from gastric ulcer. With this spur to activity the field is being clearly divided into two camps, those who believe in surgical interference and those who prescribe diet and dope for the patient. The extremest of the surgical camp may claim that the only proper treatment of ulcer is surgical, while the most positive of the internists may and do say that medicine alone is sufficient for these cases. It is undoubtedly true that gastric ulcer is much more common than some or even most practitioners believe and that some and perhaps many indurated ulcers may be best treated by extirpation of the mass, while, on the other hand it is doubtless unquestionable that surgical success is more doubtful in the case where the ulcer is minute and the edges are not indurated and where indeed it may be difficult to find the ulcer.

The field of surgery in this condition is yet to be clearly defined and while operation may not and probably will not be a cure for all these cases, yet earlier surgical interference than is now the custom may prove much more successful than is now believed. The improved methods of gastro-enterostomy, especially as evolved by the Mayos, has given more nearly the same success that is attained in operating farther down the digestive tract.

In operations on the gall bladder there has come a tendency toward the oblation of that organ where disease of it demands any surgical interference.

That the results in some operations may be fully as good when the gall bladder is removed as when drained there can be no doubt. The lessened period of convalescence and the freedom from adhesions cannot, however, be expected in every case. Operations on the pancreas and spleen must remain few in number till better indications and methods have become established than now prevail. This is a field where gradually there may come a more extensive demand for surgical interference.

Although there is still considerable written about appendicits, there is little that is new or of real progress to be reported to this body, which believes to a man in the early interference in all cases which are really worthy to be designated as appendicitis.

The surgery of the prostate is still a matter of much interest and discussion. I believe that much of the success of all the work done on this organ is because of the impetus gained toward earlier operation, and that when the best methods are employed it will not be one but the one adapted to the case in hand. In this connection I cannot refrain from recalling that I was privileged to call the attention of this society many years ago to the possible success of operation in perforation in typhoid. This seems each year to be more and more the practice of the profession as a whole and as was then expressed in response to a query by Dr. Lougee the earlier the interference the better the prospect of success. The little that is new in surgery of the extremities had best come from the orthopaedists, who, as I see, have a prominent place on the programme for the afternoon, and can speak for them

selves. In closing let us call attention to two points which are generally conceded in regard to the dread condition known as cancer.. The first of these is that continued irritation is a prolific cause of the disease and hence tumors, scars and growths are more prone to become cancerous than healthy tissue. The other is that in most, if not all cases, cancer is at first a local disease. The deductions to be obtained from these facts are easily drawn and mean simply more early operations with a larger degree of success. The cause of cancer is not demonstrated, and yet we are coming nearer to that discovery and in the quarter of a century since I began my medical studies we have seen marked advance in the care of these conditions.

CREMATION AND INHUMATION BOTH PROCESSES OF OXIDATION.-How does cremation differ in its essentials from inhumation? The one is a slow and the other a rapid process of oxidation, a simpler, surer, purer manner of rendering ashes to ashes, dust to dust, a sweeter, cleaner process of rosy heat instead of festering corruption, which may, through wells and springs, bring disease to the living. It is true it is not a common method, and it is said to be not in accordance with the Scriptures and with orthodox teaching, but so-called orthodoxy is not longer considered infallible, and the number of advocates of cremation among clergymen, philanthropists, educators and even tender women, who prefer this to any other disposal of our mortal remains, is constantly increasing. When one has seen the speedy, clean process of disposing of the body by modern methods of cremation, he rarely fails to become converted to it.-Knopf, Journal of the A. M. A., January 26, 1907.

THE INDEX MEDICUS.-The Index Medicus was established in 1879 and discontinued in 1899 on account of insufficient support. In 1903 it was re-established and still continues, although not receiving the encouragement that it should. Formerly the price was $25 a year, but the last series has been reduced to $5, the remaining cost being provided by the Carnegie Institution of Washington. By this means it was hoped to bring the publication into more geenral circulation. This has apparently failed and unless more support is received in the immediate future, the publication will be discontinued. As this is a most valuable series to the medical world, it is hoped that more physicians may be induced to assist in its survival.

Protrusion of large hemorrhoidal veins at the anus.
Anus irritated, corroded, with watery diarrhea.

SUBJECTIVE.

Rectum and anus.

Tenesmus in the rectum.

Feeling in the rectum and anus as if something twisted and turned in a circle; as of something trickling down there; as if a screw were boring up and down. The rectum and still more the anus, feels as if compressed or pinched together; as if worms were there; at the same time an easy stool.

