"A Second Series of Cases of Skin Transplantation by Thiersch's Method." J. Bell, M.D. Montreal Med. Jour. 1892-3. XXI., 881-887.

"A Case of Skin Grafting 10,200 feet Above the Sea Level." J. E. Meiere, M.D. Med. Record, N. Y. 1883. XLIII., 886.

"The Technique of Thiersch's Skin Grafting." N. Y. Med. Jour. 1893. LVIII., 154-156.

"Ueber die Transplantation Grosser Ungestielter Hautlappen." F. Krause. Arch. fur kin, Chir. Berlin 1893. XLVI., 177-182. "A Case of Skin Grafting from an Amputated Limb (Thiersch's method)." C. H. Taylor. Sheffield Med. Jour. 1892-93. I., 323. "Ueber Hauttransplantationen nach Thiersch." Carl Czygan. Konigsbi. Pr. 1893. M. Liedtke.

"Ueber die Wiederanheilung Vollständig vom Körper Getrennter, die Gauze Fettschicht Enthaltender Hautstücke." M. Hirschberg. Arch. f. klin Chir. Berlin. 1893. XLVI., 183-194.

"Zur Gewinnung Gedoppelter Lappen Entferut Von des Orte der Plastik." C. Lauenstein. Paris. G. Masson, 1893.

p. 58-65. "Heilung Grosser Weichtell und Hautdefecte der Extremitaten Mittelst Gesteilter Hautlappen aus Körpentheilen." Von Bramann. Verhandl Deutsch Gesselschr f. Chir. Berlin, 1893. XXV., p. 1, 2, 310-317.

"A New Bandage for the Treatment After Thiersch's Method of Transplantation of Skin." O. J. Mayer, M.D. N. Y. Med. Jour. 1803. LVIII., 569.

"Ueber Plastiche Deckung von Hautdefskten au den Extremitaten Durch Gesteilte Hautlappen aus Entfernten Körperteilen." Geo. R. Hartung. Halle, a. s., 1893.

DISCUSSION.

T. L. MACDONALD, M.D.: Dr. Willard asked me to discuss this paper, but I do not feel competent to do so. The subject of skingrafting may well be discussed here. There is no question as to the value of skin-grafting. To my mind, it is one of the grandest achievements of modern surgery, especially in large burns and large ulcerations, which prove to us that nature is a mighty poor surgeon instead of a good one, and there is no question as to the ease with which this method can be carried out. It is good practice for the internes of the hospital, if you have not time to look after it yourself. It is inadvisable to always remove the grafts from the thigh. If we remove the graft from the leg or thigh, and they have a leg

ulcer in after years, they will be very apt to blame us for the ulceration. In the removal of breasts where the base is very large, you know what difficulty we sometimes have in covering the denuded area. In old subjects, where the other breast is relaxed and pendulous after removing the breast, we have got to cover a large surface, and we can undermine the other breast, stretch it, thin it out and carry it across over the sternum to cover the area denuded. It is simple and requires but little time.

S. B. PARSONS, M.D.: I have not had as good results in skingrafting in burns as others, but suppose it is sometimes my fault. I have tried skin epithelium and sponges and everything else that has been used. I cannot say that either is particularly good. I have had good results from applying little pieces of antiseptic sponge put on the wound and bound down until granulation started up and became centres of cicatrization and the wound healed very nicely. I have used it again and saw no benefit from its use. Another time I took epithelial scales and laid them on and they did well. I think one reason for failures in skin-grafting is because we have not taken proper care of the case beforehand. There is some dyscrasia in the system that should be looked after before resorting to grafting. I have found the same trouble with rubber and gauze that the doctor had. I have seen long strips of plaster put on directly over each graft lengthwise, and not transversely, and the consequence was that in forty-eight hours there was no graft anywhere. These strips should be put on crosswise. Now, there is a gauze made, I think, by Leo, of Rochester, called the sterilized gauze. It is not medicated. It is aseptic. It is a sterilized gauze, and I use it in strips. It is better for holding the grafts. I do not know that they will take any quicker, but I know that they hold on better.

The doctor speaks of a case where the edge burst through the attachment of the flap and was bound to slough. I had such a case, but it was the superficial papillary layer that sloughed off and all underneath was firmly fastened down in three or four days.

