and diuretics and diaphoretics as indicated. Poultice of digitalis leaves to kidneys, quinine to cinchonism as soon as possible, stopping quinine if head symptoms supervene, using salicin or sodium salicylate as a substitute. I prefer eggnog to any other stimulant, and insist on its administration from the first, to prevent weakness and sustain the vital powers.

Typhoid fever has never made its appearance here, but we occasionally have an obstinate remittent that causes us no little alarm.

Pneumonitis has put in an appearance rather early, but so far it is easily controlled. I advocate the abortive treatment, using quinia largely, at the same time bearing in mind that pneumonitis is essentially an exhaustive disease, I give nourishment and stimulants from its inception. The liver is our most troublesome complication, and my experience teaches that an eye should always be kept in that direction. I find that a mush, a mustard poultice, to the lungs will often save the application of a blister, though I never hesitate to blister if it is indicated.

I find that in administering quinine to children much annoyance may be saved to both attendant and patient if the quinine be dissolved in good brandy and rubbed in as indicated. This is very reliable, and will produce cinchonism in almost as short a time as if administered per orem. Poor little ones, they have been put sorely to the test this season with vermifuges and the like remedies, when, if it were known, all the trouble might have been saved by paying some attention to their diet, about two-thirds of their trouble being from indigestion.

I find Dr. E. A. Neely's treatment for chronic ulcers to work well in practice, though I feel the sore need of an intelligent nurse in these cases. Dr. Whitsitt's (of Jonesboro) idea of applying fresh plantain leaves to old sores I find to be very good, one application being often of great benefit.

I very much regret the death of Dr. G. S. Graves; he was one of the bright stars of the "old class."

With a sincere wish for the future prosperity of the Miss. VAL. MED. MONTHLY and its editors,

I am very truly,

L. H. DAVIS, M.D.

HARRISBURG, ARK.

Society Praceedings.

CHICAGO MEDICAL SOCIETY.

Dr. Albert E. Hoadley read a report of Five Cases Illustrating a Treatment of the More Severe Forms of Stricture of the Rectum.

Case I. J. H. G., an engineer, æt. forty, with history of piles of eight years' standing and stricture two years. Examination revealed a hard carcinoma of the rectum within one and a half inches of the anus, immovable on account of adhesions to the sacrum. The adjacent parts were involved and the bowel completely occluded. The general condition of the patient was bad. Abdomen swollen and very tender. Had not had a passage from the bowels for two weeks. Could not take food without immediately vomiting. Pulse feeble, 120, temperature 102°. At the first examination Dr. Hoadley succeeded in separating the adhesions sufficiently to pass a syringe pipe beyond the immediate stricture. A half-pint of soap water was injected a number of times during the afternoon and evening with the effect of bringing away considerable matter and gas and giving great relief to the patient. Three operations were performed at intervals by which a fair canal through the cancerous mass was made, but without relief to pain. At the fourth operation the lower end of the growth and sphincter ani were divided with one stroke of the knife. There was little hemorrhage. The relief obtained by the division of the sphincter was tenfold greater than that from all the other operations.

Case II. A laborer, forty-two years old, with history of hemorrhoids and stricture of five years' standing. Examination revealed a firm, unusual stricture within two inches of the anus. Syphilis could not be excluded, and he was put on large and increasing doses of pot. iod., and a systematic dilatation with an elastic bougie commenced. After four weeks a bougie one inch in diameter could be passed without difficulty. There was no particular irritation at the seat of the stricture, but the bowels were very irritable and there was an

increasing diarrhoea. The stricture and sphincters were thoroughly divided and the wound packed with gauze, on which dry per-sulphate of iron had been sprinkled. Relief was immediate and complete. Examination two months after the operation showed the wound to be nearly healed, and the patient feels better than he has felt for a year previous.

Case III. An American woman, æt. thirty-nine, the mother of three children, had a stricture of nine years' standing. When the stricture was divided it was found that the rectum contained a carcinomatous mass, almost occluding the canal, higher than could be reached with the fingers. The sphincters were divided back to the coccyx, and an incision was made through the mass nearly to the sacrum, and a piece of gauze pressed on the wound to prevent bleeding. A largesized drainage tube was placed in the bowel above the disease. The rectum was packed and all secured with a T bandage and the patient put to bed. After the fifth day she rapidly improved, and left the hospital within a week after the operation. Three months afterward she was comfortable and had gained six pounds.

