic injury low down on the calf of her leg some three months ago, which became a painful unyielding ulcer. The lady is about 55 years of age, ordinarily very healthy ; she is a nurse by occupation. After she had been treated at the university for six weeks the ulcer became worse than when the treatment began. She came to my office about three weeks ago, I curetted the ulcer, put the limb at rest and applied Bovinine, which acted like magic, and by the time you have received this letter the case will be entirely well from the simple application of Bovinine. I used in treating this ulcer only about two ounces. Please accept my thanks again and again for Bovinine. Yours truly, Dr. W. G. Bailey. 27 Through the courtesy of Dr. B---■ of Chicago, we are allowed to cite the following two cases, illustrations of which will be found on pages 29 and 30. These cases were treated with Bovinine by Dr. B----with re- markable success. CASE No. 1. Name.—John J. Age.—50 Years. Relation.—Married. Work.—Mechanic. Nativity.—United States. The patient was first seen by Dr. B---August ist, 1893. An examination revealed an extensive ulceration on the left fore-arm, the result of a burn received five years previous, which the patient said had never healed in spite of all treatments applied. When first seen the ulcer was covered with a thick, viscid, sanguineous dis- charge, of very foul odor, underlying which was an unhealthy granu- lating surface. Treatment.—The ulcer was thoroughly cleansed with a solu- tion of Permanganate of Potass, and dressed with wet Thiersch dress- ing for the first twenty-four hours, after which nothing but Bovinine dressings were employed until the patient was discharged with the arm entirely healed, Sept. 20th, 1893. *n r^s case, as in the others, the patient was relieved of all pain after two Bovinine dressings. CASE No. 2. Name.—Sara Lee. Age.—45 Years. Relation.—Married. Work.—Cook. Nativity.—United States. Diagnosis.—Three syphilitic ulcers of the left leg. History.—The ulcers had gradually grown larger for the last three years in spite of anti-syphilitic and other treatments employed. Treatment.—Aug. 10th, 1893, the ulcers were scraped and dressed with wet hot Hydrarg. Bichlor. dressings (1-2000) for the first forty-eight hours, after which nothing but Bovinine dressings were used until the ulcers had entirely healed, Sept. 8th, 1893. Illustrations of ulcers before and after treatment was commenced are on page 30. 28 CORNEAL ULCER CURED BY TOPICAL NUTRITION. Dr. Louis B. Couch, of Nyack, N. Y., has described in the New York Medical Times, an extreme case of corneal ulceration, which he cured by literal feeding of the perishing tissues, with beef serum. '' The central portion of the cornea being farthest away from the source of nutrition, became yellow, infiltrated, and densely opaque, while around it appeared extensive serpiginous ulcerations, which resulted in a serious loss of vital corneal nutritive material. The cornea now became wrinkled, diminished in size, and the eye appeared greatly shrunken. The whole epithelial layer of the cornea also sloughed away, leaving the anterior elastic lamina, dull and lustreless, exposed to view. '' The case was certainly extremely dangerous and apparently hopeless. It was plainly apparent that unless new elements of nutri- tion were speedily obtained a sloughing of the cornea and an evacua- tion of the contents of the eyeball were inevitable. I was struck with the idea of direct corneal feeding of beef serum by endosmosis, and immediately proceeded to utilize it." " Obtaining plenty of juicy round steak, I applied the juices expressed therefrom almost constantly to the wrinkled, shrunken cornea. For the first day I more than held my own, and on the second day there were plain evidences of improvement, which con- tinued uninterruptedly. The cornea gradually lost its haziness, the ulcerations healed without a scar, and to-day the eye is as bright and clear as its fellow. This application of beef serum to the cornea was continued steadily till the inflammation, swelling, and pressure upon the corneal blood-vessels had subsided sufficiently to allow the natural sources of nutrition to resume their wonted functions.'' '' The absorption of the dense central opacity of the cornea and the reproduction of its epithelial layer required several weeks to accomplish, during which interval I watched and studied with great- est interest the process of Nature building, as it were, a new cornea. Commencing at the inferior sclerotico-corneal border, the new growth crept slowly upward in a nearly straight line, till the whole cornea was plated with a new, beautiful epithelium. When the pupil was partially covered, the affected eye presented a most grotesque appearance, the upper half being lustreless, dull, and dead in appearance, while the lower half was as bright and clear as a polished diamond." il ______ Fig. 5 Fig. 6 3i [Fmm "The New York Polyclinic."} Mal-Nutrition of Bone, and Repair. BY T. J. BIGGS, M. D. CLINICAL ASSISTANT, DEPARTMENT SURGERY, NEW YORK POLYCLINIC. Outline of History and Treatment of an interesting case of Re Ion. Ellen Sweeny, twenty-four years old, applied to the New York Polyclinic, October 29th, 1893, seeking treatment for what appeared to be an ordinary felon of the right index finger. The outward manifestations, however,. did not determine the extent of the deeper trouble. She gave the history of having pricked her finger with a pin ten days back. This was followed by inflammation and swell- ing of the finger and surrounding portions of the hand, for which ■condition she applied for treatment at the New York Hospital, and an incision was made over the seat of trouble. Instead of returning for after treatment and dressing, the patient takes the matter in her own hands and commences to apply the old-time and much abused treatment of poulticing. Not gaining any relief, she came as above mentioned, to the Polyclinic. An exploratory incision was first made under cocaine to investi- gate the depth and extent of tissue involved. The result of this ■exploration revealed a most extensive amount of phlegmonous inflammation to exist, the trouble having evidently started at the flexor tendon. The primary incision had apparently not sufficiently drained the tissues, and on the top of this, the poultices, encouraging suppur- ation without drainage, further promoted the progress of disinte- gration to the detriment of surrounding and deeper tissues, so that at 32 the time of the exploration the flexor tendon for about three inches of its length, was found to consist of one long slough, and in con- sequence was snapped in half without being submitted to undue tension. The pus had burrowed upward to almost the center of the palmar surface of the hand and downward to almost the distal end of the index finger, being surrounded by an area of broken down sloughing tissue. Furthermore, it had extended in depth to the bone itself, which was found to be denuded of its periosteum for the mtire length of the anterior surface of the distal phalanx and part of the second of the index finger. By the aid of a probe, it was determined that the posterior surface was also devoid of periosteal covering, with the exception of a very small area: thus the bone was denuded for a/most its entire circumference. The general appear- ance of the surface of the bone which wyas exposed, presented an almost drab color and did not bleed when the wound was opened, although it was not attempted to do any scraping at that time. The appearance was of such a dark hue and was so devoid of that '' pinkish'' appearance, which is characteristic of healthy bone, that it was thought there existed but a small chance of saving the finger, and the patient was instructed to return the next day for operation, being advised of the possible necessity of amputation. On the suc- ceeding day, under ansesthesia and with a tourniquet applied to the arm to insure a dry operation, the incision was considerably extended until healthy tissue was reached. The sloughing soft parts were completely scraped away, including almost the entire length of the flexor tendon of the index finger. This resulted in leaving an extensive open wound of about four inches in length and three- quarters of an inch in breadth, leading down to the bone at the bottom, which was exposed through a large portion of the wound, and denuded of its periosteum, presenting on the whole a most unpromising appearance. After scraping the bone only slightly, it was decided to relieve the constriction above and by inspecting determine the amount of circulation still existing in the bony tissue. The general appearance presented was not altered. * There was no discernible bleeding of the surface of the bone, and it was a question whether there existed any variation from the general darkish hue 33 vruch the whole surface presented, and which indicated the almost total lack of nutrition. In isolated spots there seemed to exist minute points, which could possibly be considered slightly pinkish in hue, and it was on this account alone that it was decided not to amputate the finger but to give the patient the benefit of the doubt and do nothing further in the way of operating, after removing all necrosed, soft tissue, and establishing ample and unobstructed drainage. For the first twenty-four hours after the operation the wound was treated antiseptically by the use of wet bichloride (Wot) dressings, and subsequently the only treatment which was pursued and the only application employed was the sterilized liquid preparation known as " Bovinine," consisting of defibrinated ox-blood and desiccated egg albumen, suspended in spiritus frumenti. The theoretical reasons which dictated