do not intend to enter into any lengthy disquisition, but merely to state briefly a few clinical facts, occuring in my own praetice, regarding the use of one of our newer remedies in a class of diseases very prevalent during the summer months. Salol, or Salicylate of Phenol, was first introduced to the profession in 1886 as a substitute for Salicylic Acid and the Salicylates in the treatment of acutearticular rheumatism. Analised, it is found to be composed of about forty per cent. of carbolic acid, and sixty per cent. salicylic acid; it is a white powder crystalline, almost tasteless of a faint but very persistent odor and nearly insoluble in water, but is soluble in ether, alcohol and the fatty oils. Its tastelessness is very probably due to its insolubility in the saliva. It passes nearly, or quite, unchanged through the stomach, but is broken up into its two component parts soon after passing into the small intestine, acting there and throughout the whole intestinal tract as a disinfectant or antiseptic. Salol in this respect possesses an immense advantage over both of its constituents, Solicylic acid in doses sufficient to produce its disinfectant action being extremely vanseous and repugnant to the taste, and often so irritating to the stomach as to produce emesis; and of carbolic acid we cannot introduce enough to disinfect the canal on account of its intense local caustic action. I have never seen Salol even in generous and often repeated doses, produce any unpleasant gastric symptoms, but on the contrary have frequently observed the tongue clear off, and have seen nausea allayed during its adminstration. The only unpleasant effect noted during a rather extended experience with Salol was that twice in the same individual during its use in five grain doses every two hours, a slight feeling of fulness in the frontal region was complained of, with a very moderate tinuitus aurium. Acting upon the hypothesis of its antiseptic action in the intestinal canal, the range of application of Salol in bowel complaints is very extensive, and it has become almost routine practice with me to prescribe it in every case of diarrhea or dysentery to which I am called, feeling certain that if not always alone directly curative, yet it does always exert a beneficial modifying influence. The best form of administration I have found to be either the pills or in emulsion. The following cases taken at random from my case-book will serve to illustrate the good effect to be derived from Salol: Case 1. Was called June 4th to see Willie S., aged 11 months-bottle fed child-sick two days with Cholera infantum; severe pain over abdomen; movements from bowels every hour; passages greenish and watery and with an intensely acid odor; some vomiting; ordered lime water in the milk, one part to six, and only small quantity to be given every hour. Prescribed: Tr. pii Deod, Bismuth Subnit, Mist. Cretae, R. m. xii zvi Zii M. Sig. Aq. menth. Pip. q. s. ad. ziv Teaspoonful every two hours, also teaspoonful liquid beef peptonoids every three hours. No improvement noted for fortyeight hours, except less frequent vomiting; then ordered grain Salol every two hours, and Bismuth mixture every four to eight hours. After the second dose of Salol vomiting ceased entirely, stools became much less frequent and of a decidedly more natural appearance and odor; in eighteen hours movements were controlled. Bismuith mixture discontinued, and Salol given in grain doses for another day-then discharged cured. A second attack equally severe in its beginning three weeks later was controlled in twelve hours by simply giving grain doses Salol every two hours. Case 2. Patrick T., 10 months old; bottle fed child, taken August 3d with non-inflammatory infantile diarrhoea, attended with severe pain and marked vomiting, ordered lime water and Bismuth mixture as in case 1, to be given every four hours; also Salol, gr. i, every two hours. In twelve hours vomiting and pain had stopped and discharges were controlled perfectly. Case 3. Ethel P., 8 months old, delicate bottle fed child, attacked August 3d, with moderately severe cholera infantum, attended with the characteristic greenish stools preceeded by severe pain, moderate vomiting, decided depression. Directed lime water in the milk, and the Bismuth mixture, as in cases 1 and 2, also gentle counter-irritation to whole abdomen. In twentyfour hours no improvement except decrease of vomiting, and the Bismuth mixture had been rejected every time, it was then discontinued, giving instead Lactopeptine, gr. iii, and Bismuth subnil. grs. ii, in powder, every four hours, and Salol 3-4 gr. every two hours. provement began at once and next day the pain, vomiting and excessive bowel discharges were all controlled; continued the Salol however three times a day for two days more. Im him with frequent pulse, elevated temperature, anxious facies, great pain in abdomen-not constant - movements from bowels every half hour, with great tenesmus and containing from the first blood and mucus-quite typical dysentery. Careful inquiry failed to show that anything irritating had been taken into stomach; applied a mustard sinapism to abdomen; gave by mouth Bismuth subnit, grs. 5, and Dover's powder grs. i, every two hours, and ordered thin starch enemata, each containing gtts. 5 of laudanum, following each evacuation. Next morning finding that the enemata were immediately rejected and served to increase the