prolapse two drams of this solution. Then with scissors I cut through the redundant cutaneous tissue quite deeply, and with pile clamp and cautery removed the entire mass in three sections, then burned with small point of cautery four grooves through mucous membrane to muscle (within the rec tum) extending upward two or three inches.

I then burned three grooves into the external spincter, hoping thereby to bring about contractions of this muscle.

The dressings consisted of a light application of iodoform gauze with strips of adhesive plaster applied to bring buttocks in close proximity. His bowels were confined for a week when he was given a large dose of castor oil with an enema of sweet oil two hours later.

He left the hospital on the fourteenth day and has had no recurrence of his trouble.

In dressing some of these cases it is well to wrap a tube with oiled gauze, and place within the rectum, to hold rectal wall against adjacent structures and also to allow the escape of gas and feces through the tube.

In prolapse of the third degree, i. e., where it begins high up in the rectum, or sigmoid flexure, and extends down. into the ampulla but does not protrude through the anal orifice, and also in prolapse of the second degree where it begins more than two inches above the anal orifice, I prefer a sigmoidpexy, or colopexy, which has given good results. in my hands, and which I think is the most rational procedure in these cases. The technique of the operation is as follows:

Case No. 1, Mr. W., age 39, consulted me in 1905, suffering with a prolapse of the third degree with all of the reflex symptoms accomponying such a condition, viz., backache, indigestion, constipation, urinary disturbances, nervousness, etc., and very anaemic and emaciated.

One reason for citing this case is to show how misleading, and sometimes, difficult it is at times to make a diagnosis of this class of prolapse. A sigmoidpexy (which was explained to

In

him) was advised and accepted. colopexy, the abdominal incision is made two inches higher than in sigmoipexy, and an inch to the left of outer margin of left rectus muscle. The technique I employed in my cases is similar to sigmoidpexy which is herewith given.

After the patient is prepared for a laparotomy, an incision about five inches long is made through left rectus muscle beginning three inshes above the pubis and extending upward.

The peritoneal lavity is opened, and the peritoneum is stripped off from the sides of the lower angle of the inrision to the extent of half an inch. The sigmoid flexure is caught and dragged upward into the wound until the entire prolapse is overcome.

The gut is sutured to the transversalis fascia with fine silk, the upper peritoneal wodnd with catgut, and the abdominal incision closed with celluloid linen.

n

The usual dressing is employed as in any abdominal section. It is important to have foot of bed elevated about two feet to keep any dragging or pulling of the gut at site of operation.

The patient is kept in this position for a week when he is given a large dose of castor oil. Two hours later he is given an enema of sweet oil and kept in bed for ten days, after which he is given his freedom.

A small meningocele may resemble a sebaceous cyst. The previous history is important in the diagnosis. A meningocele of this character is present "as long as the patient can remember" and remains about the same size; a cyst begins as a small nodule later on in life and increases in size.-American Journal of Surgery.

A small, hard, irregular nodular scalp. tumor is very likely an endothelioma. A little section should be removed under local anesthesia for microscopical examination. If the diagnosis is corroborated, radical removal is necessary.-American Journal of Surgery.

DIAGNOSIS UNDER ARTIFICIAL

LIGHT.

A. CRESSY MORRISON,
Chicago, Ill.

Member Illuminating Engineering Society.

Most physicians recognize the difficulty of accurately judging the condition of tissues by means of artificial illuminants. The difficulty has, however, usually been accepted as inevitable. Until recently no artificial illuminant has been known which has the balanced spectrum of sunlight, and so, where diagnosis has been necessary by means of artificial illuminants the physician has done the best he could, occasionally correcting his opinion after a verification of the examination by daylight.

The eye, through all ages, has adapted itself to see by daylight. Its evolution has been wrought in harmony with the solar spectrum. The seven colors of the solar spectrum have a given intensity; combined, they make white light. All artificial illuminants, save acetylene alone, have an excess of one color or another. City gas light has an excess of red, kerosene an excess of yellow and red, the Welsbach burner an excess of green, the arc light an excess of violet, the incandescent an excess of orange and red. Acetylene, on the other hand, has the seven colors in such intensity that compared with sunlight, the difference is negligible. The excess of one color or another in artificial illuminants upsets the judgment of the physician, and is bound to have an effect upon the validity of a diagnosis. If the eye has adjusted itself to see best by daylight, then, under daylight, colors have their normal values, and the mind, trained and adjusted to base its conclusions upon what the eye reports, can only with the greatest difficulty make the proper additions and deductions that an accurate conclusion may be reached. How can the mind say to the eve, which reports accurately what it sees, "You are deceived. The light by which you see that tissue is a distorted light. Therefore the color you report is not the real color of the object as seen by daylight. It is not so red as you say it is. There

fore the inflammation is not so bad, therefore the case is not so serious."

