mercy. That you may, in some degree, appreciate what the "other side" is like, I will describe to you as well as I am able, the trip that was mine.

It was growing dark. I was just sitting down to my evening meal, and was rejoicing in the prospect of being able to spend an evening by the cozy fire with my loved ones, when the telephone bell set up its insistent jangle. I was connected with the mine, and found myself in conversation with the shift boss: "Catch the last trip up, and come at once," was his message. Well I knew that the message was urgent. No common accident would have induced the shift boss to telephone me that inclement night. Somewhere in the deep recesses of that immense subterranean burrow lay a man, and, perhaps, several men, moaning out their lives in the darkness. That he was not dead was evidenced by the message. Had he been dead, there had been no call for my services. Humanity dictated that I should go at once. I snatched a few bites of food and drank a hot cup of coffee, then, donning my furs and grasping my emergency bag, plunged into the night. It was snowing as it only can snow here in the higher range. Great white feathery flakes came floating down out of the Stygian gloom, and wrapped the earth in a white pall. The little engine was puffing around the last curve below town on its down trip. I must needs hurry, if I would ride back to the mine on it. When I reached the ore-bins I found the engine stalled, and the day's work completed. They were not going back to the mine again that night. It was possible to get them to run the engine out and take me up, but it would have entailed the unwinding of so many miles of red tape that I resolved to make the journey on foot. Divesting myself of my fur coat and gloves, and slinging my bag over my shoulder, I plunged into the gloom. One by one the lights of the mill glimmered and flickered out. The steady thump of the ore crushers grew fainter and fainter, until there was silence. Such silence as is only known in the mountains when the snow is falling. As I rounded the first curve the electric lights of the town lay far below me, a faint spot of hazy light in the fog of snow, visible, and no more. These, too, soon faded and left me in the immense darkness again. Higher and higher I climbed up the mountain side, until I was above the storm. clouds, and a wintry moon struggled through the haze and lessened the intense darkness. Looking down from my lofty position I could see the snowstorm in great white billowy masses rolling down the narrow valley between the hills. Then, the last mist fled before a night wind that was chill from off the mountain peaks, and the hoary tops of the range sprang into view with startling clearness, as though some gigantic showman had projected them upon a canvas for a Titanic audience. How somber and vast they seemed when viewed thus, and how "pigmy" man by their side-man, who, with his powerful engines of destruction, was tearing great gaunt holes in their sides, burrowing along the mineral veins and extracting the precious ore that had lain there since the beginning of Time.

Miles above the town, upon the bald shoulder of the mountain, perched the powder-house, with its warning legend: "Danger!" I paused to rest, and, resting, reflected, what would be the destructive consequences should some person touch a match to a fuse connected with the tons and tons of Hercules stored in that iron structure. Then I went on to where the track crosses a deep canyon on a flimsy wooden trestle, that seemed ridiculously inadequate to sustain the immense weight that passed over it every day. Again I thought of what would happen should a rail become misplaced. I could hear the gurgling of the waters of the mountain torrent hundreds of feet below, as though they were chuckling at the idea, some day, of the engine and its train of cars plunging into that abyss. On a little way around the curve, and I could see the lights at the ore-bins, glimmering in the distance like stars in an autumn sky. Then the head house loomed gigantic and black out of the darkness. Now, I could hear the steady thump of the air compressor that pumped life into the depths of the mine, and the roar of the smith's forge, and the ring of the beaten metal. At length the mouth of the mine itself yawned, and my journey was all but at an end.

At the entrance of the mine stood several men, their lighted candles flaring in the air-current and lighting up the scene weirdly. Half a mile back in the tunnel lay a man crushed by the falling of half a ton of rock. We must hasten and reach him. In another moment we are seated in an ore-car, and are being rapidly hauled into the tunnel. The tunnel is not direct, but follows the windings of the ore body. By and by we reach a point where the main tunnel branches into a perfect labyrinth of underground streets. I thought how easily a man unacquainted with the work might become hopelessly lost in the maze. Work was going on as though nothing had happened. Far away in the distance sounded the blasts like the report of embattled cannon. It was a battle; a battle with the Titanic forces of Nature. Out of various holes in the rock the laden cars came rumbling toward us, to disappear in the darkness. We reach at last a point where all the tracks seem to come together. I hear the puffing of the hoisting machinery as it labors at winding its long steel cable about the big iron drum. Water from the roof falls over us in a shower. We seat ourselves in the iron cage, the shift boss rings a bell on the wall, and we begin to drop rapidly into darkness. Down, down until it seems as though we are never to reach bottom. The car stops with a bump, and we alight from it and stand upon the floor of one of the lower levels, hundreds of feet from the surface. Another short walk and we are at the scene of the accident. The injured man is lying upon a hastily-improvisedcouch made from the jackets of his fellow workmen. He is moaning with pain. A hasty inspection tells the story. The great weight, in falling, has rolled across his legs in such manner as to crush them out of all semblance to human appendages. To even the uninitiated it is evident that an

