normal salt solution were administered every four hours. Breath became fetid. Until May 29th, the patient was in coma, with temperature from 100 to 103 degrees.; pulse from 140 to 160, and respiration from 30 to 40, with periods of muttering delirium. On May 29th, physical signs of pulmonary edema; patient suddenly seized with a violent struggle to cough, evacuated through the mouth about half a pint of pus, and died. The Selma Medical and Surgical society met in regular session Friday October 1st, at 7:30 p. m. Dr. Ritter presented the following case: Boy age 6. When the child was born the labor was a long, tedious and severe one. The baby was a "blue baby." The mother had a severe fall when about four months preg nant. During the first 24 hours of the child's life he had peculiar attacks during which he would turn an ashen gray color. There would be no perceptible pulse beat. It was noticed from birth that paralysis of the left arm and leg was present. At about the sixth or seventh month he began having spasms resembling epileptic fits, which have continued with varying intervals up to the present time. For the past two years the attack only comes on when asleep. The spasms are very violent, almost tetanic. A very peculiar thing about these attacks is that a smart spanking will always stop them. He rarely has involuntary expulsion of urine or feces during an attack. His mental development about corresponds with that of a child three years old. He is very fond of classical music but does not care for popular airs. He has a divergent strabismus. Discussion-Dr. Gay: I think this case is one of injury to the skull during labor in which the centres controlling arm and leg were interferred with, and that the case belongs to the imbecile class. Dr. Harper: I think that a cerebral hemorrhage occurred owing to the prolonged and difficult labor. That a clot was formed over the cortex in front of the fissure of Rolando, and this clot became organized and interfered with the develop ment of that portion of the brain. I believe that much good can be accomplished by educating this child. Dr. H. D. Furniss: This case shows no evidence of rachitis, as evidenced by the absence of bow legs, rachitic rosary and cranic-tabes. The dentition according to the history given by the parents was in all respects normal. I do not consider the case one of peripheral neuritis due to intoxication (drug, alcohol, or auto-intoxication, or from specific fever) for in this case the extensors would be more affected than the muscles, not because the nerves to the extensors are more affected than the other nerves, but because they are weaker, and the first to show the influence of harmful changes' The possibility of Erb's paralysis is in this case considered by Dr. Harper, but the simultaneous appearance of disturbance in the lower extremity of the left side would not make this appear as a possible solution of the trouble. The wide separation of the affected parts would not lead one to think that the trouble was of spinal origin; the distinctly unilateral appearance of the trouble would speak somewhat against this The reflexes are not affected in the leg. Dr. Harper spoke of the condition as being a spastic paralysis but close observa. tion will reveal the fact that there is no spasticity of the affl icted parts. My idea is that this condition is due to a blood clot (cortical lesion of the right side) and this is not in the internal capsule as the face is next to the arm tract, and in this case it would be affected to some extent. In this case there is microcephalus, but I think that it is secondary and due to the inhibitory effect of the lesion on the development of the brain; in the congenital microcephalic conditions, the forehead slopes backward at a greater angle than in this patient. The history of the hard labor, and the fact that the parents said that the child's head was not abnormal at birth, would bear me out in the conclusion that this condition of microcephalus is acquired. Dr. Ward: I think the prognosis is always bad in injuries to the brain during birth. The physician can never offer the parents such hope in much cases. Dr. Harper; While on this subject I would like to mention a case which I have seen recently. I was called into the country to see a woman who had been confined a few weeks previous to my visit. I noticed that the baby had a tumor protruding from the back of the head which I thought was a caput. I saw the child a few months later and the tumor was still present. I saw the child again when ten months old and the tumor was still there, perfectly hard and about the size of a cocoanut. It protruded abruptly from the region of the posterior fontanelle. Dr. H. D. Furniss: There were three conditions that could cause a tumor in that region, viz: blood clot, meningocele and hematocele. Dr. Gay reported the following case. Patient, white, male, age 28 years. Family history unim. portant. Had had attack of pain in his abdomen since he was ten years old. He was taken sick about 6 p. m., October 23rd, with very severe pain in his abdomen. His attending physician stated that his highest temperature had been 100-6° pulse 96. When I first saw him his temperature was 99 degrees and pulse 80. The next morning his temperature was still 99 degrees and pulse 60. He had all the symptoms of appendicitis. He was brought to Selma and operated on on the 25th. One peculiar symptom he had was inability to pass his