the use of this substance, were that a bone so completely denuded of periosteum and deprived of its means of nourishment from without, and showing such incom- plete capillar}^ circulation within, would be benefited by the applica- tion of artificial nourishment supplied locally. The patient was seen daily for the first ten days, and later every other day, and each time after the wound had been washed with peroxide of hydrogen, the cavity was filled with " Bovinine," and nothing else used except an outer covering lightly applied. Four or five days after the operation there was a slight change for the better in the appearance of the bone, and from that time on the question of its recovery was no longer in doubt. The bone and surrounding soft tissues progressively regained their normal appearance, and the whole wound became gradually covered by healthy granulations, the bone itself being the last to become covered in this manner. So soon as it was determined that the whole surface of the wound was completely and entirely pro- tected by healthy granulations, no further attempt was made to keep it open, and strapping was resorted to to bring the edges of the wound together and produce union by granulation tissue. The process of repair has been uninterrupted from that time on, and at the present day the wound is absolutely healed throughout its entire length. The only difficulty that remains is the loss of 34 flexion of the second and third phalanges on account of the destruc- tion of the flexor tendon. The points of interest in the consideration of this case are as follows :— The remarkable tendency of the bone to regenerate after it had been so extensively deprived of its natural means of nourishment and the lack of a necessity for any subsequent operation, there being no superficial exfoliation of necrosed bone. Formerly it was con- sidered that bone denuded of periosteum was beyond hope of recovery, but it has since been demonstrated that while the perios- teum is the external nourishing membrane of the bone, its loss is not essentially followed by necrosis, as, in this event, the internal capillar- ies keep up the nourishment and preserve its vitality. But in this case it will be seen that the capillary circulation seemed very inade- quate, and naturally serious doubts were entertained whether there would be sufficient circulation to furnish the required nourishment and restore the bone to its normal condition of health. In cases where this has been accomplished, it has often resulted in only a partial restoration of the bone, and a superficial necrosis has followed, which had to be removed before the wound could be properly closed. In the face of the above unfavorable condition, it was deemed advisable to resort to a means of supplying nourishment artifically by direct applications, in the hope that the loss of nourish- ment from inadequate capillary circulation might be supplied through an artificial medium by absorption. The result in this case was certainly a most successful one, and its report and consideration, may not be without instructive features.—The New York Polyclinic. (Monthly Journal.) New York, November 29th, 1893. 35 Details of Modified Skin-Grafting, in a Nutritive Medium, F. L. came to the Demilt Dispensary December 22nd, 1892, having sustained two weeks previously a serious injury to his left forearm while pursuing his work as brakeman on the Long Island Railroad, the result of which injury was a large laceration of the forearm, which was denuded of the integument and superficial and deep fascias, to the extent of 7 inches in its long axis and 3^ inches in width, exposing to view a clearly dissected plane of all the super- ficial layer of muscles on the outer and posterior surface. For the two weeks prior to his appearance at the Demilt Dispensary he had been treated at several other dispensaries and hospitals under antiseptic methods, but in spite of these measures the surface of the wound revealed a large-sized black slough, about 2 inches in length and extending down to the periosteum between the supinator longus muscle and the tendon of the biceps. Furthermore, as a result of the severe blow which the muscles of this region had sustained, total paralysis of the forearm existed. The conditions had ap- peared so unfavorable immediately after the injury that he was ad- vised at the institution he first visited to have the arm amputated. This he refused to submit to ; hence his appearance at the Demilt for other treatment. The preliminary treatment pursued in his case was the employment of such applications as would tend to hasten the removal of the slough and stimulate the wound to a condition of healthy granulation—namely, Balsam of Peru, Peroxide of Hydrogen, etc. The desired condition was obtained in about ten days' time, when it was decided to undertake to heal the wound by skin-grafting. The method employed was not that of Thiersch, but by the direct application of small grafts to the granulating surface. In detail it was as follows :—After carefully cleansing the surface of 36 the wound with Thiersch's solution (corrosive sublimate was not used, as it is believed to coagulate the albumen in the tissues and interfere with the adhesion of the graft), and preparing a clean area on the other arm, from which the grafts were to be taken, several small pieces of skin were removed from this surface by means of a pair of ordinary scissors and dressing forceps, washed with the Thiersch solution and carefully placed over the surface of the wound at a distance of one inch apart each. The cut on page 37 illustrates the wound as it appeared prepared for the skin-grafting. Eight grafts were employed in all. Directly over the grafts were placed strips of rubber tissue, soaked in Thiersch solution, and over this sterilized gauze wet with the same solution. The dressing was completed by the application of more rubber tissue over the whole forearm, and finally a splint and an evenly-applied bandage. Forty-eight hours after the grafting was performed, when the dressing was removed and the wound inspected, the grafts were barely adherent and had lost their pinkish hue, showing their poor nutrition. They were not disturbed, however, but the character of the dressing was changed, and in place of Thiersch solution Bovinine was employed. From this time on, the grafts were afforded a constant source of artificial nutrition through the agency of the Bovinine, on which pabulum they thrived, developed and became permanently adherent. The cut on page 38 reveals the condition of the wound and the grafts after the Bovinine had been employed several days, The dressings from now on were changed about every forty-eight hours until at the end of about eight weeks, when the wound was found to be absolutely and entirely well, having become covered with healthy epithelium, which had traversed the surface of the wound, having been derived partly from the circumference and partly from the several grafts. The cut on page 39 shows the wound and the grafts at a later stage, when partially healed. The cut on page 40 shows the wound entirely healed. The noteworthy points in this case were the following :— 1. The rapidity with which the wound acquired a healthy con- dition prior to the skin-grafting under the use of Bovinine. Ll oc bi be L o be 4i 2. The rapidity with which the grafts became adherent to the surface of the wound under the same means. Of all the grafts em- ployed no failure occurred, except that one had been accidentally brushed off. 3. The unusually rapid and complete healing of a wound of such large dimensions. Finally, it may be stated that those who have attempted to skin- graft by this method and have used other modes of dressing cannol fail to ascribe the complete success of all the grafts in this case, and the rapid recovery of the wound, to the use of a healthy nutritive medium as obtained through the employment of Bovinine. ANOTHER REMARKABLE CASE. John Francis, aged 23 years, appeared as a patient at the New York Polyclinic June 2d, suffering from an old burn over the right sterno-cleido-mastoid muscle, of 19 years standing. The general appearance of the wound was extremely unhealthy, and consisted of flabby uneven granulations covered by a sanious discharge. The wound measured about 2^ x 2 inches in dimension, and the granu- lations, such as they Were, overhung and overtopped the wound over one part of its surface, while in another they extended below the edges, covered by a dark greenish foul-smelling slough. In some respects the general appearance presented was that of epithelioma. The patient's general condition was extremely run down and his appearance markedly anaemic. He had lost weight in the last several months to the extent of about 45 pounds. He was unable to attend to his daily work, which was that of a brakeman, on account of the undue suffering caused by the wound, and the pain also deprived him of his night's rest. From the time when the wound first oc- curred up to the present, he had resorted to every means imaginable to endeavor to produce a healthy process of repair, and had followed the advice of many competent surgeons without success. He had in fact been skin-grafted on two occasions, but this procedure had failed both times. The mode of treatment adopted in this case was the 42 same as suggested in the description of the use of Bovinine in skin- grafting. In this particular case however, the wound was in such an exceptionally unhealthy condition, a longer period was taken for the preparatory treatment, which consisted in daily cleansing, fol- lowed by the application of Bovinine as a dressing. By this means the wound was gotten into a sufficiently healthy state to warrant the application of skin-grafts about two weeks after his first appearance at the Polyclinic; a condition which had never before been at- tained as long as the wound had existed, in spite of the use of all kinds of ointments and astringent and antiseptic washes. On the seventeenth day from the patient's first appearance, three small grafts were taken from previously prepared surfaces, each abouf one-quarter of an inch in length. The wound by this time, from the treatment adopted, had considerably reduced in size and was perfectly healthy in appearance, but had seemed to have reached a stationary period, having remained exactly the same for about a week, before it was decided to resort to skin grafting. Three grafts were placed in parallel positions on the surface of the wound and held in place by small strips,of rubber tissue. The dressing employed over this consisted of sterilized gauze- saturated with Thiersch solution, for the first 24 hours after the operation, "and fol- lowing this up to the time of his recovery, which was absolute and complete, Bovinine was the only dressing used. Two weeks after the skin grafting the patient was discharged cured, the whole surface having become covered with healthy epithelium. 