to induce collapse after which pain and tender ness cease. If the symptoms have occurred suddenly and are very acute and peritonitis is present, a firm and complete obstruction is probable. A finger passed into the rectum may come in contact with the lower end of the intussusception, or the invaginated bowel may protrude from the anus. TREATMENT. The first thing to do is to determine whether the incarceration is in the large or small intes tine. Wm. Treaves says this can usually be determined by noticing the condition of the cæcum. If it be distended the large bowel is the seat of obstruction and can be found by following the course of the colon. If on the other hand, the cæcum be found empty, the occlusion must be in the small bowel. I want to add that the relation of the parts may be, and frequently are, so altered as to be very confusing. All intussusceptions that concern us occur from above downward, and the indication is to counteract the inversion from below. The methods of doing this are injections of liquids and gases with supplementary aids and direct manipulation through an incision in the abdominal walls. In addition to this indication, there is another adhered too by some practitioners, that of giving opium and awaiting the result. Dr. Senn has shown that invagination artificially produced in animals is frequently spontaneously reduced, even after suturing the neck of the intussusception and I have no doubt spontaneous reduction. frequently occurs in the human subject before a diagnosis is made. This experiment shows that all cases, if experiments on animals prove true, of the human subject, are not necessarily fatal when left to nature. The intussusception, to be susceptible of relief by injections of liquids, must be below the ileocælic junction or above an incompetent ileocæcal valve. We have seen that an incarceration involving the relations of the valve may render it incompetent and thus permit liquids safely to pass it. In order to succeed with liquid injection considerable force is usually necessary and any force sufficient to reduce the invagination, in some cases, may rupture the bowel. To apply this pressure efficiently and safely the surgeon should have an approximate idea of the amount of force he is applying and the amount the bowels will stand. The intelligent physician can have some idea of the amount of pressure to apply by the extent of abdominal distention, and when the principle of the Davidson syringe is used this is the only guide. It has been determined by experiment that fifteen pounds to the square inch is all the force that can be safely applied and this only in adults. In infants the pressure should not exceed six or eight pounds to the square inch. To approximate the force used by the fountain syringe it is only necessary to remember that the atmospheric pressure which at the sea level is nearly fifteen pounds to the square inch, sustains a column of water nearly thirtyfour feet high and will equal about one-half pound to the foot. To apply the amount of pressure that the adult bowel will stand, a column of thirtyfeet of water taking its base in the intestine. may be used or twelve to sixteen feet in case of a child. A rubber tube the necessary length may be secured and attached to the nozzle of a Davidson syringe. The long vaginal nozzle should be used. The addition of a funnel and vessel of warm water will constitute the necessary apparatus. The nozzle should be well inserted into the rectum. A shoulder should be made near its base to press against the sphincter to retain the liquid. This can be made by the use of a narrow roller bandage tightly wrapped. An anesthetic should be used to enable the patient to bear the pain incident to the abdominal distention as well as to relax the abdominal walls. The nozzle should be inserted by the surgeon and retained by one hand, while he uses the other in gently kneading the abdomen. An assistant should slowly add water to the tube as he elevates its free end keeping it well filled. If it be the case of a child the elevation should not exceed, as a rule, twelve or sixteen without success, I feel like urging a resort to feet. Plenty of time should be taken in adding the method of direct manipulation through an pressure to give the tissues time to expand. incision in the abdominal walls. The average regular physician is fast reaching the position where he will not hesitate to open the abdominal cavity, where it is clearly necessary. If hydrostatic pressure fails after a careful trial, gaseous injection may be tried by attaching a pair of bellows to a glyster pipe, or inserting the nozzle of a small pair into the anus. This method can also be used by the insertion of a nozzle connected by a rubber tube to an inverted bottle whose contents furnish gas. If I should allow a case to die without an attempt to relieve him by laparotomy, I should feel