show exhaustion before giving it, but give it to prevent exhaustion.

In those cases where there is marked emaciation and a tendency to spurious hydrocephalus, active stimulation is the only hope. If that fails to relieve, death must follow.

Thus with tannigen, the ideal intestinal astringent, bismuth the reliable antacid, water the great cleanser, and hydrozone the most potent antiseptic, with strict attention to diet and clothing, we may reasonably expect the majority of our cases to recover.

DISCUSSION ON DR. CLARK'S PAPER.

Dr. J. D. Chason, of Iron City: I have listened to the doctor's paper with a good deal of interest, and I wish to speak in reference to the use of stimulation in entero-colitis in infancy. When I began the use of stimulants in these cases, brandy was considered a good thing as well as whiskey. Whiskey, when it is diluted, is one of the best means we have to prevent nausea, in giving the medicine to an infant in that condition, and also tends to prevent hydrocephalus. Furthermore, in reference to the use of milk, milk may be prepared as a food either by sterilization or by dilution with the cereals or lime water, and it has been my experience that quite a number of cases would take cow's milk in no form or by any means that we have as yet at our disposal, and in this class of cases I have had success with Horlick's malted milk. I have found in a numLer of instances that the casein in cow's milk could not be digested by the stomach of the infant; that when the circulation was feeble hard masses would form and be rejected, while the use of barley-water and stimulant for a day or two would bring the child around so as to tolerate milk. In young infants I would especially recommend Horlick's malted milk.

I think the doctor's suggestion in reference to tannigen

is a good one, although there are quite a number of cases that tannigen will not reach on account of the pain and disturbance of the bowel. In some instances it will cause so much irritation and contraction that a certain amount of opiates has to be given to allay the tenesmus. In doing so I fully appreciate the fact that young infants stand opiates poorly. It is my rule, when I begin the use of opium, to guard it carefully with stimulants in all cases without exception, particularly in young infants. In an infant under six months old I never use an opiate preparation as strong as 10 per cent.; I never use the deodorized tincture at this age; I never use anything stronger than paragoric in those cases. I find, however, that an opiate must be administered in some cases in order to allay the tenesmus of the bowel which keeps up irritation to a certain extent and invites spurious hydrocephalus earlier. I find that the circulation of the infant is so poor that there is danger in the use of opiates unless carefully guarded.

In reference to the time of the year when we have most cases of entero-colitis, I find it to be in April and May, at the change of the spring to the summer, when we have cool nights and hot days. I think cold is as prolific a source of producing the disease as anything we have, yet I readily agree that improper diet for a child whose age is not prepared to receive it is a very fertile source of the trouble.

Dr. Clark (closing the discussion): I desire to say in reference to the tenesmus mentioned by Dr. Chason, that in my paper I could not treat of everything in the twenty minutes allotted to me for the reading of papers I have used a small amount of cocaine as a suppository or as an enema, and I find at will control any tenesmus which may occur in these cases. And so far as the irritating effects of the tannigen is concerned in an inflammatory condition of the bowels, if he gives it in proper doses he will find no irritating effects following its use. While I can conceive that

enongh of the tannigen may be given to set up irritation, yet if administered in suitable doses, together with the solution of hydrozone or peroxide of hydrogen, there will be no necessity of causing any peristalsis or griping.

BLUE PYOKTANIN IN THE TREATMENT OF

INOPERABLE MALIGNANT GROWTHS.

BY HENRY R. SLACK, PH.M., M.D., LAGRAnge, Ga.

There is no disease to which flesh is heir that so appeals to the sympathy of the physician as an inoperable case of cancer. Not even consumption's ghastly form is so dreadful to the patient and hopeless of results to the physician. The suffering from tuberculosis is almost invariably buoyed up by an ever-present but delusive hope that "as soon as I get rid of this heavy cold I will be all right”; but the poor cancer patient is bereft of hope. He sees the vulture, Prometheus-like, feeding upon his vitals, but has little hope of Hercules coming to the rescue.

Now, what are we to do in such cases? To dismiss them because we cannot promise cures would be inhuman and cowardly, for,

The paths of pain are thine, go forth

With healing and with hope,

The suffering of a sin-sick earth

Shall give thee ample scope."

These patients should be treated on the same principles as those unfortunate beings afflicted with chronic nephritis, consumption or any other disease recognized as incurable.

When the surgeon admits that his knife can promise no hope, we should bring to bear upon the case every other means to make it yield to scientific treatment. Even though we may not effect a permanent cure, if we can alleviate the excruciating pains, restore hope, and prolong life, make it more tolerable, we perform a duty worthy of our

high calling and receive alike the gratitude of our patient and his friends; to say nothing of that highest of rewards, the approval of our conscience that comes from a knowledge of duty faithfully discharged.

Since the work of Professor von Mosetig of Vienna and Dr. Willy Meyer of New York with pyoktanin, Dr. Coley by the inoculation of erysipelas and others, we labor "not as those who have no hope."

In January, 1891, Professor von Mosetig presented a very instructive paper entitled "A Contribution to the Treatment of Inoperable Malignant Growths" to the Vienna Society of Physicians, reporting on his experience with blue pyoktanin in such cases. Shortly after (April 25, 1891) appeared an article from Dr. Willy Meyer in the Medical Record, "Notes on the Effect of the Aniline Dyes, Especially Blue Pyoktanin, in the Treatment of Inoperable Malignant Growths." Dr. Meyer also has another article on the same subject in the Annals of Surgery for November, 1893. Here I wish to acknowledge my obligations to Dr. Meyer for kindly furnishing me his valuable reprints and a list of the literature on this subject.

Billioth, true to his instincts as a great surgeon, had little faith in the use of pyoktanin, and did not believe it had any specific influence whatever. He claimed that it was merely the water forcibly pressed into the tissues made them swell and unable to live. He reported three of his patients got worse under its use and one died of sepsis.

Fortunately von Mosetig and Dr. Willy Meyer had better success, and my experience agrees with theirs, as a report of the following cases will show:

Case 1.-October 21, 1896, J. E. C., aged forty-three, white, male, farmer. Father died of cancer. Complains of sore throat and difficulty in swallowing for the last two months. Examination showed a neoplasm size of hickorynut on the dorsum of the tongue a little left of the median