rhage from anastomosis, he ties the uterine, obturator and superior vesical arteries also. It seems to Le proved by his experience that Loth internal iliacs may be ligatured in continuity without causing any tissues to slough. Nevertheless it can hardly be said that surgical opinion, as yet, favors the litigation of the internal iliacs, although if experience shows that shock is not unduly increased and that collateral circulation is always established there are many advantages in this brilliant procedure. The origin of the internal iliacs must be exposed in the perfected operation in order to remove the glands which lie about it, and it is really easier to tie this artery than to trace the uterina back to its source and to tie it there, deep in the pelvis and close to the ure ter. The uterus being removed, the bladder gets sufficient nourishment from anastomosis with branches of the superior hemorrhoidal artery, while the gluteal and perineal region is supplied with blood from anastomosis with branches of the deep epigastric and of the circumflexa femoris and other branches of the femoral artery.. I have never found it necessary to tie to the trunk of the internal iliac, although I have sometimes tied the anterior branch, thus suppressing the circulation in the uterine and vesical and vaginal arteries, but not interfering with the gluteal, ilio-lumbar and lateral sacral arteries. gland-bearing, is dissected away from the floor of the pelvis. This procedure is carried on until the uterus is only connected with the body by the vaginal tube, which in turn is to be separated from its surroundings as far as may be deemed necessary. In very simple and clean cases the upper part of the vagina, including all the cancerous tissue, may be shut off with two clamps on each side, and vagina divided between the clamps. The stump is now carefully cleaned and pared and united with catgut, and the peritoneum closed over it. If the stump of the vagina is so short that this would leave too much space between the vagina and the peritoneum, the former may be drained with gauze, instead of being sewed together. If the disease is at all advanced it is better not to open the. vagina, but to push the uterus down and afterwards. to remove it from below. If the dissection has been carried as far as Werder recommends it is possible to close the peritoneum over the uterus, but this involves a deep and difficult dissection, with considerable danger of cutting into the vagina, and thus risking infecIt also leaves the woman subtion. stantially with no vagina, which is often a matter of importance. I am accustomed to free the uterus and the upper parts of the vagina and then to sew a pad to the fundus uteri and pushing the uterus down as far as possible to pack the pad into the bottom of the pelvis; this checks oozing and keeps the intestines out of the way when the uterus is finally removed. Formerly this dissection was deemed sufficient ard the abdomen was closed. but the analogy with the axilla requires us to remove all the glands, in order to extirpate the furthest lurking places of the disease. (Concluded in Nov. Issue.) Medical contributions respectfully solicited from Regular Physicians. The editor or publishers will not be responsible for the opinions expressed by correspondents. No attention paid to annoymous communications. Reprints furnished only at actual cost. Entered in the Post Office at Minneapolis, Minnesota, as Second Class Matter. SUBSCRIPTION PRICE United States, Canada and Mexico, per annum, in advance, $1.00 1.50 N. B. Matter for the reading pages should reach office of publication on the 20th of the preceding month and display advertising on the 25th, to insure attention. Vol. 5. MINNEAPOLIS, MINN., NOV. 1, 1903. Correction. The original article on "The Treatment of Pulmonary Tuberculosis" in the September issue was prepared by Prof. Chas. H. Bradley, of the Medical Department of Hamline University, No 11. and also in the direct challenge of Koch's theory of the non-identity of bovine and human tuberculosis, and in the promises of the prophylactic serum. The address was published in the Deutsche Medicinische Wochenschrift, and the author's name was accidentally of Sept. 24, 1903, and the author quotes omitted by the printer. A New Presentation of the Tuberculo sis Problem. Under the above title the Medical Record of New York, Oct. 10, 1903, has an editorial concerning the address of Prof. V. Behring before the annual congress of German Naturalists and Physicians, held recently at Cassel. The address was remarkable and rather startling in the views expressed in regard to the universality of tuberculosis, the remark of some one, "That we are all a bit tuberculous," and furnishes statistics to prove the saying is the expression of an actual fact. It is said the tuberculin test proves that from 90 to 95 per cent of the community is infected. Prof. Behring believes this statement is true, and asks of what advantage is isolation in preventing infection? It will surely be impossible to isolate so large a proportion of the community or keep them in sanitoria to stamp out the disease. Prof. Behring does not believe in the contagious ness of consumption, as generally understood, and thinks the disease is sel expect a remedy to be found in time if one exists. nesota. Under an agreement made last July by the United States Geological Survey, the State Board of Health and the University are engaged upon the survey and examination of the natural waters of Minnesota. dom acquired by adults, the develop- To Examine the River Waters of Minment in such cases being a "lighting up of a slumbering focus of infection. which the individual has had from infancy," the outbreak coming from exciting causes, exposure, ill health, and a depression of the vitality. Prof. Behring excludes the theory of heredity, and thinks the main, though not the only, source of infection in human beings is the milk, either from the tuberculous mother or that from a tubercu lous cow. He considers infants much more liable to be infected through the digestive organs than adults, "the pores of the intestinal canal being large and admit readily various microorganisms, tubercle bacilli among the rest, that are excluded by adults." But infants may be infected otherwise than by milk, the specific bacilli reaching the intestinal tract in other media. The evidence of heredity in this disease is too strong to be dismissed with the bare statement of disbelief by one or even many individuals. When statistics show whole families destroyed, most of them arriving at the same age, and perhaps widely separated in locations, the conclusion that heredity is a prominent cause appears to be well founded. Prof. Behring speaks of his work in regard to the preparation of an effective prophylactic; his method has been employed so far only with animals, and he is not yet ready to test it with human infants, while it might save many, it might destroy some one and bring the serum into grave disrepute. The investigations will be continued along these lines, and it is hoped that something may be discovered that will prove safe and satisfactory. There is now such intense interest manifested by investigators of this disease that we may The waters of northern Minnesota are being examined by an engineering aid of the geological department of the government, and especial consideration is being given to the condition of the normal waters at Cloquet, Cass Lake, Bemidji, Crookston, Ada, Beltrami, St. Hilaire, Hibbing, Virginia, Biwabik, Ely, Tower and Eveleth. The chemists of the University are conducting a series of chemical exami nations each month of waters from the following locations: Mississippi river. above the confluence of Rum river and below polluting influence of Anoka; on Rum river, at a point near its confluence with the Mississippi, and above the polluting influence of Anoka; on the Mississippi river, above Minneapolis and below St. Paul; on the Minnesota river, at Fort Snelling. Chemical and biological examinations. are being made by the State Board of Health of waters from Kettle river, at Sandstone, St. Croix river, at Taylor's. Falls, above and below Stillwater and at Point Douglas; Crow river, at Pillager; Mississippi river, above and below Brainerd; above Sauk Rapids, below St. Cloud, and above Wabasha: Zumbro river, at Rochester; Minnesota river, above and below Montevideo. and above and below Mankato; Otter Tail river, above and below Fergus Falls. The results of these several examinations will be published by the geologi |