43 Skin-Propagation from Cuticle Scrapings, By Means of Topical Nutrition. The technique of employing skin scrapings to obtain permanent repair of wounds or ulcerations that have obstinately resisted all other measures, is very similar to the method described in skin-grafting. The surface to be treated is previously prepared for a period sufficient to obtain a healthy condition of the wound; this period varies accord- ing to the state the wound happened to be in. Having accomplished the above object, a surface of healthy skin or mucous membrane from which the scrapings are to be procured, is properly prepared precisely the same as though a graft were to be taken therefrom. A small dermal curette is employed to obtain the desired scrapings, and with this instrument the surface is very gently scraped to remove the exfoliating epithelia, and then once more washed with Thiersch solution, and well dried ; after which the cells to be transplanted on the wound surface are obtained by scraping as in vaccination, without producing bleeding. Enough of these cells are removed to make a small deposit at four or five different points in a wound about two inches in dia- meter. Following this, strips of rubber tissue are applied and the dressing is the same as in skin-grafting, remembering that after the first twenty-four hours the use of Bovinine alone for the nourishment and support of the new growth of skin, is depended upon to the ex- clusion of all other dressings. The following are cases in point :— * CASE no I. Patrick M. had been coming to the Demilt Clinic for several weeks with a chronic traumatic varicose ulcer of the right leg, over the tibia, which had been treated by ordinary means, at various 44 clinics without avaii. After the ulcer had been gotten in a condition of healthy granulation the skin scrapings were procured and deposit- ed on the wound, as above described. The after dressing of the wound consisted entirely of Bovinine. Two weeks after the applica- tion of the scrapings the ulcer had entirely healed. CASE NO. 2. John Martin came to Demilt Clinic Sept. 3d, 1894, suffering from an indolent ulcer on the right leg, 3x3^ inches in diameter. After thorough cleansing of the ulcer and surrounding tissue, a wet Thiersch dressing was applied for the first twenty-four hours, after which the scrapings were applied as described in the above technique and nothing but Bovinine dressings added until the ulcer had heal- ed, twenty-six days after the first dressing. CASE no. 3. Pat, S. came to Demilt Clinic Aug. 16th, 1894, suffering from a varicose ulcer of the leg, 2^x3 inches. Patient said the ulcer had not, in spite of all treatment employed, oeen ncaied in seven yeais. The surface of the ulcer was covered with dark, unhealthy granula- tions exuding a sanguineous muco-purulent discharge. After the surrounding tissues had been thoroughly cleansed, the ulcer was curetted and dressed with bi-chloride of mercury 1-3000 dressing for the first twenty-four hours. At the end of this time the ulcer pre- sented a healthy surface and I decided to try skin-scrapings instead of grafts. Small quantities of the scrapings were deposited on the ulcer at six different points, and dressed as described in the above case. The patient was discharged Sept. 12th with the ulcer com- pletely healed and covered with new skin. N. B.—In the above described technique the epithelial scrapings may be taken from the palmar surface of the hand or plantar surface of the feet or from the mucous membranes of the external auditory meatus, nasal cavities, or even the buccal mucous membrane. The above technique may be carried out and successfully employed by using instead of the fresh scrapings, small sections procured from the horny growth of an ordinary hard corn, as demonstrated in seve- ral cases like the following. 45 CO-p.N CASE NO. I. John Polaskie, suffering from an ulceration over the crest of the left tibia about 2^ inches in diameter called upon me, having heard of the Bovinine treatment for ulceration, and, feeling that he had exhausted all other measures, requested that some form of the Bovi- nine method be applied to his case. I decided to use him as a trial case in the use of skin grafts obtained from the hypertrophied horny tissue of a corn. I treated him for a few days with Bovinine and obtained a state of healthy granulation during which period I applied wet antiseptic dressings to a well developed corn on one of his toes. I then scraped away the outer softened portion of the corn, and then pared off three thin layers of the horny tissue, and placed them at different points on the granulation surface. These were held in place by strips of rubber tissue, and dressed with wet Thiersch for the first twenty-four hours; after which the Bovinine dressing was exclusively employed. On the third day the corn grafts showed that they had taken firm hold, and at the end of third week the ulcer had entirely healed, CORN CASE NO. 2. John Skolly (born in Ireland, age 49, married) came to Demilt Surgical Clinic August 8, 1894, suffering from a traumatic ulcer 2^x1^ inches in measure, over the tibia of the left leg. The ulcer was of 15 months standing, and had been treated at four reputable institutions with unsatisfactory results. It was covered with unhealthy granulations, and exuded a very foul muco- purulent discharge. I curetted it thoroughly, removing the un- healthy granulations, and gave it a wet Thiersch dressing for 48 hours. It was then treated with Bovinine for three days as described in former cases; after which, the wound being then found in a healthy condition, five bits of corn shavings about the breadth of a split pea were distributed over the surface, and secured by strips of thin rubber tissue. Over this was placed an ample quantity of wet Thiersch gauze; then a protection of oiled silk, overlapping all two or three inches in all directions; the whole enclosed with cotton and bandaged. After 48 hours this dressing was removed, and all the corn grafts were found feebly adherent. Exclusively Bovinine treatment was then applied from this time on, until, at the end of two weeks, the patient was discharged cured, with only a small, soft, pink cicatrix in the place of the ulcer. 46 Gangrene of the Scrotum: The Member Naturally Restored! JOS. L. BLACK, M. D. COOK COUNTY HOSPITAL, CHICAGO. William F., age 30, came under my care February 28, giving the following history : Past health had been very good. During the summer had been serving as a Columbian guard. About three months before his ad- mission to the hospital he contracted gonorrhoea, which assumed a severe type. He was treated with injections and the discharge was materially diminished. About a month later, on getting out of bed one morning, felt severe pains radiating from the testicles into the groins. These became so intense that he was obliged to return to his bed. The pains continued and a severe epididymo-orchitis developed with quite severe constitutional symptoms. The circulation in the scrotum was much interfered with and soon the member showed signs of gangrene. This developed rapidly and the line of demarcation soon made its appearance, running com- pletely around the scrotum about half an inch below its origin. At this time patient came to the hospital in a truly pitiable con- dition The scrotum was completely gangrenous and almost ready to separate. Its contents were still much swollen and tender. In- tense chordee was present and the penis was swollen and extremely painful. A broad region almost across the abdomen, and from near the navel to points several inches down the thighs, was covered with an angry erysipelatous blush. The affected parts gave out a horribly offensive odor and the skin and breath partook of this to some extent. Patient was feeble and pale. Had frequent chills at irregular intervals. Pulse was feeble and thready, running 110 to the minute; 47 respirations 30, shallow. Had a profuse, offensive diarrhoea. Tem- perature fluctuated, usually keeping near 102 degrees. Treatment.