town and has enforced a general cleaning up of houses and other buildings. as well as of streets and public places. At the time of American occupation the deaths in Santiago numbered 103 a day, but after three weeks of General Wood's rule they had been reduced to 37 a day.

The Hotel Victory at Put-in-Bay during August had an epidemic of smallpox among the colored waiters. The number of cases being variously reported from 8 to 27. Up to the present writing the epidemic has not spread, which is somewhat surprising as an attempt was made for evident commerical reasons to suppress the fact of the outbreak and a number of guests and of employes were enabled to scatter over the state before a quarantine was established. The cases are all reported to have been mild.

Excuse has been made for the criminal lack of preparation for the care of the wounded shown by the Army in Cuba by pointing out the difficulties of transportation of supplies. It is well to remember that not a single surgeon of the volunteers in the corps in the south could at the close of the war say truthfully that his equipment was complete. They were told that they must not ask for their equipment! Moldy, worm-eaten operating cases which had not been touched since the Civil War were issued to them! of transportation facilities will not explain insufficient supplies of both drugs and instruments at the home camps. The lack of organization and efficiency in all the branches of the War Department which have to do with the handling of army supplies of all kinds has been such as to make every American citizen blush for very shame.

Lack

Dr. W. D. Johnson, Coronor of this County, whose term of office began January 1 this year died in Lakeside hospital August 21 of appendicitis. His was a malignant case, running its course to the fatal termination from Wednesday afternoon to 2:30 o'clock Sunday morning and being only temporarily benefited by an operation for its relief done at Lakeside Hospital Thursday afternoon. Dr. Johnson was born in this city in 1853 and had practiced medicine here for 22 years. He was a graduate of Western Reserve University medical school and previously of the West High School. He was a member of the Tippecanoe Club, the Masonic Order of the Knights of Pythias. He had a host of friends in and out of the profession and at last year's election ran considerably ahead of his ticket when elected Coronor. As a public official his short term showed him to be conscientious and anxious to do the best that his knowledge permitted. He was a charter member of the Cleveland Medical Society and always interested in its welfare. On all accounts his death is a very sad one and a loss to the community and the profession.

Dr. H. A. Eberle of Canton has been appointed Acting Assistant Surgeon, U. S. A., and ordered to Jacksonville, Fla. for duty.

Dr. H. W. Wickes, Assistant Surgeon Marine Hospital Service, on August 12 was assigned to command the station at Cleveland.

Dr. George W. Crile, Brigade Surgeon, with General Garretson in Porto Rico, was for some time Chief Surgeon of the American troops. He was expected home September 15.

Surgeon L. G. Heneberger, U. S. A., who was on board the Maine at the time of her destruction has served during the war on the St. Paul with Captain Sigsbee and has now been assigned to the Indiana.

Dr. J. J. Erwin, Captain and Assistant Surgeon Tenth O. V. I., is at Camp Meade, Middletown, Pa., with his regiment and has every prospect of remaining in the government service for some time to come.

Dr. R. D. Fry, Brigade Surgeon and Major, has been ordered from Atlanta to Montauk Point for duty. The daily papers erroneously stated that he had been in charge of U. S. General Hospital, Ft. McPherson, Atlanta.

Dr. G. A. Carmichael recently in charge of Marine Hospital in this city and now on his way to station in Honolulu has been detailed as chairman of a board to select a site for a quarantine station at the mouth of the Columbia river, Washington.

Dr. J. S. Windisch, Captain and Assistant Surgeon, arrived home September 12 with his regiment, Fifth O. V. I. Dr. C. D. Noble of Oberlin of like rank in same regiment and Dr. W. P. Love of Youngstown, Major and Surgeon to the regiment also arrived in Cleveland at the same time.

"I

ENTEROPTOSIS

Na vast number of peripatetic valetudinarians, who wander about from one physician and medical institution to another, the real difficulty may be discovered by simply noting the patient's attitude as he stands or sits. Observe his "doubled-up" position. When he sits down, he sort of shuts himself up like a pocket-knife. There is a hump in his back, a flat chest, a sunken stomach, and if you make him undress, you will find a protruding abdomen. A careful examination will very likely reveal deep wrinkles across the body at the waist, and on the spine opposite a perpendicular row of brown spots, each marking the location of a spinous process which has been pressing the skin against the seat-back, while the patient has remained. for hours daily in a doubled-up position, sitting at his work, reading, or contemplating his dismal future.

This particular attitude and the bodily shape described, signify the and colon, and is the cause of a vast number of chronic neurasthenic and dyspeptic symptoms, which may be at once alleviated by putting the prolapsed organs in place and retaining them there. This may be done by properly directed massage, by the use of a proper abdominal supporter (those in common use are of little or no account in these cases), and by the employment of a suitable course of gymnastic exercises to restore the tone of the weakened muscles, and thus enable the patient to hold himself in a correct attitude in sitting, standing or walking.

For some years the writer has made use of the means described in

dealing with a large class of chronic invalids, and with most gratifying sucCESS. A patient who had exhausted the skill of the best nerve specialists in this country, and had traveled abroad, was cured in a few weeks by simply being made to stand and sit correctly. We are obliged to make the humiliating confession that on a previous occasion we had treated the same patient for several months with no permanent benefit. He has now remained in health for the last five years.

Another patient said to the writer, when fitting an abdominal supporter, 'What a fool I have been not to think of that before! I have been going around for the last three years with my hand in my pocket to hold my belly up.'

