alternating in this way, representing in either case fatigue, exhaustion of the bowel.

Now briefly, how would we treat these conditions? First, remove the splanchnic congestion. This must be accomplished through the nervous mechanism only. What methods have we at our command for doing this? If you wili place a cold cloth over the entire abdominal area and hot bottles to the feet and hands, by stimulation of the splanchnic vessels through the cold cloth we contract them and dilate the peripheral vessels, and thus we very rapidly reduce these terrible pains. At the same time we have a reduction of the spasm that occurs in the bowel. Now there are a great many methods of doing the same thing. I have given you only the principal points to meet the physiological-pathological condition. Second, if we have atony of the colon and attempt to treat the bowel by large injections of water the water will become an irritant and the exhausted bowel can not contract. You only have more fatigue than before, and it often increases the disturbance. It is not an attempt to force out something, but to stimulate normal peristalsis. I would use occasionally for cleansing purposes slippery elm water and bicarbonate of soda. What I find best are small injections at 120° Fahrenheit, which stimulates and contracts the vessels and at the same time removes a certain amount of material from the bowel, but principally for its effect upon the walls of the bowel. Second, introducing air into the bowel and massaging it out again, thereby exciting peristalsis. This gymnastic exercise kept up daily has a beneficial effect on the peristalsis of the colon and at the same time has a very excellent effect on the circulation.

As to diet I want to briefly state one or two little points. We will find that meat in these cases produces more or less disturb ance, and it is not due to the albumen of the meat, nor to the fat, nor to the water, nor to the salts, but to the extractives. They are toxic in character and when taken into the circulation and again excreted they become irritants. Therefore we should remove the extractives, and this is accomplished by pressing the meat, which takes out 40 per cent. of the water, leaving 31 per

cent. behind. We increase thus the proportion of albumen. Then put it in an autoclave under 15 pounds' pressure, which removes the gelatin and the extractives, and we have a substance that is very digestible and becomes a very wholesome food in this class of cases. We can give large quantities without harm. It can be flavored with Wahl's Extract made from yeast, with curry or other flavor. I believe this meat is one of the important nutritious foods which is needed in the treatment of these cases. I do not call these cases hopeless at all if we will carry out the treatment on physiological lines. Fresh air and walks and sunlight are good, but we must apply our art too. We can not simply send them to the country or to the springs, we must use our art, and we can by applying these methods to the treatment of the disease accomplish quite as much as by the method extolled by the surgeons of performing a right-sided colostomy. What I have outlined is along physiological-pathological lines that seem to meet the physiological-pathological conditions present.

Dr. Geo. D. Kahlo, of Indianapolis: There seems to be so much speculation among the recognized authorities of the different countries as to the etiology and pathogenesis of this condition that perhaps we may speculate a little here. It is hardly to be expected that we will settle the question now. One possible factor in dealing with the etiology is the question of the secretory and motor functions of the stomach, which we may say are disturbed. You may have a neurotic condition. But whether this is primary or secondary can not be stated definitely. In any event an analysis of the stomach contents in a considerable number of these cases has demonstrated that we have primarily, at least, a hyperesthesia, a hypersecretion. Now if we have to deal with a hyperchlorhydria associated with pyloric spasm we can readily understand how food confined in the stomach for an abnormal period will undergo fermentation, causing distension, and it may be when it is carried along the intestinal tract is so acid that the intestinal secretions of the pancreas and the bile are insufficient to neutralize it. Intestinal digestion can only go on in an alkaline medium. Therefore we have irritation by contact alone. Now

this contact kept up for a considerable period, it is not difficult to understand, might produce an irritation upon the intestinal tract as well, and if you will examine the feces early in the history of this condition, which unfortunately is done too littleeven a gross examination-you will find the presence of mucus in a great many more cases than would be suspected, and in the beginning, at any rate, you would have to deal with an acid fecal mass. Later on it may become neutral.

