The following is an abstract of the principal papers:

A REPORT OF PROCTOLOGIC LITERATURE FROM MARCH, 1914, TO MARCH, 1915.

By Samuel T. Earle, M.D., of Baltimore, Md.

In this review of Proctologic Literature, Dr. Earle quotes freely from the following authors, giving the salient points from each of their papers:

Chas. H. Mayo, M.D., Rochester, Minn., (Surgery, Gynecology, and Obstetrics, Vol. XVIII, April, 1914, No. 4, page 401), "Resection of the Rectum for Cancer with Preservation of the Sphincter."

Daniel Fiske Jones, M.D., Boston, Mass., (Boston Med. and Surg. Journal, Vol. CLXXI, July-Dec., 1914), "Cancer of the Rectum."

Joseph Weiner, M.D., New York City, N. Y., "A New Operation for Stricture of the Rectum or Sigmoid."

P. Lockhart Mummery, F.R.C.S. Eng., London, Eng., (The Lancet, Vol. 1, 1914), “Pain After Operation for Internal Piles, and Its Prevention."

P. Lockhart Mummery, F.R.C.S., Eng., and M. K. Joshi, M.R.C.S. Eng., L.R.C.P., London, ( The Lancet, Feb., 13, 1915), "Death from Strangulated Hemorrhoids."

E. Palier, M.D., New York City, N. Y., (New York Medical Journal, Jan. 23, 1915), "Hemorrhoids and Hyperchlorhydria."

Chas. Gordon Heyd, M.D., New York City, N. Y., (Surgery, Gynecology and Obstetrics, 1914), "A Procedure for the Repair of Accidental Injuries to the Rectum."

RECTAL PROLAPSE AND ITS MECHANICS.

By Wm. M. Beach, M.D., of Pittsburgh, Pa.

The terms prolapse and procidentia are interchangable as applied to a dislocated rectum downward on account of defective anchorage.

Dr. Beach feels assured that many of the victims of dyschezia could give a history of prolapsus in childhood.

He states that we are coming to think of prolapsus in terms of hernia, the verity of which must be determined from a consideration of the pelvic fascia and intra-abdominal pressure. He gives in detail the anatomical reasons for the causation of rectal prolapse.

Under the head of treatment he states that a number of surgical procedures have been devised and advocated for the restoration of the dislocated rectum; that they have seemed to succeed for a time, only to prove a failure later on. He mentions several of the procedures and gives his reasons for and against their employment. He gives also his operation of choice.

CAUSE OF DISSATISFACTION WITH HEMORRHOIDAL OPERATIONS. By Rollin H. Barnes, M.D., of St. Louis, Mo. The reason for dissatisfaction with the textbook methods in the operative treatment of hemorrhoids, is that they are based upon the fear of hemorrhage, and that pace has not been kept with modern surgical knowledge in regard to the control of this hemorrhage.

It is easier to take care of primary hemorrhage than of secondary bleeding such as may occur from a slough following the ligature or the clamp and cautery operation, because the surgeon is not always at hand when the latter

occurs.

In the methods of Dr. J. Rawson Pennington, (A. P. A. Trans., 1914), and the author, (A. P. A. Trans., 1912), a clean excision of the hemorrhoid is done, so that it requires only controlling the primary hemorrhage, for there is no slough. The tissues are injured as little as possible so that they will retain the greatest amount of resistance against infection. There is less pain in these open methods for we do not have the "confined infection" which is especially caused by the use of sutures and by injuries to the deeper tissues.

For the control of hemorrhage the author advocates the use of pressure. Also care should be taken of the bleeding vessel itself rather than a ligature should be tied around a mass of bleeding tissues, or that they should be cauterized. He also advocates that advantage be taken of that muscular contraction which can be secured to the greatest extent by minimizing trauma. The rectal plug acts against this muscular contraction.

The author opposes the customary purgation in the preparation of the patient before operation. He prefers the cold enema as a means to clean out the lower bowel. He contends that the daily enema in the after-treatment does not result in constipating the patient but rather aids in securing regularity of bowel action.

