The grave and often, I believe, fatal anemia that Bothriocephalus latus induces in its hosts sometimes, should not be forgotten. It would, naturally, be expected to occur in the ranks of our numerous and always increasing European tourists. I think that Leidy showed that our northern rivers' highly-prized shad are at times its intermediary host.

I shall close by citing from the records of the War Department a unique case,- one of Bilharzia disease, which I trust will serve as an incentive to every one here not to neglect his microscope, and to do always his day's work well. The reporter is Dr. G. W. Daywalt, a North Carolinian, who graduated in 1884 at the Medical Department of the University of Tennessee; and the wanderlust that our late differences with Spain inspired in him, is now being gratified by contract army medical service. 'FORT ST. PHILIP, LOUISIANA, May, 1904.

"Bilharzia Hæmatobia. Philip Plummer, age 48, was born in Louisiana, about six miles from the Fort. He has always lived here, was never out of the state. He was a canal and ditch digger up to seven years ago, and hunted alligators at night, often in muddy water for hours up to waist, and when very thirsty drank marsh water. I first saw patient last October. Family history negative; mother living, age 75, health good. He had dysentery thirteen years ago; became chronic, lasting for about four years; but finally was cured and remained in perfect health for four years. In October, seven years ago, he was taken with severe pains in lumbar region, lasting two or three hours, generally at night. He has not been well since, and has had as many diagnoses of different diseases as physicians seen. Sometimes for months he would feel fairly well, but then the pains would suddenly return, and leave him greatly exhausted.

"When I saw him he had had the night before a severe attack of pains in left lumbar region, radiating to the iliac region and even affecting the left testicle. I found small calculi, oxalate of lime, in urine. I diagnosed renal calculi, and put him on piperazin and iron tonics, and he was much improved. I did not see him after December. April 20 he reported again, having

had another severe attack. A sample of bloody urine was shown. With microscope I found the ova bilharzia hem. in abundance; when put in water they soon assumed the stellate form.

"I induced him to come to the hospital May 12, but he would only remain three days, it being 'too lonesome.' I have made a number of examinations and always after an attack of pain find ova. Patient is anemic; hemoglobin forty per cent.; marked eosinophilosis, with some megaloblasts, otherwise blood is normal. Oxalate of lime predominates in his urine, with traces of albumen. He is still under observation and seems to be improving under urotropin (.5 gram night and morning) and gelsemium (F. E. .5 c. c., t. i. d.), and on iron tonics (pyro-phos, with pepsin) after eating. So far as I know, it is the first case observed in the United States.

[Signed]

"G. W. DAYWALT, M. D.”

5

I think this case of much more than curious interest. Not so much, perhaps, because of indigenous infection with bilharzia, which has, I believe, been observed in home-keeping Englishmen, but more as a commentary upon our inexaggerable national carelessness about matters which would seem to demand the very greatest of care. To cite an analagous case, Dr. Smith has detailed his finding this parasite at Atlanta in numerous members of the Boer War Contingent that visited the World's Fair at St. Louis, remaining in this country for more than a year. Further, he pointed out that "salted" horses (id est, horses affected mildly with trypanosomiasis, and unlikely to die of it), accompanied this show. Yet, in our anxiety to avoid its importation into this country from the Philippines, we forbid the importation thence of all animals whatsoever. It may be interesting to note that we Americans probably introduced trypanosomiasis (otherwise called surra, etc.) into the Philippines from India; my own unsupported opinion is that this was done by importing animals for army use and by efforts to improve the stock-raising industry there. A chief surgeon then on duty there told me that, up to that time (1902), all animals but men and chickens (Plato's featherless bipeds) had died of it; and it has since been proved to be fatal to the former.

It may not be amiss to note here that a Missourian made the diagnosis of trypanosomiasis in the Philippines. I refer to Dr. J. J. Kinyoun, now director of Mulford's vaccine and serum laboratories at Glenolden, Pa.

In concluding this inexact paper, Mr. President, and Members of the Middle Tennessee Medical Association, I beg leave to tender you my sincere and most hearty thanks for the honor of your invitation.

BIBLIOGRAPHY:

Medical Record (correspondence), 1897; 2 'Animal Parasites and Messmates,' - Appleton's "Science Series;" "American Medicine,' May 27, 1905; also the 'Ladies' Home Journal,' March, 1906, p. 6: “An Address Delivered before the Association of American Physicians, and Published in American Medicine, and Here Abridged for Publication"; 'Aequanimites,' p. 360; American Medicine, 1905.

