DROPSY-ITS TREATMENT.-Prof. Tyson (Ther. Gaz.) considers absolute rest, limitation of the amount of fluid ingested, and free movement of the bowels, the most important means in the treatment of obstinate dropsy. The bowels are acted upon by Rochelle salts in doses of one half to one ounce in about four ounces of water. This may be preceded by a moderate dose of calomel. Digitalis combined with squills and calomel is very useful. Among the newer drugs the author finds theobromine most effectual in the dose of 45 grains per diem. This remedy is given dry on the tongue and washed down by a draught of water. Theobromine acts, the writer thinks, better than diuretin, which is said to consist of equal molecules of sodium salicylate and a compound of theobromine and soda. Next after theobromine comes sparteine sulphate, the active principle of broom. The dose should be from a quarter to two grains in twenty-four hours. Baths administered after the Manheim plan are a valuable auxililiary, so is massage, which seems to aid in the absorption of the effused liquid.-S. im Am. Medico-Surg. Bulletin.

HEMORRHOIDS.-In operating for hemorrhoids by clamp and cautery, be sure you clamp the tissues in radiating folds so that the eschars shall be to the anal center as the spokes of a wheel to the hub. Subsequent stricture is thus avoided. Do not include too much tissue, for the cautery often burns deeper than one might expect. Only the pile-bearing mucous membrane should be burned; if it is desirable to remove the external or skin piles, it may be done by ligation, previously incising through the skin to avoid the pain of the constricting ligature.—International Journal of Surgery.

GOOD ADVICE.-In making daily visits on a fever patient, afternoon calls are best for doctor and patient, because fevers are worse from noon until midnight and the doctor's presence is of most interest when symptoms assume the most serious aspect. Visits at about the same hour each day afford us valuable comparisons in determining the nature and tendency of the disease. -Am. Med. Compend.

Editorial.

MIDDLE TENNESSEE MEDICAL ASSOCIATION.

The ninth annual meeting was called to order in the assembly rooms of the Tulane hotel, in this city, Thursday morning, Nov. 17th, by the Chairman of the Committee of Arrangements, Dr. M. C. McGannon, quite a goodly number of resident and visiting members being in attendance. Among those from adjacent towns may be mentioned Dr. J. B. Cowan, of Tullahoma, one of the organic members, an ex-president, and who has been recently most fittingly and appropriately honored by election as the first President of the Association of Medical Officers of the Army and Navy of the Confederacy; Dr. S. T. Hardison, of Lewisburg; Dr. J. B. Murfree, of Murfreesboro; Drs. C. M. Lovell and E. W. Riding, of Dickson; Dr. A. J. Swaney, of Gallatin; Drs. W K. Sheddan and brother, of Williamsport; Dr. F. B. Reagor, of Flat Creek; Dr. G. W. Moody, of Shelbyville, Dr. J. S. Edwards, of Erin; Dr. H. R. Coston, of Fayetteville; Dr. R. W. Read, of Blackman; Dr. E. D. Blair, of Normandy; Dr. W. J. Jolly, of McMinnville; Dr. K. S. Howlett, of Bigbyville; Dr. S. Thach, of Decherd; Dr. G. White, of Chapel Hill; Dr, J. S. White, of Franklin; besides quite a number of others, many of the physicians of Nashville putting in an appearance, some from time to time, others continuing throughout the session.

After prayer by Rev. Jas. I. Vance, and the report of the Committee of Arrangements, quite a number of new members were elected on the recommendation of the Committee on Credentials. The President, Dr. E. W. Ridings, of Decherd, announced that the reading of papers and discussion was the next order of business.

The first paper was an excellent one by Dr. L. L. Sheddan, on the Treatment of Acute Croupous Pneumonia, in which he deprecated the use of the lancet, blisters and depressant remedies, advocating the use of cold applications locally, strychnia, alcohol, good nursing and diet.

In the discussion, Dr. G. P. Edwards concurred with the essayist, advising stimulants to maintain heart's action, and eliminants. The disease could not be aborted.

