Search

War has always been and always will be a great national calamity. The deliberate, legitimate killing of men on the field of battle has remained as a necessary evil and continues to receive the sanction of the most civilized peoples when it becomes necessary to protect the rights of nations, tribes or individuals, and to diffuse liberty and humanity by a contest of arms.Under the influence of modern civilization the legitimate causes for war are becoming less and less from one century to another, and warfare itself more and more humane. The battlefield itself is rapidly losing its barbaric aspects and is assuming the scene of a dignified, manly contest between the armed forces representing the casus belli. Personal ambition, the spirit of revenge, religious fanaticism, individual and national greed, which so often have provoked war in the past, seldom suffice now in inciting nations to a resort to

One of the grave problems of modern warfare is the proper care and nursing of the sick and wounded.Our recent experience during the war with Spain has brought the subject prominently to the attention of the military authorities and the people of the United States. The war just ended has furnished the most instructive and forcible object-lesson, in demonstrating the importance and necessity of making adequate preparation for the proper care and management of the disabled soldiers in war time. The motives which precipitated the war were of the purest, noblest kind, arising from the desire to bring freedom and liberty to the legitimate owners of our neighboring islands, who, under the iron rule of an effete, bankrupt monarchy, had been deprived of their liberty, happiness and prosperity for centuries. On our part, the war spirit was aroused by a sense of duty to our neighbors and to advance

The short, decisive campaign with Spain just ended was characterized, from a medical standpoint, by the smallness of the number of those killed in the field, the prevalence of disease and the large number of deaths from this source. The brilliant victories on land and sea which forced Spain to sue for peace have cost us so far over three thousand lives—less than three hundred from the effects of bullets and over two thousand nine hundred from disease. The number of deaths from disease will be increased materially, as the different military hospitals at home and abroad still contain a large number of our sick, many of whom will succumb to the diseases contracted during the campaign. Even in case the hostilities are not renewed, it is impossible to predict the total loss of life at the present time, to say nothing of the thousands who will never recover the

ERYSIPELOID. Erysipeloid, an acute inflammatory affection of the skin, described by J. Rosenbach, is a disease of the skin not often recognized. It is usually mistaken for erysipelas. The parasite was described by Rosenbach more than ten years ago, but it has never been classified. Attempts to cultivate it have failed so far. This disease is met with usually among persons engaged in the handling of fish and meat, that is, cooks and butchers. It is attended by very slight constitutional disturbances and its local progression is slow as compared with erysipelas. The starting point is generally a finger, where infection takes place through slight surface defects or a puncture. It consists, pathologically speaking, of a subacute inflammation of the lymphatic channels of the skin. The affected skin presents a bluish color instead of the bright red seen in erysipelas. Another and perhaps more important characteristic sign in the differentiation

The American Medical Association was born at the dawn of a great era in the history of medicine. Only a few years before its organization was effected anesthesia, which has robbed the operating room of its greatest terrors, came into general use and at once opened up new fields of usefulness for the surgeon. The new science of bacteriology, upon which is based our modern views regarding the etiology and prevention of disease, has been founded and firmly established since that time. The principles which govern the present treatment of wounds conceived by the immortal Lister and developed to the existing state of perfection by a host of his enthusiastic followers, have revolutionized the practice of surgery during the last quarter of a century. Normal and pathologic microscopic anatomy are recent acquisitions to our knowledge of living tissues in health and disease. Aseptic midwifery is the direct descendent of aseptic

The male genital organs are the seat of as yet imperfectly understood conditions which predispose them to tubercular infection. The literature on tuberculosis of these organs is scanty as compared with tubercular affections of other organs, such as the lungs, pleuræ, peritoneum, lymphatic glands, bones, joints, meninges and skin. A careful search of what has been written on tuberculosis of the male genital organs will convince the searcher for truth and instruction that this subject has not received the attention its importance demands. The observations of many clinicians in this comparatively new field of surgical pathology present no uniform and many times diametrically opposite results. The deductions drawn in the postmortem room by professional pathologists likewise lack uniformity, and the different results obtained have often been taken as a basis to fortify the opinion of individual surgeons. This department of surgical tuberculosis is in its primitive stage and offers many