Shooting, constructive pain in the anus while faeces passed. Peculiar creeping, tickling in the anus and in less degree in the rectum.

Burning pain in the anus and pain in the back during stool.
Contractive spasm in the rectum.

Disagreeable drawing in the stomach.

Pressure, tension, pricking in the abdomen.

Rumbling in the bowels before stool.

Drawing pain from the umbilicus down the right side while straining at stool.

Back:

Pain in the sacrum and kidneys.

Pain in the lumbar vertebrae extending to the sacrum.

Accompaniments:

Tenesmus of the bladder.

Frequent desire to urinate.

Pain in the penis while urinating.

Frequent urination, but quantity not more than normal.
Mucus in the urine.

Stool:

Fruitless efforts to defecate.

Unsatisfactory.

Constipation; tardy habitual daily stool is omitted for two or

three days, there being no desire.

Hard, small lumps, with much effort.
Dry and dark green; greenish black.
Copious and soft; thin, bright yellow.

Soft and brown; yellow, consistent, easy.

Very hard and black, requiring whole force of abdominal muscles to expel them.

Loose, preceded by colic.

Scanty, light brown and, though soft, expelled with much straining.

Entirely of blood and membranous shreds.

Early, yellowish-brown, mixed with black spots.

Slimy stool, with ascarides.

Drug Characteristics:

Anaemia.

Therapeutic Indications:

We must not assume that ferrum is a remedy for disease conditions that are primarily rectal. It has some marked rectal symptoms, but they will be found secondary to other and constitutional troubles, although the local symptoms may be the chief source of discomfort to the patient. We sometimes get hemorrhages from the rectum in the early stages of anæmia, and here ferrum will be called for, and it will cure the rectal bleeding because it restores the blood to its normal condition. Believing that here iron is a food rather than a dynamic remedy I give it in small but material doses.

We often find that an urinic condition is secondary to the hemorrhoidal. The direct result of the loss of blood. Then the hemorrhoids may best be cured by operation, or some other remedy, and ferrum be called upon to establish the cure through its profound action on the blood and the entire circulatory apparatus.

OBJECTIVE.

FLUORIC ACID.

Hydrofluoric Acid. H. F. L.

Small light carmine-red blood-vessels, resembling little flesh warts. Under strong and steady pressure the blood disappears, but immediately returns. These are on the chest, arms and face.

SUBJECTIVE.

Rectum and anus.

Feels as if wind were retained in the anus.

Abdomen:

Shooting pain in the bowels as from wind.

Back:

Aching in sacrum, with jerking sensation.
Pain under scapulae and in lumbar region.

Deep-seated pain in left lumbar..

Accompaniments:

Frequent urination.

Dull pain in region of bladder before and after urinating.

Urine offensive odor.

Moist palms of the hands.

Stool:

Evacuations protracted, insufficient and lumpy.

Hard stool.

Diarrhea, with umbilical pain.

Therapeutic Indications:

While this drug has not been extensively used in the treatment of rectal diseases, its pathogenesis, as far as it is known, gives it an important place in the treatment of venous conditions. The provings made of it are meagre. My attention was first called to it, some years ago, by J. C. Burnett, in his book, "The Medicinal Treatment of Diseases of the Veins." He speaks with great assurance of it in the treatment of varicose veins in any part of the body. Richard Hughes said of it, "Varicose veins have shrunk to half their size." Through these suggestions, rather than the symptomatic indications, I have used it in the treatment of hemorrhoids with good results. If indicating symptoms are sought for they will be constitutional rather than local.

Its producing elevated and distended blood vessels on the skin suggest its homeopathicity to internal hemorrhoids, that bleed. readily but present no large, well-defined tumors, and especially in the aged and poorly nourished. I think it should not be used lower than the sixth dilution, and I like the tenth.

GRAPHITES.

OBJECTIVE.

Large and painful hemorrhoidal veins.

Fissures, painful, burning..

Subjective.

Rectum and anus.

Tenesmus and stitches in the rectum with hard stool.

Burning in the rectum.

Smarting in the rectum with bloody stools.

Bearing down and burning in the rectum and anus.

Stitching pain in the rectum and anus.

Dull, tearing, lancinating pain from the anus upwards.

Cutting in the anus.

Itching and sore feeling in the anus.

Feeling as if the anus were swollen.

Prolapsus recti, even when there is no desire for stool, as if the

sphincters had become paralyzed.

Smarting and sore feeling around the anus.

Great itching and stinging in the anus.