thread, if the operator knows the various steps of the operation and is at all dexterous with his instruments. He had done the operation five or six times on dogs and never required more than 20 minutes. There are cases of extreme urgency, however, in which the Murphy button might be used advantageously, as one or two minutes more time might prove fatal.

The greatest interest is in connection with the second case. From a superficial examination, one would conclude that there had been an old hydrocele. The omentum very likely projected through the ring, was cut off by a spontaneous amputation, and attached itself to the gut again for nutrition. Then, by a process of scar contraction, the gut was gradually drawn down and its lumen narrowed, producing a chronic obstruction which became acute by a sudden twist in the bowel.

The case is similar to one operated on by the speaker together with Dr. Cordier at All Saints Hospital nine months ago. The constricting band came from the internal abdominal ring, and was due in all probability, to some old inflammatory trouble. There had been а chronic obstruction of the bowel, rendered acute by a sudden twist, and resulting in perforation of the gut and perforative peritonitis. The pulse was very high and temperature 96 degrees. The work was divided by the two operators, and lateral anastomosis with the Murphy button performed, as extreme haste was necessary. In the great hurry the button was not quite closed, and was carried by the patient 115 days before being discharged. This caused great anxiety for a time.

Dr. B. C. Fairbrother inquired whether Dr. Meisenbach considered it injudicious to inject large quantities of water into the bowel for the relief of intestinal obstruction.

Dr. Meisenbach answered, that at a certain stage of an obstruction this precedure does no good and certainly can do a great deal of harm. Treatment should be instituted in a systematic manner. If the case is seen in its earliest stages, fluid injections may be used together with mild cathartics. If the condition does not yield to this treatment promptly, its continuance would be dangerous and the surgeon should be called in. He should have a thorough knowledge of the abominal cavity, and should make a careful examination by superficial and deep palpation and percussion. It is questionable, however,

whether the injected fluids ever reach the affected part, or even go beyond the sigmoid flexure in many instances.

Speaker thought that the end to end anastomosis was very properly being relegated to the past by most surgeons, which is due to the great danger of perforation or gangrene resulting from an interrupted circulation of the mesentery at the site of junction. By the bone plate method this is largely obviated on acount of the large expanse of bowel which overlaps itself.

It usually requires from 20 to 25 minutes to do the operation, and not five to eight minutes as the books would indicate. Speaker had never seen it done in so short a time.

He had expected to hear some objection made to his method of treating these cases by end to end anastomosis instead of depending upon the formation of an artificial anus and a consequent secondary resection. The reason for adopting the method is the low per cent of mortality accompanying primary resections. There have been collected 71 cases of strangulated hernia during the year 1872-73. Of these, fifteen artificial anus operations were done with five recoveries and ten deaths, a mortality of 662.3 per cent. The bowel was returned into the abdomen in nine cases, with five deaths, or 555.9 per cent. Resection was done in 47 cases, with 22 recoveries and 25 deaths, a mortality of 53 9-47 per cent. The results of Zeigler, gained in St. Petersburg, coincide exactly. He tabulated 289 cases of primary resection, giving a mortality of 49.13 per cent; and 287 cases of resections for correcting artificial anus, which gave a mortality of 74.02 per cent. This shows a mortality, 25 per cent greater in secondary resections as compared with 'primary operation. This increased mortality is doubtless due to infection of the peritoneum from the suppurating wound.

Dr. Senn has recently contributed an article on a new method of bowel resection, which might. revolutionize the statistics of this operation.

His method consists merely in preventing the escape of faecal mater from the bowel, by introducing the transverse suture before freeing it from its surrounding attachment to the parietes. He reports two cases successfully treated by this method. It is certainly an advantageous method in many cases, but whether it is applicable to all cases will have to be determined by experimental research.

Mississippi Valley Medical Association

The secretary of this association announces the following preliminary program for the twentieth annual meeting in Hot Springs, Ark., November 20, 21, 22 and 23, 1894:

Ball, James M., St. Louis-"Cases of Traumatic Cataract in Children Treated by Extraction."

