tered, and of which we can conscientiously say we do not tire, being daily more and more convinced of its advantages. With the long and very extensive practical experience we have had of its value, we would be at an infinite loss to replace it in our daily practice, now that our confidence in its real merits has been so fully established. J. K. BAUDUY, M. D.

IMPORTANCE OF RECTAL EXAMINATIONS.--Rectal examinations are not so frequently made as they should be. Two or three cases which I have met with impressed this fact upon my mind. One of those cases was that of a lady who had recently been confined, and called me, supposing herself affected with piles. She stated that bunches came down, and that there had been some bleeding. I thought it best to examine before prescribing. Passing the finger into the rectum, I found a mass of fæces packed in there, completely filling the rectum and distending it to two or three times its normal size, and which it would be utterly impossible to expel en masse. I ordered the persistent use of injections until free evacuations occurred. In this way the mass was softened and dissolved; it passed off.

Another case was that of a patient who, some weeks previously, had been taken with typhoid fever, but who failed to get up from the bed after the fever had run its course. It was stated that the bowels moved only after using injections, and then only liquid fæces formed, attended with much pain. I made a rectal examination, and found the rectum packed full of fæces, distended to twice its natural size. Not only the rectum, but the colon also, in its entire length, seemed to be packed full. It required several days of persistent work with enemas before the mass could be removed, but finally it was accomplished, to the great relief of the patient. Livermore Falls, Maine. H. REYNOLDS, M. D.,

A STRANGE CASE.-I will give the history and symptoms of it; this case I have on my hands now: Mr. L. W., aged thirty; sanguine temperament; has been affected about five years. Had fair health up to Aug. 1st, 1886, then had hemorrhage of the stomach. Pulse about 90 to 95°; tongue red. At different times had pain in left side, extending sometimes to the right; pain in the left lung and

left shoulder, pain seating under the clavicle. At times, pain in the spinal column; cold and chilly at times. His voice would suddenly fail him, and he could not speak above a whisper; profuse perspiration at times; has hot flashes up the left side; every third day would turn spotted (purple spots), then changing to yellow. When lying down would have a purring sound in the throat; every third day, hands, face and stomach would bloat. At times his flesh would feel numb and have a tingling feeling; evolution in the stomach; bowels costive; kidneys normal. Aphrodisia feeling almost uncontrollable; every third day voracious appetite. I would be pleased to have more light on this case. What shall I do, and what is the matter?

B. T. LANDERS, M. D., Ava, Mo.
Reading your article on

MOTHER'S MARK.-Dr. Younkin: "Mother's Mark," I concluded to give you the most remarkable case that ever came under my notice:

When a girl, one season we had cholera as an epidemic, and my father charged his slaves to exercise unusual self-denial in their diet. Knowing a command would be but little heeded by so epicurean a race, we never knew whether the advice was heeded or not, save in one instance. The housekeeper, a mulatto of unusual intelligence, gave birth to a fine little son, on whose yellow little back was the perfect picture of a good large green cucumber, which she laughingly said was evidence of obedience to her master, as she had a struggle to keep from eating them as she gathered them for pickles. I might add, having almost died previously for indulging in cabbage, the color impressed me as most wonderful.-MRS. J. T. B.

SUBSTITUTE FOR IODOFORM.--The hospitals of this city are loud with the fumes of iodoform. Every old sore and every surgical operation are kept yellow with this drug. Vaginas are stuffed with it, and male chancres are powdered. Men, women and children that go to certain clinics are known by the smell. When they enter the street cars they are shunned, and people are seen holding their noses, or turning away, or sticking up their faces and looking sour. Why don't they use a substitute? Iodol is better and is destitute of smell. I am now using this agent in all such cases where I formerly used the iodoform.

EDITOR.

SELECTIONS.

LAPAROTOMY AS A DIAGNOSTIC RESOURCE. BY T. GAYLORD THOMAS, M. D.

We clip from the Medical News the following remarks, read before the New York County Medical Association. Emanating from such an author, and so full of sound reasoning on this important subject, we desire that our readers shall have the benefit.-EDITOR.

Throughout the domain of surgery, there is no field in which diagnosis is more surrounded with difficulties than that of abdominal neoplasms. This is due to three facts: first, the superposition of the intestines; second, the great thickness to which the abdominal walls commonly attain; and third, the accumulation of gases in the intestines, which increases all pre-existing difficulties of exploration. Previous to the time when antiseptic precautions rendered the opening of the peritoneum a safe and warrantable procedure, even when the case was not one of life and death, the diagnosis of abdominal tumors was allowed to rest upon deductions capable of being drawn from rational and physical methods, the latter of which were limited by the abdominal walls without and the pelvic roof within. To-day, surgeons devoting themselves to this department of our art fully agree as to the propriety of opening the abdominal walls for the purpose of exploring the viscera fully by touch, and, to a limited extent, by sight.

