to prepare the stump properly for the wearing of an artificial limb.

I have only touched upon a few of the most important subjects bearing on emergency surgery, but enough has been said to emphasize the importance of this part of the work of the general practitioner, who is usually called upon to render the first aid. Of late years emergency surgery has been overshadowed by operative surgery to such an extent that it has fallen into unmerited neglect. Let us revive the interest in the surgical work of the general practitioner and bring emergency surgery more prominently to the attention of the medical profession for revision and much-needed improvement.

In conclusion, permit me to congratulate your State Medical Society on the work it has accomplished in the past, to wish it Godspeed in the future, and to thank you for the distinguished honor of having given me the opportunity to address you on this your semi-centennial celebration.

CHRONIC DIARRHEA.

BY T. M. GREENWOOD, M.D., MINERAL BLUFF, GA.

This term is used to denote a morbid frequency of intestinal dejections which are, also, liquid or morbidly soft, and often otherwise altered in character; which frequent dejections have been kept up for a sufficient length of time to be called chronic.

In treating this subject it is not our intention to include certain pathological conditions which occasionally give rise to an eliminating process, amounting in some cases to a diarrhea, such as renal disease and cirrhosis. This is vicarious conservation and should only be held in proper bounds; no attempt should be made to arrest it. But, it is our intention to treat the subject as an entity. Were I to attempt to state in the fewest possible words what causes these troubles, or a majority of them, and confine the same to my own section, would say, overeating of badly cooked food. Were I next to undertake to name the two utensi's most to blame, would say, the coffee-pot and frying-pan. In this country where the culinary art has been little studied; wheresalt pork, fried brown (or black), corn bread and black coffee form the principle menu for each of the three meals of the day, how could it be otherwise! The wonder is that more of it does not exist.

After the foregoing explanation, we would put it thus: Overeating, indigestion, constipation, followed by a diarrhea which soon becomes chronic; nor, is this the only fault to our crude and rugged mode of living. We take our tobacco strong and fresh from the stalk without any of the finer processes of manufacture, or the benefits of age; and, our whiskey warm from the worm and without water. But to the point. A chronic diarrhea is to treat. Books are full of suggestions of more or less value; remedies without number are given in the dispensatory, and in works on materia medica, mostly astringents. To say they are useless. would be, perhaps, too broad; but of all remedies put forth, in my hands astringents have been of the least value.

My first insight to the treatment of this class of diseases was gained from a lecture delivered by Dr. J. S. Todd, of the Atlanta Medical College, quoting, in part, from his own experience and, in part, from that of the late lamented Dr. Armstrong. Digressing somewhat, I will say here, that if force of utterance could make medicine act, Todd's patients. would all get well. Nor have I been much disappointed in following his advice. Thus armed, I took charge of the following case, as my first experience in treating this class of diseases:

Case 1. Male, aged 45; been sick eight years, had taken various kinds of treatment, failing to get relief. After making two or three visits, I decided on the following (from Todd): Take one lb. of rice flour and one oz. of tannic acid,. mix together well; put one teaspoonful of this in a pint of sweet milk and add one teaspoonful of grated chocolate; boil thoroughly, and serve while hot, morning, noon and night. I made him eat all of this, three times a day, which was his meat and drink for eight days, as long as I could keep him on it. But his bowels were checked, and remained so. A careful diet and a good line of tonics were then prescribed, and the man got well, has had no further trouble. This was ten years ago.

Case 2. My next case of importance was a man, aged 40, sent me by Dr. McHatton of Macon, Ga.; had suffered for six years. He had had gonorrhea; was strictured; weighed 80 lbs., and was 6 ft. high. Bowels acted almost every hour; appetite gone; night sweats, and incontinence of acid urine which gave him great annoyance. This latter trouble was corrected by an alkaline treatment; a hot bath was ordered twice a day; and the rice flour and tannic acid mixture, as above described, was given for the bowel trouble. No other diet was allowed. The stricture was treated with bougies. This was kept up, and with little variation, for one month, when he was able to take a regular diet, and had gained 30 pounds.

I heard of this case two years later, and he weighed 175 pounds, and was in perfect health.

Case 3. The next case under my charge was a lady, aged 45; mother of eight children, all living and fairly healthy. She was very much emaciated, burning in stomach; mouth and throat sore; tongue would crack and bleed; family history good. Commenced August, 1896, which was kept up persistently for two months, with little improvement. The rice flour and tannic acid was not given, as the bowel trouble seemed to be a symptom. The various pepsin mixtures for indigestion were given, together with the usual remedies for diarrhea, but they all failed. I then put her on 10 grains of the salicylate of bismuth three times a day; this checked the bowels; but there was no improvement in the general symptoms. I was perplexed. The woman was a member of one of the best families of the community, and had been treated by almost every physician within a radius of twenty miles. She was in imminent danger of death from inanition, and further delay was hazardous. With no clinical history, or physical signs, except a small nodule midway the sternum to warrant it, I put her on one-sixteenth grain of bichlorid of mercury, and 7 grains of the iodide of potassuum with compound tincture of gentian. This was give

three times a day in a half glass of water after each meal. In less than a week her symptoms had all improved, and in three months the patient was comparatively well. She now weighs 160 lbs. and is in fine health. While this case was no doubt specific, a number of cases of bowel troubles, with similar symptoms, have yielded kindly to the same treatment, where no such suspicion could exist; showing that this is a much neglected remedy, and covers a wide field.

Going over a number of cases, and leaving out some perhaps of interest, I shall report one other case.

Case 4. Was called in June, 1897, to see a man, aged 62, who had been under constant treatment for two years, and for seven months had been confined to his bed. He had been pronounced incurable by six physicians. Bright's disease had been diagnosed by some of them, and his condition pronounced hopeless. The doctor who had him in charge, a graduate of the Jefferson Medical College, and a man of considerable experience and success, did not concur in the opinion of the others that he had Bright's, but told me, on my first visit, that the man could not live more than ten days, and that he was glad for me to take the case; this I was reluctant to do.

Almost all the known remedies that could be given per oram had been tried, save the ones mentioned in former cases. My first prescription was equal parts compound tincture of benzoin, tincture opium, essence peppermint and tincture of camphor; one teaspoonful in water every four hours, until bowels checked; this failing, I gave twenty grains of salicylate of bismuth every four hours; this checked the bowels. At this juncture a thorough investigation was made of the lower bowels by a speculum and otherwise, when, to my surprise, I found that the whole of the rectum, as far as could be ascertained, was ulcerated, and for a time I feared malignantly. Alum enemas