urine from the time he was taken sick. At operation a very large and long gan grenous appendix was found. The tip of it pointed towards the bladder and was probably slightly adhered to it. This may have been the cause of his bladder symptoms. The patient did not do as well as I would like to have seen him do. He suffered considerable pain and his temperature did not come down. On the fifth day the wound was opened again and a considerable amount of pus escaped and I am suspicious of a fecal fistula also. His condition is more satisfactory since the wound was opened. Dr. Ward: Dr. Gay has launched us on a subject that is practically inexhaustable. It is almost impossiable to pick up a journal nowadays without finding an article on appendicitis. Discussion: Dr Harper: Dr Harper: This patient is to be congratu lated on having fallen into such good hands. In another twentyfour hours without operation he would have been "in glory." This well illustrates what a serious condition an appendix may be in without any symptoms to indicate such a condition. If there is a fecal fistula in this case it is probably due to sloughing of the cæcum or to lymphatic infection. A New York surgeon, instead of amputating the appendix in the usual way, takes out a portion of the cæcum with it. In my opinion this ought to be done or else make provision for drainage. Dr. H. D. Furniss: It is possible that the infection in this case came from a thrombus in one of the arterioles of the mesentery. A special danger in cases where the appendix is gangrenour, is infected thrombus. This case in which the appendix was in such a gangrenous condition, and in which symptoms were so much out of proportion to the condition found at operation, goes to show that no man can tell what is going on in the abdomen in cases of appendicitis. Dr. Rogan: I would like to call attention to the analogy between appendicitis and mastoid empyema which is often called appendicitis of the head. We frequently have disastrous changes taking place in the mastoid and neighboring portions of the skull or brain when the symptoms would never lead one to suspect it just as is often the case in appendicitis. Dr. Gay in closing the discussion: If a perforation had been found I would have of course have drained. It is known to be a fact that the peritoneum can take care of a few germs. Professor Olhausen of Germany never drains even in purulent cases. The thrombus spoken of in this case was covered under four layers of sutures. It is a hard thing to tell when to drain and when not to drain. Dr. Harper reported the following case: On last Tuesday morning about 7 a. m., I was called to see a gentleman and found him suffering excruciating pain in the abdomen. There was considerable swelling in the hypogastric region and tenderness was present over the entire abdomen. He said that this attack came on sometime during the night and that he had been vomiting considerably. His bowels had acted three times the day before. He said that he had had similar attacks before. I gave him a hypodermic injection of mor. phine and went back a little later and on close examination I found that he had a hernia that had existed for several years. He had not been wearing a truss for the last two years. I spent some time in trying to get his bowels to move, by means of enema of salts and glycerine. He passed some flatus but no fecal matter. The hypogastric region was considerably distended. I drew his urine and found that it was not due to a distended bladder. He would not consent to an operation. He said he would be all right if he could get a dose of salts. I had him sent to the infirmary where he was seen by Drs. Ritter, Donald and Rogan. They were all of the opinion that he had obstruction of the bowels. There was no visible hernia, but we thought that a knuckle of intestine had become caught in the inguinal canal and strangulated. He was in bad shape for operation. He was cyanosed and his extremities were cold. He remained in about the same condition until about 3 o'clock when he suddenly went into a state of collapse and died about 11 o'clock that night. Discussion-Dr. Gay: I operated on a case for obstruction of the bowel two or three years ago and found a ventral hernia and gangrene involving about ten inches of intestine. It is needless to say that the patient died. My experience has led me to the conclusion that the formation of an artificial anus is better than to attempt excision. Dr. H. D. Furniss: I have seen four cases of strangulated hernia operations this year with three deaths. There is danger in making taxis if the gut has been down long. I have seen very flattering reports on the use of atropine in this condition. Dr. Harper: In closing the discusion I would like to call attention to the rapidity of the fatal termination of this case. It is very important not to attempt taxis in long standing cases. It is far preferable to make an artificial anus than to do excision. In regard to time of operation it is useless to operate on a dying man. It brings the operation into disrepute and everybody blames the surgeon. I think it is the duty of every practitioner to advise every person who has a hernia to have the redical operation done, especially young people. With modern improvemedts in surgery it is an operation prac tically devoid of danger. Meeting Friday, November 7th, at 7:30 p. m. A colored man, age about 78 years. Nothing of importance in family or per |