largest (available) sized Murphy button was introduced in the distal part of the bowel and a lateral implantation effected in the upper part of the (transverse) colon. Before introducing the button, the proximal end of the intestine was emptied of about one quart of fecal material. The button was reinforced with Lembert sutures, and the toilet of the peritoneum completed. The belly cavity was filled with normal salt solution, and closed in the usual way, without drainage. It required fifty minutes to make the operation.

Post-Operative Notes.-The patient left the operating room with a pulse of 110, and reacted very well from the anesthetic, having neither nausea nor peritoneal irritation, for the first twenty-four hours. His bowels moved five times within three hours after his return to bed, and the second day found his condition excellent. The third day his temperature reached 99.5, the pulse was 80, and he complained of but little pain and retained the liquids administered per rectum.....No bowel movement followed the five evacuations immediately after the operation, and on the morning of the fourth day flatulency became troublesome. This was relieved in part by the giving of an olive oil enema. Gas was expelled. There was no evidence of peritonitis, and the lumbar pains were relieved by a change of posture of the patient. ....At noon on the fourth day he complained of rectal tenesmus and while endeavoring to use the bed pan was seized with excruciating pain, and within twenty minutes presented the symptom-complex of profound collapse. He died four hours later from a general peritonitis.

Autopsy. Permission was obtained to remove the Murphy button, and the abdomen was opened through the line of incision. The belly cavity was filled with gas, the fluid contents of the intestine and pus. A perforation the size of the end of a lead pencil was found at the seat of anastomosis. On opening the gut, the section of the Murphy button in the proximal end of the colon was found blocked with a plum seed. The seed was covered with a tenacious fecal material, which so increased its size that it could not pass the lumen of the button, but played the part of a ball-valve and completely obstructed the fecal current.

Pathological Report.-The specimen removed showed a complete closure of the bowel. I am indebted to Dr. Ernest Scott for the laboratory report of an adeno-carcinomata.

The next case (patient presented) is one of umbilical hernia, and shows the result of the Mayo operation.

This patient, Willie Brown, is seven years of age and an acrobat by profession. The history of the present trouble dates back three years, when he had an attack of whooping cough, and later developed a slight protrusion in the region of the umbilicus. The swelling was so small, and seemingly harmless, that the mother permitted the condition to go untreated. When four and a half years old he toured the world with a minstrel troupe; and during the trip was overworked and sick the greater part of the eighteen months. In Austria he had a severe attack of enteritis, and during his stay in the hospital was fitted with a truss. In May, 1905, he had enteric fever, and was confined to bed for three weeks. The illness was followed by an uninterrupted recovery. In the following June he was referred to me by Dr. Benson, and later sent to the Protestant Hospital for operation.

Physical Examination.-Pulse, temperature, heart, lungs and kidneys normal; the appetite is poor and the bowels constipated. The boy is under size; has no superfluous fat and is anemic. The abdominal wall is thin, and the contour of the belly suggestive of rickets. Phymosis is not a factor. The hernial mass was never obstructed.

The hernial protrusion is considerably larger than a hen's egg, and is covered with healthy skin. The contents of the sac are reducible. The ring is well defined and will admit the tips of four fingers. The boy has, with pain and discomfort, worn a truss for the past two years, but has never been able to satisfactorily retain the rupture. The protrusion has materially increased in size since the attack of enteric fever.

Operation. June 8, under anesthol narcosis, I made the Mayo operation....The boy was given a dose of castor oil the day previous to operation. The abdomen received no preliminary preparation....The peritoneum and transversalis facia were closed with No. 0 chromicized cat-gut, and three

sutures of No. 3 chromicized cat-gut were used for fixing the aponeurotic flaps. The skin was closed with interrupted silk worm-gut, and a dressing fixed with broad strips of zinc oxide adhesive.

Post-Operative Notes.-There was no post-operative nausea, and the boy complained of neither pain nor distention. The bowels moved two days after the operation; the stitches were removed on the sixth day; he sat up on the seventh, and was discharged sixteen days after admission.

This case is presented, purposely, to emphasize the following points:

(1) That 98 per cent. of all cases of umbilical hernia in childhood are curable without operation.

