pressure method of Sauerbruch, with the employment of a special operating chamber, etc., was too expensive and too cumbersome to be used where the scene of operation had to be shifted from place to place. His method of positive-pressure operating is to blow compressed air into the lungs through the mouth, but this must be done gently. It has been said that all of the positive-pressure methods lead to dangerous results, because of bad effect upon the circulation. Yet experimental work upon dogs, with the thoracic cavity open, with exact estimation of blood pressure, showed no changes. The pulmonary pressure showed no change. In the presence of open wounds of the chest, with air compression there is no change in the blood pressure. This seemed to dissipate this erroneous idea. He spoke particularly of one experiment, where oxygen was introduced through a thoracotomy wound by means of a catheter, with both thoracic cavities open, and the animal was kept alive over one hour. This has, likewise, been proven by simply allowing air to enter through the catheter, with both sides of the chest open, with no bad results. He said that the results obtained by experimental work, and by actual operations upon the human subject, with positive pressure, showed that circulatory disturbances do not occur, and neither does embolism. When vomiting occurs, there is a chest mask for application to the chest.

He advocated the use of rectal anesthesia in operating upon these

cases.

Samuel Robinson, of Boston, then gave another paper on the positivepressure method of operating in intrapulmonary surgery. He said the difficulties of operating in this region may be laid at the door of a rigid operating wall (the chest), and the deep-seated position of the viscera. He expressed the opinion that better results are obtained upon the human subject during the course of actual operations than are obtained in experimental surgery upon dogs. He claimed that it is a mistake to believe that dogs are less susceptible to infection than man.

He called attention to Janeway's explanation of the occurrence so frequently of infection after operations upon the oesophagus as due to seepage or leakage from suction, in negative-pressure operations. He then discussed the prime indications for operations upon the oesophagus, which are stricture of the oesophagus, carcinoma of the lower end of the œsophagus, diverticula of the oesophagus, and foreign bodies in the sophagus. A special operation has been devised by Green for suturing the divided ends of the oesophagus after operation, something like the Murphy button. Ether is always used in these operations. The ether vapor is always warmed before entering the mouth. The speaker said that he always went through the eighth costal space, opening the diaghragm from above, pulling the cardiac end of the stomach through the diaphragmatic opening, after which the operation is performed and the button applied.

THE SUTURING OF BLOOD VESSELS.

An important discussion before the surgical section was the work of Alexis Carrel, of New York, and C. C. Guthrie, of St. Louis, upon bloodvessel surgery. They showed that the substitution of a segment of artery or vein for fresh arterial or venous segment taken from another animal is successful. When a segment of a vein is shifted into an artery, the vein readily adapts itself to its new arterial function. A cat, whose segment of vena cava was grafted onto the abdominal aorta, lived for nine months, during which time its circulation was, apparently, normal. If a segment of an artery or vein from man or dog is transplanted into a dog or cat, the result will be excellent. They showed the possibility of utilizing this experimental work in practical surgery by keeping vessels removed from living animals or fresh cadavers, and keeping them for several weeks. in sterile, sealed tubes, at a temperature slightly above freezing. They demonstrated that a spleen has been successfully removed and transplanted into another animal. A thigh can be taken from a fresh cadaver and substituted for the thigh of another dog. Dr. Carrel recently attracted attention by connecting the blood vessels in the arm of Dr. Adrian Lambert, of Columbia University, to the leg of his infant daughter, and by induced circulation of healthy blood enabled her to recover from a supposedly-fatal hemorrhage.

A NEED FOR MORE THOROUGH STUDY OF MENTAL THERAPY.

Dr. Oliver Osborne, of New Haven, Conn., urged that a part of the training of the ministers of the gospel should be a study of medicine. He criticized the extremes to which the adherents of mental healing have carried their claims. He said, in his paper before the section of pharmacology, "every minister should be given a course in pathology before being given charge of the care of training of the human mind. We all of us approve, to an extent, the theory of the influence of the mind over disease. Psycho-therapeutic instruction should be a part of the course of study of every medical school. The administration of drugs now forms but a small part of the treatment of disease. But I do believe it is time to refute the theory that Nature is a good physician, and that everything should be left to her care. We must assist Nature."

GERMS CARRIED BY THE HEALTHY,

Dr. Myer S. Cohen, of Philadelphia, in his address before the section of hygiene, said that diphtheria germs are distributed widely by apparently healthy people, and that this disease will always remain common as long as these healthy "carriers" are allowed to mingle with other persons. He cited many instances to prove this assertion. He recommended the clinical examination of all exposed to diphtheria, and their isolation until it is

made certain that they are no longer carrying the Klebs-Loeffler bacilli around with them. He said, among other things, "reliance is placed by both the public and the profession upon the precautions adopted by the health department, whether efficient and sufficient or insufficient. Consequently, a false sense of security is often imparted. Of no disease is this so true as of diphtheria. When, after recovery from this disease, the sanitary officials disinfect a house and remove the placard, all danger of infection is believed to be at an end. That articles infected by diphtheria patients may transmit the disease to others, all seem to recognize."

THE CANCER PROBLEM.