The University—Over-crowding in the Profession —Doctors and Rich Wives—Nussbaum; his Work-Extirpation of Struma — Ovariotomy — Winckel— Perineo-Plasty—Angerer—Excision of Knee for Tubercular Osteo-Myelitis—Heidelmeyer. DEAR DR. FENGER: —When I arrived in Munich I felt at home, as I attended lectures here during the year 1878. I remained for a whole week, and during this time saw many interesting cases with my former teacher of surgery, Professor Nussbaum, and Professors Winckel and Angerer. The Allgemeine Krankenhaus has undergone no change for the better since I attended before. The University in this city now numbers 1100 medical students. Considering the number of universities in Germany and the large number of students in attendance almost everywhere, it becomes a serious question what is to become of these young men after their graduation. The country is now more than supplied with physicians, and if the increase continues for a number of years in the same

Cicatricial Indications of Scientific Attainments; Their Scientific Aspect—Heidelberg Hospital—Carcinoma of Head of Pancreas—Carcinoma of Face— Riedinger's Method of Resecting the Knee—Schoenborn—Removable Plaster Splint—Sarcoma of Base of Skull—Iodoform—Leube and Naunyn.I left Stuttgart perfectly satisfied with the principal object of my visit, and arrived in the famousUniversity town of Heidelberg April 6. I reached Heidelberg at the wrong time, as Easter vacation had commenced and Prof. Czerny had improved this opportunity for obtaining a much-needed rest by a trip to the French metropolis. I was very anxious to meet Czerny, not only to become personally acquainted with him and to see him operate, but also for the purpose of discussing with him certain topics in intestinal surgery which have engaged my attention for some time, and upon which I knew he could impart more information than any other surgeon.A look at the straggling students that remained during vacation must

Kœberlé; his Methods; Treatment of the Abdominal Wound—Burckhardt—Stab-wound of the Liver— Stab-wound of the Stomach—Extirpation of the Larynx—Empyema of Frontal Sinuses—Antisepsis in Stuttgart Hospitals—Tuberculosis of Bone, Joints and Lymphatics—Peritoneal Sarcoma or Tuberculosis?—Osteotomy for Genu Valgum and Varum: DEAR DR. FENGER : —One of the most interesting men in Strassburg is Dr. Kœberlé. He is 65 years of age, and until recently lived the life of a bachelor in his comfortable and luxuriously furnished house opposite the Allerheiligen Hospital His young and beautiful wife has done her share towards his rejuvenation, and the climax of happiness culminated in the Kœberlé family on the appearance of an heir to the fame and fortune of the distinguished laparotomist. For nearly half a century this faithful worker knew no pleasure outside of his profession, laboring faithfully in the interest of science and for the welfare of his fellow men, and is therefore entitled to

Surgeons of the National Guard, Ladies and Gentlemen: Every good citizen takes a just pride and a deep interest in the safety and prosperity of his country. His patriotism should bear a direct ratio to the degree of freedom and protection he enjoys and the richness of the natural resources within his reach. If freedom, protection, and prosperity are the elements which are productive of patriotism every citizen of the United States is or should be imbued with love and gratitude for his country and ready to defend it in times of danger. It is a great privilege to be a citizen of the greatest country on the face of the earth, and to belong to the most powerful and progressive nation in the world. Our country has taken a place in the front rank among the ruling nations. Its brief history is an unbroken record of unparalleled growth and

The journey from Athens to Constantinople at this time does not reveal anything that would remind the traveler that a war raged so recently between the two countries. The olive trees, which are seen everywhere, are laden with their oily fruits, and the endless vineyards promise a rich harvest of luscious grapes. The patient donkey carries his burden to the market in slow measured steps as though nothing had disturbed so recently the financial prospects and calculations of his master. In the many fatherless houses the dusky black-eyed children sing and play merrily, ignorant of the violent political eruptions which so recently threatened their lives and homes. The great caravans of camels bringing grain, fruit, spices and oil from distant parts of Asia wind their way along the narrow, crooked streets of Smyrna unmindful of the presence of armed soldiers who are arriving daily from the late seat of war.