—Was in such poor condition on admission that im- mediate stimulation was resorted to. When the pulse had been steadied, the affected parts were cleansed, and a boracic acid wet dressing applied. This was continued for 24 hours, at the end of which time the affected skin regained its normal appearance and the scrotum sloughed away, septum and all, leaving the testicles as bare as if they had been carefully dissected out. Internally, arsenicum 3x,gr.x, and whiskey § ss were given four times a day for five days. Then the whiskey was discontinued and the arsenic given alone for two weeks. The case was seen by a number of physicians and the}' were unanimous in the opinion that nothing but a plastic operation would answer, some advising the removal of one testicle. Instead of resorting to this I resolved to try Dr. Pratt's Bovinine treatment. The testicles were thoroughly cleansed with a solution of boracic acid, then dressed with iodoform gauze saturated with Bovinine and sprinkled with sulphate of quinine. This dressing was changed twice a day. At the end of 48 hours the raw surfaces began to glaze over and, a few days later, granulations sprouted plenti- fully from the stump of the scrotum. These spread downward and the testicles drew up slightly, and at the end of about three weeks the latter were completely covered in. Very shortly after the use of Bovinine was commenced, there was a marked improvement in the general condition. Temperature soon remained at the normal point and all other evidences of septi- caemia disappeared. The appetite was good, sleep perfect, bowels regular. At the end of two weeks, patient was able to sit up, and made an uninterrupted progress to recovery. The functional activity of the testicles has been fully regained. Was discharged April 5th, in perfect health. That this has continued, and that the cure was complete may be inferred from the fact that Mr. F. is now a member of a baseball team and engages in various kinds of active work. 48 GENERAL, TECHNIQUE OF THE VARIOUS METHODS OF EMPLOYING BOVININE. First.—The internal administration of Bovinine. Bovinine may be taken internally in doses from five drops to two ounces "pro re nata," combined with either milk or seltzer water or with any other suitable vehicle. Second.—Rectal injections. Bovinine may be given by rectum combined with either milk or a neutral salt solution, preferably from four to eight ounces in a pre- paration of two parts Bovinine to one of the other, and repeated as necessary. An ordinary size soft rubber catheter should be attached to the syringe and introduced about eight or nine inches to reach the sigmoid flexure. Remarkably successful results have been obtained after severe haemorrhage and shock, by this method, when the pure ox's blood serves to immediately compensate for the sudden loss of the human fluid. The manner in which the Bovinine is obtained from the first gush of the carotids simultaneously with the death of the animal excludes the possible presence of any ptomaines, and eminent author- ities testify to the absence of any tubercle bacilli. Third.—Subcutaneous injections. Bovinine is used subcutaneously where a rapid response is de- sired, as. after a haemorrhage or severe shock, in a proportion of two parts Bovinine to one of neutral salt solution (teaspoonful plain salt to pint of water) heated to 100 degrees F. Here, as in rectal alimentation, the wonderful phenomena of os- mosis are brought into play, by virtue of which the human fluid extracts from the animal blood what it has lost by haemorrhage. In employing this method a good size aspirating needle should be selected and everything should be cleansed and sterilized before proceeding. After carefully preparing the surface, inject the fluid deeply into the soft tissues of either buttock, after which gentle mas- sage should be employed for about ten minutes. 49 Fourth.—In skin grafting. Iu this technique the application of Bovinine is resorted to on the second day after the graft has been deposited on the previously prepared surface. It has been practically demonstrated that the use of Bovinine here hastens the adhesion of the grafts, and by furnishing an active supply of nutrition for their sustenance, the success of the procedure is more certainly assured and more rapidly accomplished. The dressings are the same as employed in ulcerations, and should be changed each day and narrow strips of rubber tissue should be laid over the grafts to prevent their being rubbed off. Fifth.—In all kinds of ulcers. DIRECTIONS FOR USE. Having thoroughly cleansed the ulcer and surrounding tissue with warm water and castile soap, apply to ulcer Peroxide of Hydrogen or a five per cent, solution of Permanganate of Potassium. After gently drying the surface with absorbent cotton, the ulcer is ready for the application of Bovinine, which should be made as follows : — Cut four or five pieces of plain sterilized absorbent gauze, saturate them with Bovinine and simply lay upon the ulcer, if it be even with the surface, or if undermined pack beneath its edges ; cover the gauze with sheet lint; and as an outer dressing to prevent evapora- tion, place oiled silk or muslin (the sheet lint and oiled silk or muslin should be large enough to overlap the edges of the ulcer at least four inches). Over the whole apply a cotton bandage to keep the dressing in position. The dressings should be changed daily in the early stages, and later every other day. N. B.—Care should be taken not to apply solutions of Corrosive Sublimate, strong Carbolic Acid, Acetate of Lead, Tannic or Mineral Acids, strong Alcoholic Liquors, Boiling Liquids or any sub- stance which precipitates or coagulates Albumen, co-incident with this method of treatment; or if they have been used the surface should be washed with plain water. If antiseptic solutions are absolutely necessary, saturated solutions of Boric Acid, Permanganate of Potash, Peroxide of Hydrogen or Pyrozone (in very indolent cases), may be used, as none of these are capable of disorganizing the Bovinine. 5© SOME VALUABLE COMBINATIONS OF BOVININE. In the surgical treatment and dressing of various lesions, highly satisfactory results have been reached by combining Bovinine with the antiseptics or medicaments most appropriate to the case, properly proportioned and chemically compounded. As a beginning, we present the following formulae, which have been wrorked out under the direction of medical experience in Haematherapy, by an able chemist, and have been successfully tested in practice for the simultaneous and composite action of the ingredients. I. BOVININE AND MERCURIC CHLORIDE. Parts:—Bovinine 1,000: Mer. Chloride i: Sodium Chloride 3. The Chlorides are first dissolved in water separately: then the solutions are mixed and added to the Bovinine. In this instance, an albuminate of Mercury is formed, which is dissolved by the excess of Sodium Chloride. II. BOVININE WITH THYMOL. Parts:—Bovinine 940: Thymol 25: Alcohol 20: Glycerine 15. Thymol is dissolved in warm Alcohol: then Glycerine is added: when cold, the Thymol solution is added, little by little, to the Bovinine. By taking half as much again of Glycerine the work is facilitated; but care must still be taken to mingle very slowly, as otherwise a precipitation of albumen will follow. III. BOVININE WITH IODOFORM 2 PER CENT. Parts:—Bovinine 100: Iodoform 2: Ether 5: Gum Acacia 5. In preparing the 2 per cent. Iodoform and Bovinine, little trouble is met with. There is absolutely no change taking place in the Bovinine proper. IV. BOVININE WITH IODOFORM 4 PER CENT. Parts:—Bovinine 90: Iodoform 4: Gum Acacia 6. The 4 per cent, emulsified mixture requires more care. The Iodo- form is triturated with ether, the Acacia is added, and an emulsion is prepared with the Bovinine. Two per cent, more of Acacia will form a still better mixture. - It is worthy of note that in these compounds the obnoxious odor of Iodoform is completely masked. 5i The facts deduced from a series of experiments have proved Bovinine to be the aliment '' par excellence'' and to contain every substance necessary for the production of healthy granulations, whether it be implanted in sponge grafts for the cure of osteo-necrosis, applied to muscle-tissue, or for the regeneration of the superficial structure. After a few local applications of this nutritive material there follows a subsidence of the inflammatory conditions, the granu- lation will proceed to develop with marked rapidity, the secretions will be totally altered in character and diminished in quantity, but will bear a direct relation to the amount of repair being done by the cellular tissues. Experiments which have been and are now being conducted in the hospitals and dispensaries afford corroborative evidence demon- strating the unprecedented advantages afforded by the above mentioned treatment, not only in chronic, indolent, syphilitic, vari- cose, and tuberculous ulceration, but also in skin-grafting, sponge- grafting, rectal fissures and ulcerations, osteo-necrosis, deep-seated abscesses, and in those cases where healing must of necessity ensue by secondary intention, or in other words with loss of tissue. In every case thus far reported, uniformly good results have been obtained, and ninety-five per cent, of the more than five hundred cases presented have been positive cures. 