Barclay, W. F., Pittsburg-"Toxics." Barr, A. D., Calamine, Ark.-"The Philosophy of Stimulants."

Bernays, A. C., St. Louis-"Conservative Surgery, and What It Means at the Present Time."

Beard, Charles H., St. Louis-"Squint, With Special Reference to an Operation."

Brayton, A. W., Indianapolis-"The Deeper Inflammations of the Skin."

Buchman, A. P., Fort Wayne, Ind."Intestinal Indigestion."

Campbell, Robert M., Esq., Ashland, Ohio-"The Medical Expert Witness." Cline, L. C., Indianapolis-"Some Observations on ore Throat, Due to Concretions in the Tonsils."

Conklin, W. J., Dayton, Ohio-"The Differential Diagnosis of Coma."

Cook, George J., Indianapolis-"Constipation."

Corlett, William T., Cleveland-"Syphilis, and Its Relation to Other Affections, Especially Those of the Skin."

Cordier, A. H., Kansas City, Mo."Surgical Treatment of Uterine Fibroids; Disposal of the Pedicle."

Dalton, H. C., St. Louis-"Stab Wound of Pericardium; Resection of Rib; Suture of Pericardium; Recovery."

Dean, Davis A., Pittsburgh-"Surgical Treatment of Trachoma."

DeCourcy, J. O., St. Libory, Ill.-"Possibilities of Medicine."

Denison, Charles A., Denver, Col."Some New Instruments and Means of Physical Diagnosis."

Dixon, Arch, Henderson, Ky.-Subject unannounced.

Fry, Frank R., St. Louis-"Quinine in Chorea."

Hamilton, John B., Chicago-"Report of a Case of Trephining for Cerebral Clot; With Loss of Vision; Recovery." Hughes, C. H., St. Louis-"Spot Specialism."

Humiston, H. W.. Cleveland-"The Management and Treatment of Endometritis, and the Prevention of Tubal and Ovarian Diseases."

Hulbert, George F., St. Louis-"Functional Stenosis; Its Relation to Malformations, Dislocations, and Flexions; and Conditions Characterized by Amenorrhoea, Dysmenorrhoea and Hyper

aemas; With a Scientific Rationale in Therapeutics."

Kerr, W. S., Mansfield, Ohio-Subject unannounced.

Keiley, W. E., Cincinnati-Subject unannounced.

Lewis, Bransford, St. Louis-"The Neatest Method of Circumcising."

Link, J. E., Terre Haute, Ind.-"Colles' Fracture."

Loeb, H. W., St. Louis-"Double Nasal Atresia, Due to Small Pox."

Love, I. N, St. Louis-"Tubercular Meningitis."

Loving, Startling, Columbus, Ohio"Physicians' Prescriptions."

Lowe, George N., Randall,, Kas."Traumatic Lesions of Cranium and Brain; Report of Clinical Cases."

Lydston, G. Frank, Chicago-"Observations on Residual Urine and Remarks on Perineal Section."

Marcy, Henry O., Boston-"Modern Surgical Technique."

Marks, Heine, St. Louis-Subject unannounced.

McLean, Donald, Detroit-"Tumors of the Neck."

Mathews, Joseph M.. Louisville"Advantages and Disadvantages of Kraske's Operation."

Meisenbach, A. H., St. Louis-"Resection of the Knee for Separation of the Lower Epiphysis of the Femur; Case of Two Years Standing, in a Patient Thirteen Years of Age."

Moyer, Harold N.. Chicago-"Accidents and Injuries from Electrical Currents of High Potential."

Norbury, Frank P., Jacksonville, Ill."The Mental Symptoms of Cerebral Syphilis; A Clinical Study."

North, John, Toledo, Ohio-"Enlarged Tonsils and Their Treatment."

Owen, A. M., Evansville, Ind.-"My Experience With Gold as a Therapeutic."

Parker, Charles B., Cleveland-"The Surgical Treatment of Injuries of the Head.'