METHODS OF DRAINAGE. —At present there are three methods of drainage in general use: 1. Tubular drainage. 2. Capillary drainage. 3. A combination of tubular and capillary drainage. All of these methods have their advocates and are applicable under certain circumstances. No one method of drainage will answer in all cases. TUBULAR DRAINAGE. —Tubular drainage is specially indicated in cases in which the abdominal cavity contains pus. The tubes employed are made either of glass or soft rubber. Keith's glass drains answer an excellent purpose in draining the lowest portion of the abdominal cavity. They should be slightly curved at the abdominal end so as to reach the floor of the pelvic cavity without making harmful pressure against the bladder. Frequent aspiration of the contents of the drain is necessary for the purpose of removing the fluid inflammatory product as soon as it is formed. The rubber drain answers the

The war between Greece and Turkey is ended. It was a short and in many respects a remarkable combat. After six or seven conflicts little Greece was conquered by an overpowering foe. In a little more than a month the little kingdom found itself trampled under the feet of a fanatic and greedy conqueror. Fate was against Greece from the beginning of the conflict. The scanty resources of the country made it impossible to maintain an army upon a modern war footing and its citizens, the descendants of the proud and warlike Hellenes, are no longer the equals of their forefathers whose daring exploits and victories have been immortalized in prose and poetry. Centuries of subjugation to foreign power and policies have resulted in a loss of confidence and a diminution in the intrinsic resisting power of the nation that once, under the leadership of great statesmen and warriors, constituted

The successful surgical treatment of peritonitis caused by infective lesions of the appendix vermiformis constitutes the most brilliant chapter of modern aggressive surgery. The surgeons have taught physicians by scientific research, as well as by lessons learned from clinical experience, that peritonitis, in the majority of cases, is a secondary affection, and that its successful treatment depends largely upon the detection and removal of the primary cause. The present large amount of knowledge concerning appendicitis and its complications is largely the result of the work of American surgeons. The European surgeons are slow in accepting the teachings and practice, as developed and promulgated in this country, but in the near future they will have to submit to the most convincing proof—the results of clinical experience. During the last five years so much literature on the surgical treatment of inflammatory affections of the appendix has accumulated that this subject has become

SPANISH HONDURAS. Puerto Cortez, the principal seaport town on the Atlantic side of Spanish Honduras, is reached from Belize by boat in twelve hours. On the downward trip the steamers of the United Fruit Company make a short stop at Port Barrios. The larger part of the voyage is made in what is practically an inland sea made by the numerous islands, or keys, as they are called, situated some distance from the coast, constituting as they do a broken seawall. Port Barrios is a small dilapidated village notwithstanding it is the Atlantic terminus of the Guatemala Railroad. The cornerstone laid for a public building by the late General Barrios remains as he left it, but is beginning to show the effects of the ravages of the elements and the gradual decay of old age. Puerto Cortez is a strange little city, lining as it does the shore for more

There is no subject in pathology and surgery that has been studied with more care and diligence during the last two decades than the carcinoma question. The most intense interest in this subject was awakened with the origin and development of the modern science of bacteriology. As soon as it became known that all inflammatory processes are caused by specific pathogenic micro-organisms, it was natural that by reasoning from analogy the conclusion was reached that carcinoma is a parasitic disease. There are so many similarities between chronic infective diseases, notably tuberculosis and carcinoma, that we can readily appreciate the motives that led to the investigations in all parts of the civilized world concerning the microbic origin of carcinoma. Various methods of tissue staining, cultivation and inoculation experiments have all been utilized by thousands of earnest investigators in their efforts to discover the essential microbic cause of carcinoma. Numerous intracellular and

Nearly five months of continuous service with the army in the camp and field has afforded me an excellent opportunity to make a practical study of the above subject. This time was spent in Camp Tanner, Springfield, Ill.; Camp George H. Thomas, Chickamauga, Ga., and the Cuban campaign, the time being about equally divided in the different places. The first four weeks were occupied in Camp Tanner, where I assisted in the capacity of Surgeon-General of the State in the organization of the State troops. This service brought me into closer contact with the National Guard of our State than at any time before. A physical and professional examination in which I took part brought out the shady as well as the sunny side of their qualifications. The result of my experience here convinced me that the average National Guard surgeon is a faithful doctor, with more than average professional

