Patient gradually grew worse, appetite became poor, and he assumed a sluggish, drowsy appearance, complained he could not sleep on account of pain, and said that he felt a tumor in his abdomen which was not stationary, its range of mobility was by no means confined to the abdominal cavity. He would feel it at times between his shoulder blades, at other times in his legs, but most often in his abdomen-but repeated and careful examinations failed to show any abnormal growth, and patient quit me to consult other physicians.

Patient returned to my office in about a month; he looked pale and emaciated, and said he found no relief. He cried bitterly, saying he knew he had a cancer, and that he was going to die; and said the tumor was the size of a child's head. I spoke to Dr. Claude Smith about the case, and he suggested that I humor the patient.

Accordingly, next day I asked him to point the tumor out to me, which he did, pointing to the right side of his chest, about the fourth intercostal space, but immediately afterwards he claimed that the tumor had wandered down to the lower part of his abdomen. I made deep pressure over the part and put adhesive straps tightly over it, telling the patient that this would anchor the tumor. I put him on a general tonic, and twice daily applied the galvanic current over the supposed site of the tumor.

The patient improved gradually, and from time to time stated his tumor was growing smaller. On December 15th patient said the tumor was all gone but the root. I told him that I would remove the root that very day. While wetting my sponges my patient suddenly cried out. I ran to him and found him foaming from his mouth, his face congested, his knees drawn up, throwing his hands. about as if grasping for support, he was gasping for breath, his pulse rapid, and he was emitting groans that

I thought could be heard all over the building. I chloroformed him, and while under anesthesia I again examined him carefully, but could find nothing. He lay in my office for almost three hours, and the first question he asked was, "Did I remove the root?" I assured him that the same was now thoroughly eradicated, and he seemed to feel better. He came to my office a few more times for electrical treatment, and was finally discharged as completely cured on December 20, 1904. He has returned to work, has never had a return of the symptoms, enjoys good health, and tells an interesting story to his friends. how a large tumor was removed, or rather electrocuted, in his abdomen.

Case No. 2.-T. S., female, married, but separated from her husband, has one child seven years old, had a miscarriage five years ago, and was curetted for an abortion a year ago. Claims to have hurt her hip in a runaway accident, and complained of pain in hip and on left side of abdomen. Patient had a temperature of 104 degrees, and on examination of hip could find no evidence of any serious injury, except a slight bruise. On vaginal examination I found a rather large uterus; the cervix was flabby, and a dilated os. Patient was curetted without an anesthetic being given and remains of placenta removed, which patient declared was left over from last year. Patient became delirious, temperature went up to 105, and complained chiefly of pain in the abdomen. For a month patient was in a precarious condition, running a septic temperature, as shown in this chart, and finally recovered, recuperating and regaining her usual health in a remarkably short time.

Case No. 3.-S. J., male, age twenty-nine, single, storekeeper; had never been sick before a day of his life. Was called to see him on May 15, 1905, at his place of busi

ness, and found him attending to his usual duties. He complained of pain in his abdomen, said his bowels had not moved in two days. This was about six p.m. Patient's temperature was normal, pulse was 128, and he appeared in pain. I advised him to go home and let me examine him, but patient insisted that he was not sick enough to go to bed. He asked if an enema would hurt him. I said "no," and he replied that he would try that, and would let me know if no better. No amount of persuasion by me could induce him to go to bed. I was again called at midnight, and found patient suffering agonies from pain in the abdomen. The pain was generalized. Two high alum enemas failed to produce a movement of the bowels. I advised surgical consultation, but the patient and his family would not listen to such a thing. On his brother's suggestion that a couple of porous plasters would relieve the condition, I was dismissed from the case to be called on again next morning early. Patient said he spent a miserable night; his general condition seemed to be good; his bowels had not moved. After more or less objections, they finally consented to have Dr. Nicolson called into consultation. Immediate opera

tion was advised, but the family again objected, but called me over the 'phone about an hour later and said they would consent to the operation. Drs. Nicolson and McRae performed the operation. The whole abdominal cavity was found full of pus and his appendix greatly inflamed. The patient for a week suffered the greatest of agonies; his bowels had not moved; and died on the sixth day after the operation. It will be important to note that this patient was operated upon within eighteen hours of the initial attack. His temperature was subnormal until a few hours before death, when it reached 105.

Case No. 4.-F. B., female of immoral character. No

history of childbirth or miscarriage; had gonorrhea about a year and a half ago; had no syphilis; about six months ago had an attack of pain in her left side. A doctor had put something in her arm, and she got better. Three weeks later was taken with pain in her left side; was treated in Grady Hospital for two weeks; she refused any operative interference, and says she was entirely well until September 14 of 1906, when she was taken with pain in her left side and thigh-most of the pain being in her left thigh.

She had a profuse vaginal discharge, and the cervix uteri and vagina was full of erosions. On palpation a large mass could be felt in the posterior wall of Douglass's pouch. For two weeks she was treated by douches and local application, which benefited the discharge and healed the erosions, but the pain in her left thigh was as severe as ever, and she would disturb all the patients with her moans. She finally consented to have an operation performed.

The appendix was found inflamed and imbedded in a mass of adhesions from the uterine adnexa. The left tube was distended with pus and convoluted around the left ovary, which was diseased. The right ovary was found to have undergone cystic degeneration, and the right tube was elongated and distended with pus—all of which were removed, the patient making a complete recovery.

I have selected these four cases to illustrate that pain as a symptom in the abdominal diseases occurs under so many various conditions, and is of such a great deal of importance in an unlimited number of pathological conditions, that it must not be treated lightly, and that every case of abdominal pain deserves the highest consideration at the hands of the physician.

COUGH AND ITS TREATMENT IN CONSUMP

TION.

BY M. M. SALIBA, M.D., SAVANNAH.

For as nothing is of greater importance in the management of a case of consumption than the proper treatment of the cough, especially when this symptom takes, as it frequently does, a prominent place in the sufferings of the patient, I was led to bring this rather trite subject to your attention. Circumstances brought me in quite close contact with a number of tuberculous patients, and I will state that there is no symptom of which they complain so urgently as of cough; and there is scarcely any which so often baffles our efforts for its relief. Cough is a reflex act set up by some exciting cause, and as a symp tom of pulmonary consumption is almost always present. However, in some cases, it is never severe; in others it does not appear until late in the disease, and in a few not at all.

It is the result of a forced expiration with rima glottidis closed, and is due to irritation of the vagus, or one of its branches, which transmits an impulse to the medulla, where the respiratory motor nerves are acted upon. The irritation may be caused by chronic pharyngitis, by laryngitis, bronchitis or tuberculous ulcers in the larynx or trachea, though the last named is rare; by pleuritic irritation from superficially seated tubercules; by enlarged bronchial glands, or by the presence in the bronchi of acrid material from a phthisical cavity, or by tenia or other forms of a gastric or intestinal irritations.

Cough in consumption is one of the earliest as well as