how it is used as to whether it does an injury, and should be used systematically, and unless you do, you might as well let it alone. But if you begin at one point and use it with discretion, I cannot see the great danger that the doctor points out. It is not the intention of any gentleman who favors the curet, that it be used in every case, but there must be some cause for its use in certain cases. If it is used intelligently, there certainly can be no harm come from it. Take an abortion, when everything is cleared out freely, you do not use the curet; but where the fragments are remaining, something must be done in order to check this hemorrhage and clear away these fragments. Now in my estimation there is nothing that is better than the curet for this purpose, and no instrument that can be used with as little danger as the curet. Every one cannot determine whether he is cureting the uterus or whether he is cureting fragments, and with the finger of the left hand these pieces can be brought down so you can tell what you are approaching. Now in regard to the douches, one would very naturally conclude that it was the constant practice of all to use some form of irrigation in cases of abortion. Now what is the object of irrigation and when should it be used? I know that some hold that it should be used in all these cases, and should be kept up for several days. When we resort to the chemical solutions, such as bichloride of mercury and other antiseptics, we interfere with the process of nature, which in a healthy condition is calculated to take care of the state of affairs that usually arise. Now the rule was formerly with abdominal surgery, that irrigation was practiced for the purpose of removing hemorrhage. I do not believe it is necessary to use irrigation in cases of abortion any more than I believe it is necessary to change the dressing of the womb. To insist upon irrigation from day to day one or more times, is in my estimation bad, but where there are any constitutional symptoms, then I think irrigation is a necessity. Then I would resort to the least harmful solutions which are ordinarily used. If they fail, I would probably use corrosive sublimate, in

some cases, though not in all, where the uterus is soft, but I would always follow with sterilized water, three or four times.

DR. BARNES closes the discussion: I think I have no reason to regret having used the corrosive sublimat in these cases. So far with the treat ment I have used it has been more or less successful, and I always give it myself. I do not intend to recommend the tampon except in cases where hemorrhage seems to call for it. There of course are a great variety of antiseptics used. I do not believe it is necessary to use the doucne in every case. I want to thank you for your liberal discussion, for I had expected none at all after the discussion of the paper last night.

Paper read by DR. JONAS, of Omaha. Subject, "Large Intra-mural Abscess Following Labor; Treated by Abdominal Section; Recovery."

(See page 332.)

Discussed by DR. WILLIAMS. wish to say that this is too good a paper not to be discussed. The expla nation seems reasonable. Following along his line, his reasoning is good. and it follows the idea that I presented in my paper that the abnormal conditions, the breaking down of the tis sues, as in some cases of apoplexy. which being infected would become a starting point for just such a collection. It is another evidence of how little we know till we find the truth, and how blind we are till we see.

DR. WARD: That case was SO nearly like mine, that I almost feel that it was a case that I had. I had no means of knowing, as the doctor has said, the exact formation, except that there was so much muscular tissue surrounding the tumor. Of course in this case the pus was in large quantities. I may have been mistaken that it was formed by the mucous membrane, but in making this opening as I did, I found there was also quite a wall, perhaps half an inch thick. The condition that led me astray was that of the uterus, and yet upon examination it seemed like a pregnant uterus.

The doctor is certainly to be complimented on the result of the case. Now in the case I report, there was

just a little opening and some little mucus discharge. In this case however, the pus was very offensive, and it was simply impossible to stay in the room. I never had such a trial to keep my stomach down as I did in that case.

DR. SCHRADER: Three years ago last July I had a case at Iowa City. This was following an abortion. The abdomen was as large as would be at full term. She had had inflammation something like four weeks before that, but as soon as she recovered she came to Iowa City and reported for treatment for eighteen days, when I made an abdominal incision and came down to the wall of the tumor and found it adhering throughout its entire length as far as the incision extended, and I carried that up to the umbilicus. Upon examination I found the uterus occupying nearly its former position, but a little upward, and I think a little forward, as in this case. I could introduce the sound about five inches into the uterus. Tried to separate the tumor from the walls of the abdomen, but found it imposible. Then I opened the cyst and found that it was filled with decomposed blood and such; had a very offensive smell. The contents was so thick that it could not be discharged. I opened it and dipped it out with a scoop, so that it was cleansed. In this case I did not have to stitch the cyst wall. I cleansed the cavity, closed it up and first put in some gauze and followed that with drainage, washed it out once a day for about six weeks, it finally closed. That patient's temperature never exceeded 101 after the operation. it came down to normal and continued so.

She gradually diminished in size, settled down in the abdomen, and she remained until it closed up, which required six or seven weeks. The patient went home apparently well. But six or eight weeks after, she came to me again and I made an examination. I found only the remains of the former tumor that I could discover attached to the uterus, a mass that was not larger than a hen's egg and hardly as large. It gradually contracted, and disappeared. Had no inflammation afterwards. I am sorry that I have not the notes here to give you a full account of this in connec

tion with the tumor, as required of Dr. Jonas; in some respects it was quite similar, and to me a very important case, and this coming up makes it doubiy so.