REPORT OF CASE OF CARCINOMA OF THE SIGMOID: WITH STEREORADIOGRAMS.

By Walter I. LeFevre, M.D., of Cleveland, Ohio.

Patient, male, age 55 years. Suffered with abdominal pain in the left iliac fossa for one and a half years. Complained of constipation, becoming gradually worse until a natural passage was impossible. Use of enemas resorted to but difficult to retain.

Stereo-roentgenogram made by injecting Barium Sulphate emulsion (consisting of Barium Sulphate 6 oz., Pulv. Gum Tragacanth, 2 drams, Aqua, 40 oz.) This would start to be expelled when about 10 oz. was injected, but by repeated efforts 30 oz. was finally injected and retained long enough to get the pictures. Some of the emulsion passed to the upper end of the ascending colon; the transverse colon was filled; the descending partially filled; the sigmoid and rectum entirely filled. The pictures show the sigmoid loop bound down in the pelvis and almost occluded. Operation confirmed the findings. Condition hopeless. Patient died.

EMETIN HYDROCHLORIDE IN THE TREATMENT OF AMEBIC

DYSENTERY.

By Geo. B. Evans, M.D., of Dayton, Ohio.

Amebic dysentery is epidemic in tropical regions. It may become endemic by importation. Although various authors have contributed to a very comprehensive knowledge of the disease, there still exists considerable confusion in the interpretation of those symptoms and signs which make for accurate diagnosis and prognosis.

Dysentery may persist for months or years after the amebic ulcerations have been healed, without amebiasis being present. It may exist in a mild or severe form.

A positive diagnosis can only be made by the aid of the microscope. The smears should be taken preferably from the ulcerations on the free border of the rectal valves.

The author believes that treatment by irrigation is a thing of the past. It has been supplanted by emetine hydrochloride hypodermically.

Diet and rest are very important in treatment.

The conclusions are that what quinine is to malaria, and mercury to syphilis, emetine hydrochloride, hypodermically, is to amebiasis.

THE PRESENT STATUS OF LOCAL ANESTHESIA IN THE SURGERY OF THE LOWER BOWEL.

By Louis J. Hirschman, M.D., of Detroit, Mich. Nowhere has the real value of local anesthesia been demonstrated more conclusively than in entero-proctologic surgery.

Dr. Hirschman employs local anesthesia in the surgical treatment of the majority of his cases of anal and rectal diseases, as well as in a small proportion of cases involving surgery of the colon. The results in both classes of surgical operations have been so satisfactory to both the patient and the surgeon that the author advocates with great earnest

ness the further employment of local anesthesia not only in the field of intestinal surgery but also in every branch of surgical activity where absolute unconsciousness of the patient is not a strict necessity.

The technique which Dr. Hirschman uses in his ano-rectal operations and in his work on the colon is given in detail.

WHICH IS THE BEST ANESTHESIA TO BE USED IN ANAL AND RECTAL SURGERY.

By Wm. H. Kiger, M.D., of Los Angeles, Cal.

Dr. Kiger was prompted to write this paper on seeing a statement in a recently published book on "Diseases of the Rectum and Colon" which read, "Spinal anesthesia has a very limited field of usefullness. Indeed one is hardly ever justified in using it in rectal work."

After a personal experience in over five hundred rectal operations without a single unpleasant result, the writer of this paper is constrained to differ from the text-book author, and is forced to the opinion that the latter has not given spinal anesthesia a fair trial, or that he, mayhaps, did not use the proper agents.

Dr. Kiger calls attention to the ease of administration of spinal anesthesia; that it may be given without the assistance of an expert anesthetist; that it saves time by doing away with the delay incident to an operation under a general anesthetic; that by its use the dangers of chloroform and ether are eliminated, as are also their after effects; that when it is employed there is no need to dilate the sphincters as all the operator has to do is to ask the patient to strain and the gut will easily protrude through the relaxed sphincters; and finally that it avoids shock.

He uses novocain or tropococain and gives in detail his technique for spinal anesthesia.