Now the essayist has spoken of the influence of diet, and while he did not go into detail he speaks of the possibility of employing predigested food, but saying that the objection to this is that the patient is not properly nourished. I believe it is a very decided objection. I do not believe we are justified in resorting to a diet of this kind where the question of nutrition is so important. I think we can select a diet of great nutritional value without being irritant, especially before the trouble has reached a point where there is catarrhal inflammation. Some of the cases are, I believe, organic in the later stage, but functional in their developmental period. I think the meat free from extractives as outlined by Dr. Turck a most excellent preparation. I believe the foods that should be selected are those having little residue with as much nutritional value as possible, and certainly we should eliminate such foods as fruits and uncooked vegetables that are frequently given where constipation exists.

Dr. Hessler, closing: I believe I have nothing to say in reply to what has been said in the discussion of my paper, except that when I spoke of the use of predigested foods I meant for an acute diarrheal attack following the passage of the mucus and not for the treatment of the affection itself.

I may add that had time permitted I should have presented a number of cases to show civic influences, and furthermore I did not dwell on the nervous features because I shall take them up in a special paper later on.

Presumably some expected me to say something about treatment. I would place pure air treatment first, and that means simply air free from sputum contamination, both as a cure for

present attacks and to prevent future attacks. In uncomplicated cases little medicine is required, and then chiefly during the height of the attack. For excessive pain an anodyne may be required, and for the rapid elimination of mucus a brisk cathartic, preferably a good purgative mineral water.

Nutrition should be kept up and a rational dietary adopted by the patient; an examination of the stomach may be of great service in advising about the use of suitable foods. For the anemia, often marked, some iron preparation may be of service, but we should not be misled by the advertisements of manufacturers of new iron preparation and their "clinical reports" based on cases that tend to get well on any remedy, depending on surrounding conditions.

One of the chief problems is to keep the bowels active and prevent the accumulation of mucus, and that means to prevent attacks. Physical exercise, the free use of fluids, plain food, a squatting position and a regular time for going to stool, the use of salol as an intestinal antiseptic chiefly, all help; the avoidance of the use of ice water, tobacco, and the bolting of food, should also be mentioned.

Since Fleiner's paper on the treatment of constipation by the use of large enemata of oil appeared, in 1893, this method has been largely used and is mentioned by practically every writer since then. But it is a disagreeable method and I get almost equally good results from the internal administration of the oil of petrol, or liquid petrolatum, a substance wholly foreign to the body and acting mechanically and not unpleasant to the taste.

ELECTRICAL TREATMENT OF MALIGNANT

GROWTHS.

BY J. P. HETHERINGTON, M. D., OF LOGANSPORT.

Malignant growths are usually so apparently innocent in their incipiency, and often so horrible and repulsive before they claim their victim, one often feels helpless and inclined to follow the common custom of advising a patient to "wait and see if it keeps growing" and then have "something" done. How common it is to see a patient who has all the confidence in the world in his family physician, present a tiny, innocent looking, warty spot to his physician. Possibly it is near the inner canthus. The physician sees it is not a wart, not a mole-it is suspicious, but he does not like to advise his patient to submit to an operation that will disfigure or involve delicate structures, neither does he wish to turn the case over to some one else, for fear the patient may not return. So he kindly tells his patient to "wait and see if it grows." It is very slow in growth and may disappear for a time, but suddenly the patient returns. This time it has invaded the inner canthus, the patient is handled in the best way to save the physician's reputation, after a little more delay a surgeon is consulted, who advises it is too late to operate, and a little later in the scene the physician's reputation is safe, because "dead men tell no tales."

A lady comes in with a story of discovering a little lump in her breast. Careful examination detects a small, hardened mass. The finger detects no enlarged lymphatics, so she is advised to "see if it grows." Surgeons tell us that more than 50 per cent. of these cases are malignant, and they should all submit to immediate operation if they expect permanent results. Suppose an operation discloses nothing but a cyst-what a pity all could not be as fortunate!

In treating these cases the patient naturally shrinks from caus