ued without interruption. Painless birth at 2:47 a. m. Mother smiling as head passed over perineum. Crede's method failed to deliver placenta; accomplished by introduction of hand into uterus with entire absence of pain. Prompt uterine contraction and no ill after effects.

Case XXXII.-E. O.; private Troop L, Fifth Cavalry. In the first week of an attack of typhoid, this soldier exhibited marked abdominal symptoms suggestive of intestinal perforation; tympanites, muscular rigidity, rapid and weak pulse, etc. Exploratory operation August 20, 1905. Tropococaine grain one, spinal injection third and fourth lumbar point, and as large per cent of perforations in typnoid occur within twelve inches of caecum, incision was the usual one for an appendectomy. Incision was painless. The peritoneum inflamed and when opened evidences of acute peritonitis. No perforation, but appendix showed inflammatory involvement. Appendectomy performed. No appreciable pain until traction with rat-tooth forceps made upon inflamed and adherent peritoneum in the act of suturing. A few breaths of chloroform, not to exceed twenty respirations, tided over the closure of the peritoneum without pain, and the muscular and integumentary tissues were closed under the original analgesia entirely free from pain. Patient at this writing (September 9, 1905) just beginning the convalescent stage from typhoid fever. Abdominal pain and discomfort entirely ceased after operation. Union by first intention. Patient passed through an ordinarily severe case of typhoid fever.

Case XXXIII.-C. K.; private Company I, Twentyninth Infantry; age, 22. Diagnosis, extensive prolapsus recti. Operation August 31. Tropococaine spinal injection third and fourth lumbar interspace. Analgesia per cautery scarification prior to reduction and subsequently, with entire absence of pain. At this writing (September 9, 1905) rectum has retained normal place. No after effects.

Case XXXIV.-W.; white; age, 24; wife of an officer. Diagnosis, chronic metritis. Tropococaine spinal injection third and fourth lumbar interspace, grain three-fourth. Analgesia immediately. Operation uterine curettage September 1, 1905. Entirely painless. No after effects

Case XXXV.-F. H.; white; male; age, 25; occup tion, stone cutter. Third week of typhoid fever developed indications of intestinal perforations. Onset of intestiral symptoms sudden. Condition serious. At 2 a. m., September

2, 1905, tropococaine spinal injection, grain one, third and fourth lumbar interspace. Analgesia complete by time. field of operation was prepared. Painless incision over McBurney's point. Evidences of purulent peritonitis. Perforation four inches above caecum. Operation lasted twenty minutes, and though patient was entirely conscious, was accomplished without pain. Patient died at 9 a. m.. September 2, 1905. Some improvement following operation, but at 8 a. m., collapse occurred.

Cases XIX to LXXII were operated upon subsequent to presentation of my report to Arizona Medical Association.

SPINAL ANALGESIA IN OPERATION FOR PROLAPSE OF RECTUM.

Case XXXVII.-Mrs. R; white; age, 25; September 12. 1905. Diagnosis, pelvic peritonitis. Pyosalpinx (left) Tropococaine, 48 mg., spinal injection third and fourth lumbar interspace. Analgesia prompt and lasting two hours and forty-five minutes. Operation, vaginal puncture and drainage of abscess. Slight pain noticed only when peritoneum was pushed or pulled upon. No unpleasant after effects.

Case XXXVIII.-Mexican; male; age, 25; September 19, 1905. Diagnosis, umbilical hernia size of hen egg. Tropococaine 64 mg. spinal injection, second and third lum

bar interspace. Operation a modified Mayo. At time of operation it was discovered that the patient was the subject of tubercular peritonitis, with extensive tubercular deposits. Abdominal drainage was established. At time of spinal puncture about eight minims spinal fluid lost. Operation painless. Patient asked for cigarette during its performance. Analgesia lasting one hour and a half. Complained of trivial headache following day.

Case XXXIX.-Mrs. A. O.; Mexican; age, 33; September 25, 1905. Diagnosis, retained secundines.

Sapremia. Tropococaine, 48 mg., spinal injection, third and fourth lumbar interspace. Analgesia in lower extremities prompt and in field of operation soon after. Patient had been begging for chloroform because of severe pains and sufiering. Operation, dilatation of os and curettage of interior of uterus. Absolutely painless. Trivial headache day following.,

Case XL.-M. L. J.; white; male; age, 26; clerk; September 26, 1905. Diagnosis, ischio-rectal abscess complicating advanced pulmonary tuberculosis. Tropococaine, 32 mg., spinal injection, third and fourth lumbar interspace. Analgesia at field of operation immediate. Operation, incision, exploration, drainage. Absolutely painless. Slight headache soon after operation; worse on day following, but free from same if head was kept upon pillow.

Case XLI.—Mrs. J. D.; white; age, 44; October 11, 1905. Diagnosis, retained secundines; sapremia. Tropcocaine spinal injection third and fourth lumbar interspace. Operation dilatation os and curettage uterus. Complained of slight pain when uterus was pulled upon at time of forcible dilatation. Otherwise painless. No after effects.

