stomach will not tolerate any form of medicine the high enemas should be at once instituted and repeated every two hours until results are obtained. Some times, I am sorry to say, it is all in vain, for we sometimes fail to get the results, then it is a bad day for the patient and also for the doctor, but fortunately the majority of cases do yield to the treatment I have outlined. The time during which a patient should be kept in bed varies of course considerably, not only in different operations, but in different patients upon whom the same kind of operations have been performed. It seems that it is a general custom to keep all patients in bed much longer than is necessary, but as no hard and fast rule can be laid down to suit every case, the discretion of the surgeon must decide the practice in each individual case. All that can positively be said is, that provided all symptoms are favorable and good union of the wound, the abdomen may be well strapped with adhesive strips transversely. To give additional support the patient may be allowed to sit up in an easy chair at the end of two weeks. Patients who have always been strong and accustomed to plenty of exercise up to the time of their operation, two weeks in bed seems to them a very long time. The sooner they can sit up or get out of bed with perfect safety, the better. But the condition that interests me most and what I desire to call your attention to is the extreme nausea that sometimes progresses to a condition of reverse peristalsis and stercoracious vomiting, and the gaseous distension of the stomach that we sometimes see on the second or third day after an operation that I have already mentioned and briefly outlined the treatment. I am, therefore, very anxious to hear from other members of the profession who have had a great deal more experience with this line of work.

Report of a Case of Recurrent Diphtheria.*

BY W. G. HARRIS, M. D., PLANO, TEXAS.

GENTLEMEN: I wish to report two cases of Recurrent Diphtheria. On January 23d of this year I was called to see a little boy, Mack by name, three years and four months old, fairly well grown for his age, with rather a large head and a mind beyond his years. Always with an anemic appearance, whose skin is of that transparent kind, and who might be termed of a strenuous diathesis and nervous temperament.

*Read before the North Texas District Medical Association, December, 1905.

On this day I found him with a temperature of 1021, pulse 150160, respiration somewhat increased, and complaining of soreness and stiffness of his neck, which was swollen, more especially on the left below the angle of the jaw, and on either side were enlarged glands. Bowels were constipated; buccal mucous membrane red and saliva dribbling from the corners of mouth, tonsils swollen and very red, which looked like tonsilitis. Treatment at this time consisted in half grain calomel every two hours until bowels moved well, which took four grains. One-sixth grain of calcium sulphide in one teaspoonful of water every hour, and antiphlogistine to swollen neck.

On the next day patient was about the same-neck swollen hardly so much, but there were whitish spots on the tonsils. Then a spray of hydrogen peroxid, cinnamon, water, and aqueous extract of Hamamelis, equal parts, was used every two or three hours, and the calcium sulphide was given every hour when the spray was not used.

Consultation was called, and we agreed that the patient seemed to have a typical case of follicular tonsilitis.

On the third day the patient's nose bled, spots on tonsils began to coalesce, so I gave 2000 units of antitoxin and sprayed throat every hour through the day and every two hours through the night -stopped calcium sulphide.

On the morning of the fourth day there was membrane on right arch of soft palate, tonsils and uvula. Gave 3000 units of antitoxin and in the afternoon the membrane began to come away from the soft palate, right tonsil and uvula, but within a few hours began to reform on right tonsil. I then gave 2000 units more.

On the fifth day there was about the same condition as the night before, so I injected 2000 units more, making in all 9000 units, when he began to convalesce.

The precaution was taken to burn all cloths used about his mouth and nose as soon as used, and sputum was burned each time immediately after spraying the throat. The linoleum on the floor. was thoroughly washed with a solution of bichloride of mercury 1 to 500. Everything that could not be boiled was burned, and the room fumigated with formaldehyde.

Everything went well until February 21st, when he was taken sick very similar to January 23d, although his tonsils had been sprayed three times a day in the interim. February 22, I administered 3000 units anti-toxin-used a spray as in previous attack. On February 23 he received 2000 and 1000 units of anti-toxin. A little membrane formed this time on the tonsils only, and in a few

days he was convalescing. Until February 28th we have heard nothing from baby brother 20 months old, who has been kept in the next room with his mother. This morning he is sick with all symptoms of diphtheria. He gets 500 units of anti-toxin in his back, and his throat is sprayed. In a few days he is well.

On April 10th, thirty-eight days from the beginning of the last attack Mack was for the third time taken sick. Made a microscopic examination of swab from his tonsils, finding Klebes-Loeffler Bacilli plentiful. He got 2000 units of anti-toxin and his tonsils sprayed as in previous attack. No membrane formed this time, and in few days he was up.

On April 30th, just two months, the baby was taken sick for the second time. Microscope showed Klebes-Loeffler bacilli very numerous. He took 3000 units of anti-toxin, with some improvement; May 1st, 2000 more; used spray every two hours during the attack as well as three times a day between attacks. No membrane formed this time, and in a few days he was well.