Case IV. A German woman of fifty-six years, the mother of several children. She had enjoyed good health until the development of the stricture of the rectum about three years before. The stricture and sphincters were divided, and on introducing the finger the bowel was found blocked up with other strictures of a malignant character. These were dilated with the fingers. A violent inflammation supervened and the patient's life was threatened. She made a slow recovery, and was convinced that she was made worse by the operation. Dr. Hoadley thought that if the strictures had been incised instead of divulsed, the patient would have derived benefit.

Case V. An American of sixty-seven years, the mother of four children. Labor had always been normal and easy. She had a stricture of five years' standing. Examination revealed two or three open sinuses and fluctuating abscesses in the ischio-rectal region. The abscesses and sinuses were opened and packed with iodoform gauze and the stricture divided, the sphincter being simply dilated. Great relief followed

the operation, which was made to relieve pain and not with the hope of prolonging life.

From a study of these cases Dr. Hoadley deduced the following principles:

First, it is dangerous to practice divulsion of malignant stricture of the rectum; second, division of a severe stricture of the rectum without dividing the sphincters is of little practical value and has no tendency to cure; third, division of malignant strictures with the sphincter gives great relief and tends to prolong life; fourth, division of severe non-malignant stricture with the sphincters gives great relief and tends to perfect cure; fifth, division of both stricture and sphincter, whether malignant or non-malignant, is not attended with danger. Therefore we may conclude that in all severe strictures of the rectum, whether malignant or non-malignant, complete division of the stricture and all the tissues below it back to the tip of the coccyx affords the greatest relief, and of the non-malignant strictures the best means of permanent cure at our command.

Dr. J. Frank thought that if the author had divided his paper into relief for malignant strictures, and treatment for non-malignant strictures, it would have been a better classification. He had not had much experience with malignant strictures, but had divided one in the manner described by the author, by cutting down through the cellular tissue. He thought there was little danger in performing the operation, and was surprised at the small amount of hemorrhage. But the benefit from the operation lasted only for a short time; there was relief at first, but in six or eight weeks the symptoms returned. Even in extirpated cancerous growths, as far as his information went, they generally return within a year. He had had one case in which the whole cancerous growth was extirpated, but in six or eight months it commenced to return, and in a year's time the patient died with cancer. He thought that in dividing the strictures care must be taken not to go too far up in the bowel, or too deep, as the peritoneum might be cut into.

Dr. A. E. Hoadley in closing the discussion said: Dr. Frank

suggests that we be careful in dividing the strictures high up; I think if we do not divide them higher than we can reach with the finger, dividing them in the posterior line, there is little danger of opening the peritoneal cavity. The peritoneum does not come down as a rule, where it can be reached with the finger. In regard to hemorrhage, those cases sometimes bleed profusely, even though they are divided right in the median line, where we least expect to find blood vessels; the tissues become vascular, new vessels form, and it is necessary to tampon the wound, and in doing so it is best to put in a tube to relieve the bowels of gas. The suggestion made in reference to the division of the paper is quite proper; perhaps it would have been better to have said report of cases illustrating a treatment. The treatment is palliative in malignant strictures, and in non-malignant strictures sometimes effects a cure. In answer to the question how many inches up may we go: It is rather a difficult matter to reach the peritoneum of the posterior wall of the rectum with the finger, even if the sphincter is divided; you can reach about four inches with the finger by pushing hard, and I think I would hate to divide a stricture further than I could reach with my fingers. Even the inferior mesenteric artery (superior hemorrhoidal) comes down sometimes, before it bifurcates into the lateral branches, within reach of the fingers, and may be divided, but that is no drawback to the operation, because you can put a tampon into the rectum so firm that all hemorrhage can be perfectly controlled, and on the next day you may remove about half of the tampon to relieve tension, and the remaining half will tumble out itself three or four days later. It has been my experience, and it is on the authority of the text books, that the vessels there can be controlled with the tampon very securely and with perfect safety. It is best to prepare for it and always tampon where you make that division, because moderate hemorrhage is sometimes quite persistent.

PROCEEDINGS OF THE TRI-STATE MEDICAL ASSOCIATION.-None received. We suppose on account of the illness of the Secretary.