ΙΟΙ being nicer than liquorice powder, or confection of senna and sulphur. The diet should mainly consist of milk and beaten up eggs; the addition of a little soup, beef tea, mutton or chicken broth is welcome and will do no harm. As soon as the temperature has fallen a more liberal diet is permissable; bread soaked in milk, custard milk pudding, lightly boiled eggs, and thin bread and butter devoid of crust may be added. Local treatment of the throat should be rigidly enforced, irrigate or spray the throat every few hours with some mild antiseptic fluid, nothing being better than an acid solution of chlorate. of potash. Insomnia, restlessness and delirium should be relieved by cold or tepid sponging. If this fail, opium, sulphonal or chloralamide may be tried. Diarrhoea appearing late in the disease should not be neglected; for such Dover's powder and bismuth subnitrate should be given, and repeated if necessary. For the otitis, the ear should be irrigated with water as hot as can be borne; afterwards a few minims of laudanum or glycerite of carbolic acid may be dropped into the canal. When this fails a few drops of 5 per cent. solution of cocaine in liq. atropia proves effectual, if any bulging of the drum is detected, incise at once, though somewhat difficult in the young. The treatment of albuminuria and nephritis should be directed towards the encouragement of a free action of the other excretories, the skin and bowels, and towards lowering the arterial blood pressure, sulphate of magnesia or soda, the compound powder of jalap, elaterium, or scammony may be employed, the re-establishment of the urinary secretion, attended by a fall in the blood pressure, the disappearance of oedema, and a normal temperature are the signs to be looked for. AMENORRHEA DUE TO CONSTIPATION. CASE REPORTED BY DR. D. GUY ROBIN HOLD, FORTY FOrt, pa. The case that I have to report this evening is one of Amenorrhea due to Constipation. The constipation in this case was most remarkable. Patient. M. S. White. Age, 19. Female. Dressmaker by occupation. Patient first came to my office January 20, 1902, complaining of a continuous dull headache and at times of hot flashes passing through her body. Upon examination I learned that her bowels had not operated for more than two weeks prior to coming to see me, and that she had not menstruated for a period of six months. At that time menstruation lasted but one day, the flow being scanty. Menstruation was established at the age of 15; it was regular for about six months, then became irregular. She informed me that her bowels had not operated for periods of three weeks or more. Her general appearance indicated good health, weighing about 150 lbs. Her appetite was good. I did not make a blood examination, but started at once to treat her for constipation. I ordered for her a capsule containing the following: Sig. One capsule to be taken night and morning, followed the first morning by one bottle of the Citrate of Magnesia. In addition to this I ordered her to massage the abdomen upon retiring at night and before arising in the morning. To exercise freely, and drink freely of water, especially shall she drink two glasses before breakfast. Her diet was of a vegetable character almost exclusively. I ordered her to respond immediately to rectal calls and to go to the closet at a regular time each day and make an effort to evacuate the bowels whether successful or not. I again saw her two days later when she told me that her bowels had not operated. I ordered her to continue with the treatment and take another bottle of the Citrate of Magnesia. I again saw her the following evening when she told me that her bowels had operated twice and each movement being large and soft. I continued the treatment and saw her again one week later. During this period she had been having one evacuation of the bowels daily. I next saw her one week later, her bowels having operated about every second day and she had menstruated during the past week, menstruation lasting 4 days, the flow being about normal. After this I lost trace of the patient until eight months later she again came to me complaining of the same trouble as before. She said her menses and bowels had been regular until two months ago when they became irregular. Upon examination I learned that she had neglected her treatment. I ordered the same treatment to be carried out that was used during the last attack. The patient finally made a complete recovery. SUBDIAPHRAGMATIC ABSCESS BY DR. C. P. STACKHOUSE, WILKES-BARRE, PA. READ SEPTEMBER 2, 1903. On the 21st of April, 1899, J. B. White, age 25, teamster, was admitted to Dr. Musser's wards in the Philadelphia Hospital complaining of pain and tenderness in the