Two important causes are destined to bring about a radical change in the treatment of gunshot wounds as practiced in the war of the rebellion and as will be taught and advised in the Spanish-American and future wars: 1, the modifications which the weapon and projectile have undergone since that time; 2, the introduction into general practice of aseptic and antiseptic surgery. The diminution in the caliber of the bullet, the metallic jacket, the substitution of smokeless for black powder, the greater velocity and power of penetration of the missile, are conditions and influences which must necessarily modify the character of wounds inflicted with the modern weapon. Volumes have been written on this subject by writers in all countries in which the old weapon has been abandoned and the new one introduced. Numerous experiments have been made on cadavers and animals for the purpose of studying

The title of this paper will probably appear somewhat strange and out of place to the general practitioner and the surgeons who have not kept fully abreast with the great advancements that have been made during the last decade in the diagnosis and surgical treatment of localized lesions of the intestinal tract. Our increased knowledge of the location, nature and clinical tendencies of accessible tubercular affections has opened a wide and fertile field for successful surgical intervention. There is hardly an organ in the body which when the seat of a localized tubercular process has not been exposed and subjected to direct treatment with a fair expectation of removing or limiting the further extension of the disease. The medical treatment of tuberculosis in its various forms at the present time is not much in advance of that of fifty years ago. The numerous specifics invented and vaunted in different

The timely and intelligent application of the modern hemostatic resources enables the surgeon to deal successfully with external hemorrhage, but the treatment of visceral hemorrhage from the large vascular internal organs is by no means a closed chapter. Hemorrhage from wounds of the spleen, liver and kidneys is usually profuse, and is more frequently the result of injury to the parenchyma and veins than to the principal artery or its larger branches; in other words, the loss of blood is more frequently due to parenchymatous and venous than arterial hemorrhage. As a rule, the severity of traumatic hemorrhage of these organs bears a direct relation to the degree of their vascularity. The absence of muscular tissue in these organs is largely responsible for the profuseness of the hemorrhage and the difficulties encountered in attempts to arrest it. The severed vessels do not contract; their lumina remain patent, thus maintaining

The two cases reported in this paper are intended to serve as a contribution to the as yet scanty literature of resection of the cæcum. In complete excision of the cæcum the section on the proximal side of the portion to be removed necessarily falls through the ileum near its junction with the cæcum, while on the distal side the ascending colon is divided transversely, which, after the removal of the cæcum, makes it necessary to unite two bowel ends of unequal lumina if an attempt is made to restore the continuity of the intestinal canal by circular suturing. As the resected end of the colon is at least three times larger than the ileac end, circular suturing is impossible without resorting to some device by which the two lumina are made more nearly alike in size. Two methods have been suggested to accomplish this object: 1. The excision of

Hofstetter—Tuberculosis of Ribs—Kocher—Antisepsis— Kocher's Method of Suturing — Antiseptic Catgut—Struma Operations—Injection of Salt Solution — Tubercular Synovitis of Elbow — Synovial Tuberculosis of Knee—Cavel—Tubercular Implantations in Animals—Julliard—Struma Operation—Hospital Tents. DEAR DR. FENGER: —In Lucerne I visited the Kantonspital, which contains about 80 beds. The surgical wards are in charge of Dr. Hofstetter, a young surgeon of more than average ability. When I called he was just getting ready to remove a carcinoma of the mamma in a lady 76 years old. The tumor was about the size of a pullet's egg, firm, immovable and located at a point corresponding to the right margin of the left breast. The patient had noticed the swelling for several years, but it had given no particular inconvenience until recently, when it became painful and tender; axillary glands not enlarged. As the tumor appeared to be attached firmly to the bony wall of the chest