We seldom think of it, but there is literally no color. The blue sky is not blue, but light makes it appear so. Light, falling upon particles of matter, is diffused, but space, where there is no matter which will hold light, is absolutely black. The silver moon is matter, and this matter reflects the light of the sun to us. Therefore, the moon is visible. The green grass reflects to our eye the green rays which come to it from the sun. Speaking broadly, if it could not reflect the green rays and could not reflect any other, the grass would be black. Color, therefore, does not exist except as the waves of light are thrown back into the eye from the object upon which we look. Waves of a certain length have a certain color. The slowest rays are red, and the quickest visible rays are violet. If an object absorbs and neutralizes all the rays or waves except the very long ones, and these are thrown back to us, we say the object is red. All light and color and every wave has ceased but red. The application of this to diagnosis must be immediately apparent. If a tissue is examined under city gas light, in which the spectrum shows that there is a large excess of red rays, then a tissue, which in laylight would be normal, would, under gas light, appear to be much redder than it really is. The eye accurately reports the excess of red color, and as inflammation increases the ability of a tissue to reflect red rays, the mind instantly says the tissue is inflamed, while, as a matter of fact, it is not the tissue which is inflamed, but to put it in a certain way, it is the light which is inflamed. It has an excess of red. If a physician is examining tissues under a green light, the tissues have an abnormal and ghastly appearance. Green light, if thrown upon a red surface in sufficient purity, leaves the red without light; therefore, the red appears black. green rays fall upon a surface which in daylight would be red, the surface cannot respond; therefore, it has no color, and, in the absence of color, it is black

If

It is unnecessary to go further in

this line of thought, as physicians are already fully aware of the difficulties of proper diagnosis with artificial light. There are, however, some phases of the subject which are not always given consideration. In the case of an examination of the blood to discover an anaemic condition, it should be remembered that, if examination under artificial illuminants is made, with an illuminant giving an excess of red, the condition of the blood appears much better than it really is, and under an illuminant which is deficient in red, the apparent condition of the blood is much worse than it really is.

So important is accurate judgment to the physician and the surgeon that the adoption of acetylene, which is really daylight at night, in the operating rooms of hospitals is almost a necessity. The spectral similarity between. acetylene and sunlight has only been recently brought to the attention of physicians, and its advantages were immediately recognized.

The ordinary portable lights like a house lamp, with a suitable reflector, have been adopted and brought into use by physicians who have seen the necessity of acetylene. As a matter of fact, small acetylene lamps of a portable character are in use in fifty-four out of the sixty public hospitals in New York city. The most eminent physicians connected with these hospitals have spoken of the value of acetylene in the highest terms. The investigation of the matter went no further than New York city, but the large proportion of hospitals in which acetylene is appreciated and in constant use was a surprise to the writer. These minor units do not meet the full requirements of the case. They are convenient because they are movable, and as an accessory to the system of hospital lighting have been proved valuable. There should, however, be in every hospital operating room a complete. system of acetvlene illumination, proper reflectors should be provided, and whether the source of acetylene should be the modern house generator or cylinders, which are now used so extensively in railroad illumination, is a

question which would be decided by local conditions. A perfect light for emergency operations at night is a desideratum of primary importance, and there should be no hesitation in working out a plan by which the hospital operating room should be given this nearest approach to daylight at night.

Acetylene is within the reach of every physician, and especially these in the country, as an individual household generator is now made by manufacturers in almost every city which will produce acetylene for lighting an entire house, at a cost, candle power for candle power, which compares favorably with city gas at a dollar per thousand cubic feet. The apparatus and piping are not expensive and can be put into any house without disturbing furniture or walls, by a good plumber in two or three days. Över 150,000 individual installations are now located in country homes throughout the United States, so that its safety and utility are completely demonstrated. Many physicians have adopted acetylene as the common illuminant in their homes, and find it of inestimable value in their practice, and of great benefit to their patients.

Acetylene illumination is already recognized of immense value by dye houses, lithographers, artists and others who require an illuminant which will not be slow to add to their equipment so simple an improvement.

After an operation for extensive carbuncle of the neck, a comforting support may be supplied by placing under the bandage a piece of heavy manila cardboard (book-binders' board), wetted and shaped to the back of the head and neck. -American Journal of Surgery.

If a scalp wound extends through the periosteum it is safest to sew the periosteal wound at once and leave the scalp unsutured for twenty-four hours. Fracture should be excluded, if possible, before closing the periosteum.-American Journal of Surgery.

*ALKALOIDAL MEDICATION.

G. B. DORRELL, M. D.
Republic, Mo.

President Southwest Medical Society.

We may safely assume that there is nothing which interests the average man or woman quite as much as mat ters medical. For every last one of us wants to live as long as he possibly can and in every possible way to avoid physical suffering and the diseases which conduce to this and to the shortening of life. Nevertheless it may sur prise many to know that a remarkable movement has been progressing for the last fifty years in medical circles, which bids fair to revolutionize the practice of medicine. Moreover this movement has grown to remarkably large proportions without having as yet in any way come to the attention of the public. There has not yet appeared a line in regard to it, in any publication not designed especially for the medical profession. The reason for this is, that the movement has been carried on strictly within the lines of that secretive clan. It has been a reform inside of the party, and the promoters have jealously confined it to the profession, withholding from all except physicians the privilege of subscribing to the publications treating of it, and refusing to sell the remedies employed in it to the public. For these reasons the progress of the movement has been comparatively slow.