like I had fallen short of my duty. A desperate condition warrants a desperate remedy. A New Law. The method of gaseous injection has the advantage of adaptability to any part of the intestinal canal, as its passage is not obstructed EVERY CASE OF TYPHOID FEVER MUST BE REby the ileocæcal valve, but has the disadvan-tage of your not knowing how much force you are applying. PORTED TO THE HEALTH OFFICER. Typhoid fever is a disease which the State Board of Health has declared to be "dangerous The longer the existence of an invagination to the public health," and as such it comes unthe less the chances for relief by either of der the law requiring physicians to report to these methods on account, in most cases of the health officials. Any physician who shall the opposing serous surfaces. These may neglect to immediately give such notice, form so strongly in twenty-four to forty-eight "shall forfeit for each such offense a sum of hours as to endanger the integrity of the intestine before they will give way. In applying these methods an inclined position of the patient, head downward, will be found advantageous by favoring retention of liquid and reduction of the invagination. Judging from the findings of the autopsy in the case above reported, liquid injections might have succeeded in overcoming the invagina tion some considerable time after its occurrence, perhaps, three or four weeks. If the incarceration be in the small intestine and the ileocæcal valve competent the injection of liquid should not be thought of as any pressure sufficient to overcome it, always causes multiple longitudinal la cerations of the peritoneum with but one result-death to the animal. not less than fifty nor more than one hundred It seems important that the public generally shall understand that this new law applies to diseases dangerous to public health, as well as scarlet fever, diphtheria, small-pox, and all to typhoid fever. At this season, typhoid is most prevalent, and is especially dangerous in times of drouth; therefore the safety of the people will be greatly promoted by having Officer, who (Sec. 1, Art. 137, Laws of 1888) is every case promptly reported to the Health required to promptly attend to the restriction of the disease. The new law makes it a misdemeanor, punishable by fine or imprisonment, for the Health Officer to knowingly violate that section of the enactment, or for any person to violate the orders of the Health Officer made in accordance with that section. The actual penalty, however, which is incurred, is death! And about one thousand people are lost in this State annually from typhoid fever alone. The saving of a large proportion of these lives is the real reason for the effort, in which it is hoped all people will join.-The Michigan Medical Age. SOCIETY PROCEEDINGS. been using creolin in from one-third to full strength in these cases with good results. South Kansas Medical Society. [These proceedings were in type for last issue, but by a press of advertising matter they were unavoidably crowded out.]-PRINTER. The South Kansas Medical Society held its thirtieth semi-annual session in the city of Newton, November 11th, 1889, Dr. C. E. McAdams, vice-president, in the chair, Dr. W. K. Harris at secretary's desk. Routine business disposed of at morning session. Board of censors-Drs. Vannuys, Klippel and Axtell. Board reported favorably on admission of Drs. V. E. Lawrence of Halstead, and Jeffrey Martin of Marion. Dr. Oldham thought ground had been fully covered and endorsed the paper. Dr. Lawrence wanted to know how he treated the accompanying vertigo. Had treated a case not long since, with good results except as to that. Dr. Axtell thought it the most common disease of woman we are called upon to treat. Thinks laceration of cervix a prolific cause. Treat laceration and cure will result of itself in most cases. Dr. Martin suggested hot water as a means of preparing patient for treatment, and in conjunction with white pinus, a very good remedy. Thinks laceration should also be treated. Election of officers for ensuing year resulted Dr. Adams. The paper is a classical one, in Dr. C. E. McAdams, president; Dr. J. W. I have had no success with any one line of McCracken, first vice-president; Dr. Whitte-treatment. Social laws, customs and surcar, second vice.president; Dr. Harris, secre- roundings are against us in the treatment of tary; Dr. C. C. Furley, treasurer. such cases. Cases of laceration which had been cured by resorcin justified the treatment. Before adjourning morning session, a motion was carried appointing a committee of five to suggest changes or revision of Constitution and By-laws, and report them at 1:30 o'clock p. m. Chair appointed on committee, Drs. Klippel, Furley, Vannuys, Hamilton and Harris. AFTERNOON SESSION. Committee reported and made the following suggestions as to change: That Article 4 of Constitution