ity. The results were perfect. The use of the wire, however, seemed awkward. The lead plates and wire twisted over them, seemed undesirable; a discomfort to the patient, and capable of producing considerable traumatism upon removal. The writer therefore sought to devise a substitute for the lead plates. Lead wires were covered with rubber tubing. This pliable cylinder seemed ideal as a material, over which to tie the retaining suture, which material was celluloid linen; it being waterproof, renders it less likely to become septic. The first case to present itself for operation was a lad of 13, who had a complete cleft of both hard and soft palate. The lip had been rather imperfectly resorted in infancy, the nose and lip were, therefore, improved by an operation, and at the same time, a convergent squint was corrected. Adenoids, which are always present in these old cases, were also removed at this seance. At the subsequent operation upon his palate two weeks later, the edges of the cleft were split, and nothing trimmed away. Considerable separation of muco-periosteal flaps from the palate bones was necessary to allow of closure of the hard palate. The soft palate could be brought together after separating the plataonasal covering off the hard palate. The uvula was united to its end. Now, instead of taking of the tension by the customary incisions, or by chiselling off the hamular processes, as recommended by Billroth, three double sutures of the Pagenstecher, were passed one-half inch from the suture line, by means of a full curved needle. The lead cylinder was placed in the loops on one side, and the sutures were tied over another cylinder on the other side. The purpose was fulfilled admirably, having furnished ample support as intended. On the fourth day, however, the cylinders came out, but the union was not disturbed, the result having been perfect throughout. The principle being established, we have since decided that buttons may take the place of the cylinders; they cannot get away. Can be even more readily used and their removal will be most readily accomplished. (Jan. 1st. The buttons have been used in three cases with perfect results.) We feel assured that lead and wire can be dispensed with; which will save time. The mouth will not be encumbered with this, somewhat, crude appliance and the removal will be easily accomplished without traumatism. The writer wishes to assert his opinion, however, that part of the success is due to the practice of splitting instead of trimming the edges of the soft palate. This enables the operator to suture and approximate the surfaces accurately, before the retention sutures are placed. Great advantages has been experienced by the use of Crile's method of anesthesia, which consists in introducing the ether by means of rubber tubes in the nostrils, extending to the epiglottis. The previously cocainized pharynx being packed with gauze. The ether is administered through a funnel filled with gauze. The funnel joined by a large tube and Y to the smaller tubes in the nostrils. Care should be taken to avoid hypersaturation of the gauze, which would allow liquid ether to find its way into the larynx. By holding the funnel upside down this can be readily avoided. The advantages of Crile's method are apparent; but must be experienced to be fully appreciated. The anesthesia is continuous and no coughing when anesthesia is complete. The anncyance from hemcrrhage is minimized. The operation shortened. Shock and hemorrhage neces sarily lessened, and the operation is made less disagreeable and trying to the operator. Text-books are not up-to-date on the subject of cleft palate. More especially on the time for operation. It should always be performed before talking is begun; and it may be sucessfully and safely performed in the first weeks of life. PUZZLE OF LIFE. Homer Clark Bennett, M. D., Lima, Ohio. Human life's a puzzle, Try with all our might, Ignorance is corpulent, Knowledge mighty slim, Weaknesses are plenty, Passion 's in the van-guard, Thorns among the roses, Principle 's a jade. Knockers crowd the front rows, Boosters all sit back, Vices come so easy, Virtue 's on the rack. Temperance is "fogy", Money bags are heavy, Preaching 's fine in theory, Influence is powerful, Merit gets the axe. Wonder why is this thus, Human life's a puzzle, Solve it if you can. Medical Association of the Southwest OFFICERS AND COMMITTEES: President, C. M. Rosser, Dallas, Texas. EXECUTIVE COMMITTEE. For Arkansas: C. E. Hurley, Bentonville: E. -Oklahoma: A. L. Blesh, Guthrie; Leroy Young, OFFICERS OF SECTIONS. GENERAL MEDICINE: President, S. C. James, SURGERY: President, Jabez N. Jackson, Kansas First meeting at Oklahoma City, October 29, 30, 1906 Papers read before the Section on Diseases of the Eye, Nose and Throat. Chairman: Dr. H. L. Alkire, Topeka, Kas. Ear, Secretary: Dr. Z. N. Short, Hot Springs, Ark. ADDRESS. H. L. Alkire, M. D., Topeka, Kan. Chairman Section Eye, Ear, Nose and Throat. ENTLEMEN: When the secretary asked me to prepare an address for this section, to be read at this time, I thought a few words along the line of medical organization would be in harmony with the cause which prompted you to gather here. Believing every gentleman present to be familiar with what has been done and what is being done toward more efficient medical organization. My remarks will be very brief. If I understand this important question it has a two-fold object: The first is, a higher and better development of the science and art of medicine. The second is to give better protection to the life and health of the people. Any action to secure conditions so important, ought to receive the hearty support of every honest practitioner of medicine and of every loyal American citizen. Organization being the first step in any great and successful effort of a people, the medical profession must become thoroughly organized. The plan of organization is to recognize the American Medical Association as the central organization; to divide the United States into six or eight districts, and have in each a district society, and in each state to have a State society, district and county societies. Such an arrangement, I believe, will be sufficient, if the membership is active, to carry an influence for good into every part of the United States. To conform with this idea Texas, Arkansas, Oklahoma, Missouri and Kansas have joined in the formation of the Medical Association of the Southwest. This society to be in purpose and in function a district society of the American Medical Association. Believing these states to be the best states in the best country on earth I also believe the medical profession in these states be of the best. I believe in the near future this society will be one of the strongest and best associations on earth. I am sure it will if each member will appoint himself a committee of one to make it the best. How is this organization to benefit the members of this section; those who are limiting their practice to the diseases of the eye, ear, nose and throat? 