It is the writer's custom to examine carefully the whole trunk in every case of chronic disease, to note especially the position of the viscera and to look out for wrinkles in front and 'corns' on the back as we sometimes call them, in our attempt to impress the patient with the need of an immediate and earnest effort to reform his attitude."-Modern Medicine and Bacteriological Review.

The medical fraternity especially, and the general public as well, are to be congratulated on the removal and reopening in their new store of The Helman-Taylor Company, at 23-25-27 Euclid avenue, Cleveland, O. This house has had a remarkable and vigorous growth. Entering upon its career a little over a year ago, it has steadily enlarged, until today it takes its place. in the front ranks of retail and wholesale book establishments. Conservative in policy, attentive to details, and considerate of the wishes of its patrons, it has laid a solid foundation for permanent success.

The store itself is divided into departments. On the first floor are located the retail book, stationery, photographic supplies, and the periodical departments. Here anything and everything in these lines can be procured. Half of the second floor is devoted to art, which, by the way, is no small part of this firm's business. It may not be known to many of our readers that we have in our midst in Cleveland the largest stock of selected art goods, such as carbon reproductions, imported photographs, casts, etc., to be found in any one store in this country.

On the same floor is found also the medical book department, full and complete with the newest and standard books of the profession. This department is a boon to all interested in medical science. Here one can sit down and look over the latest publications and investigate any subject that may be under consideration. Here also are to be found the subscription books, which one can carefully peruse before buying, and if they do not meet with approval can be laid aside. These facts are of especial interest to patrons, for we realize the discomforts often sustained at the hands of subscription agents. One practice of this department that is a special advantage to the busy physician or student is, that by constant circularizing, the very latest books and the results of the most recent research are placed before him. On this floor are also the religious and juvenile departments, and the offices. In every department of the entire store are found new books, clean, bright bindings, the very latest publications, and all the standard works.

The third floor is devoted entirely to the wholesale business.

Professor of Surgery, Medical Department, Western Reserve University; Surgeon to the Lakeside

I

Hospital

N presenting before you today the subject of operations upon the kidney, it has seemed to me that it might be of interest to show a series of kidneys illustrating various diseases which demand extirpation. For this purpose I have brought a number of specimens, removed for those diseases which most commonly demand operation. They are first, tuberculosis; second, stone; and third, inflammatory conditions, which have so destroyed the substance of the kidney and occluded the ureter as to render the organ useless and the restoration of its function impossible. I night also show you a series of kidneys removed for sarcoma as well as for cther diseases. To go into a complete discussion, however, illustrative of those conditions which may occasionally require removal of the kidney, would occupy more time than is at my disposal.

The two most common conditions demanding removal of the kidney are tuberculosis and stone. Next to this, I should say, are cases of inflammatory disturbance and sarcoma. To establish accurately the relative frequency of the various diseases would of course require careful tabulation of a large series of cases. This I have not made, but am speaking simply from the impression which has been made upon me by the cases which I have

seen.

The subject of operating for tuberculosis is a most important one, and the question must always arise in each case whether by operation the disease can be entirely removed. It is still a mooted question by what channel tuberculosis gains admission to the genitourinary tract. It has been held by some that it is an ascending disease, traversing the urethra, hladder and ureters, and attacking lastly the kidney. If this were true, the e would be small hope of benefit in removing the kidney. Others have held that the

bacillus tuberculosis is deposited in the kidney through the channel of the general circulation, and that this is the first organ attacked. There may be truth in both of these positions, but it seems to me that there is a varying susceptibility of the tissues to the infection of the tubercular process. I have seen most advanced tubercular disease of one kidney involving a portion of the upper part of the corresponding ureter without any evidence of a tubercular process in any other part of the body.

One very marked case may be of interest. It was that of a lady with a distended kidney filled with tubercular debris. An aspirator was inserted into the kidney to demonstrate the presence of the purulent material. I had asked my hospital assistant two different times if he knew how to put the aspirator together, and if he were positive it was all right. He assured me that it was. I think this was the first time in all my operative experience. that I have entrusted the preparation of an aspirator to any assistant, no inatter how skilled, and it has been the last. The needle was inserted into the kidney and the piston of the aspirating pump pulled out two or three times. I saw that the aspirator was not working and withdrew it instantly. I asked the anesthetizer, who was my friend Dr. H. J. Lee, concerning the pulse. He stated that it was regular and normal. The instant the needle was withdrawn I incised the kidney through its entire length. In about two minutes Dr. Lee informed me that the patient's pulse was flagging. It gradually grew more feeble and irregular and in five minutes the patient was dead. I made an immediate investigation with the consent of the family and found that the air had broken its way into the renal vein and had followed the ascending vena cava into the heart, so that the heart was filled with froth. An examination of the entire urinary tract showed that the kidney was extensively diseased and that there was inflammation of the upper third of the corresponding ureter. There was no evidence, however, of any other tubercular process in the body. A case of this sort would seem to argue for the renal origin of tuberculosis.

Another case would seem to render the point of origin uncertain. It was that of a patient who had extreme pain in the region of the kidney, so that I removed this organ. I found it studded with points of tuberculosis. The patient improved after the operation, but about four months later came back with tuberculosis of the epididymis of one testicle. The testicle was removed and on examination the material was found swarming with the tubercle bacilli. Some five months later a similar process attacked the other testicle. This was also removed and was found to be similarly extensively infected with tuberculosis, the diagnosis being beyond question. It is about three years since the second testicle was removed. A short time ago I saw the patient and he was well and strong, having developed no further tubercular disease. A case of this sort would lend strength to the