52 Osmosis; Alimentary Osmosis; and Rectal Alimentation. The theory and practice of clinical nutrition falls short of proper development, if the wonderful physiological faculty of Osmosis be not well understood and employed, in a multitude of the most critical situations that confront the physician. This resource overlooked, as it too often is, or the most effective nutrient to be introduced thereby neglected, there is in many cases no other help for the perishing patient. A few elementary memoranda may properly introduce the record of the latest progress in the employ- ment of this great physiological faculty (so to call it) to save life in .extremis. Nutriment is passed into the constructive channels and organs -of the body not only through the millions of microscopic mouths called absorbents, but also, in no unimportant proportion, through membranes in which there are neither passages nor pores, being tissueless as a waterproof gum. The emulsified food, in this physi- ological process does not filter through the membrane, as if through a strainer, but first gains entrance into the very substance of the membrane by something like a solvent process; which, being of course dependent on some quality in the substance of the membrane itself, is called the power or faculty of imbibition. This property ope- rates from both sides of the membrane, bringing both liquids together within it(the blood, and the lymph or chyle of digestion) where the well known law of inter-diffusion of liquids effects a new composition, each side losing something to the other, and partly passing by each other to opposite sides ; but the main body, consisting of the incom- ing fluid as modified and reinforced by the other, keeps on to its junction with the vital stream. This is Osmosis : the exit of the inter-diffused fluids which had met so easily within the membrane by the familiar process of soaking into it from opposite sides; but 53 which offer to our contemplation a mystery in their going forth : a mystery even greater in physiological osmosis than in our extra- physiological experiments ; where we make the membrane of an egg, or a neutral liquid, a diaphragm between two liquids of different densities, or of different composition, in passing through which dia- phragm they will so intermingle and interchange as to form one homogeneous solution throughout both receptacles, as if they had been connected by a pipe; or else as in certain cases will make two new solutions differently modified by having exchanged constituents with each other. For, considering the vital results in physiological os- mosis, and especially considering the distinct selective powers of different membranes for acquiring (or imparting) widely different secretions from the same nutriment, there is reason to infer a more than mechanical process of entrance and exit—imbibition and os- mosis—something more recondite than the imbibitory and osmotic power exhibited in non-vital apparatus. The employment of the absorptive properties of the mucous membrane of the larger intestine is a useful expedient in all cases where it is desirable to afford the stomach perfect rest or whenever it is impossible to reach the circulation through this organ. We have in the large intestine a large vascular area which is always ready to receive and imbibe the nutrient material introduced from without for the purpose of restoring and maintaining impaired or lost vitality. By virtue of the wonderful phenomena of osmosis we are thus enabled to reach the circulation by the use of rectal enemata, and it is a well known fact that a person may be kept alive indefinitely by this means. For this purpose various nutrient substances have been employed as enemata, such as milk, eggs, beef-tea, etc. In making a selection we should choose a preparation that contains all the necessary principles which sustain life, is readily assimilable and unirritating. After careful experimentation I find that Bovinine fulfills these requirements in a most satisfactory manner and is a valuable resource in all cases where rectal feeding is relied upon to support life. A still more important factor is the mucous membrane of the large intestine, as a means of directly reaching the 54 circulation, where prompt action is imperative, as after sudden and severe haemorrhage. Here the system is suffering a deprivation of its most vital properties and often if restoration is not immediate the loss becomes irreparable. Under these circumstances it is essential to have at hand a preparation which can immediately sup- ply the loss the system has sustained, and this is no doubt the explanation of the great success attending the use of Bovinine under these circumstances, as will be seen in the subsequent report of cases. No one doubts that in cases suffering from Cancer or Ulcer of the Stomach, Gastritis or Stricture of the Oesophagus, persistent vomiting, shock, or haemorrhage, that rectal alimentation is, very desirable, and that with colonic feeding we can get better and more prompt results, when we are using non-irritating enemas, than we can by any other means. Formerly rectal alimentation was not often resorted to, because patients were unable to retain it for any length of time on account of the irritation produced thereby. There seems to be no reason to believe that any special secondary digestive process occurs, in the caecum or any part of the large intestine, but it is possible that con- stituents of the food which has been partially digested and escaped absorption in the small bowel, may become absorbed and assimilated in the large intestine; and the power of this part of the intestinal canal to digest fatty, albuminous or other matter, may be gathered from the good effects of nutrient enemata. Probably the quickest and best method that can be used in case of emergency is to mix,— Bovinine..........i oz. or Bovinine.-.........i oz. Milk..............4 oz. Water............4 oz. Pancreatine or Chloride of Sodium may be added to either of the above formulae Or, the following formula may be used to better advantage:— Powdered Starch............................3 drachms. Cold Water.................................$ oz. mix and pour into five ounces of boiling water and cook thoroughly. When cooled to 115 degrees F., add,— Forbes' Diastase............................30 minims. 55 Digest for 15 minutes, strain and add Bovinine...................................1 ounce. To be used for each injection. Directions for use:—Place the patient on the left side, or knee- chest position, and carefully introduce a well-oiled tube, connected with a syringe filled with the fluid. Having inserted the tube, gently force it along, at the same time pumping in fluid to distend the bowel after the sigmoid flexure is reached. Some difficult}- may be experienced in passing the sigmoid flexure, but by care, patience and perseverance, it will be easily overcome. If, in spite of the patient's efforts, the bowels must be emptied, allow them to do so and again introduce the tube and give another injection. Injections should not be used warmer than 105 degrees, or colder than 80 degrees F. Huber has recently shown by actual experimentation, that from 58 per cent to 70 per cent of fluid egg albumen may be absorbed from the rectum without peptonization. A slightly larger proportion of albumen was absorbed after peptonization, but less than half as much when chloride of sodium was not added. The proportion of salt found necessary to stimulate absorption, was one gram, or one-fourth of a dram, for each egg. CASE No. 1. Mr. B. came to Dr. K's private hospital May 2nd, 1894. An examination revealed an atonied bladder with a rigid neck, for which a perineal section was performed. At the time of operation the patient had about two per cent, of albumen in his urine, and undoubtedly pyonephrosis. During operation patient bled only slightly, but six hours after, packing of perineal wound was resorted to, to stop apparent oozing from wound. On the second day after operation the patient had a violent spasm, followed by copious discharges of blood through the perineal tube. Pressure at first seemed to control this unexpected complication, but only to be followed by a recurrence a few hours later. This state of affairs continued for several days in spite of all measures to overcome it, such as pressure, hypodermic injections of ergotin, &c. After the patient had bled almost constantly for one week, his condition became so alarming that recovery was almost despaired of. The 56 bleeding was finally controlled by the use of alum solutions thrown into the bladder. In spite of the cessation of haemorrhage the patient's exsanguinated condition presented small hopes of recovery. It was at this time that the rectal enemata of Bovinine were resorted to, in the following manner. A catheter was introduced into the rectum up to the sigmoid flexure of the colon, and six ounces of Bovinine and salt water injected into the rectum, (the injection was one-fourth salt water and three-fourths Bovinine). As the patient was unable to retain anything by the stomach he had to depend en- tirely on this means of nutrition, as a result of which he made a rapid and uninterrupted recovery. An examination of his urine just before he left the hospital revealed the presence of only about one- eighth of one per cent, albumen against two per cent, prior to the operation. On leaving the hospital the patient was instructed to take one ounce of Bovinine in milk every three hours. He is at present enjoying health, having entirely recovered from the shock of the operation and haemorrhage. T. J. BIGGS, M. D. RECTAL, ALIMENTATION. A DESPERATE CASE WITH GRATIFYING RESULTS. CASE No. 2. Miss B., age 16, of Lincoln, Neb., was admitted to hospital in Kansas City, Mo., June 9th, 1891. Laparotomy for ovarian cyst performed on June 12th. History of the case in brief as follows : Anaemic in the extreme when admitted and generally in bad condition for an operation, but the case demanded immediate relief and the operation was deemed particularly successful, but the low vitality and extreme nervous irritability of the patient gave no promise of a favorable outcome. Shortly after the operation the stomach became so irritable that all nourishment and even cold water were rejected. The tempera- ture and other grave symptoms indicated sepsis. On June 18th, the date of my first visit to the hospital, the patient's life was despaired of, and the last rites of the church were being administered at the time of my arrival. Dr. G., the surgeon in charge, kindly gave me a history of the case and I at once