1st. To associate together in a truly fraternal manner, strive to lay aside the jealousy; which like germs of infection, are to be found in every climate, and where found are antagonistic to a healthy condition; culti vate the bond of good fellowship, which tend to draw men closer together, and to make them living examples of a brotherhood which teaches, that each is mortal and like mortals has in him the elements of honor, the inspiration of ambition and the courage of hope; has his periods of darkness and of sunshine; that words of counsel from a brother practitioner, or of cheer fom a friend increases the sunshine and lessens the darkness. 2d. By having careful report of cases and logical discussions of the cases reported, well written essays, and original research. How is medical organization to benefit the people? 1. By better preparing us to do our work of relieving them when afflicted, but more especially to advance preventive medicine. The people must be educated before they can appreciate what the medical profession is doing to improve the conditions of the citizens and of the nation. I know of no better way than to invite persons from every profession and trade to attend our meetings and hear papers on preventive medicine. Especially should we try to interest and to educate the represenatives of the press, and through them reach the people. Before the press can render the desired assistance the editors must learn that to publish the skill and wonderful cures of the advertising doc. tor, or the patent medicine vendor, makes him, the editor, a party to the crime committed. For it is a crime to take advantage of the sick or afflicted. He should also learn that sensational publicity of operations and cures are of no value to the public or the doctor. The courses of study in our schools and colleges need to be revised to meet the requirements of health. At present the way of education is too well marked by the eye troubles, nerve disorders and disease. The shop, office and factory need to be arranged to better protect the inmates. I Many are the benefits which should come through efficient medical organization. No doubt each of you have in mind a long list of them. will not take more of your time for we have many valuable papers which all want to hear. ADENOIDS. F. Vinsonhaler, M. D., Little Rock, Ark. T is not the intention of the writer to discuss the most interesting subject of adenoids except from the standpoint of treatment. It is assumed that all are familar with their symptoms, diagnosis and pathology, at least there can be little opportunity for controversy upon those points. Upon the question of anesthesia, however, the most varied ideas are entertained. Killian, one of the most celebrated of continental authorities, operates without an anesthetic, and he has considerable following among the prominent American authorities, among them Gradle and Loeb. The majority of operators in this country and in England favor a general anesthetic, but are unable to agree as to which one should be used. Cassellberry operates with nitrous oxide and oxygen. Bishop uses bromide of ethyl; Schmidt condemns it and reports five deaths from its use. Birkett prefers ether. Knight in an elaborate discussion upon this very point reaches the conclusion that gas and ether are by far the fastest. Kyle, of Philadelphia, while admitting the danger of chlorofrm prefers it in the hands of a competent man. Coakley gives chloroform under six years of age, and ether in patients over six; exactly why he does not state. Mayer prefers gas and ether. Dr. Hcvell, who is regarded as one of the most conscientious of English surgeons, uses gas and ether, and sometimes chloroform after ether when it is necessary to prolong the anesthesia. Dr. Hewitt, who administers anesthetics in these cases exclusively, expresses a preference for gas and ether. In the south I find it to be the custom almost universal to give chloroform in adenoid operations. There can be no question but that is an ideal anesthetic in so far as the objections to the other anesthetics apply, the freedom from nausea, the ease with which children go under it, the absence of pharyngeal congestion and mucus. The small amount of hemor rhage render its use especially acceptable. There is one fatal objection, children die and one never knows when trouble is to come. Death usually occurs during the administration of the anesthetic and before operative procedures have begun. The fact that the child has taken chloroform began without accident does not insure against a fatal termination. The writer knows of one where chloroform was administered for a minor operation safely, later upon being administered for an adenoid operation death ensued before operative procedures were begun. Knight truthfully says that the death list from chloroform in adenoids has grown to such proportions that we can no longer ignore its dangers. Those visiting Gray's Inn Road in London on adenoid day are familiar with the use of somnoform in that place, when sometimes as many as thirty anesthesias take place in succession, and in all somnoform is administered. Somnoform is a mixture of chloride and bromide of ethyl, and so far as experience goes no better than chloride of ethyl, and not a bit safer. Deaths are on record against all of them; the latest estimate of their safety place them midway between chloroform and ether. The advantages they possess are many-the short period of anesthesia, absence of nau |