Formation of Fat and Causes of Obesity—Immediate Coaptation in Compound Fractures—Skin Grafts —Scoliosis in School-children—Hydronephrosis—Antagonism of Germs—University of Basle—Antiseptics —Socin—Fœcal Fistula—Excision of Larynx for Carcinoma— Supra pubic Cystotomy — Volvulus — Intra-glandular Enucleation of Struma—Garrè— Fehling — Hegar — Myo-fibroma Uteri—Colpo-perineorrhaphy—Wiedow—Kraske—Extirpation of High Rectal Cancer—Coxitis—Osteotomy for Rickety Legs. DEAR DR. FENGER: —While in Basle I attended the meetings of the Medical Society of Basle and of the Central Verein; the latter is a National society representing the German Cantons, and has 1,100 members. The Basle Medical Society met the evening before the meeting of the Central Verein, and was attended by many of the visitors. Professor Massini, the President, made a short address and introduced Professor Bunge, who read a paper on "The Formation of Fat in the Body, and the Causes of Obesity," the subject being treated from a strictly scientific and chemical standpoint. He showed clearly that fat

Read in the Section on Surgery and Anatomy of the American Medical Association, May, 1884.The differential diagnosis and operative treatment of tumors of the neck, are subjects which belong to the most imperfect and unsatisfactory topics in surgery. The great difficulties which are often encountered in the diagnosis of cervical tumors, and the importance of the anatomical structures which are involved in all operative procedures for their removal, val, are well known and appreciated by all who can speak from personal experience. One of the most important, and, at the same time, one of the darkest chapters treating of tumors in this region, relates to cystic tumors, and more particularly that variety which originates from congenital defects of development, the matrix being composed of fœtal epiblastic or hypoblastic tissue, which remains in its embryonal state for an indefinite time, and later, by proliferation of its epithelial elements, gives rise

(Concluded from p. 363.) 2. Treatment of Gunshot Wounds of the Stomach and Intestines. The propriety of surgical interference in cases of gunshot wounds of the stomach and intestines will depend on one of two things:1. Dangerous internal haemorrhage.2. Visceral wounds of the stomach or intestines large enough to permit of extravasation and the escape of hydrogen gas on applying the diagnostic test.Alarming intraperitoneal hæmorrhage furnishes an urgent indication for treatment by laparotomy irrespective of the existence of the visceral lesions of the gastro-intestinal canal. In these days of aggressive surgery it would indeed be unjustifiable to permit a patient to die slowly but surely from hæmorrhage from an intra-abdominal wound which in itself is amenable to successful treatment by prompt surgical means.The signs and symptoms of profuse internal hæmorrhage come on soon after the injury has been inflicted, and are so plain and significant

(Continued from p. 320.)Hydrogen Gas Test as Applied in the Diagnosis of Perforating Gunshot Wounds of the Abdomen.I have up to the present time applied this test in over one hundred cases of gunshot wounds of the abdomen intentionally produced in dogs, and in every instance where the stomach or intestine was wounded, the visceral complication was positively diagnosed before the abdomen was opened; hence I have no reason to make any retraction from the claim previously made, that the test is infallible in making a positive differential diagnosis before abdominal section is made, between a simple penetrating gunshot wound of the abdomen and a penetrating wound complicated by visceral wounds of the gastro-intestinal canal.In all these experiments the animal was strapped on one of Pasteur's operating tables, the abdomen shaved, and after the animal was fully under the influence of

The geographic distribution of disease, the study of primitive races, of their climatic conditions, customs, habits and manner of living as etiologic influences, their methods employed in combatting disease and their resources in the treatment of accidents are subjects which can not fail to interest physicians who are concerned in the progress of their profession and the welfare of humanity the world over.My vacation trip this summer brought me in touch with, and afforded me an excellent opportunity to study, one of the most interesting peoples in the world, the Eskimos of the far north, in the very heart of the Arctic region. These people are scattered in small settlements along the northern part of the west coast of Greenland, extending from Upernavik to Etah, a distance of about 600 miles. Etah is the most northern habitation of the Eskimos. It is in latitude 78° 40' N. and is

PREVAILING DISEASES. The average temperature of the inhabited part of the island, which can not be much less than 78 to 80 F., has a relaxing influence on the natives, and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers are not obliged to serve for more than the same length of time, when they are relieved. It is this relaxation which, to a certain extent at least, is responsible for the great mortality of comparatively mild acute infectious diseases and the acuity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes

MR. PRESIDENT AND MEMBERS OF THE AMERICAN MEDICAL ASSOCIATION: —Modern surgery has attained a degree of development which entitles it to the distinction of a science and an art. As a science surgery is of recent date, having been founded and perfected during the last half of the present century. As an art it has been practiced for centuries by our ancestors with credit to themselves and benefit to the injured, the crippled and the sick. When Boyer wrote the introduction to his classic work on surgery he expressed the conviction that surgery had reached perfection. How little did he dream of the great changes that would be wrought in the practice of his cherished profession by the progressive pathologists and surgeons of the next few generations! How innocent and absurd does such a statement appear in the face of the labors of such men as Virchow, Rokitansky, Rindfleisch, Klebs,

Every great operation in surgery has a period of evolution of varying duration. Each marked advance in medicine and surgery is preceded by attempts which led to the elucidation of old ideas or the conception of new ones. All great discoveries are overshadowed by the labors of a host of earnest and progressive workers which ultimately crown the efforts of a favored few. Nearly all of the improvements in medicine and surgery which have characterized the present progressive age are only a repetition of the work of our professional ancestors. Many a so-called modern operation is only a recent and not always an improved edition of the operative technique as devised and described by one of the old masters. These remarks apply with special force to vaginal hysterectomy. The operation of removing the carcinomatous uterus through the vagina, so recently developed to its present state of perfection, was planned and

The wear and tear incident to a large hospital practice, the fatigue following the work during a long college session, and the unrest attending the demands of a progressive and exacting profession made it absolutely necessary for me, this year, to tear myself away from my sphere of activity and transplant myself to some foreign country to seek a much needed mental rest. I selected for this purpose Ireland, Norway and Sweden. It was my object to combine recreation with a study of the clinical advantages to be found in these countries. After an unusually smooth passage of less than seven days, on one of the palatial Cunard ocean greyhounds, I landed at Queenstown Saturday, July 13. At this time of the year, Ireland is at its best, the deep green of the lawns and meadows imparting to the landscape a most pleasing aspect. The stranger here has no difficulty

It has been known for a long time that in exceptional cases an attack of erysipelas has exerted a curative effect on malignant tumors. A number of years ago Billroth reported a case of inoperable sarcoma of the pharynx cured by a severe attack of facial erysipelas. The tumor mass sloughed and the large defect healed rapidly by granulation, leaving a healthy scar upon the site occupied by the tumor. Isolated cases of this kind have been reported from time to time, but the diagnosis was not always established by sufficiently careful clinical observations and microscopic examination of the tumor tissue. The discovery of the microbe of erysipelas by Fehleisen, and the cultivation of the streptococcus upon artificial nutrient media outside of the body enabled investigators to produce erysipelas artificially in the uncomplicated form in man and the lower animals. As soon as it was demonstrated experimentally that simple uncomplicated

AUTOTRANSFUSION. —In threatening danger to life from hemorrhage much can be gained from autotransfusion. The exclusion from the general circulation of unessential parts of the body will often secure for the vital organs an adequate blood supply. Autotransfusion for this purpose is secured promptly and efficiently by elastic constriction of one or more extremities at their base. This can be accomplished by Esmarch's constrictor, suspenders, or in the absence of elastic material, by the use of the Spanish windlass. According to the urgency of the symptoms presented, the base of one or more extremities is constricted after rendering the limb comparatively bloodless by elevation. By exclusion of the circulation from one or more extremities, intravascular pressure compatible with essential functions is restored and life is bridged over for a sufficient length of time for the employment of remedies of more lasting value. SHOCK. —Next to hemorrhage, shock should receive the

