was in my office today and has gained materially in weight. Entire subsidence

of pelvic pain.

Remarks. This case is not only interesting from its rarity, but from the relief following the operation.

INTESTINAL OBSTRUCTION.

Specimen VII-Section of Small Intestine four inches in length (Figure VII)Murphy Button; Strangulated Femoral Hernia.

History.-MRS. S. O. N., aged seventy-nine years, has had a right femoral hernia for fifty years, for which she wore a truss all that time. She has noticed for a long time a small swelling just above Poupart's ligament which could not

uary 14 the doctor's attention was called to the hernia as it seemed to be larger than formerly. Taxis only partially reduced it. The cathartic was not effectual. Other cathartics together with rectal enemas failed to evacuate the bowels. January 15 DOCTOR COVENTRY sent for me with the view of operating.

Present Condition.-Temperature 99°; pulse 86 and though irregular, was not considered of importance as it had existed for years. Abdomen slightly tympanitic. Swelling in groin was not very sensitive on manipulation. Tongue heavily coated. Nausea slight; had vomited once or twice during the day. All efforts at evacuation of the bowels had been futile. We both agreed that the hernia was strangulated and that immediate surgical interference was necessary.

Operation 4:30 P. M. Incision directly over tumor, freely exposing a mass of omentum as large as a small hen's egg. This was incised and a knuckle of black and partially gangrenous intestine exposed. The sac was cut off. The intestine was found to be firmly adherent within the femoral canal, and on attempting its liberation it ruptured. After enlarging the femoral opening the intestine was withdrawn and four inches resected. Before resection, however, purse-string sutures were made to encircle the intestine through the healthy portion above and below the diseased portions, the omentum tied in sections and a Murphy button applied. My reason for so doing was that it is much easier, quicker and more accurately done before resection than after, and there is less liability of escape of fecal matter from the cut ends of intestine. The symptoms were favorable until the twelfth day when the lower end of the wound

EE

gave way, discharging a small amount of pus and the fifteenth day fecal matter escaped and continued to do so for several days, when it gradually ceased and the opening closed completely on the thirtieth day. On the forty-fifth day the button was passed. At the present time she is up and about in her usual health. Remarks. It was a question at first whether the fecal drainage was at the point of attachment of button or in close proximity. It should have been remarked that there was a suspicious dark spot of intestine just below the button adjustment which might have given away. In all probability there was a defective point of union at the button attachment. In any event dame

nature gave us the benefit of her aid and closed up the intestinal fistula. Specimen VIII-Section of Small Intestine one and a half inches in length (Figure VIII).

Previous History.-MR. L., aged sixty years, suffered for several years from chronic diarrhea and afterward with obstinate constipation, necessitating cathar

FIGURE VIII.

tics and high rectal enemas. He had frequent attacks of temporary intestinal obstruction which usually passed off in a few hours or a day or two. The last attack came on Tuesday, February 15, 1898, and all attempts at relief failed. Stercoraceous vomiting, pain and tympanites were the prominent symptoms. There was at no time any great amount of rise of temperature or accelerated pulse. DOCTOR A. L. SEELEY, of Mayville, Michigan, his medical attendant, sent for me to operate February 22.

Present History.-Temperature 100°, pulse 108; marked tympanites. Had not vomited for several hours. No tenderness. Apparently some better than the day previous. Operation.-Assisted by DOCTORS SEELEY and GARVIN. Median incision, through which escaped quite a quantity of light-colored serum. Intestines darkly congested and inflated with gas. Point of obstruction was readily found in the ileum a few inches from the ileo-cecal valve made by an adherent band of omentum which had nearly cut the intestine in two. There was also another band a short distance farther on. The latter was separated leaving a slight erosion at point of constriction. The impairment of intestine at first point of constriction was of such a character as to necessitate resection and adjustment with a Murphy button. Abdomen closed and gauze drainage introduced. In a recent letter from the doctor he stated that the symptoms up to the tenth day were favorable when he discovered a discharge of fecal matter from point of drainage. Patient died within twelve hours. Unfortunately no autopsy was permitted.

Specimen IX-Ascaris Lumbricoides, removed from small intestine by section. Previous History.-ADDIE MCL., aged four years, entered Harper Hospital December 30, 1897, by the advice of DOCTOR W. H. MILLEN, of Wheatly, Ontario. The mother stated that for twelve days previous to coming to the hospital all attempts to evacuate the bowels had been ineffectual. Vomiting and tympanites had been the most prominent symptoms. Although a very active child she has always been poorly nourished and constipated.

