one extension table and a smaller one which subsequently served as an instrument table. The floor was mopped up, carbolic acid solution, about 10 per cent, was liberally sprinkled about in every nook and corner. The instruments were boiled in an ordinary bread pan, towels and sheets were boiled in a carbolized solution of 10 per cent strength. The patient having been prepared in the usual manner, was brought in and the operation was commenced. An immense ovarian tumor was removed; it had a twisted pedicle and there was an active hemorrhage going on into the free abdominal cavity from the tumor. The result of this case was a surprisingly uneventful recovery in three weeks' time, not even a stitch hole abscess developing.

CASE 2. Also through the kindness of Dr. Landis. A young man greatly emaciated, jaundiced to saturation, with persistent vomiting, complained of excruciating pain in the right hepatic region. Temperature 103° F., pulse 120, very thin. The diagnosis made by Dr. Frank was an obstructed gall bladder and an operation was advised. In this instance the hospital was suggested, but the patient as well as the mother strenuously objected to have the operation performed away from home, so the kitchen was again utilized. An incision was made over the prominent point of dullness through the peritoneum, exposing a tense white surface in the lower third of the right liver. There being but slight adhesions in two places the peritoneum was stitched to the border of the white surface found in the liver. sponges were packed around and an aspirator introduced. The fluid so characteristic of hydatids, was withdrawn, the wound was dressed and left for subsequent opening which was performed four days later when hundreds of daughter cysts popped out. The patient rallied nicely, and in four weeks' time was up and about. Ten weeks after the date of operation the fistulous opening closed. The patient had gained twenty-six pounds in weight and was able to follow his vocation which was that of a teamster.

Cases 3, 4, and 5 were ladies who had a great horror for hospitals.

CASE 3. Patient almost moribund. She had a large pyosalpinx; celiotomy was performed and drainage was established through the vagina. Aside from the fact that she gained so very rapidly, there is nothing worthy of mention relating to her recovery.

CASE 4. Removal of a large ovarian tumor on the right side, and a pyosalpinx on the left. Ten weeks after the date of opera

tion the fistulous opening leading down to several sutures which were used in ligating the sacs is still open.

CASE. 5. Through the kindness of Dr. Coy. This was an ordinary laparotomy, yielding two ovarian tumors about half the size of a fetal head. Complete union in three weeks.

CASE 6. Mrs. A., aged seventy-seven, was operated upon for the removal of a large ovarian tumor, Professor Senn being present. Five years ago she had her left breast removed for carcinoma. During the last five years the tumor was tapped four times. Ten weeks before the operation she developed a pneumonia, but rallied nicely, although she had a slight elevation of temperature at night. The last tapping which occurred two and onehalf weeks before the date of operation, showed the fluid to be septic. The old lady died three days after the operation. The postmortem showed everything to be in an aseptic condition. There was an arterio-sclerosis of the coronary artery.

In closing this article I wish to state that no surgeon will choose the kitchen for an operating room in preference to a modern hospital operating room, with trained assistants and nurses at hand, but the assertion can be made that good results can be obtained in the most unfavorable surroundings, and that the surgeon who is brought face to face with a desperate case in private practice, where a removal to a hospital means a delay of several hours at best, and where the ride, the exposure, and the excitement incidental to a removal at perchance a late hour at night. That these cases can be operated upon with safety, by choosing the most convenient room obtainable, and paying strict attention to the thorough asepticization of everything within the immediate vicinity of the field of operation. Cases are often brought into hospitals for operations in such a low state that the surgeon be he ever so skillful, is taxed to his utmost to remove the patient alive from the table, where perhaps if the operation could have been performed a few hours earlier it would add greatly to the chances for the recovery of the patient. Finally we must not overlook the cases that contract various diseases, as pneumonia, pleurisy, etc., in their journey to the hospital, in these cases the operation is successful, but the pneumonia carries off the patient. We, as physicians, understand how these sad affairs come about, but the laity cannot realize that anything but the operation is responsible for the death of their friend.