May 2d, only twenty-two days had elapsed from the previous attack when Mack came down for the fourth time. Made microscopic examination and behold, the Klebes-Loeffler bacilli were more numerous than ever. Within two hours from the time he was taken sick he had 2000 units of anti-toxin in his back.

May 3d his condition was no better. He got 3000 more units, and no membrane had yet been formed. On May 4th membrane began to form on both tonsils, and he got another 3000 units of anti-toxin. On May 5th I gave still another 3000. On May 6th injected 2000 in the morning and 3000 in the evening. May 7th he received only 2000 units. May 8th, in the morning, 2000, and, in the evening, 3000 units were injected, having given during this attack 23,000 units of anti-toxin. The membrane now began to give way, but very slowly, and it was two weeks before all was gone, although his tonsils were sprayed every hour or two day and night. He now made a slow convalescence. The parents now moved a couple of blocks to a relative's who had no children, while the house was repapered, where they remained for several weeks with decided benefit to the children's general health.

Seeing that the shortest period between attacks was twenty-two days, I now determined to give anti-toxin about every three weeks as a prophylaxis as long as the bacilli could be found in the children's throats.

On May 19th the microscope showed bacilli in baby's throat, and he got 1000 units for his trouble.

May 29th, bacilli still in Mack's throat, and he kicked when 1000 units was put in his back.

June 9th, still bacilli in baby's throat, and he took 500 units. June 19th, Mack got the regular dose of 1000 units.

June 20th, baby was taken with a severe spell of dysentery, which lasted two weeks.

July 1st, no diphtheria bacilli to be found in the baby's throat. July 11th, bacilli still to be found in Mack's tonsils, although he seems well, so he got a prophylactic dose of 1000 units.

July 13th, 13-that unlucky number! Mack piled up in bed again. Microscope showed diphtheria bacilli numerous. 3000 units were put between his scapulae, and his little brother got 500, just for luck, although there were no bacilli in his throat.

July 14th, Mack absorbed 4000 units more of anti-toxin. July 15th, Mack much better, and he made a rapid recovery. August 2d, Mack's tonsils still contained Klebes-Loeffler, so said. microscope, so in went another 2000 units, that caused considerable inflammation of the skin at the site of injection, which subsided in twenty-four hours. Mack had now taken 52,000 units of antitoxin. During the first and fourth attacks there was a little dermatitis. There was not at any time any albumen in either of the children's urine. In all of the attacks Mack took strychnine arsenate, gr. 1/134, every three or four hours and three times a day for the greater part of the time between attacks.

Since August 2d there has not been found any diphtheria bacilli in either of the children's throats, and they are in better health than before.

Between attacks the children's throats were sprayed two or three times a day with equal parts hydrogen peroxide, cinnamon water and aqueous extract of Hamamelis, until in July, when we began the use of Alphozone, 1 to 500, mopped on the tonsils two or three times a day.

The rooms were fumigated after each attack by burning sulphur, except the first, which was formaldehyde.

Did the wet spring have anything to do with the tenaciousness of the bacilli ?

Were the children's throats over-treated?

Did the children get enough anti-toxin, or too much?
Gentlemen, it is up to you for criticism.

Society Notes.

Meeting of the American International Congress on Tuberculosis Held in New York City, Novem

ber 14, 15 and 16, 1906.

The opening ceremonies of this Congress were held at the Hotel Astor on the morning of November 14, 1906. The meeting was called to order by Judge Clark Bell of New York City, and the ceremonies were opened by prayer by the Rev. Dr. Jefferson, which was followed by an address of welcome on behalf of the Hon. Clark Bell as president of the Medico-Legal Society, who briefly referred to the history of the organization, active interest taken by the United States government in its meetings and interest shown this Congress by the Hon. Elihu Root in sending invitations to all countries of the western hemisphere having diplomatic relations with the United States. He referred to the active interest taken in the success of the society by the Medico-Legal Society of New York City, and closed his remarks with extending hospitalities of the city of New York to the various delegates from the various countries of the western hemisphere and reminding them of the great work and responsibility resting upon their shoulders in their great philanthropic work for the prevention of this fearful disease.

He next introduced Dr. A. N. Bell of Brooklyn, New York, the distinguished editor of The Sanitarian for twenty-five years and the first president of this Congress, who came at the age of 84 years to deliver an address of welcome on the part of the medical profession. Dr. Bell spoke feelingly of the great work that confronts the philanthropists of the world who deal with the tuberculosis problem and made the assertion that the reduction in the percentage of deaths from tuberculosis had been reduced from 18 to 36 per cent since the year 1881 by work being done by organizations of this character. Dr. A. N. Bell's remarks were spoken feelingly and from the heart and he was warmly applauded by his colleagues and the delegates at large.

Dr. F. E. Daniel of Austin, Texas, the active president of the Congress, was next introduced and delivered his masterly address as the active president of the Association, which was received most enthusiastically and with applause from time to time throughout his delivery.

The next business declared to be in order was to call delegates. The chair first introduced the delegate from Equador, Senor Don