It appears to me that no more important era has of late years marked the advance of abdominal surgery than the general recognition of the fact that when doubt exists as to the diagnosis of abdominal neoplasms, or the significance of certain pathological conditions within the peritoneum, the question at issue should be settled by explorative incision. So fully am I individually convinced of the propriety of this practice, that, were I called upon to select a motto for the walls of a hospital devoted to abdominal surgery to-day, I should, without hesitation, select this one: "When a doubt as to the diagnosis of an abdominal neoplasm of serious character, or of certain obscure pathological conditions of the abdominal cavity which threaten life, exists, give the patient the benefit of explorative incision." And this mural legend should always stand before the

eyes

of the doubtful diagnostician, that it might prove a constant reminder of a most important duty.

After an experience yielded by seven or eight hundred cases, approximately, of laparotomy for various causes, extending over a period of twenty-three years, I am very sure that I can say with entire truth that I have never once regretted opening the abdomen, and that I have in a dozen cases, at least, deeply regretted having failed to do so. It is in my mind certain that, in the future, explorative abdominal incision will become the rule in all cases of the following conditions which do not yield to medical means, and concerning the etiology of which there is great doubt: First, wounds and injuries of the abdominal viscera; second, intestinal obstructions; third, the presence of stones in the gall bladder or kidneys; fourth, the accumulation of blood, pus, or serous fluid from any cause; fifth, the existence of a neoplasm in any part of the abdomen; sixth, the occurrence of serious organic changes in certain of the viscera of the abdomen, such as the kidneys, the uterus, the Fallopian tubes, the ovaries, or the spleen; seventh, ectopic ges

tation.

It is a remarkable fact, and one which constantly excites the wonder of the uninitiated, how grave errors of diagnosis in reference to abdominal tumors are made by men of the largest experience, the maturest judgment, and a life-long devotion to the work of gynecology. The truth is, that all over the world errors in diagnosis in the field of abdominal tumors are, and probably will forever be, common, unavoidable, and, except in rare cases, entirely excusable. He who declares that he does not frequently err belongs to one of two classes: that of those who lack the intelligence to appreciate their shortcomings, or the courage to confess them, for it is only the good diagnostician who can afford to own to diagnostic errors; or to that of those who by suppressio veri or suggestio falsi are shortsighted enough to hope to deceive the community which watches their careers.

It is for the purpose of avoiding such errors that explorative incision is peculiarly valuable. It may be that there is doubt as to whether a neoplasm is a fluid tumor of the ovary or a solid one of the uterus; or whether an abdominal dropsy is due to incurable hepatic disease, or to some tumor no larger than an apple situated

deep down in the pelvis; or as to the benign or malignant nature of some growth about which nothing positive can be settled. In such cases the results of opening the abdomen are most striking and gratifying; they beam upon the existing obscurity as the rays of an electric light upon previous darkness; and even although the result of the incision may serve to assure us merely that death will very soon close the scene, this certainty is better than the cruel uncertainty which previously existed, and the grief of relatives is assuaged by the feeling that "no stone has been left unturned" to procure a relief which science is powerless to bestow.

I know of no way in which I can better convey my views and give my experience upon this subject than by mentioning first some cases as examples of the class in which I have had to regret noninterference on my part, and then relating others in which more active measures have produced happier results.

CASE I. About seventeen years ago I was called to Fordham by the late Dr. Wohlfarth, to see a strong, healthy young coachman, about twenty-five years of age, who had been suddenly seized with obstruction of the bowels, which had resisted all medical means, and which was, evidently, going to result fatally. The abdomen was immensely distended, and, except when under the influence of opium, the patient suffered great agony. The question of laparotomy was carefully canvassed, and, unfortunately, we decided not to perform it. The patient died, and, on a post-mortem examination, a loop of intestine was found constricted by a false membranous string, the result, probably, of some long-past peritonitis. This, as was apparent as soon as the abdomen was opened, was the sole cause of the obstruction, and could at once have been overcome by the snip of a pair of scissors. At that time laparotomy, had it failed, would have met with universal condemnation; we probably lacked moral courage to meet the issue, and we let the poor fellow die, "hoping against hope" for a relief which became less likely to occur with every hour that elapsed.

CASE II.-About fifteen years ago, Prof. F. N. Otis asked me to see, with him, a woman who for years had suffered from a uterine fibroid. This had gone on growing until, when I saw the patient, it weighed forty pounds. It filled the whole abdomen, and pressed so much upon the viscera under the diaphragm that it was evident