discussed other points. If I had been talking altogether to a body of pathologists, I would have gone into the pathology of the appendix, but I thought it would be interesting to confine the few remarks I might make on this subject to certain practical points in which the practitioner is interested.

Dr. Elliot asks about opium. I do not hesitate to give morphia if a patient is suffering. I do not have the slightest hesitancy in doing so either before or after operation. It is altogether wrong, of course, according to the dietum of some people. It is just exactly how you use opium and other remedies. I think to give salts in a case of fulminating appendicitis would be wrong. It would only add to the trouble. To give salts after suppuration has taken place would be mischievous. To give saline purgatives during the period of lull in an ordinary case of appendicitis is very valuable. I intend to keep that up. Therefore, it is according to circumstances. Get a case suffering with appendicitis; the patient rolling in agony on the floor or bed, it being difficult to restrain him. That patient may die unless relief is afforded, and a subcutaneous injection or a small dose of morphia will do good. The dose should be small. The cry is never to give morphia. One surgeon said that milk and morphia after laparotomy means death. Well, I give them both, and my results are usually good. I operated on a child five years of age who had suppurative appendicitis. After the operation I put in a drainage-tube, and also used gauze drainage. I only put in one stitch. I wanted complete drainage. The little patient rolled over in bed and did what he pleased. When I entered the room I found the nurse holding him, saying that she could not manage him at all. I gave him the sixteenth of a grain of morphia, and after that time the little fellow went on and got well. I stopped the frightful pain the child had.

Dr. Richardson quotes from Mr. Treves on appendicitis. I would ask him to tell me the date of that book.

Dr. Richardson: The 1895 edition, Doctor. Dr. McGuire: That is for appendicitis a good while ago, doctor. Mr. Treves has written very extensively on the subject, and I do not believe he has written anything I have not read. He has had two or three papers in the British Medical Journal lately on the subject. I believe he has operated oftener than any other man in England. When cases of appendicitis need an operation, they need it badly. I will give you an illustration of the urgency of operation.

I was called to see a man in Richmond only three or four weeks ago who was the son of the Professor of Surgery of Yale, who, you know, is one of the first surgeons in the land. A young doctor asked me to see the patient, saying he was very ill; that he had appendicitis; that he did not care to take the responsibility of the case, and asked me to operate for him. The patient had been freely purged and yet the symptoms did not abate. Purging had been radically done, yet the symptoms continued just as if no purging or any other depletion has been resorted to. His pulse was not good, very much like what we used to call the abdominal pulse. His temperature was 99. It was two o'clock in the day. The young gentleman received a telegram from his father to the effect that he would be in Richmond at 7 o'clock that evening. I think most surgeons would feel justified in waiting or delaying operation until the father had arrived. But I decided to operate at once, and as an excuse for the operation I did what I always do in removing the appendix; I clamped it with a pair of artery forceps just above where I cut it off so as to prevent any matter from the appendix escaping into the belly cavity. After I clamped it and cut it off, I said I would keep it in the forceps and show it to the father when he came,

and that would be a sufficient explanation for the urgency of the operation and for not waiting for him. The appendix was gangrenous. The young man got well.

Here was a case that would not admit of delay. The temperature was only 99, but there was tenderness and muscular tension over the appendix, and he had all the symptoms in his face of a man mortally ill.

But take another case. I will take the case of a girl who was brought into my hospital with a temperature of 102 1-2, delirious, belly swollen and tympanitic. She was nearly dead. It would bring surgery into disrepute by operating on such a case as this. I therefore gave her a big enema of salts, glycerine and turpentine, threw it with a long tube high up in the bowel, and it acted promptly. After that I gave her a dose of morphia. She was so much better after this was done that I waited a week before I operated on her and by that time the symptoms had nearly all subsided. So it is hard to lay down any fast rule and lines by which any of us can be governed in these cases.

With reference to the operation, I do not believe that anybody ever died from the operation for appendicitis if it was tolerably well done. I am sure nobody will die in the hands of an experienced gynecologists, particularly one aecustomed to doing abdominal surgery, merely from the operation. It is the sepsis that is present before the operation that kills the patient and not the operation per se. The operation itself adds hardly anything to the danger.

A little boy, aged twelve, was brought to me four days before I left home, from Charlotte, N. C., by Dr. Faison. He was taken with a violent pain in the region of the appendix three days before. The first day his temperature was 104, pulse 120, constipation insuperable. This was Monday morning. This condition continued all day Monday, but Tuesday he got a little better. Wednesday the boy grew worse again, and was brought to my hospital

profoundly comatose. pulse 150. I opened the abdomen, found the appendix and removed it, and for the first time in my life I found a foreign body in this organ. This was a little piece of apple skin, rolled up and stuck in the appendix. Besides the apple skin there was a small bit of fecal matter. The tip of the organ was swollen hard, there was no suppuration. There was really very little evidence of inflammation, certainly not enough to account for the violent symptoms, and in my mind there is a question of how much the nervous system has to do with all of this. More I expect than we know of. The little boy, a few hours after the operation, had his bowels move spontaneously, and when I left home he was getting well.

His temperature then was 103,

I am very much obliged to you gentlemen for your great kindness and attention.

AN ACT TO CREATE A COMMISSIONER OF HEALTH AND DRAINAGE FOR THE STATE OF GEORGIA.

BY J. C. LEHARDY, M.D., SAVANNAH, GA.

Mr. President and Fellow Members of the State Medical Association:

GENTLEMEN:-I offer to-day, for your consideration and discussion, the following draft of an act to be presented to the next legislature, entitled:

An Act to create a Commissioner of Health and Drainage for the protection of life and the preservation of health, and the prevention of disease, in the State of Georgia.

Section 1. Whereas, The interests of the people of this commonwealth require the enactment of some law for the preservation of the public health and for the thorough drainage of malaria-laden lands and swamps; therefore be it

Resolved, By the General Assembly of the State of Georgia, that within thirty days after the passage of this act, the Governor shall appoint a Commissioner of Health and of Drainage for a term of four years, who shall be a physician of skill and experience, the graduate of a chartered school of medicine in good repute, and who shall be indorsed by the State Medical Association, who shall have control of all matters pertaining to public health in the State, and who shall supervise the drainage of lands and of swamps, whenever the use of convict labor is called for by the authorities of any county in the State and the same is granted by the Governor thereof.

Section 2. There shall be provided in the capitol of the