DR. JONAS closes the discussion. In comparing my case with that of Dr. Ward's I had the advantage in my case over his. In my case there were absolutely no adhesions. In fact there was an entire absence of anything which was the condition which Dr. Summers has explained to us. Here we have a muscular wall covering this whole mass which is a half inch thick, and as we opened the abdomen the pus was very offensive. I had an opportunity of examining the patient before she left the hospital, but not since. I understand she is doing her household work and apparently in good health.

(To be continued.

DIARRHEAS-TREATMENT WITH ZINC AND CODEINE COMPOUND. The teachings of our earlier days are deeply rooted and it is difficult to overthrow them. Most of us have been taught to prescribe medicines in doses that, when uncombined, are at least visible. When we are advised, therefore, to prescribe arsenite of copper for cholera infantum in doses of one five-hundredth or one-thousandth of a grain, we are likely to become incredulous as to its efficacy and make no trial of it whatever.

After considerable experience with this remedy, I must say that I have cured, with it, some very severe cases of cholera infantum as well as of diarrhea in adults. Yet I do not prescribe arsenite of copper with the same confidence that I do sulphocarbolate of zinc. The reason is that the dose seems so minute.

This prejudice would, probably, not exist if the remedy were an alkaloid, because this class of remedials is very powerful and, usually, very small doses are given. Here is a salt, however, which is given with great benefit in doses that are smaller than those of the most active alkaloids.

In prescribing, but one medicine at a time should be used whenever it is possible. Combinations are some

times necessary, yet their administra tion is confusing, especially when three or more kinds of granules are to be taken at different times during the day. Mistakes are so easily made and directions are so quickly forgotten, that it is our duty to make our instructions as plain as possible.

If remedies will admit of some variation regarding the dose, it is best to use the same number to indicate the number of granules and the time interval, e. g.. two granules every two three hours, three granules every hours. This is less confusing than two granules every three hours or three granules every two hours.

In the treatment of colic of the gastro-intestinal canal and of diarrhea, the writer has used, ever since he began the dosimetric method, a combination of sulphocarbolate of zinc, codeine and hyoscyamine. Three kinds of granules were found, however, to Je inconvenient for dispensing and a combination of these remedies into a tablet was thought of. When this tablet was ordered of Dr. Abbott (the Abbott Alkaloidal Co.), he wisely suggested the addition of sulphate of strychnine and the use of sulphate of codeine, instead of simple codeine.

The "zine and codeine compound," as I have always called it, is composed of

Zinc sulphocarbolate....
Codeine sulphate
Hyoscyamine amorph
Strychnine sulphate

gr. 1 gr. 1-4

gr. 1-250

gr. 1-134

The indications for the use of this tablet are diarrhea, occurring during phthisis, typhoid fever or influenza; or diarrhea resulting from any cause. It can be recommended in colic and in all painful affections of the gastr intestinal canal, even dysentery. When pain follows immediately after meals, or a few hours after, it is particularly valuable. I have never found a combination that gave me so much satisfaction in the treatment of the above mentioned disorders.

In severe colic or diarrhea, adults may take one, or even two tablets. every hour or every two hours, until some improvement is manifested. Then one tablet should be taken when the pain returns, or after each stool.

In the treatment of children, solutions are generally used and it is better to make, for each one, such combinations as the circumstances of the case demand. The pain, the number and the character of the evacuations vary, thus indicating the use of cod eine, zinc or perhaps emetine in dif ferent amounts, the according to prominence of the different symptoms Still, if deemed desirable, the following method may be adopted when prescribing these tablets for children. One tablet for each year of the pain tient's age should be dissolved twenty-four teaspoonfuls of water to which some saccharine has been added. Of this mixture, from half to one teaspoonful should be given every hour, in severe cases, and every two or three hours, in milder ones. The dose should always be diminished when improvement is marked. The value of this combination will be apparent when we consider the synergistic qualities of the medicines which compose it.

Codeine, as a means of relieving all painful affections of the gastro-intestinal canal, is undoubtedly better than any other opiate. It also checks hypro-secretions and excessive peristalic movement. Hyoscyamine has the well earned reputation of controlling all spasmodic contractions of the involuntary muscles, and is therefore extensively and successfully prescribed in all forms of colic. It also checks secretions. Sulphocarbonate of zinc ranks among the first as an antiseptic. It not only prevents decomposition but, by means of its astringency, it also checks secretion. Strychnine, through its action on the cerebro-spinal nerves, improves the therapeutic value of nearly all medicines. Most diseases are accompanied by diminished nerve action with loss of muscular tonicity. Nerve action is still further depressed by the secondary effect of narcotics but, when strychnine is combined with them, this depression is to a great extent prevented.

From considerable experience with this combination, I am fully convinced of its great usefulness and of the advantage of prescribing one tablet, instead of four different granules.-Jno. M. Shaller, M. D., in Alkaloidal Clinic.