Pope, Curren, Louisville-"Headache." Ransohof, Joseph, Cincinnati-"Address on Surgery."

Ravogli, A., Cincinnati-"Syphilis." Reed, Charles A. L., Cincinnati-"Reform in the Management of the Insane and the Neurotic Viewed from a Gynecological Standpoint."

Reynolds, Dudley S., Louisville-"Retinitis Syphilitica."

Ricketts, B. Merrill, Cincinnati-"The Spine and the Elevator."

Ridlon, John, Chicago-"Infantile Paralysis."

Scott, X. C., Cleveland-"President's: Address."

Solly, S. E., Colorado Springs, Col."Climate and Tuberculosis."

Sterne, Albert E., Indianapolis-"Toxicity in the Production of Nervous Diseases."

Straus, Leon, St. Louis-"Constipation from a Surgical Standpoint."

Sutton

R., Stansbury, Pittsburg"Laparotomy for Pelvic Diseases No Longer Necessary."

Thomas, Homer M., Chicago-"Topical Treatment of the Air Passages; With Exhibition of a New Atomizing Vaporizer."

Walker, A. B., Canton, Ohio-"The Importance of Urinalysis in Diagnosis." Walker, Edwin, Evansville, Ind."Reflex Irritation as a Cause of Disease."

Walker, H. O., Detroit-Subject unannounced.

Whittaker, J. T.. Cincinnati-"Address on Medicine.'

Wirt, William E., Cleveland-“Tumors of the Knee Joint."

Wishard, W. N., Indianapolis-"Influence of Inflammation of the Seminal Vesicles in Maintaining Gleet."

Zinke, E. Gustave, Cincinnati--"Modern Antiseptic and Aseptic Midwifery in Private Practice."

A

The railroad rates for this meeting will be one fare for the round trip. special train will leave St. Louis for Hot Springs Sunday night, November 18, via Iron Mountain route.

A stop of several hours will be made at Little Rock, Ark., on Monday, November 19.

It is requested that all who contemplate making this trip arrange their plans to join the official train at St. Louis, Sunday night.

FREDERICK C. WOODBURN,
Secretary.

Order. a. Opening Address, by Chief Surgeon Granville P. Conn, M. D., on "Hygienic Training of Men in charge of Railway Trains."

b. Discussion of same, limited to five minutes each.

c. Expert Examination of Plaintiff in Damage Cases, when Ordered by the Court." By George Chaffee, M. D., exPresident New York State Society of Railway Surgeons.

d. Discussion, limited to five minutes, by Clark Bell, Esq., Judge Roger A. Pryor, Nelson Smith, Esq., Judge Abram H. Dailey, H. W. Mitchell, M. D., Prof. Stillings, of N. H., Chief Surgeon V. C. R. R., M. Cavana, M. D., and ex-Surrogate R. S. Ransom.

e. The True Line of Duty of the Railway surgeon." By Clark Bell, Esq.

f. Discussion, five minutes each, by Surgeon George Chaffee, M. D., Surgeon A. M. Phelps, M. D., R. S. Harnden, M. D., C. M. Daniel, M. D.. S. S. Thorne, M. D., J. B. Murdoch, M. D., Nicholas Senn, M. D., W. B. Outten, M. D., G. ` P. Conn, M. D., and others. Eminent Surgeons have been invited to submit views on this subject who cannot be present. Reports will be read from various parts of the whole country.

g. "Medical Witnesses." By R. S. Harnden, M. D., ex-President Erie Railway Surgeons.

h. Discussions, five minutes each, by H. W. Mitchell, M. D., Chief Surgeon Estes, Lehigh Valley R. R., M. Cavana. M. D., C. M. Daniels, M. D., and others.

The New York State Association of Railway Surgeons holds its annual meeting at the Academy of Medicine on same day-morning and afternoon session-to which all our members have been invited, and the members of that Society are cordially invited to attend our meeting, and take part in the discussion.

A general attendance is requested. Members, not on programme, wishing the floor, on either subject, will forward their views, in brief, to the Secretary. if unable to be present. Members will please be prompt in attendance.