suggested rectal feeding. This had already been tried with unsatisfactory results, beef tea and milk having been used. At my earnest request I was permitted to test the value of Bovinine, the doctor saying at the time the patient would not live 48 hours. Bovinine, one ounce, sterilized water, one ounce, Pancreatine, five grains, raised to a temperature of 100 57 degrees F. were employed and forced high up into the rectum This was retained and the same dose was repeated after an interval of two hours. After eight hours the distress and painful retching subsided and if food was not alluded to the stomach remained tranquil. For twelve days the only nourishment administered was Bovinine every three hours day and night, and by this process of nutrition alone, the vitality of the patient was lestored so that at the end of that period she sat up in bed and, for the first time since the operation, expressed a wish for food. Bovinine with carbonated water, followed later with Bovinine and a little diluted cream were given. From this time rectal feeding was discontinued and on July 3d, this moribund girl was pronounced convalescent. The peculiar value of Bovinine as Rectal Aliment lies in the fact, first, of its ready adaptability to the wants of the system and because all unassimilable matter has been eliminated, thereby avoid- ing rectal irritation. Thus this product containing as it does all the nitrogenous elements necessary to sustain life, is at once appropriated and used in the repair of the waste going on in the organism. W. H. Parsons, M. D. Omaha, Neb. CASE No. 3. Bedford, Pa., Aug. 31, 1892. Dear Sir:—Your representative kindly left with me last spring some samples of your Bovinine, and now I remember that I owe you a debt of gratitude which I cannot sufficiently give expression to; not for the samples, but for placing within my reach and that of the profession, so valuable a remedy as Bovinine. ^ Its stimulant and nutritive qualities are seen in all cases where it is given, but I wish to speak particularly of a case that came under my notice last summer. A Mr. B. is a railroad official high up in the service of the N. Y. Central R. R. He came to Bedford early in the summer of 1891; his case was thought to be a hopeless one and was diagnosed by one of the most prominent physicians in New York City, to be cancer of the stomach. We kept him alive for days at a time by rectal injections of Bovinine, and when the stomach would bear anything administered Bovinine'by the mouth, until he was built up sufficiently to take solid or semi-solid food, with Bovinine as a support between other forms of food, and last fall he was so far recovered as to be able to resume his duties as railroad manager, and this summer he is still imoroving and I feel confident that if he had not had such support 58 as was afforded by Bovinine, he could not have gone through safely, and I meet people at our Spring Hotels nearly every day, who are loud in their praise of Bovinine for bringing themselves and friends safely through some trying ordeal of sickness, in connection with the best remedies used. I am, Respectfully yours, J. A. CLARK, M. D. CASE No. 4. 514 Colerain Ave., Cincinnati, Ohio, April 24, 1893. To the Bovinine Co., New York. Genteemen:—I am glad to give my experience with Bovinine in rectal feeding in a severe case of vomiting in pregnancy a few months ago. At the suggestion of one of your representatives, I used a formula consisting of half teacup thick boiled starch, digested with Forbes' Diastase, to which was added one tablespoonful Bovinine. This quantity was given every three or four hours for a period of three weeks, the patient taking nothing by mouth, except occasion- ally a little water. The rectum was washed out twice daily with salt water before the administration of the nutrient enema. A rectal tube was not used, all of the injections being made by an ordinary syringe; still, the rectum was not in the least irritated, and I believe not a single injection was expelled. The patient gained considerably in appearance of weight, very much in strength, becoming able to sit up in a chair, notwithstanding that she was unable to raise her head off the pillow when treatment was begun. Very truly, W. E. Shaw, M. D. SUBCUTANEOUS AND RECTAL INJECTION OF BOVININE. The following cases which occurred under the personal observa- tion of Dr. T. J. Biggs contribute further evidence of the rejuve- nating properties of Bovinine as used by rectal and subcutaneous in- jection after severe haemorrhage. September 19th, 1894, I was called to see Mr. V. who had lost a large quantity of blood, the result of several incised wounds received in a fight ; one cut had opened the radial artery. The haemorrhage had been controlled prior to my arrival, but the patient had lost so much blood that he was unconscious and his life despaired of by the 59 family physician and friends. I immediately stimulated the patient with hypodermic injections of Strych.-Sulph., Glonoin and Tr. Stro- phantus, following which ten ounces of Bovinine and salt water were injected subcutaneously, four into the right nates, four into the left nates, and two into the right thigh. Twenty-three minutes after the last injection the patient regained consciousness with a decided im- provement of the pulse and respiration. A rectal injection of five ounces of Bovinine and salt water was now employed, and an hour after, the patient fell asleep, from which he awoke one hour and thirty- five minutes later, much improved. For the following three days rectal injections of Bovinine and salt water (six ounces each) were administered every three hours. The patient has improved daily up to date and is now out of danger, with the wounds healing kindly. T. J. BIGGS, M. D. AN EXTREME CASE OF POST-PARTUM HAEMORRHAGE. June 23d, 1894, I saw with Dr. S., Mrs. T. who had lost a large quantity of blood, the result of a post-partum haemorrhage. The patient was in a collapsed state and presented all the symptoms of that form of anaemia following the loss of large quantities of blood. Her pulse was very weak and ranged from 173 to 179, the skin was cold and clammy and the respiration rapid. It was decided to stimu- late her with hypodermics of Strych.-Sulph. and Glonoin, and then employ subcutaneous injections of Bovinine and salt water. One twentieth grain of Sulphate of Strychnine, one fiftieth grain of Glonoin and four drops of Tr. S rophanthus were injected, and im- mediately following this six ounces of Bovinine and salt water were injected into the right nates, and four into the left, with the most happv results. In an hour the patient's pulse had dropped to 99 and was stronger ; her respiration was almost normal. A rectal injection of six ounces of Bovinine and salt water was now administered, which the patient retained and in about an hour she fell into a quiet sleep. For the following three days the patient received nothing but Bovi- nine, milk and sherry wine. Two weeks from the date of the first subcutaneous injection the patient was in full possession of her health. ^ ^ mGGS} M. D. 6o A VALUABLE AGENT IN THE TREATMENT FOLLOW- ING PARTAL AND POST-PARTUM HEMORRHAGE. By Dr. STAFFARD. It is a well known fact that a patient's life is still endangered after the loss of a large amount of blood either at the time of labor or from a post-partal haemorrhage, even though the temporary reaction seems fairly good. Should the body not be made to rapidly replenish itself with vital principles similar to those lost by the haemorrhage, there is left a weakened condition the ready prey of disease which in a period varying from a few months to a year or more will probably manifest itself in some form. Hence, it should be our aim to restore the lost vitality as early and as effectually as possible. The nutritives used in these cases are numerous. They consist of eggs and various preparations from milk, beef, blood, etc. All of these preparations are nutritious and valuable, but vary to quite a degree as to their digestibility and assimilability in conditions of low vitality. To over- come past difficulties experts have for years been vieing with one another to form a combination of nutritives which would contain the largest amount of nutritive material and be at the same time the most readily digested and assimilated. The best preparation now on the market is Bovinine. It is prepared by The Bovinine Co., of London, New York and Chicago, and reflects great credit upon the manufacturers, as more nearly meeting the indications in these anaemic cases than any of the many prepared foods. Bovinine is not a new preparation, having been upon the market about fifteen years, but its value as a reconstructant, especially in labor cases attended by haemorrhage, undoubtedly has not been fully appreciated by the obstetrician. For those unfamiliar with this preparation it is perhaps well to state that it is a dark brown fluid consisting of defibrinated beef blood and other vital principles obtained from beef by a cold process of extraction, desiccated egg albumen, whiskey in sufficient quantity to act as a preservative, and a few other ingredients which act as palliatives and favor absorption. The process of extracting the vital principles from beef without the aid of heat is undoubtedly OI a very good one and probably furnishes more of the nutritive material contained in the beef and in a manner to be more readily cared for, than by processes in which heat is employed, as the effect of high temperature upon albumen and blood corpuscles is known to be un- favorable to the ready digestion of the former and to destroy the latter. A drop of Bovinine examined with the microscope reveals the presence of a substance containing a large