epigastrium. He gave history of an attack of colic three weeks prior to admission, which was relieved by Jamaica Ginger, but the next day there was an attack of excrutiating pain in the epigastrium which doubled him up and caused him to fall to the floor. This pain radiated up his right side to the shoulder and up the right side of his neck to the back of his head. The attack lasted only a few minutes and since then the pain has been confined to the epigastrium. His bowels were constipated before the attack, but afterwards were quite loose. He was not jaun diced at any time. About two weeks before admission he developed a slight hacking cough. Upon admission the abdomen was somewhat scaphoid, recti muscles quite rigid. There was a prominence in the epigastrium continuous with liver dullness above and extending down to one and one-half inches above the umbilicus, which did not move with respiration but was extremely tender to touch. The right lung showed flatness from about one inch below the scapula posteriorly and the fifth interspace in axillary line down to the base. Tactile fremitus and breath sounds were absent in this region. Just above this area, up to about the angle of the scapula or a little above, there was a tympanitic note, bronchial breathing, broncophony and pectoriloquy, and again above this area the lung was quite normal. The left lung presented nothing abnormal. Liver dullness was continuous above with the flatness noted at the base of the right lung and in the axillary line extended down to the costal margin; in front it was continuous with the mass in the epigastrium extending down to about one and one-half inches above the umbilicus. There was tenderness over the whole area. For three days the patient's condition remained unchanged. On the afternoon of the third day he had a violent attack of coughing which lasted the whole afternoon. During the attack he expectorated large amounts of yellow, vile smelling pus, which caused a great deal of irritation to his throat. After this time the patient was unable to lie down as he would immediately begin coughing and expectorating large amounts of pus. Microscopically this pus showed diplocci and a bacillus resembling the colon bacillus. He tried to drain the pus cavity by lying down twice a day and allowing as much pus as would to run out, but this only gave a few hours' relief. After he had drained the cavity in this manner a succussion splash was elicited. The temperature was normal on admission and varied between 98.2 degrees and 102 degrees except on the evening fol lowing the attack of coughing, when it reached 103 degrees. A blood count was made and showed, red cells 3,500,000; white cells 16,500. Haemaglobin 65 per cent. The patient kept gradually growing weaker and as an empyema was suspected Dr. Frazier was called in and advised immmediate operation. A quart or two of thin, greenish, fecal smelling pus was evacuated through an incision in the axillary line between the sixth and seventh ribs. The patient was greatly relieved by the operation and could lie down after it, although he continued spitting up a small amount of pus similar to that expectorated before operation. After a few days he began to fail and died on May 3d, twelve days after admission. At the post-mortem, performed by Dr. Riesman, upon opening the abdominal cavity, the omentum was found well stretched over the intestines, and was adherent by fairly firm adhesions to the sides of the abdomen. There was quite an extensive pelvic peritonitis. The coils of small intestine, chiefly ileum, being bound down against the posterior wall of the bladder and to the sigmoid flexure and rectum. The appendix was bound down for almost its entire length to the caecum and outer surface of ascending colon, the tip being free for about one inch. Upon separating the appendix from its adhesions a small abscess cavity was found containing about a thimbleful of yellow, non-odorous pus. At the point 21⁄2 cm. from its tip, on the side toward the colon, there was an opening in the appendix communicating with the abscess cavity just described. The perforation was within one cm. of the free portion of the process. The appendix pointed upward, its apex being 51⁄2 cm. from the liver margin. The boundaries of the abscess cavity described were the outer surface and lower part of the ascending colon on the inner side and the appendix on the outer side. At a point 5 cm. below the ensiform cartilage, just at the junction of the right and left lobe of the liver, there was an abscess. cavity bounded posteriorly by opposing surfaces of the liver at the fissure, and anteriorly by the anterior abdominal wall. The cavity was lined with lymph and connected by a short sinus |