At the time of entrance her temperature was 99° and pulse 108; greatly

distended abdomen with vomiting. Efforts were again made to evacuate the bowels without avail, and it was evident that surgical interference had become. a necessity as the abdomen was becoming enormously distended and the pulse 120 and feeble.

Operation, January 1, 1898, on the fifteenth day of the obstruction. Median incision. Abdomen contained considerable quantity of bloody serum. Intestines darkly congested and greatly distended. The obstruction was located within four or five feet of the ileo-cecal valve caused by an organized band of omentum an inch in width. When ligated and cut away the intestine had the shape of an angular anastomosis of the small to the large intestine indicating that the constriction had been of long standing. No other points of obstruction were discovered. On attempting to close the abdominal wound it was found to be impossible on account of the great quantity of gas and liquid fecal matter in the intestine. I opened it at two points, first introducing purse-string sutures, and incising the bowel within its circumference. Nearly three pints. of fecal matter were removed aside from an enormous escape of gas, together with the round worm here exhibited. Approximation of the abdominal incision was then a matter of ease. Hot towels were, however, first introduced, in order to restore abdominal circulation, as the long continued manipulation necessarily caused a cyanosis of peritoneum and intestines. This maneuvre repeated made quite a change in their appearance before closure. No drainage used. Saline infusion was injected beneath the skin before leaving the operating room. Bowels moved next day and she made a remarkable recovery, leaving for home on the 16th of January.

Remarks.-The high mortality following intestinal obstruction of the past necessitates an early and correct diagnosis and timely surgical interference for the future. The point of obstruction may be sometimes difficult to determine but its existence should be apparent. Some writers lay great stress upon the amount of pain present in this class of cases. It has been my experience that pain is far from being a prominent symptom. Abdominal uneasiness would be a better expression. Vomiting, constipation and tympanites are the trio of symptoms to be considered in making a diagnosis.

BICYCLING: FROM SOCIAL, BUSINESS, AND HEALTHFUL

STANDPOINTS.*

BY THEODORE R. MACCLURE, LANSING, MICHIGAN.†

[PUBLISHED IN The Physician and Surgeon EXCLUSIVELY]

THAT the bicycle is one of the greatest inventions of the age, is accepted by nearly every class of society. While bicycles have been known many years, it is only within the past ten years that wheeling has become so universal. The wheel has become an important element in modern life; and, although considerable has been written on the subject, much has not been written, much more will be written, and the subject will be discussed pro and con for years to come.

It might be well to mention that the object of this paper is not in any way to discourage the use of the wheel; but, on the other hand, to encourage its judicious use; and, by discussing certain features of the subject, endeavor to suggest to cyclists ways in which they can guard against any possible dangers.

This paper will endeavor to deal with wheeling from three standpoints: Social, business and healthful, but with especial reference to its influence upon the healthfulness of the exercise.

*A paper presented at a Sanitary Convention, under auspices of STATE Board of HEALTH, held at Detroit, December 9 and 10, 1897.

+ Chief Clerk in the State Board of Health Office.

FROM A SOCIAL STANDPOINT.

There can be no question of the utility of the bicycle in society. Never during the history of civilization has any invention been more of a boone to society. The enjoyable features of the wheel are so apparent that little need to be said on that phase of the subject.

What can be more enjoyable than riding a wheel? There is no grander sight than to see the young lady, or the young man gliding down our streets, through the beautiful drives of our parks, or enjoying the grandeur of the country scenery; it is a healthful and pleasing exercise combined.

Bearing upon the influence the bicycle has had upon society, I take the liberty to copy from a recent issue of Good Health the following verses:

THE OLD.

THE SONG OF THE WHEEL.

In and out of her golden hair
The sunbeams softly steal.

And her voice floats out on the summer air
As she sings to the hum of her wheel.

Little feet lightly the pedals press,

A white hand moves to and fro

THE NEW.

The wind has ruffled her careless hair,

She is dust from her head to her heel,
But she gaily whistles a rollicking air
As she springs to her seat on her wheel.
Stout little boots the pedals press;

In an instant she's off and away,

As she sits in her quaint, old-fashioned dress The muscular maid in her bicycle dress
At the wheel of long ago.
On the wheel of the present day.

PREVALENCE OF THE WHEEL.

Just to whom we are indebted for the invention of the bicycle it is difficult to ascertain, and it would occupy too much time to go into the minute history of the evolution of the bicycle. It is enough to say that the bicycle probably came into use about the year 1808 when there appeared in Paris the original "dandy or hobby horse" wheel which had somewhat the same shape as the present safety, except that there was no gearing or motive power. The seat was placed near the center of the frame holding the two wheels in tact, and was just high enough from the ground so that the operator could push himself along by touching his feet to the ground.