DR. WALTON: In the preparation of the wound lies much of the responsibility. I know that many men, in cleaning a wound, use the bichloride solution so strong that they cook the tender grafts. You might as well boil your corn or wheat before planting it as to use these solutions too strong. I believe if we had an abundance of blood serum to use it would be just as good as anything for the wash. It is the last thing that comes in contact with the wound and with the hands and with the flap before the application of the graft.

One practical point in regard to the preparation of the soil; Sometimes if you curette an old ulcer it leaves a very deep area, and under these circumstances we will find our old poultice to build up a platform of young granulation. We must have a granulation surface under the grafts in order to make a good result.

DR. WILLARD: I think Dr. Walton's position is the correct one. We have been working three years along this line in our hospital. The first time we ever tried it was with a drunken man with a varicose ulcer of the leg. We were too anxious to try Thiersch's method. While everything was clean, the strength of the solution was the trouble. We have some one now to notice and see that the operation is done correctly. We kept the old gentleman in the hospital for three or four weeks and then tried it again, and then it was a success. In the meantime we shaved off the granulations and shaved off the grafts very thin and we had good results. We thought when we had grafted that we had cut it too thick. We did not understand all the methods of Thiersch's plan. So we cut it too thick. The method here is to scrape with the instrument as you see in the picture here. That is the proper way. We take only a very thin slice of tissue, and we find that it heals up so much more readily. We do not use anæsthesia at all; it is not very painful. We generally use our hands instead of the instrument for holding down the tissue. You take up half an inch larger than the place to be covered, and when it is cut off take it up with the forceps and put it right in place or it curls up and makes trouble. The great point of all is that if you do not pay particular attention to cleanliness and the strength of the salt solution, there is trouble. You had better have the solution weaker rather than stronger, but you must wash off the bichloride thoroughly before you put on the graft. We have in winter time a great many of them who come there and want their old sores healed up and want some place to stay for the winter, and we want them to stay so that we can try Thiersch's grafts.

DR. OBETZ: I want to ask the gentlemen their experience in covering bone with grafts. I have one case now in which I am going to fill up the pleural cavity with skin graft, and I want to know what the experience of the gentlemen is in bone grafting. A great number of ulcers are over the tibia and on the skull.

DR. WILLARD: Most of these varicose ulcers of the leg are nearly always on the tibia, and if the bone is not exposed, and if you can get a plain, healthy granulating surface underneath, the grafts will take, but you cannot do it on the bare bone. You must have periosteal covering on the bone before you can graft upon it.

DR. CAMPBELL: I call Dr. Obetz's attention to an article by Dr. Penn (?) reporting a case in which three-fourths of the hairy skull had been denuded, and he perforated the outer table and granulation sprung up and he went through the ordinary plan of skin grafting and the case was completely cured. The article appeared about four months ago in the New York Medical Record.

PROGRESS OF SURGERY AND ITS LIMITATIONS TO HOMEOPATHY.

BY P. C. MAJUMDAR, M.D., CALCUTTA, INDIA.

THE science and art of surgery have undergone vast improve ment of recent years. From the monopoly of illiterate class of barbers, surgery gained a resting place in the hands of most advanced and educated physicians at the present day. In my recent travels to Europe and America, I am quite struck with the marvellous development of this branch of medical science. In both the old and new schools of medicine, the position of a surgeon is very high in the community. The remuneration of a surgeon in these Western countries, I was told, is vast. It is no wonder, therefore, that the votaries of medical science devote a good deal of their energy to become adept in this art. My heart rejoiced when I found that in Homoeopathy we have numbers of very able surgeons, accoucheurs, gynecologists and ophthalmologists.

We have a galaxy of surgeons in America, with Helmuth as Nestor, who have made Homœopathic surgery honorable the world over. Dr. Pratt has revolutionized the medical practice by the discovery of orificial surgery. Our Talbot of Bostou, Van Lennep of Philadelphia, McClelland of Pittsburgh, Ludlam of Chicago, and a host of others are monuments of surgical skill.

Our British surgeons are no less skillful. They have contributed a great deal towards the development of surgery in that country. In India, though our numbers are few, we are now alive to our defects in these branches of the healing art. In our little Homeopathic hospital surgery is practiced rather freely. One of our young physicians is now devoting his energy to the field of ophthalmic sur gery and one to gynæcology.

This is a very bright picture, no doubt, but there is another side of it which I deplore most. Along with the excellencies of this branch of study, there is a solid neglect on the other side. We are not like Allopathic physicians, devoid of curative treatment in many