number of healthy red blood corpuscles. Knowing in a general way the composition and process of preparation of Bovinine, it is readily seen that two things should be avoided in its administration, the one is heat and the other any strong preparation of alcohol which would produce a coagulation of the albumens and destroy the blood corpuscles. Another good point about this preparation is the tolerance which an irritable stomach has for it. If any food will be retained Bovinine is that food. Should the stomach refuse to tolerate food we have a useful remedy in Cocaine Hydrochlorate, of which a drop of the four per cent, solution should be given in a small teaspoonful of Vichy every ten minutes for three or four doses, after which the Bovinine will usually be tolerated in small amounts. Bovinine when administered by the mouth probably furnishes the best results when combined with peptonized milk. At first if the patient is very weak it is better to begin with one or two drachms of Bovinine to two ounces of peptonized milk, to which may be safely added a small amount of brandy or whiskey ; but if the conditions require any degree of stimulation it would be better to administer the stimulants at such times when they will not come in contact with the Bovinine in the stomach. The smaller quantity of Bovinine and milk may be repeated every half hour, and if well tolerated may be increased so that from one and one-half to .wo ounces of Bovinine may be administered in eight ounces of peptonized milk every three or four hours. It will be surprising to the obstetrician who uses this preparation for the first time to observe the more rapid improvement in his patient than he has been accustomed to see by the employment of other prepared foods. The improvement may be still more rapidly "pushed "- by administering Bovinine by the rectum, as it is usually well tolerated and quite readily absorbed from the lower bowel. It should be given 62 in from two to three ounce quantities diluted with about a third of its quantity of water to which a small amount of table salt has been added. The enema should be given warm, high up through a rectal feeding tube, care being observed to inject the solution slowly, thus allowing the bowel to acquire a greater tolerance to its reception. These enemata may be repeated usually three or four times in the twenty-four hours, and in especially weak cases may be kept up for some days, care being observed to use laxative enemata occasionally so as to leave the gut in a favorable condition for absorption. The above described plan of treatment is one which should appeal to all physicians doing obstetric work, and if once employed will be found to be several paces in advance of other methods here- tofore used in this class of cases. The following is a report of three cases treated by Bovinine. CASE i. Mrs. K., age 21, primapara, family history bad, having lost both parents and a brother, of phthisis. The patient was poorly nourished, anaemic, not well developed, having a diminished chest expansion, and had scarcely seen a day when she felt perfectly well, from childhood to the time of taking this history. Sudden changes in temperature had an unfavorable effect upon her, so that for the past four or five winters she has had a '' cold'' which lasted the greater part of the season. During early life she was taken South each Winter, but for the past five years has lived north. As puberty was reached dysmen- orrhcea and catarrhal endometritis added to her discomfort. Later on she was advised to marry, but this change seemed to have but little effect other than to lessen the severity of dysmenorrhcea. After marriage about four months she became pregnant, but «ven this change seemed to have but little effect upon her general nutrition. The patient went to term with but little change ; the labor was tedious because of the inefficiency of the pains, and as the patient was getting weak and the friends anxious about her, the writer was called in consultation. The usual low-forceps operation was performed, and the placenta removed with but little attendant haemorrhage, but it was noticed that the uterine contraction was inefficient. About two hours later the writer was again called to find the patient having quite a severe haemorrhage, but one which was readily controlled by ergotol and hot intra-uterine and vaginal douches. During the haemorrhage the pulse became so weak it was 63 difficult to distinguish the beats, the surface became cold, and the patient was gasping for breath. ^ In addition to the usual treatment the writer advised a high warm enema of Bovinine 3 i ss, Spts. Frumenti 3 ii, Aqua Fervens 3 i, table saltq.s. to be repeated every four hours, and by the mouth Bovinine 3 iv and peptonized milk 3 ii every half hour. The patient showed improvement as time elapsed; the enemata were well absorbed, as was the nourishment taken by the stomach. The enemata were continued after the first thirty-six hours only three times in the twenty-four hours for a week, after which they were discontinued. The physician in charge of the case at first objected to this plan of nourishment, but seeing the marked and rapid improvement in the case, said he believed with the writer, that it gave the best and quickest results he had seen. Bovinine was continued by the mouth, 3" ii three times a day for about four months, at the end of which time it was no flattery to say she looked better, felt stronger and weighed more than ever before. CASE No. 2. Mrs. W. L., aged 28, II-para, family history good. Her prev- ious labors had been prolonged, but otherwise normal in every way. The present labor was complicated by an accidental haemorrhage, necessitating rapid delivery. The large quantity of blood lost pro- duced the usual symptoms in exsanguination, syncope, cold surface, feeble pulse, etc. The usual treatment, such as surrounding the patient with hot bottles, elevating the foot of the bed, administering hypodermic injections of ergotol, strychnia and brandy, was done. A high enema of Bovinine 3 ii, warm water 3 i, table salt qs., was given and repeated every three hours for three doses, after which it was given only four and later three times in the twenty-four hours for ten days. Small quantities of Bovinine and milk were given by the mouth every half hour, and as more could be taken, were increased to two ounces in a glass of milk every three or four hours and later on given three times a day. This treatment was con- tinued four months, at the end of which time the patient considered herself well. CASE 3. Mrs. Annie T., age 29, Vl-para, family history good. She had always been in good health with the exception of having the diseases of childhood, up to the time of her marriage. She gave birth to six children in nine years and nearly always became preg- nant while she was nursing, thus really never giving the uterus a chance to undergo complete involution from one dehvery to another pregnancy. The patient was of good physical development, had a roomy pelvis and her labors had been not at all difficult. 64 At the last labor, which occurred on Oct. 17, '93, upon vaginal examination there appeared to be no abnormality, but a short while subsequent to the commencement of the real labor pains and dilata- tion of the cervix uteri there was a profuse haemorrhage which was found to be due to an undiscovered placenta previa marginalis. Delivery was hastened as much as possible, but not until exhaustion was quite marked. The pulse became very weak and the advisability of transfusion considered, but conveniences were not at hand to do it, and as there was a disagreement between the consultants it was abandoned. The heart was stimulated by Strychnine and whiskey. Bovinine § ii, warm water 3 i, table salt q. s. was given by high enema and repeated in four hours. In the meantime Bovinine and pepton- ized milk was given by the mouth, alternating with brandy and digitalis. The reaction in this case was slower than in either of the former two reported, but as soon as it had taken place sufficiently to favor absorption the improvement became more marked, so that at the present time she is feeling quite strong, but has not regained her former flesh and strength. ____________ SOME CASES OF OTHER PHYSICIANS. Lewiston, Me., April 12th, 1887. Gentlemen;—Permit me to speak in the highest praise of your Bovinine. I have tested it in several cases, notably in one severe case of Placenta Previa, which occurred two years ago in one of the most dangerous of all the presentations in child-birth, my experience with which I will relate. I had just returned from the Philadelphia Lying-in Hospital, where I had been for the Winter for study in the department of Obstetrics, and the lady had been awaiting my re- turn for some weeks before her confinement two years ago. She had had several severe haemorrhages, which had weakened her very much, and she was in a critical condition to undergo parturition. On my arrival I was called to her bedside, and on examination I found her very weak and exhausted. There was no time to lose and I stimulated with Bovinine and brandy. I immediately ruptured the membrane, and turned and delivered the child as soon as the os uteri could be dilated sufficiently. From the great loss of blood both before and after delivery, the case looked doubtful. She could retain nothing but Bovinine, with a little brandy and milk, for weeks. I am confident that Bovinine saved her life, and to your splendid fluid food both this mother and child are indebted for their existence, as the child was violently ill a year after from cholera infantum, and was brought through by 65 Bovmme alone the great nutritious qualities of which are a boon to humanity. I have