Case XLII. Mr. G.; white; male; age, 72; October 11, 1905. Diagnosis, osteomyelitis left fibula. Tropococaine spinal injection, 48 mg., third and fourth lumbar interspace. Lost all of fluid with dissolved tropococaine at time of first. injection through leakage at cup of needle. Repeated dose and had immediate analgesia. Operation, excision of six inches fibula upper portion and drainage lower leg to tendo achilles. No pain experienced until closing wound with sutures, when analgesia was wearing off. No after effects.

Case XLIII.-B. M. E., sergeant Troop L, Fifth Cavalry; age, 27; October 21, 1905. Diagnosis, phimosis. Tropococaine spinal injection, 48 mg., third and fourth lumbar interspace. Analgesia prompt. Operation, circumcision and section of frenum absolutely painless. Analgesia lasted two hours and fifty minutes. No after effects.

recti.

Case XLIV.-C. K., private Company I, Twenty-ninth Infantry; age, 22; October 26, 1905. Diagnosis, prolapsus Tropococaine spinal injection, 48 mg., third and fourth lumbar interspace. Analgesia prompt. Operation, correction of prolapsus by Vernuil's method. Length of operation, one hour. Entirely painless, except when rectum was strongly tracted patient complained of a dragging sensation "in the stomach." Length of analgesia, two hours. No after effects.

Case XLV.-C. B. St. C.; private Company I, Twentyninth Infantry; age, 21; October 29, 1905. Diagnosis, ischio-rectal abscess and communication sinuses. Tropococaine, 42 mg., spinal injection third and fourth lumbar interspace. Analgesia prompt. Operation, incision, exploration, laying open three communicating sinuses, drainage. Absolutely painless. Operation required ten minutes. No after effects.

Case XLVI.-J. B.; white; male; age, 70; miner; November 2, 1905. Diagnosis, fracture neck of femur. Tropococaine, 64 mg., third and fourth lumbar interspace, spinal injection. Unusual difficulty experienced in entering subachranoid space, due to posture and nature of injury. Operation "setting" and splinting limb. Absolutely painless. No after effects.

Case XLVII.-M. L.; colored; porter; age, 22; November 7, 1905. Diagnosis, ischio-rectal abscess. Tropococaine, 48 mg., spinal injection, third and fourth lumbar interspace. Analgesia immediate. Operation, incision, irrigation, curettage, drainage. Entirely painless. No after effects.

Case XLVIII.-O. T.; white; male; age, 20; clerk; November II, 1905. Diagnosis, phimosis. Tropococaine, 32 mg., spinal injection, third and fourth lumbar interspace. Analgesia immediate. Operation, circumcision. Entirely painless. Decided and peculiar headache for five days, but did not keep patient from his work.

Case XLIX.-A. M.; white; male; age, 32; miner; November 15, 1905. Diagnosis, phimosis. Tropococaine. 32 mg., spinal injection third and fourth lumbar interspace. Analgesia immediate. Operation of circumcision entirely painless. No after effects.

Case L.-Private C. K. same individual and same operation as described in case XLIV. Same results.

Case LI-Mrs. Y.; white, age, 31; December 7, 1905.

Diagnosis, primipara in second stage of labor with marked dystochia. Tropococaine, 48 mg., spinal injection, third and fourth lumbar intersapce. Most of solution lost through leakage at cup of needle, due to manipulation in faulty light. Despite this, anagelsia was prompt and gave absolute freedom from all pain for twenty minutes, but chloroform was employed for forceps, as same had not been sterilized at time puncture was made and analgesia existed.

Case LII.-P. K.; private Troop L, Fifth Cavalry; age, 28; December 12, 1905. Diagnosis, necrosis styloid process and head of right ulnar. Tropococaine spinal injection, 64 mg., third and fourth lumbar interspace. Operation, removal by bone forceps and curette of necrosed tisPain insignificant during operation, and entirely ab sent at completion thereof. Analgesia lasted in upper extremities one hour and forty minutes. Could pass needle through integument of neck and cheek without pain. Complained of headache and dizziness for one week after operation.

sue..

Case LIII. Same individual, operation and results as described in case XLV. At this time the fistula was discovered to be tubercular, and there was also pulmonary infection. Case transferred to Fort Bayard. Operation

December 19, 1905.

Case LIV.-J. B.; white; male; stone cutter; age, 25; December 23, 1905. Diagnosis, urethral stricture middle spongy portion; 22 sound could not be passed. Gonorrhea two years previous and history of gleet last eighteen months. Tropococaine, 48 mg., spinal injection, third and fourth lumbar interspace. In this instance a blood vessel was punctured and the spinal fluid was mixed with blood, so that it was uncertain to the mind of the writer if the interachnoid space had been entered. Assuming from the sensation communicated to the fingers that the space was entered, patient was prepared for operation. Operation, forcible dilatation to the size of a 32 sound with entire absence of pain. No after effects.

Case LV.-M. G.; age, 27; private Troop L, Fifth Cavalry; December 27, 1905. Diagnosis, ingrowing nails both great toes. Tropococaine, 48 mg., spinal injection third and fourth lumbar interspace. Operation. removal two edges both nails. Absolutely painless. No after effects. Case LVI.—J. D.; white; male; age, 43; December 27, Diagnosis, recto-perino-scrotal fistula. Tropoco

1905.