tenesmus, discontinued them, and added grs. ii, of Lactopeptine to the powders. No improvement in thirty-six hours, except slight diminution in frequency of discharges. Then began Salol grs. ij, every two hours, continuing powders as before. In two days the mucus and blood had entirely disappeared from the passages and the little patient made a slow but sure recovery. A peculiarity of this case was that neither plain milk, milk with lime water, or even peptogenic milk powder, or cream alone or diluted with water could be digested, but would be either vomited or passed per anum in coagulated masses; the diet was confined to liquid beef peptonoids, rice thoroughly boiled and eaten only moistened with a little water, and the expressed juice of raw beef. from which all fat particles had been carefully removed. given this case in extenso because it proves very conclusively to me the very marked good effect of Salol. Case 5. Jacob W., 18 years of age, called July 29th, profuse diarrhoea attended with marked pain; had continu Case 4. Called suddenly in the night, August 25th, to Herbert B., aged four years, a rugged, healthy child. Founded twenty-four hours, and for which home remedies had been used with no effect at all, except that pain was increasing and passages becoming more frequent. Could obtain no history of any indiscretion in diet. Prescribed Pil. Salol, each grs. 5, one to be taken every two hours, also Bismuth Subnit, grs. 10, and Dover's powder, grs. 4, four hours. After fourth dose of Salol the movements markedly decreased in frequency and were entirely controlled in twenty-four hours. every Case 6. Martin H., 21 years of age, bartender, temperate, taken July 31st with acute summer diarrhea, not following excessive eating or drinking. Took a variety of remedies with no benefit for thirty-six hours, when I saw him and ordered Pil. Salol, each grs. 5, one to be taken every two hours, also a mixture containing of Bismuth Subnit, grs. 10, Tully powder, grs. 5 and paregoric, gutt, 20. Improvement in twelve hours when all medicine was omitted, with return of previous symptoms. Then gave the Salol, grs. 5, every two hurs, and discharged him well next day. Case 7. Mrs. A. B. B., aged 22 years; pregnant three months with first child; following unusual exertion in hot sun was taken with profuse watery diarrhoea accompanied by severe pain and postration. Domestic remedies failed to relieve and I was called in twenty-four hours from commencement of attack. Directed Pil. Salol, each grs. iiss, one pill every two hours. After the third pill the movements and pain ceased entirely, and on second day was obliged to order a mild laxative to open the bowels. Case 8. Mrs. S. P., 81 years old; mild dysentery, having 8 and 12 discharges from bowels per diem, each containing small quantity of blood and mucus and attended by considerable pain and tenesmus. Had taken a great number of home prescriptions but objected strenuously to "Doctor's stuff." Saw her Sept. 20th, and prescribed Pil. Salol, each grs. iiss, two to be taken every two to four hours, also liquid beef peptonoids, a dessert-spoonful every four hours to counteract weakness and depression. The improvement was almost immediate and in two days the mucus and blood had entirely disappeared and the evacuations had become natural. Case 9. Harry M., 10 years old-a delicate boy, subject to attacks of diarrhoa, called "bilious" by his usual medical attendant. Saw him August 31st, after having been sick four days; was having from 6 to 10 thin watery movements from bowels, during the twentyfour hours, attended with no pain, but brought on by the slightest exertion, and was a good deal prostrated. Ordered Pil. Salol, each grs. iiss, one pill every two hours, also Bismuth Subnit, grs. 6, Dover's powder, grs. ii, Lactopeptine, grs. iii, every four hours. In the following twenty-four hours only had three passages, and they were of a more natural character; discontinued powders, but continued Salol, and fol lowing day discharged him convalescent, but continued Salol three times a day, one hour after eating, to counteract the fermentative action going on in the small intestine. Case 10. Wm. T., colored, aged 44; taken suddenly with acute, profuse diarrhoea Sept. 20th, which continued until 3 p. m. the 21st, when I was called. Prescribed 4 grs. Salol in emulsion every two hours. Next morning discharges had stopped entirely and he made an uninterrupted recovery. Case 11. Allie C., 2 years of age, taken sick Sept. 2nd; profuse watery discharges from bowels of a greenish color, and very frequent, but with no pain. Directed Salol, gr. i, in emulsion every two hours, and gave no other medicine. Result-Complete relief in six hours. Case 12. Mrs. S., colored, aged 40 years; September 24; in second week of typhoid fever, having from 4 to 8 movements from bowels during the day. Ordered grs. 4, of Salol in emulsion three times a day. After four doses the movements ceased entirely and a mild laxative was needed to open the bowels. Many more cases might be cited to substantiate these and still further prove the good effect to be derived from the administration of Salol in these bowel complaints, but with the result simelar the recital would be tiresome. In Salol, then, we have a valuable addition to our list of remedies with which to combat these prevalent summer diseases. In no case, however, should the dietwhich under any method of treatment is of the utmost importance--be