Dr. J.B. Cowan raised the question if it is a microbic disease do the diplococci exist in a healthy lung and wait for suitable conditions to get in their work? He commended the paper, and had used cold applications, strychnia and alcohol with most satisfactory results.

Dr. A. J. Swaney asserted that the disease could be aborted with venesection. Stimulants suited to certain cases only. Advocated a middle ground. You must know your patient and his condition. No one plan would suit all cases. Blisters were harmful in early stages of any disease, but in certain conditions were invaluable. The mortality to-day, he said, was greater than forty years ago.

Dr. W. K. Sheddan had very little respect for statistics, as they could be used to support anything. He had treated 125 cases, with only four deaths, and had never bled or blistered. Every inflammatory process is microbic. Reparative were different from inflammatory processes. His cases were in the country, and as a rule were robust; yet he be

lieved would have been made worse by despoliative action. Alcohol was not a stimulant, but acted here as a sedative, or possibly developed an antitoxine. Opiates would but add to the mortality, as would tart. antimony, depressants and blisters. He stated that the mortality in Nashville had, only a year or so ago, reached 47 per cent. The patient must be treated, not the disease. Nature will cure the former if you will properly care for the latter.,

Dr. G. C. Savage questioned the statement as to the mortality in Nashville. For the cure of the disease it was necessary to develope something that would destroy or prevent the action of the microbe. Alcohol would possibly put them to sleep-stupefy them-chlorine would kill them. Had used blisters when in general practice twenty years ago, with good effect, Thought they had been abused. They should be produced quickly and quickly healed-they would lessen the amount of plastic exudate or effused material. The effusion consists of serum and plasmin. Jaborandi and potas. iodide would promote their absorption. The discussion was closed by Dr. L. L. Sheddan in a few remarks advocating his views.

Dr. J. 8. Edwards read a paper on " Difficult Dentition in Children, with a Plea for the Use of the Gum Lancet."

Dr. S. T. Hardison concurred with the essayist.

Dr. W. K. Sheddan stated that pathological conditions from the eruption of teeth were rare. If close investigation was made another cause, generally an error of digestion, would be found at the bottom of troubles which from ignorance were attributed to dentition. Had not lanced a child's gum in ten years.

The discussion was closed in a few brief remarks by the essayist. The next paper was on "Chronic Pleurisy," by Dr. F. B. Reagor. In the discussion, Dr. J. B. Murfree said that it was an important disease, but does not occur as often as one would believe from the statements made by most authors; however, cases did occur that were overlooked, and the pathological condition attributed to other causes. Pus in the pleura was a serious condition, and demanded immediate relief by surgical procedures. A serous efiusion can be relieved by sorbefacients in many instances, but would be aided by aspiration. When pus exists, a free opening should be made. Would not aspirate in any case unless prepared to do a more complete operation, which might be necessary, such as a thoracotomy with irrigation and drainage. It is sometimes necessary to remove a portion of one or more ribs, wash out the pleural sac and pack with gauze.

Dr. J. A. Witherspoon said that while the disease was rare, it ex isted more often than it was detected. It frequently exists in tuberculosis of the lungs. He doubts the existence of idiopathic pleurisy, but it might possibly be due to exposure to cold, but most always the result of a streptococcic or other bacterial infection.

Dr.

said that the physical signs of serous and purulent ef

fusion were similar, but that the rational symptoms would differ materially. The constitutional symptoms in most cases would serve to differentiate. In doubt, would use the hypodermic needle to clear up the diagnosis. If sepsis resulted therefrom, it was the fault of the doctor.

Dr. W. K. Sheddan said that aspiration was not the proper method for treating even a serous effusion; it was a cowardly procedure. Simple thoracotomy seldom relieved an empyema. Resection of two or more. ribs was the true method. Estlander's or Schinde's operation was ad Vocated.

Dr. J. B. Murfree said that even with greatest care the use of the hypodermic needle or aspirator may result in sepsis. He thought Dr. Sheddan extreme in his views.

Dr. Reagor closed the discussion,

Dr. Jas. S. White read a brief paper on "The Use of Antidiphtheritic Serum in Membranons Croup, with Report of a Case," in which he used 500 units of Parke, Davis & Co.'s serum, and on the next day 1,000 units, the patient being much improved. Several days later, the patient becoming worse, 1,500 units, and recovery complete, the child being quite well at this date-four weeks after the attack.