(2) That in the case presented, operation was justifiable, because it was impossible to eliminate the factors that contributed to the excess of intra-abdominal pressure, namely, violent exertion, straining, constipation, and flatulent distention of the stomach and intestine, the products of bad feeding. Again, no truss would have cured the hernia, not so much for the reason that the ring was unusually large, or that the sac did not contain fibrous tissue, but because it was lined with a serous membrane, that was adherent to the subaponeurotic layer and was non-reducible. It is impossible to keep any ring in the human body open unless it is lined with either a serous or mucous membrane.

(3) Until the adoption of the Mayo principle for the cure of umbilical hernia, plastic operations, which had to do with the closure of the abdominal wall after the same manner of an ordinary abdominal section, were attended with many difficulties, a large percentage of recurrences, and a high death rate.

(4) Mayo's operation is applicable to fat subjects, and to herniae of immense size. The method eliminates the fatal and unnecessary traumatism of the ordinary operation, and gives an expectancy of cure, and a result, equally as satisfactory as the radical operation for the cure of inguinal hernia.

The Mayo operation was illustrated by drawings.

The next case (patient presented) is an esophageal stricture, and offers no very unusual features.

The patient is a girl, thirty months old, who was well until one year of age. At this time she swallowed two ounces of a concentrated lye solution. The physician who attended her tells me that the child lingered between life and death for two weeks, and that the burn was extensive. The child has never been able to take nourishment normally since the accident.

When referred to me last June, the mother gave the following history: "For five months there had been a gradually increasing difficulty in swallowing. The child had never been able to swallow solid or semi-solid food, since their taking would excite a violent attack of vomiting. She frequently vomits after the taking of liquids, and expectorates an excessive amount of mucus. The vomited material is never bloody. Frequently the stricture becomes spasmodic, when it is impossible for her to swallow any form of fluids for several days at a time. For the past month she has taken but little nourishment, and averages about four ounces of milk per diem. Operative treatment had been advised."

The patient weighs 24 pounds, is weak, constantly hungry, and is greatly reduced in flesh. The bowels are constipated and she complains occasionally of abdominal pain.

Treatment. The patient was sent to the Protestant Hospital June 19, 1905, and for the following two weeks the stricture was dilated once daily with a semi-rigid (male) bougie. The stricture is single and located opposite the cricoid cartilage. At the commencement of treatment it was impossible to pass anything larger than a No. 15 bougie. Since July I have dilated the stricture on an average of once in three weeks, and can now pass a No. 28 instrument without trouble. The girl has gained fourteen pounds in weight, is the picture of health, had learned to thoroughly masticate the food before attempting to swallow, and eats everything.

This case is presented because it shows the result of persistent dilatation, and that it is inadvisable to operate on children, since the stricture can invariably be dilated and kept open.

The child should be instructed with regard to the thorough mastication of food, and should drink considerable water at the time of eating.

It is usually unnecessary to dilate a stricture of 25 calibre more than once every six weeks to two months. This patient will, at a later date, be instructed with regard to the passage of the instrument, and will no doubt go through life without much inconvenience.

Society and Association Proceedings.

STATE ASSOCIATION OF MEDICAL TEACHERS. Minutes of the Afternoon Session of the Meeting of Dec. 26, 1905, at the Great Southern Hotel, Columbus, Ohio.

The meeting was called to order by Dr. J. U. Barnhill at 2:15 p. m.

Upon the motion of Dr. Barnhill, which was seconded, Dr. Starling Loving was unanimously elected as temporary chairman.

Dr. Loving took the chair and called for nominations for Temporary Secretary. Dr. F. C. Waite was nominated. Upon motion and second he was declared elected.

Dr. Loving, upon taking the chair, read a paper setting forth his views upon the question of educational requirements in medical training, and briefly reviewing the history of the advance of medical education in Ohio.

Dr. Barnhill moved that the chair appoint a committee of three on organization and nominations. Seconded. Carried. The chair appointed on this committee Drs. Barnhill, Howard and Waite, with instruction to be prepared to report later in the afternoon.

The meeting then proceeded to the carrying out of the printed program.

Dr. J. U. Barnhill of Ohio Medical University read a paper on "The Advantages and Purposes of an Organization of the Medical College Teachers of the State." Discussion by Dr. W. A. Dickey.

Dr. C. C. Howard of Starling Medical College read a paper on "The Medical College Curriculum-The First Two Years." Discussion by Dr. J. G. Spenzer.

Dr. J. C. Oliver of Miami Medical College presented a paper on "The Medical College Curriculum-The Last Two