It may be recollected by some of our older members, that the early popularity of homeopathy was due to its presentation to the public. In fact many physicians adopted the homeopathic methods and remedies, not because they desired to do so, but because they were compelled to do so by the public demand. Many an oldschool doctor became a homeopathist simply because his patients would have it, they having ascertained that there was a method of treating disease by safe and not unpalatable remedies.

*Read at Crane, Mo., December 3, 1907, before the Stone and Lawrence County Medical Society.

Whether these were as effective as the older forms is not to the point; the fact remains that it was this public demand which gave general vogue to homeopathy.

The promoters of the present movement, however, have shown themselves to be orthodox of the orthodox,

going so far as to appeal to the subscribers of their journals, that they shall not allow them to be seen in their waiting rooms, where those outside of the profession may have the op Portunity to see them. Nevertheless. despite these precautions, the method has spread until more than fifty thousand American physicians are using it to a greater or less extent; and if the matter once comes to the attention of the public, it is possible that there may be such an interest aroused that the remainder will be compelled to fall in line and study and practice the new method, or be forced into retirement.

What is this method? At first sight it seems to be a simple matter, rather a question of drug selection than anything else. It is simply the substitution of the active principles for the oldfashioned tinctures and extracts.

As

we say, this at first sight seems to be a trivial matter, simply the preference of a doctor for one form of a remedy over another; but in reality the matter goes very much deeper than this, and in fact constitutes a revolution in the practice of medicine.

The reason for this lies primarily in the uncertainty of the old preparations. The constituents of medicinal plants may be arranged under two groups, one consisting of such ingredients as have medicinal activity, that is, those that exert some influence upon the human body in the state of health or disease; the other of inert substances, those that have no effect so far as known. Among the latter we group woody fiber, gum, sugar, pectin, etc., which, presented in the form of medicine, are simply so much ‘dirt' encumbering the true medicinal principles, increasing the dose, rendering it disagreeable, and more difficult of absorption. The object of pharmacy has heretofore been, to leave out as much

as possible of this useless matter, so as to present the true medicinal principles of the plant in as clean a state as possible.

For this reason the crude drugs, roots, bark, leaves, herbs, wood, etc., are reduced to powder; and water, alcohol, glycerin or other substances employed to extract the really valuable principles, throw aside as much of the dross as possible. The result is a series of preparations known as tinctures, extracts, etc. These preparations, however, contain besides the really useful principles, others which are undesirable. For instance, tannic acid is almost always extracted with the desirable elements This is objectionable in that it often precipitates and renders the medicinal principles insoluble, hinders. their absorption from the stomach, interferes with digestion, and altogether is an undesirable ingredient of these medicines. Besides, this, such preparations are liable to certain changes which go on constantly. The alcohol and water of tinctures and fluid extracts evaporate, leaving the remedy in a more concentrated form and consequently stronger than when it was first made. On the other hand molecular changes occur by which the active principles deteriorate, being changes into coloring matters and other worthless products, so that there is a continuous loss of the really valuable principles. This goes on in varying degrees under varying conditions; but it is of sufficient importance to have attracted the attention of pharmacists; so much so, that one very popular retai! pharmacy in an Eastern city had the custom of annually taking all its liquid medicines and emptying them into the river, replacing everything on its shelves with fresh preparations, so that there was never a liquid in the place that was not less than one year of age. During this year the two processes mentioned, that of evaporation and of deterioration, went on constantly; so that the actual medicinal strength of the preparation depended on the degree to which each of these processes

had proceeded. Its actual strength was, therefore, in all cases a question for experiment; and the physician. might find that a remedy taken out of the same bottle was either stronger or weaker this month than it was the preceding month.

This, however, is only one of the objections to this class of medicines. Another is to be found in the varying chemical composition of the original plant. The medicinal value of plants depends on the presence in this of certain chemical bodies, known as akkaloids, glucosides, etc. Most plants contain more than one of these bodies. Opium contains at least twenty-six. These are developed in varying proportions, as the plant grows under the varying conditions of soil, culture, sun, shade, moisture, dryness, coolness. heat, etc. It follows that every plant develops its active principles in quantity and in proportion to suit itself; that is, to suit ts own needs and not those of the possible human being who may require it for his ailments. The preparations made from these plants, therefore, vary. For instance, in opium the principal ingredient for which it is generally used is morphine; but the quantity of morphine may vary from a maximum of 18 per cent down to nothing at all. It will be seen that even if all the preparations from a plant-drug are manufactured in exactly the same manner, no two of these will show exactly the strength at the beginning, even before evaporation or deterioration has commenced.

same

These active principles found in plants vary remarkably in their effects, and it is by no means unusual to find that the same plant contains principles which are exactly antagonistic in their action. For instance. that wonderful store-house of remedies, opium, contains among its numerous active principles several such as morphine, codeine and narceine, which are sedatives, relieving pain and inducing sleep; others like thebaine and laudanine which act like strychnine, being powerfully stimulant and ac