Dr. W. A. Atchison advocated the use of the seurm.

Dr. J. A. Witherspoon stated that the Loefler bacillus and the streptococcus were not related. Membranous croup can exist without the Loefler bacillus. He would not accept the theory of the unity of these two diseases unless the Loefler bacillus as well as the streptococcus could be demonstrated. While endorsing the use of antitoxin in primary diphtheritic infection, would not use it after streptococci had developed.

Dr. J. B. Murfree said that he treated membranous croup with Parke, Davis & Co.'s antitoxin successfully. It was the only reliable remedy. He believed that membranous croup and laryngeal diphtheria were identical. The antitoxin was the best remedy for diphtheria. He reported a case existing for one week, where he used 2,000 units in one day, and the same amount on a succeding day, with perfect recovery.

Dr. J. B. Cowan asked, "What is the physiological action of antitoxine?"

Dr. W. K. Shedan did not believe in the identity of diphtheria and croup. Did not believe that the mortality in diphtheria had been lessened by antitoxin. Each epidemic and each locality had its own mortalily, some high, some low.

Dr. S. S. Crockett: "How many cases of croup get well after tracheotomy?"

Dr. Sheddan: "Seventy-five per cent."

Dr. Crockett commended the paper and the practice of the essayist. He had not seen a case of croup relieved by antitoxin. However, he had only seen it used in two cases, both of whom died, the remedy not having been used until after at least the fifth day of the disease. He had used it in fifteen cases of diphtheria, all recovered. He believed the antitoxin

produced an immunity for a short time-it prevented the development of the bacillus, either by destroying it or rendering the system sterile to its growth. He believed that membranous croup and diphtheria were identical.

Dr. W. A. Atchison wanted to know, if they are the same, why is croup non-contagious, non-infectious, and diphtheria is? Why does croup occur in isolated cases and diphtheria in epidemics?

Dr. Coston made some remarks in regard to their identity.

Dr. Witherspoon said that the antitoxin would build up the phagocytic action of the blood.

Dr. Murfree said that diphtheria had not been recognized in former years. Antitoxin had been remarkable in its results in his hands.

Dr. Sheddan did not think error of diagnosis in the past was the reason that it had not been recognized.

Dr. S. Thach reported three cases of membranous croup treated by antitoxin; in one he used three injections of 2,000 units, recovery; second case seen on fifth or sixth day, used two injections of 2,000 units, died; third case seen on second day, used two injections of 2,000 units, recovery.

Dr. Murfree did not advocate the use of antitoxin to get rid of the membrane, but to enable the system to resist the invasion of the disease germ-it was an antidote to the poison.

Dr. White closed the discussion with a few brief remarks, thanking the gentlemen for their kindness in the discussion.

The Association then adjourned until 2 P. M.

The first paper of the afternoon session was one by Dr. W. J. Jolly, on 'Reflex Nervous Diseases in Women," in which he advocated in certain conditions operative procedures.

Dr. J. R. Buist, in the discussion, said that gynecologists had gone too far in their resort to operative measures to relieve nervous symptoms; but cases did occur in which pathological conditions in the pelvis produced marked disturbance elsewhere that had been relieved by proper treatment or operation. However, healthy tissues and organs should not be removed to relieve nervous affections.

Dr. W. K. Sheddan said that operations on healthy organs for relief of supposed reflex nervous conditions was an absurdity; but removal of diseased organs and tissues was proper.

Dr. McGannon stated that a large number of insane patients had been operated on have resulted in failure. Healthy organs should not be removed for nervous disturbances.

After a few general remarks on this line by Dr. J. B. Cowan, Dr. Jolly closed the discussion.

"Ataxias: Their Differential Diagnosis," was the title of a very excellent paper by Dr. L. E. Ragsdale, which fully covered the ground and was ably discussed br Dr. W. K. Sheddan.

Dr. Geo. P. Edwards' paper on "Electro Diagnosis in Nervous Diseases was discussed by Dr. Geo. H. Price.