overlooked or neglected. CHRONIC INTESTINAL OBSTRUCTION-REPORT OF CASE AND OPERATION. BY WILLIAM PHIPPS MUNN, M. D., ALLEGHENY, PA. Paper read before the Allegheny County Medical Society, September 18, 1888. CASE `ASE:—Mrs. E. A., aged thirty-one, is the mother of five children, the youngest aged eleven months, the oldest is twelve years of age. Two years ago she began to be of a constipated habit, I but had no special medical attention. Early in 1887 she became pregnant, and in October was delivered at full term un by myself. Her confinement was complicated, and her recovery uninterrupted. She resumed her household duties sooner than I thought advisable, on account of not being able to secure proper help. She never became quite as robust as she had been, and complained of constant dragging pain in the back and pelvis, but especially on the left side; the tendency to constipation continually increased, her general health failed in spite of tonic treatment, and her face assumed a cachetic appearance. In January I was called to see her on account of a more than ordinarily obstinate attack of constipation, the bowels not having moved for seven days, although enemata had been employed every day. During the next three days she took successively calomel, 20 grains in divided doses, castor oil, sulphate of magnesia and sulphate of soda, but without any effect. Then I prescribed an aloin, strychnia, belladonna and ipecac tablet every three hours; by mistake she took one of these every hour until twenty had been taken, at the same time using hot water enemata twice daily. No effect was produced beyond excessive tympanites. Digital examination of the rectum showed it to be empty; per vaginam a sensitive induration was discovered posterior to, and slightly to the left of the uterus. Dr. W. S. Foster now saw her in consultation. Placing her in Sims' position, with the hips well elevated, we introduced the long tube of a stomach pump into the rectum, until it encountered some obstacle at or near the sigmoid flexure, which was partially passed after a little careful manipulation, and then injected about a quart of hot water into the bowel. She could feel this passing through the descending and transverse colon, but on rising and using the chamber, only the water retained in the rectum was evacuated; the remainder drained away slowly after several hours, but only one or two small lumps of fæcal matter passed. Five times in the next three days I repeated this manuever, adding each time an ounce of castor oil to the warm water in the syringe, and she finally had a free fluid movement, very large in quantity. This was on the fourteenth day, and all this time, although the abdomen was somewhat distended and the pelvic pain continued as before, there was no elevation of temperature or any other sign of peritonitis. she gained strength for several weeks, and at the end of the month she was able to be out of bed for a few days, but the improvement was only temporary, and the end of April found her once more bed-ridden. Two attacks of localized peritonitis occurred between this time and the 10th of June, and each time the patient rallied more slowly. Her appetite began to fail, and even the semi-daily administration of salines failed to keep the contents of the bowels soluble. The contants catharsis was also a severe drain on a naturally strong constitution. The exact nature of the obstruction could not be determined, but it was certainly at or near the sigmoid flexure. The possible conditions were from; 1st, simple stricture or narrowing of the bowel; 2nd, a neoplasm, perhaps malignant, involving the bowel at this point; 3d, constriction by fibrinous bands, resulting from peritonitis; 4th, a tube or ovary, probably the left, attached to the bowel as a result of inflammatory action and forming the obstruction. Palliative and expectant treatment and persistent use of electricity having utterly failed, and the patient's condition becoming progressively worse, Following this attack she improved much, but it was found necessary to keep the contents of the bowels in a fluid condition by the daily administration of salines; neglect of this for twenty-four hours was invariably followed by a recurrence of the old symptoms, and necessitated a return to the long tube of the stomach pump, as before. All this time she kept up the daily use of the hot vaginal douche; but, notwithstanding this, the induration in the pos-operative interference seemed the only terior cul de sac appeared to increase; the left ovary could be isolated by careful bi-manual examination, and though somewhat enlarged and very tender, it was very slightly movable. The right ovary seemed to be normal in size, location and mobility, but was abnormally sensitive. Her pelvic pain radiated from the ovaries, and was constantly increasing in severity. Early in March an attack of peritonitis threatened, but was averted by the free and persistent use of saline cathartics. Following this resort, with the view of removing the obstruction if possible; and if not removable, to then stitch the bowel to the abdominal wall, and establish a fæcal fistula. Accordingly, on July 13th, assisted by Dr. W. S. Foster, I opened the abdomen by a linear central incision five inches in length. The whole length of the bowel, except the transverse colon, which was inaccessible, was carefully examined for constricting bands, but none were found; no stricture could be |