be amended so as to read, "That the stated meetings of this society shall be held the first Tuesday in May and third Tuesday in November of each year, and shall be at such places as a majority vote shall determine." And further recommend that Article 9 shall be amended by striking out the words "fifty cents" and inserting "one dollar." Also recommend that five hundred copies of Constitution and By-laws be printed and each member of society be furnished a copy. Signed J. D. VANNUYS, C. C. FURLEY, Discussion opened by Dr. Klippel. Discussion closed by Dr. McCracken. This disease might occur if os uteri had been extirpated years before. One must be on the watch and guard against cardiac trouble, menta worry, etc. We do not examine close enough in the start. We should inculcate caution and study closely all cases. If laceration of the cervix exists, operate. The "Lady's syringe, from convenience for use, is a valuable aid to treatment, and use hot water. When I say hot water I mean hot water. I would not treat a case unless I could have complete control of patient as to dress, habits, sexual congress, etc. Dr. McClintock, of Topeka, read a paper on "Orthopaedic Surgery," and presented a case under treatment for talipes equino-varus, caused, he thought, by pre-natal spina bi-fida. Also demonstrated on the patient the method of applying plaster Paris bandage. Dr. Coleman-I believe such cases are hereditary. Cited a case where a pregnant woman from seeing a case had forebodings, and at term brought forth a child worse deformed than the original case. Dr. Buck-Would not relapse have been prevented by resorting to tenotomy in the Had beginning? Dr. Cordier. How long had eiectricity been pregnant. The walls of the vagina were agtried in this case to overcome paralysis and glutinated but easily separated by the finger, stimulate the growth of muscles in calf of leg? when a tarry fluid drained away and the pregDiscussion closed by Dr. McClintock. Bet- nancy vanished Bi-chloride, I to 5000 is the ter treat varus first, then perform tenotomy. best antiseptic wash. The death rate in these cases is too great considering the antiseptic precautions and hence I believe there is some other cause for death than septicæmia. Dr. Martin-In these cases the uterus should Dr. McClintock in closing the discussion said: Maternal impressions do have a determining influence in some cases. In answer to Dr. Buck, would say tenotomy had been made when the child was four months old, after first having treated the varus. The plantar be washed out to prevent septic poisoning. fascia should be cut if extremely resistant. Good results have been obtained by the use of electricity in paralytic atrophy of the mus cles. When it is thought a cure has been affected, a retentive dressing should be used for one or two years as a precautionary measure. Dr Adams-Scarlatina or diphtheria may cause atresia vagina. Had I another case to treat I would operate antiseptically, but I would not use a wash internally after operating. Apply externally an antiseptic dressing. Sepsis causes the sudden deaths. A small opening should be made in those cases, for I think In answer to Dr. Cordier who asked re- it a dangerous operation. Laparotomy in the garding contractured tendons, I would say case I reported I think would have done no they exist only in the mind of one man. good. In one case there might. have been There is no such thing as contractured ten- a double uterus and emptying but one may have set up uneven contractions. dons. Dr. Harris. There are contractured tendons. Dr. Buck moved that all papers read before the society or by title be referred to the com treatment? Is nine weeks too soon? have them published in the KANSAS MEDICAL Dr. McClintock-No, they are never too JOURNAL by the consent of the writer young, but be careful of excoriations. Dr. Adams read paper on the malformations of the uterus and vagina. Dr. Klippel-I have never seen such cases. Dr. Richmond, of St. Joseph, Mo., has related a case treated with a glass plug. Dr. Harris read a paper on "Transition of Fevers in Southwest Kansas. Dr. McCracken-Some eight or nine years ago met with such fevers. They puzzled me at first. Thought they were diseases of older countries. Drinking water people used was from open wells. Such fevers, doctors of that time called, as did army surgeons, typhomalarial. After a while I thought them typhoid. Did not use so much quinia as Dr. Mass., Dr. Hamilton-The case detailed by Dr. Adams I saw in consultation in 1885. The head was above the superior strait. I applied the forceps and had the doctor examine to see if they were right before making traction. Harris. Spoke of a seminary at Pittsfield, The head was brought down and a mass of foul debris came away in a gush, The delivery was completed by removing the placenta, to which I called the physician's attention that no