From that early date the bicycle has passed through a period of evolution of the most varied kind which forms one of the most interesting chapters in the history of mechanics. Sometime about 1840 a clever mechanic in Scotland, KIRKPATRICK MACMILLAN by name, succeeded in attaching a motive power to the original "dandy or hobby horse" and by means of cranks and pedals, was able to show to the world a wheel which could be propelled without touching the toes to the ground and thus push the machine along. It was a great marvel and it is stated that MACMILLAN was at one time in Glasgow taken into custody for causing a crowd to collect and thus creating an obstruction in the street.

It was not until 1888 that the safety bicycle as we now understand it was brought into use, and almost immediately the cushion and pneumatic tires were invented. It is an interesting bit of history to trace the evolution of the bicycle through its many improvements.

The introduction of the bicycle as we now understand it, has been so marvelous that it would be difficult to go to any civilized part of the world and not encounter one of the modern up-to-date pneumatic safety bicycles.

Cyclists in Germany are blessed with what are called "sand-papered" roads; and, together with beautiful scenery, it is indeed a great pleasure to ride. However, in some cities of that empire the police regulations are very exacting and troublesome. In some cities it is necessary to have what might be termed a license to ride a wheel. Before being permitted to ride a wheel upon the streets it is necessary to appear before a police board of examiners who determine on your proficiency as a wheelman. If you are accepted and pass the examination, you are given a card bearing your full name and address and the full title and seal of the police commission. This card is to be carried at all times, in order that you may be inspected at any time a policeman may take it

into his head to do so. The restrictions are rigidly enforced and it is hardly worth the while to undertake to become a licensed wheelman. The red-tape is ridiculous.

Under the laws of France every owner of a bicycle must have it registered. A recent census in that country showed 329,818 wheels in use, an increase of 73,734 over the previous year. These statistics are for only one out of many countries. It would be interesting to see a similar census taken in England, and America, as well as other civilized countries of the world. Considering the population of France, and the number of bicycles in that country, it will be seen that one in about every one hundred persons living rides a wheel. It is believed that the ratio of wheelmen to population in England and America. would be even greater. In cities the ratio would be much greater; in some localities the proportion is extremely small. I have in mind one city of a number of thousand inhabitants where one out of every ten rides a wheel. It is believed that this same proportion would hold true in many cities in the United States. It is known that there are over a million wheels in use in the United States.

The time is not far distant when all classes of society will rely upon the wheel for a rapid, convenient, enjoyable and healthful method of transportation. In a recent issue of Judge is an ingenious bit of prophecy that glances into the future. The scene is laid in the year 1997. In the commodious museum our highly specialized and scientifically developed descendants are spinning along on their bicycles over the asphalt floors. Some are whirling along by themselves, looking at the strange sights; but most of the crowd is following the eloquent professor who rides around- the hall on a wheel whose model has not yet been dreamed of and explains the marvels of the exhibition. Stopping before a wild-eyed and timid-looking man who is seated on an elevated platform the professor holds forth as follows:

"Here, ladies and gentlmen, you see the greatest marvel of the age, and see what will probably be known to your descendants merely as a tradition. This man, who was born and reared on the almost inaccessible slopes of the Rocky mountains and spent his life in wild fastnesses into which none but the most daring bicyclists could penetrate, was finally captured and at a great expense brought here for your entertainment. Ladies and gentlemen, you see before you the last and only living man who knows how to walk. I will now pause for a moment to allow you to purchase photographs of him in the act of walking. Afterward we will proceed to the next platform, where I will explain to you all about the stuffed horse, and tell you some of the characteristics of this wonderful animal that flourished from the preglacial period to within fifty years of the present time."

GOOD ROADS AND SIDE PATHS.

What goes to make up a beautiful city, or a beautiful farming country more than good roads. The use of the bicycle should be encouraged because it has come to stay, and because its permanence will in time insure good streets in our cities and good roads in the country. Improvements of the road means improvement of the property, and it is to the interest of every property holder to insist that good roads are made and maintained. The bicycle will injure no road; it is a roadmaker itself, as will be observed where any number of wheels have used a certain road; the center of the road will be in poor condition, while the side where the wheels have run, will be packed and even.

Before the Michigan legislature last session there was a bill to put a small tax upon each wheel for the purpose of constructing and maintaining sidepaths. I do not believe there would be any objection to such a law by the wheelmen, and there certainly should not be by others. However, it was surprising to hear the objections made by farmers, that it would injure their property, et cetera. It would certainly have the opposite effect; it would increase the value of all farming districts. The legislature would not even