cases he claims the enormous production of mucus is a pure neurosis. In the other class of cases he claims the individuals are attacked by a true intestinal catarrh, and, being nervous, they develop a neurosis of secretion. Von Noorden also attributes the overproduction of mucus to a neurosis of secretion; but he believes chronic constipation to be the exciting cause, and states that almost without exception his patients suffered for some weeks or months from obstinate constipation. I know of two cases in both of which alarming hemorrhage occurred. In one of these examination of the rectum revealed the existence of internal hemorrhoids; in the other, which occurred at the Grady Hospital, unfortunately no examination of the rectum was made.

Prognosis: Prognosis in relation to cure is bad; most of these cases run a long and tedious course. The disease itself rarely, if ever, proves fatal, though a few cases have developed hysterical mania, resulting in death.

Diagnosis: This condition has been mistaken for appendicitis, and the appendix has been removed with no resulting benefit to the patient. This has been done not in one or two instances, but in a considerable number, and by some of the most prominent surgeons in this country. The stomach has been held responsible for the symptoms of this condition, and has been treated for months with no improvement, a frequent diagnosis being gastroptosis. Notwithstanding these errors in diagnosis, it is not a difficult one to make, for it depends upon finding the mucus in the stools, and if you are careful to examine these, and instruct your patient to do likewise, you will soon be rewarded.

Treatment: If a patient is seen in an attack the bowel should be emptied of its mucus by high enema; pain, if possible, controlled by hot applications to the abdomen.

If this fails, codeine or morphine hypodermatically. For the general treatment of this condition I know of no drug that does much good. I have gotten the best results by relieving the constipation with six ounces of olive oil at bedtime, to be retained overnight (the olive oil should be shaken in warm water to dissolve out the fatty acids, then poured off and injected). Some do well on the diet recommended by Von Noorden, which consists of articles of food that leave a large residue, such as graham bread, asparagus, boiled or baked potatoes, grapes (swallowing the hulls), milk one-third cream, and large quantities of butter. He claims for this treatment permanent success in fifty per cent. of all cases, incomplete success in fifteen and eight-tenths per cent., relapses in thirteen and onetenth per cent., unknown in fifteen and eight-tenths per cent., failure in five and two-tenths per cent. In the extremely nervous cases the rest treatment, with massage, seems to give the best results.

DISCUSSION ON DR. ARMSTRONG'S PAPER.

Dr. H. F. Harris, Atlanta: I think the thanks of this Association are due Dr. Armstrong for bringing this matter before us. I think there is no disease that is so common, and yet so frequently mistaken. I know of three cases that were operated on for appendicitis in the last three years, where the mistake was made, and the patient was subjected to the operation, and the whole thing might have been avoided by making a correct diagnosis. I know of several instances where they were getting ready to do the operation when a recognition of the condition saved the patient from the operation.

I have nothing to add, and want to thank Dr. Armstrong for presenting the subject, and I endorse what he has said.

THE DIAGNOSTIC AND THERAPEUTIC IM

PORTANCE OF THE RECENT ADVANCES MADE IN THE EXAMINATION OF THE FECES.

BY H. F. HARRIS, M D., ATLANTA.

The offensive and otherwise unesthetic peculiarities of the feces have very naturally prevented that close examination and investigation that has been accorded to the other excretions, and, as a consequence, one of the most valuable and reliable means of acquiring knowledge concerning the condition of our patients has been in the past almost totally neglected. No better illustration of this truth could possibly be given than our failure for generations to properly diagnosticate hook-worm disease-perhaps the most common of all the serious affections in Georgia. Happily for our patients this state of affairs can not long continue, for recent investigations have shown that so much information of the utmost importance may be gained by an examination of the feces that the matter can not much longer be neglected.

Of the many possible ways that the feces may be investigated only two have so far proven of importance— microscopic examination and chemical analysis—and both should invariably be employed except in those cases where we wish only to establish the presence or absence of parasites by an examination for their eggs.

In order to facilitate matters a brief reference at this

point will be made to the technic of the investigation of feces for eggs of parasites. Fortunately this is extremely simple, as it is only necessary to place a small particle of the excretion on a clean slide, if not already sufficiently fluid add a drop of water and mix thoroughly, after which a cover-glass may or may not be placed over the mass and the specimen examined under a fourth or fifth inch objective. In instances where this method fails to reveal the eggs of a suspected parasite it is well to add to a small quantity of the feces enough water to make the mixture quite fluid and centrifugate; in the sediment the eggs will generally be found without difficulty where a parasite is present. This simple method of detecting the eggs of parasites where they are few in number is due to my friend Dr. Claude Smith, of this city.

Where the examination is made for amebæ no water should be added to the feces, nor should there be urine or other extraneous substance mixed with them; particles of bloody mucus, which are so often seen in the stools of those suffering from amebic dysentery, are the most favorable portions in which to look for the parasites. The specimen should be examined, immediately after it is passed.

In those cases where we wish from an investigation to form some idea of the chemical composition of the feces, and to determine the extent and nature of the digestive processes, it is always necessary to place the patient on a "trial diet" for at least forty-eight hours before obtaining the stools for examination-the character of this diet depending on what we particularly desire to learn.

In those instances where we wish to determine the extent of the functional activity of the digestive processes

the trial diet devised by Schmidt and Strasburger (1, 2) bids fair to be of the utmost service, though time and experience only can show just how much importance can be attached to the results. It may, however, be confidently stated that either this trial diet or some modification of it will in the future play an important part in working out diagnoses in obscure cases of chronic dis

ease.

The diet and the method of its administration is as follows:

Breakfast. Two glasses of milk. Where this is not well borne two glasses of cocoa prepared as follows may be substituted: Two-thirds of an ounce of cocoa, onethird ounce sugar, one-half glass milk, and one and a half glasses water. With this is eaten a roll or two slices

of bread.

II a. m.-A gruel prepared as follows: One and a third ounces grits, one-third ounce butter, one-half glass milk, and one and a half glasses of water; cook well and add one egg. Strain.

Dinner. Four ounces of well beaten beef so cooked that it is very rare in the inner portions; to this is added two-thirds of an ounce of butter. With the beef are eaten six ounces of mashed potatoes, to which a half cup of milk and a third of an ounce of butter are added.

5 p. m.-Milk or cocoa with bread, as in the morning. 8 p. m.-Gruel prepared as for the II o'clock meal. After the patient has been on the diet for forty-eight hours the stools are investigated daily for as long as may be desirable. In many instances one or two examinations will suffice, but in order to get a satisfactory idea as to the true condition in chronic disorders of the digestive apparatus it is generally well to carry on the observations for several days or a week. In cases where