mistake might be made as to its removal. Dr. Fabrique reported a case of imperforate Dr. Coleman came in contact with it some hymen with retained menstrual fluid. Rup- years ago. Lost five cases in one family. ture of the hymen, permitting the fluid to es- Physicians could not account for disease. cape, completed a cure. Found as a cause the house was built on low Another case in which the girl menstruated ground, a hill rising up from it to a thicket, one year. Menstruation ceased and the family with stable and hog-pen between house and brought the girl to him believing she was thicket. Thicket used for outhouse or privy, where an outbreak of typhoid was traced to break in a sewer. Some forty cases resulted. Does not think it necessary to import it to have it here. Causes are local, but know not what they are. all the water or flow coming from it to well one hundred and three and a half or higher, on low ground. Spoke of typhoid cases in tell them it will not be typhoid, or is not ty Newton, where only source of infection found was a well, the water of which was contaminated from privy vault. Dr. Klippel-Winter of '85 was very dry, lots of hog cholera and a great deal of fever. Called it typhoid. Had seven autopsies, and in all found lesions of Peyers patches. Now as to conclusion, in 1881 less, and in 1888 still less. Believe decaying animal matter and excrementitious discharges can cause typhoid. Dr. Martin-Think it now conceded no difference between typhoid and typho-malarial. Such cases are more prevalent in dry weather or years. Does not dread it any more than lung fever. Think the paper very good. Dr. Fabrique-Know from autopsies we have typhoid,also fevers different from typhoid. I call them malarial fevers, if we know what malaria is. Pulse is different in typhoid. A man will come into your office with a temperature of one hundred and four or five degrees. It must be continued fever. Dr. Martin-Should draw a line between typhoid and remittent tever. Quinine may do in one, treatment must be tentative in the other. phoid. A proper amount of quinine given would break a remittent fever. Eight or ten years ago, when I first advanced the ideas I do to-day, was told it was nonsense to talk of such being typhoid: no such fevers were here and could not come until imported. Find the profession coming round to my views. Do not think there are as many cases as laity are led to believe. In answer to Dr. Martin's question. "Have you ever given twenty grains of quinine at one dose, to a patient?" No; took one such myself fourteen years ago; never have tried it on any one since. "Disease of Mastoid and its Treatment," by J. E. Minney, M. D., was last paper read. Owing to lateness of the hour, did not receive the discussion so interesting a paper should. Auditing committee made a report approving the reports of Secretary and Treasurer. Motion, Secretary's bill be allowed and order drawn on Treasurer for same. Receipts of meeting, $4.50. Society adjourned to partake of supper at Clark house, after which toasts were proposed and responded to by Drs. Furley, Minney, Foote and Buck. Academy of Medicine and Surgery. Dr. Oldham-Typical diseases as a rule are easily diagnosed. We have typhoid and some other fevers which I think are remitting. We find fevers taking symptoms of both. You The academy of medicine and surgery met find cases of temperature of one hundred and at their hall in regular monthly session, Tuesfour or five that lapse into typhoid. Typhoid day evening December 3, Dr. L. H. Munn, the must have a specific course. Cited outbreak at newly elected prsident in the chair. Plymouth, Penn. There people, using separate wells had no typhoid, those using reservoir water had. Infection was traced to case up on mountain, whose dejecta being thrown out on ground, melting snow carried it to reservoir, hence the infection. Dr. McAdams-There are two distinct fevers. One comes from decaying vegetation, algæ, and the other from some specific contagion. There were present during the evening Drs. Stewart, Mitchell, McGuire, Righter, Longshore, McVey, Hogeboom, Green, R. E. McVey, Peers and Chapman. Dr. H. T. McLaughlin a visitor was invited to take part in the discussion of papers. Drs. McGuire and Stewart were appointed by the chair to act with Dr. Ward, as censors on the application of Dr. E. C. Chapman, a graduate of the Keokuk medical college, class of 1879, for membership. The report being favorable Dr. Chapman was elected a member of the Academy. Discussion closed by Dr. Harris, Our fevers are changing from intermittent and remittent to typhoid and relapsing. As to question, "How do you diagnose cases when first seeing The president in accordance with a resoluthem?" If patient has not been sick more tion passed at the last meeting addressed the than 24 to 36 hours, and find temperature of meeting. He related that after performing |