Dr. George W. Crile, of Cleveland, before the surgical section, gave strong basis for the hope that cancer may be cured. Tests are being made which contemplate the forming of a group of "human cancer immunes," whose blood, transfused into the veins of sufferers from the disease, will work a cure as effective as that of antitoxin for diphtheria. Methods by which transplanted sarcoma in dogs have been cured were described by Crile. The cured animals became immune, and were successfully employed for curing other dogs and rendered them immune. Six human subjects, upon whom Crile has been working with this method, are showing some favorable symptoms of improvement. Sixteen months have now elapsed since the first case was put under this treatment. We can use these cases as an argument upon which to form a final judgment. Should they be cured and become immune, it is probable that they will become available for curing others, so that eventually a group of human immunes may be established. The whole matter of immunizing against cancer is at this time still in an experimental stage, and the statements made by Crile must be taken accordingly. Immunity in dogs was produced by the growth of a transplanted tumor. Its complete disappearance under treatment followed. The speaker estimated that there were 80,000 cases of cancer in the United States. There are possibly 1,000,000 cases in the world. According to statistics, one woman in eight who reaches her thirty-fifth year becomes the victim and dies of cancer. When operated upon, according to the highest standards of surgery of the present day, the favorable group of cases show a three-year cure in approximately 80% of cases. Dr. Rudolph Matas, chairman of the surgical section, characterized Dr. Crile's address as a "message of hope to the world."

FOREST SCHOOL A CONSUMPTION CURE.

Dr. Alexander McAllister, of Camden, N. J., in an address before the section on pediatrics, advocated forest schools for tubercular children, like the famous Waldschule of the Germans, and open-air life, where Nature has made the air purest. He would go to the extreme in his treatment of this disease. Live discussion followed his paper, but he

would not recede from his position. School life under the trees, preferably without roof or tent, comfortable seats and desks, if necessary, but nothing to keep the breezes from the pallid cheeks of city children, was the radical reform in education proposed. With this scheme in operation, the speaker thought the disease could be stamped out. Sunshine and fresh air were the only medicines necessary. This municipally-supported public school proposed by McAllister would take children from their homes as soon as the springtime weather came. He would keep them in the fresh air of the country twenty-four hours of the day. Books and slates would not be thrown aside. Not only would the pupils be benefited, but also the teachers, who are often equally in need of fresh-air treatment for tuberculosis. Teachers, broken down in the school room by drudgery and unsanitary conditions following poor ventilation, would find it a boon to their health. The speaker said that he did not believe the scheme would be adopted without bitter opposition, but that it is the only salvation of the nation. Fully 150,000 persons die every year in the United States of tuberculosis. It has been shown that consumption appears in the incipient or prephysical stage in children between the ages of one and five years. This stage may not develop into a full-blown case until adult years begin. Children born in a family with a tubercular history ought to be given the benefit of a forest school education. Dr. McAllister showed that it is practically impossible to give the open-air treatment at home. Houses are not constructed for the giving of open-air treatment. The average sleeping room is merely a bed room, with windows for ventilation. The fresh air must necessarily be cold air. To dress and undress in this cold air is dangerous, and produces diseases which militate in favor of tuberculosis rather than aid in the fight against it.

THE THYROID AND THE PARA-THYROID BODIES.

Dr. Herman Tuholske, of St. Louis, discussed the surgery of the thyroid and the para-thyroid bodies before the surgical section. He said that there is a belief that these bodies are essential to life. There is a claim that these bodies differ from each other anatomically, embryologically and histologically. Death follows removal of the para-thyroid bodies in cats, but this death can be prevented by feeding them beef para-thyroids. There are usually four para-thyroids in man. The speaker carefully reviewed the literature upon this subject. The original part of the paper was the plan of operation proposed: to ligate the thyroid veins, in order to produce increased pressure, along the line of the "stauungshyperemie" of Bier. This increased blood pressure means transudation of plasma within and without the body of the para-thyroid. This crowds the cells together, and the so-called "vagrant cells," which are harmful and the least fit to live, die. This, then, lessens the size of the gland.

In the discussion of this paper, Dr. Chas. Mayo, of Rochester, Minn., said that we are now learning more and more about these bodies. We must consider that all these glands, the thyroid, the para-thyroid, the thymus, and even the pineal gland, have definite functions. The parathyroid bodies seem to have a function of their own in controlling the equilibrium of the nervous system. Mayo said that he had removed many para-thyroid glands without any trouble following. He called attention to the fact that disorders connected with these bodies have been considered by every specialist in medicine as their very own. For instance, the neurologist considered them nervous diseases, and treated them by rest. The enterologist considered them stomach diseases, on account of the diarrhea, putting them on a light diet, etc. And so on down the line. This dispute is all because of the absence of eye-symptoms in these cases. When the eye-symptoms appear, they all say, "Oh, well, I could have made a diagnosis had the eye-symptoms been present." Mayo recommended the gradual ligation of the arteries of the thyroid gland. In his own operations there were 94% improvements. He emphasized the fact that many of these cases are treated so long by the internal medical men that the surgical fraternity has to shoulder the high mortality, whereas it should go to the medical side.

TUBERCULOSIS OF THE FEMALE GENITALIA.

One of the most striking utterances heard at any section meeting of the association was the statement of Professor A. Martin, of Berlin, before the section on obstetrics and gynecology, that 24% of all cases of pyosalpinx are tubercular, proven by laboratory methods. He emphasized the importance of carefully scrutinizing all tissues, etc., removed during tubal operations, all uterine scrapings, in fact, for he maintained that many cases are erroneously diagnosed for something else, when, in reality, they are cases of tuberculosis. He called attention to the importance of closely examining all pus tubes for tubercles and tubercle bacilli.

MALIGNANT GROWTHS DEVELOPING IN OPERATION WOUNDS.

Dr. I. S. Stone, of Washington, D. C., read an interesting paper under this caption. He said that surgical wounds are sometimes infected by carcinoma because of lowered resistance. He said that the recurrence of cancer in a cicatrix after vaginal hysterectomy is due either to incomplete operation or immediate return in the incision from direct infection. In certain cases recurrence is first seen in suture tracts, while in others both tuberculosis and cancer may develop in the abdominal incision before secondary union of wound surfaces has been accomplished. He emphasized the importance of taking every precaution to prevent immediate infection in all operations for malignant disease. All sloughing