amputation is necessary. It is not now the problem of amputation that troubles me so much as that of how to get him to a place where the surgery may be done. Our good old Spencerian copybook told us something about "necessity being the mother of invention." The doctor, out here in the West, without adaptability, is a ship at sea without a rudder. There are no instrument-makers here to whom you can appeal in times of need who will furnish you with something that will just fit your case. No, out here we have to make it ourselves, and what's more, have to know how to make it. There is no doubt that there are many of you who would crack a very superior sort of smile at some of the rough appliances we are compelled to use, but being honest men, you would not smile at the results that we attain, and that's what we are all after-results. In this instance I made, in a very few minutes, a quite efficient set of fracture boxes out of an empty dynamite box. Not very elegant in design, perhaps, but very effective in operation. After immobilizing the limbs, the next problem was to get the man to the surface. This was accomplished by taking a piece of lagging timber two by twenty-two inches, six feet long, and securely strapping the patient to it. Standing the man upright in the "skip," he was hoisted to the upper works and loaded into an orecar. You will appreciate the fact that all this was not done without great pain to the patient, but he never murmured. These men are not of the murmuring kind. Grinding his teeth together to choke back the moan that was endeavoring to escape from his lips, he lay with anxious eyes and watched the manipulations necessary to his transportation, and when his friends hoisted him into the ore "skip," he even smiled as he bade them good-bye. The gray dawn came creeping down the mountain, and the little engine came creeping up at the same time. My patient was lying by the fire in the blacksmith shop mercifully asleep, as the result of an hypodermic. Gently we placed him on the engine and lowered him down the hill, where a conveyance carried him to the hospital. By noon he was lying in his cot in the ward minus two legs, but smiling and cheerful, optimistic in his belief that he would get well, and be out soon. We will leave him in his bed under the care of a white-capped nurse, who will attend him as carefully and lovingly as though he were the heir to millions instead of a poor workman from the grime of the mine.

DISPENSING SYNTHETICS IN TABLET FORM NOT ADVISABLE. Synthetics, such as sulfonal and acetyl-salicylic acid, are commonly administered in tablet form. Dr. W. Cohn, in the Medizinische Klinik. considers this practice objectionable, for he has found that patients void these tablets unchanged, so that they might just as well not have taken them at all. He states that the modern hypnotics act more promptly when administered in powder form, mixed with water.

THE APPENDIX THAT HAS BECOME A FOREIGN BODY.

BY HERMAN E. PEARSE, M. D., Kansas City, Mo.

[Written for the MEDICAL BRIEF.]

When we consdier the question of when to operate upon cases of appendicitis, we are met with answers from two groups of men, and the number of each group is losing to the other constantly. The opinions of men will be changed by added investigation.

One group is convinced that in selected, given cases, delay is the means of lowering the death rate-and lowering the death rate is what we all strive for. The other group is satisfied that delay holds more danger than operation in all cases, and that the lowest mortality is obtained in every case by operation as soon as the diagnosis can be made, and a surgeon found who can do the operation properly.

Without presuming to decide which of these two groups is right, and without even declaring my own position, I submit the following cases and specimens:

Case 1.-Both sides of the appendix are shown (see illustration). Patient was an elderly man, who had had some four or five attacks of appen

A

B

No. 1.

dicitis. At the present attack he did not recover, as had been his custom in the past. but continued from day to day with increased temperature and spreading inflammation. He was brought to the hospital and the abdomen opened. Peritonitis was found that was diffused over the lower one

third of the abdomen, and spreading faster than nature could prepare her defenses. The appendix was successfully removed and the patient recovered. Examination of the illustration shows the following points: At point A, complete line of obliteration. B shows a mass of granulation tissue. It will be noticed, also, that the walls of the appendix approximate one-eighth of an inch in thickness, and that the outer surface shows enlarged vessels, and the various pathological evidences of chronic infectious inflammation. No matter how frequently this man might have recovered from individual attacks, he was sure to continue having such attacks and, sooner or later, one would find him with his resistance enough below par that death could claim him.

Case 2.-This patient was a resident of Kansas City, a stock man. He had had one previous attack of appendicitis, leaving a sore abdomen since

that time. He had been sick with appendicitis about a week when his physician was hastily summoned to find him in collapse, with distended abdomen, thready pulse, cold extremities, exceedingly high temperature, severe vomiting-a picture of rupture and onset of peritonitis. I was telephoned for and had the patient removed at once to St. Luke's Hospital. The abdomen was opened and this specimen removed. (Illustration No. 2.) The very thick walls of the appendix can be observed. At A-B it will be noticed that the lumen of the appendix was interrupted by a hole bored through into the bowel. It is impossible, in considering this specimen, to suppose that such a mass of infiltrated tissue could ever have been absorbed. It would simply cause one attack after another, sure in the end to do what it did in this attack, threaten the man's life.