Figure 12 is a photo of a lateral tear extending to the rear of the rectum. This operation gives infinitely better results than any other. It possesses the advantage of anatomical restoration, and is attended with very little or no pain. When done under aseptic precautions, there is little or no redress in the line of union.

The dressings should be changed sufficiently often to keep the parts perfectly dry, as moisture softens the epithelium and encourages the growth of infecting bacteria, and adds much to the discomfort of the patient.

I have done a number of these operations in the last few years, and some of my friends have followed me in its use. So far as my observations go, it is uniformly successful and infinitely superior in its result, to any other method.

DISCUSSION ON DR. NOBLE'S PAPER.

Dr. R. R. Kime of Atlanta: I do not think the interesting demonstration of Dr. Noble should pass without some discussion or comment. The subject is an interesting one to all of us. Nearly every physician who practices general medicine has to deliver children. We have many cases in which laceration of the perineum is produced by the injudicious use or application of the forceps, and the old physician, who practiced medicine for twenty-five years and never had a lacerated perineum in his practice, has passed away. These lacerations occur under the best care the physician can give the perineum.

As to methods of repair of the perineum, there are quite a number of them, and every man has his own ideas in repairing perineal lacerations. I think Dr. Noble struck the keynote in recommending the bringing together of the fascia as well as the sphincter muscle itself. There are a great many cases of complete perineal tear that do not in volve the rectovaginal septum, and unless the sphincter muscle is properly approximated in these operations, the operations will prove a failure. The essential thing to do is to approximate the ends of the sphincter muscles. I resort to the flap-splitting method in the repair of a lacerated perineum. I learned a lesson in operating on a case that had previously been operated on three times, where the rectovaginal septum was involved, and the patient lost control of the bowel. The three previous denuding operations were failures, because the operator did not bring the sphincter muscles together, nor the perineal body itself.

On account of previous removal of tissue in that case, [ prepared myself to operate with the expectation of having a failure because I had very little tissue to work upon to make a success. However, by resorting to the flap-splitting method, putting seven stitches in the rectum, a successful operation was done. In complete perineal lacerations, where we have the sphincter muscle involved, we should bring the fascia together so as to form a support for the muscular structures in the splitting process.

I use silkworm-gut in this kind of work, to approximate the perineum; catgut in the rectum and for the buried sutures when needed. The flap-splitting method is the ideal operation, where sphincter muscles and rectovaginal septum are involved, and when properly performed should get ideal results.

Dr. Noble (closing the discussion): I have only a word or two to say about the flap-splitting method; I look upon it as unsurgical and unscientific, and I never perform it. I think the flap-splitting operation, for laceration of the perineum, made so prominent by Lawson Tait, was devised to show the dash and brilliancy of the surgeon's skill, rather than for the patient's interest.

I thank the gentlemen for their kind attention, etc.

CONSTITUTION AND BY-LAWS

OF THE

Medical Association of Georgia.

CONSTITUTION.

ARTICLE I.
Name.

Section 1. The name of this Association shall be "The Medical Association of Georgia."

Oljects.

Sec. 2. The objects of this Association shall be to organize the medical profession of the State in the most efficient manner possible; to encourage a high standard of professional qualifications and ethics, and to promote professional brotherhood.

ARTICLE II.

Members.

Section 1. Any white physician, who resides within the limits of the State, who is a graduate of a regular Medical College in good standing, and who adopts and conforms to the Code of Ethics of the American Medical Association, shall be eligible to membership in this body.

ARTICLE III.

Officers.

Section 1. The officers of this Association shall consist of one President, two Vice-Presidents, one Secretary, one Treasurer, five Censors.

Sec. 2. The President and Vice-Presidents shall be elected for one year; the Secretary and Treasurer each for five years; each officer shall continue in office until his successor is elected and installed.

Sec. 3. Members of the Board of Censors shall be elected for a term of five years. There shall be an annual election of one member. Vacancies occurring from other causes shall be filled for the unexpired terın.

ARTICLE IV.

President.

Section 1. The President shall be the chief executive officer of the Association. He shall preside at all the meetings of this body, preserve order, and perform such other duties as parliamentary usages impose on presiding officers.

Sec. 2. He shall appoint the requisite number of delegates to the American Medical Association, and to such other scientific bodies as may be desirable.

Sec. 3. The President shall be ex officio member of all annual committees.

Sec. 4. He shall, in the intervals between the annual sessions, direct and control the general policy and business of the Association, with careful attention to its constitutional provisions.

Sec. 5. He shall appoint all annual committees, except Committee on New Members; he appoints only the Chairman of this committee (Art. V., Sec. 7, By-Laws); also an Auditing Committee, consisting of three members, whose duty it shall be to investigate and audit the books and accounts of the Secretary and Treasurer, and report their findings to the meeting.

ARTICLE V.

Vice-Presidents.

Section 1. Vice-Presidents, in their order, shall, in case of the absence or the death of the President, discharge all the duties belonging to the presidential office.

ARTICLE VI.

Secretary.

Section 1. The Secretary shall have charge of all the books, papers and records of the Association, except those belonging to the office of Treasurer, and shall record the minutes of the Association at all its meetings. He shall be ex officio member of the Publishing Committee.

Sec. 2. He shall, by February 1st, send a notice to each member, of the time and place of ensuing meeting, requesting his interest and his personal efforts in securing a large attendance, and requesting each member to send the title of his paper to the Chairman of the Program Com

mittee.

Sec. 3. He shall keep the roll of the members of this body who have retained their membership by compliance with the provisions of this Constitution, and also the names of those who have forfeited membership, together with the cause of such forfeiture.

Sec. 4. In the absence of the Treasurer he shall collect