At non ingenio quaesitum nomen ab ævo excidet: ingenio stat sine morte decus. (Propertius.)On November third, nineteen hundred, there transpired an event in the city of Chicago unparalleled in the history of medicine. The great banquet hall of the Auditorium Hotel presented an inspiring scene. Four hundred and eighty physicians representing one hundred and thirty-nine medical societies and every section of the country, from Canada to the Gulf and from the Atlantic to the Pacific, were gathered around the festive board in honor of a colleague who. by his pioneer scientific work in this city, had won their esteem and veneration. No participant of that great banquet will ever forget the transactions of that memorable evening. It was a gathering characterized by an unanimity of feeling. Colleagues and students had come to pay their tributes to a master. The occasion was a genuine love feast. The walls of the

CASE 18. —Scanlon, Company K, Third Cavalry, was wounded on the second day of the battle of Santiago. The ball entered the chest through the third rib midclavicular line on the right side, passed downward and backward and escaped in the gluteal region on the same side, after perforating the ilium (Fig. 21). The ball must have passed through the lung, diaphragm and liver. Hemoptysis slight, but distressing nausea, vomiting and pain. Admitted to the hospital ship Relief July 15. At that time he had a constant temperature ranging between 100 and 102 degrees F., vomiting, diarrhea and rapid emaciation. Great pain over the liver and ascending colon. Hemothorax and marked swelling in the region of the liver and abdominal cavity on the right side. Examination of urine negative. Owing to the great debility and pronounced anemia it was not deemed advisable to resort to laparotomy. CASE 19. —Harry Mitchell,

In Cuba our army met as its most formidable enemy one of the most dreaded of all infectious diseases—yellow fever. The Cuban invasion was characterized by hasty action, a lack of organization, and inadequate preparation. The last crippled the medical department and is responsible for the early and extensive outbreak of yellow fever. In less than two weeks after our army landed in Cuba, yellow fever made its appearance, and almost simultaneously attacked the troops from Siboney, the base of invasion, to the trenches before Santiago. In less than two weeks from its appearance nearly 500 fever cases, most of them yellow fever, impaired the fighting force and seriously taxed the limited resources of the medical department. Fortunately for the army, that type of the disease was mild, the number of deaths few as compared with some of the epidemics in the past. Under the circumstances, it was fortunate

The occupation of Cuba and the Philippine Islands by our conquering navy and army in such rapid succession seemed to increase the desire of conquest and opportunities to test the strength of our arms. With the destruction of the weak navy of our enemy there was nothing in the way of sending troops to any of the many Spanish possessions. The fall of the heroic Cervera and his faithful little band, off the harbor of Santiago, before the murderous fire of our wellequipped fleet cleared the pathways of the ocean of further sources of danger. It was but natural that the beautiful island of Porto Rico, one of Spain's most valuable possessions, should have been selected by the military authorities as the next objective point for contention. Repeated attacks by our navy on its best stronghold, San Juan, had failed to bring about surrender and to gain a foothold on

The literature of the surgical treatment of affections in the ileo-cæcal region has been increasing very rapidly during the last few years. A great deal has been said and written concerning the propriety of surgical interference in cases of perforative appendicitis, typhlitis, paratyphlitis and perityphlitis. Post-mortem examination and clinical experience have demonstrated that with few exceptions localized and diffuse peritonitis as well as suppurative inflammation of the connective tissue originating in the ileo-cæcal region, are caused by an antecedent affection of the appendix vermiforniis, which has resulted in perforation or gangrene of that structure. While it cannot be said that unanimity of opinion exists among surgeons in reference to the exact indications for operative treatment in cases of appendicitis and suppurative perityphlitis, it is safe to assert that the majority of them would not hesitate to resort to the knife in every instance where it would be possible to ascertain

The treatment of a fracture of the neck of the femur is always a source of anxiety to the surgeon. In many instances the diagnosis is attended by unusual difficulties and not infrequently a fracture of this kind is overlooked, even after what appears to have been a thorough examination, while at other times, for want of a correct diagnosis, patients have been submitted to a long and debilitating treatment when no fracture existed. Patients suffering from this injury are with few exceptions advanced in years and liable to succumb to complications incident to prolonged confinement in bed. The marantic changes in the tissues of the aged and in persons rendered prematurely old by hereditary or acquired causes are known to be antagonistic to a rapid repair of such an injury, while at the same time the anatomical conditions at the seat of fracture are such as are well calculated