OSTEO-SARCOMA OF THE LOWER JAW; WITH REPORT OF A CASE.*

BY DUNCAN EVE, M. D., OF NASHVILLE.

EXCISION of the lower jaw or a portion of the same, has become a frequent operation since its introduction in 1810 by Dr. W. H. Deaderick, a Tennessean.

The external incision should be made in such a manner as to avoid the unsightly appearance resulting from a large and exposed scar. For this purpose, when it is designed to remove one half the bone, the line of incision should, as a general rule, be made along its base from the zygomatic process, about three fourths of an inch in front of the ear, to the chin, and thence some distance up the chin, or even as high up as the vermilion border of the lip. Treves' advice is to carry this incision down to the bone, except at the point of the facial artery, at which location it must go through the skin only. The facial artery is now to be sought for, tied in two places, and divided. When the tumor is of immense size, two incisions are sometimes required, so *Read at the Seventy-Third Annual Meeting of the Tennessee State Medical Association, at Memphis, Tenn., April, 1906.

as to include an elliptical portion of the soft parts; but, unless this is the case or the skin be seriously involved in the disease, not a particle of integument should be sacrificed; for during the healing process there is usually great contraction of the tissues, and therefore if this precaution be neglected, great deformity will be the consequence. By making the perpendicular incision in front of the ear, there is little danger of wounding the temporal or external carotid arteries and the trunk of the portio-dura. Sometimes when the disarticulation is effected with difficulty, a short horizontal cut, just below the zygomatic process, will be of advantage. The duct of Steno should always be avoided, as it readily may be by being careful not to carry the scalpel too high up or far forward.

In severing the soft parts from their connections behind, the tongue must be firmly held, otherwise its support being lost, it might fall back into the throat and suffocate the patient. A ligature or silver wire should afterward be passed through this organ and secured to the dressings, where it should be retained until the tendency to retraction has ceased by the formation of new attachments, which usually takes place in five or six days from the time of the operation.

With a Gigli wire saw, the bone should be divided, after pulling a tooth at the interior limits of the morbid mass, which greatly expedites not only the process of disarticulation, but the separation of the jaw from its muscular and mucous connections, as it enables the operator, by seizing its anterior extremity to draw the bone outward. So that the mylo-hyoid insertion is cut, the internal pterygoid muscle is cut or the periosteum at this spot is lifted, and the inferior dental artery is divided and tied.

One of the most important circumstances to be observed in excision of the lower jaw, is to keep in close contact with the morbid structure, and yet sufficiently away from it to prevent any portion of it from being left behind. Two great ends are thus attained, the easy removal of the mass by a neat and rapid dissection, and the ordinary avoidance of hemorrhage.

In liberating the coronoid and condyloid processes, a sharp periosteotome or bone gouge will be found of great advantage,

as either instrument combines the principles of a lever with a knife. The body and ramus of the jaw being detached from their connections, the periosteotome or gouge is insinuated beneath the fibrous covering of the coronoid process, and after separating the same for some distance, the bone is prized out. The insertion

of the temporal muscle and the external pterygoid muscle, in some cases, will be found hard to sever. Finally the capsule of the joint is opened, and the bone is separated from the ligaments, which should be cut. The whole procedure is the work of only a few minutes, and its great advantage is the ordinary freedom from the danger of hemorrhage. When these processes with their investing structures are perfectly sound, the separation must be effected, at least in part, with the scalpel or scissors, but even then the periosteotome or gouge will afford valuable aid.

After all bleeding has been arrested, the wound is sutured, a tube is introduced in the posterior portion of the wound and retained for twenty-four hours. Antiseptic dressings are held in position by a Gibson or Barton bandage.

The gap which is left by the operation is often filled up, especially in young subjects, by a fibrinous or cartilaginous formation, which, while it serves to support the jaw in mastication, also assists materially in re-establishing the symmetry of the features. Even when as much as one half of the bone has been removed, nature sometimes succeeds most admirably in her object.

Excision of the lower jaw affords very favorable results. Of 419 cases tabulated by Prof. O. Weber, only eighty-three, or twenty per cent. died. Of these, 246 were excisions in continuity, with forty-six deaths; of 153 disarticulations of one half of the bone, 117 recovered; and of twenty extirpations of the entire lower jaw, only one died.

I take pleasure in reporting the following interesting case of osteo-sarcoma of the lower jaw:

Lucinda Oliver, colored, of Perry County, this state, consulted me last September, informing me that the tumor she presented on the right side of her lower jaw was first noticed about nine months previously, and that she had advised with several physicians, who proposed its removal; to which at first she was un