used it m many cases and find it always to be relied upon. You are at liberty to use this letter in the interests of suffering humanity. W. S. HOWE, M. D., 135 Ash Street. * Toronto, Ontario, Nov. ist, 1887. GENTEEMEN:—I have used Bovinine with great satisfaction in several cases where a highly concentrated nutrient was indicated and especially in partial collapse from haemoptysis. I have found that it caused systemic reaction with almost the rapidity of trans- fusion. In all cases Of severe haemorrhage from' any cause or in low and depleted conditions of the body resulting from typhoid fever or septicaemia, and more especially in diphtheria, gastritis, gastric ulcer or malignant disease of whatsoever nature, its place cannot be supplied by any other preparation. R. HEARN, M. D. C. M. St. John, N. B., March 3rd, 1887. Gentlemen:—I have used large quantities of Bovinine in my practice during a year past, and have found it especially useful in restoring the strength after excessive uterine haemorrhages and in irritable conditions of the stomach, as well as in all cases of exhaus- tion or debility from whatever cause. GEORGE A. HETHERINGTON, M. D. BOVININE IN RECTAL INCRETION. Joseph M. Matthews, M. D., Professor of Principles and Practice of Surgery, and Clinical Lecturer on Diseases of the Rectum at the Kentucky School of Medicine, said: " I cannot understand why anyone would advise Colotomy in cases of ulceration, per se, of the rectum. With strict antiseptic precautions the rectum can be kept perfectly clean, and by the aid of the different meat extracts and fluid foods in the market the bowel can be absolutely rested any length of time. "The milk diet, as recommended by Mr. Allingham, can be used, or what is better than all in my experience, the preparation called Bovinine, which contains 26.58 of soluble albuminoids, and is the vital principle of beef obtained by a new process. It is a raw fluid food extract, and admirably suited to those cases which require, during treatment, entire abstinence from the solids. ^ I have kept patients for weeks on this preparation alone, during which time local applications were made to the bowel until all ulceration had healed." 66 Bovinine as a Food Stuff in Typhoid and gastro-lntestinal diseases. By Dr. MAC GRAFF. Bovinine is a concentrated, easily assimilable, nitrogenous food stuff, especially adapted to the treatment of those diseases accom- panied by marked wasting of the tissues; particularly diseases of the alimentary tract and long-continued fevers. In typhoid fever, a disease in which the waste of the nitro- genous elements of the body is excessive and where the function of assimilation is markedly impaired, Bovinine is an ideal food and is of especial value, being concentrated, and very readily absorbed for the most part from the mucous membrane of the stomach. Not only is the excessive emaciation absent, but during the whole course of the disease the heart action remains much stronger, and owing to the prevention of the excessive waste and degeneration of the tissues, there is not the usual need for cardiac stimulants. It is best given in quantities of from two to four teaspoonfuls in each glass of milk. In acute gastritis where the irritability of the mucous membrane of the stomach is marked and all other food is rejected Bovinine in small quantities will be retained, and being easily absorbed, allows the inflamed mucous membrane to regain its normal tone. In the treatment of chronic gastro-intestinal diseases, from its concentration and readiness of assimilation it is most valuable. In bad cases of gastric dyspepsia where the emaciation and weakness are the most marked symptoms, the administration of Bovinine gives results that are most satisfactory. In the worst cases it may be necessary to give Bovinine exclusively for a few days, or combined with milk; with milk it is given in quantities of from one to three teaspoonsful three or four times a day. 67 In other cases the simple regulation of the diet, chiefly milk and Bovinine, and proper mode of life, are all that are necessary to effect a cure. In these cases the effect may be noticed from the start and is continuous and steady. In anaemia, especially the cases with emaciation and marked gastric symptoms and defective assimilation, the use of Bovinine produces the most satisfactory results. The Bovinine is given, a teaspoonful before meals in three times the quantity of milk or water. In carcinoma of the stomach where all other foods are vomited, Bovinine is retained and actually prolongs life, preventing the rapid emaciation and starvation and the pain and discomfort caused by ingestion of less concentrated food. In acute and chronic inflammation of the intestinal tract accom- panied by emaciation and diarrhoea Bovinine is again a valuable agent—many obstinate cases of chronic enteritis and colitis being cured by a diet exclusively of milk and Bovinine. In treating the gastro-intestinal diseases of children Bovinine proves itself to be very useful—many cases of cholera infantum which reject every food, will retain Bovinine given in small quanti- ties at frequent intervals—many of these cases if the nutrition can be kept up recover, that would otherwise die. SPECIMEN CASES IN TYPHOID FEVER, ETC. Indianapolis., Ind. Dec. 30th, 1887. Gentlemen:—I have had the pleasure of using your fluid food, Bovinine. I have used it in several cases of typhoid fever and have observed that it sustains the patient's strength better than broths, beef-teas, etc., and is better borne by the stomach, being less bulk}-. It hastens convalescence and enables them to better resist the disease. The improvement from its use is noticeable to the patient himself and relations. Its effects are so gratifying that the patient asks to be supplied with it. I have used it in pneumonia, where its effects are equally well marked. I have also used it in a case of pyonephrotic abscess, the patient subsequently undergoing an external urethrotomy complicated by a perineal abscess, a fistulous tract connecting abscess with urethra. The patient, debili- 68 tated by the pyonephrotic suppuration,- was not well prepared for the subsequent operation and disease. The tissues wasted and his vitality diminished. He became so weak that his relations became alarmed. It seemed impossible to secure union. Bovinine was administered at this time and union dated from the commencement of its use. The patient soon was strong enough to sit up. He is improving rapidly under its use. Care should be exercised in beginning its use, commencing with a small dose. It gives me pleasure to say that I cannot speak too highly of its use. G. W. COMBS, M. D., 22 E. Ohio St. Pittsburgh, Pa., Dec. 10th, 1887. Gentlemen:—I recently made use of your fluid food Bovi- nine, in the case of my own wife, who was suffering from debility brought on by lung trouble. She was utterly unable to take any food at all, as her stomach was in so weak a condition that it would reject everything. The Bovinine, though, was retained, and she lived for upwards of two weeks on Bovinine solely. The fluid was administered at first, a teaspoonful every three hours, and gradually increased to a tablespoonful four times a day. The patient gathered strength under this treatment very rapidly, and now, after three weeks' time, is able to take solid food and is rapidly regaining her normal health. I have also used Bovinine in a variety of cases of typhoid fever with most excellent results, and am now using and recommending it in every case where there is nourishment necessary. It certainly is the highest and best form of concentrated nourishment of its kind that ever was brought to my notice, and I take great pleasure to call the attention of my professional brethren thereto. Respectfully yours, JOS. B. ENOS, M. D. Cincinnati, Ohio, Dec. 27th, 1887. Gentlemen:—I take pleasure in saying that in a practice of twenty-two years I have never used a beef food that has given me the satisfaction that your Bovinine has. Samples of it were given me by Health Officer Dr. Byron Stanton. I commenced the use of it on several patients under my care, who were typical cases of typhoid fever, and after the second or third day I noticed great improvement in the pulse. Their stomachs retained it without the least appear- ance of nausea. It is entirely free from unpleasant taste or smell. I am certainly well pleased with it, and as a new and vitalized blood-maker, am sure it is all you claim for it. H. H. WATSON, M. D., 399 John St., Assistant Health Officer'. 69 Chicago, 111., Nov. 3rd, 1887. Gentlemen:—I have been prescribing Bovinine in hospital and private practice for the past two or three years in cases of mal- nutrition or wasting produced by typhoid fever, tuberculosis and allied conditions, and find it of marked benefit in sustaining the strength of the patient. I usually combine it with milk. D. A. K. STEELE, M. D., 1801 State St. [President of the Chicago Medical Society and Professor in the College of Physicians and Surgeons.] Winona, Minn., Feb. 4th, 1888. Gentlemen:—I have used Bovinine with great satisfaction in cases of mal-assimilation, chorea, and typhoid fever. In the latter disease it is a nutrient of wonderful value. In one case, a young lady whose temperature reached 105 ° for two days, with other very unfavorable symptoms, it did glorious work and it was continued during subsequent convalesence. Very truly, L. G. WILBERTON, M. D. Indianapolis, Ind., Dec. 30th, 1887. Gentlemen:—I have given your preparation, Bovinine, a thorough trial with convalescents from typhoid fevers and gastric troubles with a great deal of satisfaction. I have also used it in enteric diseases of children with wonderful results. I have truly f