For Section on Medico-Legal Surgery. GRANVILLE, P. CONN, Chairman. CLARK BELL, Vice-Chairman and Secretary.

GEORGE CHAFFEE, M. D., Treas

urer.

For Medico-Legal Society,

W. H. MITCHELL, President.
CLARK BELL, Secretary.

F. B. DOWNS, M. D., Asst. Secy.

The Strychnine Treatment of Pulmonary Consumption

Next to rest and food, strychnine in large doses is the most important agent in the treatment of pulmonary consumption. Begin with 1-32 of a grain, and gradually increase to 1-16, 1-10, or 1-6 of a grain, or even larger doses, given four times a day. According to the author, it does not produce albuminuria or diabetes, as is generally supposed. It alleviates the loss of appetite, the vomiting, the constipation, the nervousness and sleeplessness, the pain in the chest, the cough and expectoration, the dyspnoea, the weakness of the heart, and acts as a blood-builder in an eminent degree. Its usefulness rests of course, on the its influence over nervous system, and is another link in the chain of evidence which shows that in the great majority of cases pulmonary consumption is the direct result of primary disease of the pulsupply.-Thomas monary nerve Mays, in College and Clinical Record.

Sugar to Produce Muscular Work

J.

The subject of sugar as a food producing muscular power was discussed last winter before an English society by Dr. Vaughan Harley. From a brief summary of his paper, given in Nature, we make the following extracts: During a twenty-four hours' fast, on one day, water alone was drunk; on another, 500 grammes of sugar was taken in an equal quantity of water. It was thus found that the sugar not only prolonged the time before fatigue occurred, but caused an increase of 61 to 76 per cent in the muscular work done. In the next place the effect of sugar added to the meals was investigated. The muscle energy producing effect of sugar was found to be so great that 200 grammes were added to a small meal increased the total amount of work done from 6 to 39 per cent. Sugar (250 grammes, about 8 ounces) was now added to a large mixed meal, when it was found not only to increase the amount of work done from to 16 per cent, but increased the resistance against fatigue. As 250 a concluding experiment, grammes of sugar was added to the meals of a full diet day; causing the

work done during the period of eight hours to be increased 22 to 36 per cent. -Scientific American.

Strophanthus in Alcoholism—

Strophanthus, like digitalis, appears to be sometimes of value in cases of alcoholism. Dr. Skworzow publishes an account of an old man who was corpulent and had a weak heart and intermittent pulse. He was a confirmed drinker. After being put upon seven drop doses of tincture of strophanthus three times a day, he felt very sick and began to dislike alcoholic drinks, which dislike, fortunately, became permanent. Two other similar cases were likewise successfully treated in the same way. In all these the immediate effect of the strophanthus was to produce nausea and profuse diaphoresis, results which are unusual when this drug is given in ordinary cardiac cases. It may be remarked that though alin discontinued cohol was suddenly these three cases, no evil result followed.-The Lancet.

The Salicylates in Rheumatic Peri

typhlitis

Dr. A. Haig (La Semaine Medical No. 40, 1894) is of the opinion that recently derheumatic perityphlitis, scribed by Professor Burney Yeo, is far from being rare. Haig has observed a number of these cases, which he terms gouty perityphlitis or intestinal gout, where the salicylates have yielded brilliant results. He has also seen a case of general chronic peritonitis treated in vain for several months with morphine (quite rational!), where it was completely cured in a few days by the salicylate. The writer even goes so far as to state that the majority of cases of perityphlitis are of a gouty nature. If more of the salicylates were given early in appendicitis fewer would surgical operations be neces

sary.

Massage in Infantile ConvulsionsSchumann (Therap. Monatsh., March, 1894,) after describing the intestinal causes leading to eclampsia and convulsions in children, dwells on our inability to render much active and immediate assistance. Anesthetics, purgatives, etc., are dealt with, and the author then describes how he has lately, in the case of several children, resorted to abdominal massage, which led