CIVIL SERVICE AND THE DEPARTMENT OF HEALTH.

BY DR. ARTHUR R. REYNOLDS, CHICAGO.

EX-COMMISSIONER OF HEALTH.

In the Department of Health of our city government for the past two years, I have noticed that employes who gained positions purely as payment of a political debt were generally incompetent. They were imbued with the notion that they should not be required to work, and looked upon their appointments altogether as sine

cures.

This lack of application in a part of the force makes doubly hard the duty of those appointed for their fitness and who believe the duty due the public is paramount to all personal or political allegiance.

I do not wish to be understood as saying that all those who labored in the department were of this sort. The majority felt keenly their responsibility, and worked diligently, some even developing rare genius for the places assigned them. Particularly is this true, I am happy to say, of those who are members of the medical profession.

It is wholly unreasonable to expect men who are useful in political campaigns and whose chief delight and occupation are the allurements of practical politics to be attentive to routine duty. during the excitement of a pending election. Indeed, I have observed that for some weeks preceding and following an election, a large part of the force has been quite demoralized. The full import of this can be realized when we consider that we have an election of some sort always once, and frequently twice, in a year. It is doubtless right and proper that those placed in positions where they are required to aid in shaping the policy of an administration should be in full political sympathy with the principles approved at the polls. Medical and sanitary administration, however, in caring for disease or in preventing it cannot by the widest stretch of an intelligent imagination be so construed. Their ideas upon the coinage question or the tariff constitute no factor in their qualifications or their disqualifications for the work they have in hand.

A civil service examination of all employes in the Department of Health would at least give it agents who could write intelligible reports of their work, and it would be a guarantee of capacity for further training. There have been appointees who couldn't write any sort of a report at all.

Read before the Practitioners' Club April 29, 1895.

The civil service examination as proposed may not be the best test for the strictly medical branch, to ascertain for example, the ability to diagnose the contagious diseases or to determine the possession of that tact and good judgment so necessary in dealing. with people who come under the ordinances relating to the suppression of contagion. But it is the entering wedge that must eventually do away with the "ward boss" as well as other objectionable features of party management. There are high qualities

of executive ability necessary in dealing with the multitude of perplexing questions that constantly arise, and in disposing wisely of all shades and character of demands made upon those in charge. Aside from this are the grave and more difficult complications that attend an outbreak of epidemic disease, to meet which successfully, requires trial and experience as well as natural aptitude. is a happy combination and one that is decidedly rare. When men are found who possess it, their services should be secured permanently and an adequate salary paid them.

It

Those who are charged with the serious responsibility of suppressing an outbreak of epidemic disease, when human life is at steak and interruption of social and commercial intercourse threatens, should be selected with at least as much care as is exercised by merchants, bankers and corporations in employing their managers, as cashiers and other trusted executives, or the military general uses in choosing his officers and the equipment of his command.

The past two years have, undoubtedly, been the most trying. term in the history of the department. The truth of this statement may be better comprehended when we reflect upon our enormous and rapid growth, both in territory and population, during the last decade, and upon the fact that within the two years just closed we have had to deal with the World's Fair sanitary problems and with an epidemic of smallpox.

In this presence I may perhaps be satisfied in speaking of some details of our experience with reference to the epidemic.

A long period of freedom from any unusual demand upon the resources of the department and the frequent changes made in the entire personnel of the force with changing administrations, has led to a very natural result. The force of the department had been pruned away to a minimum, and its regular appropriations had been rigidly scaled down. Its hospital facilities were inadequate and its ambulance service was equal only to the most ordinary demands.

Appropriations were to be secured and their necessity demonstrated. The working force had to be reorganized; the hospital facilities extended; an ambulance service created; a small army of competent men selected and drilled to work with economy and precision. The entire city had to be vaccinated. Lifelong prejudices against vaccination, among diverse people of foreign tongues and habits of life, had to be overcome and were overcome by diplomacy and persuasion. The usual rebellion against removal of the afflicted to the hospital occurred, extending even to open riot by an armed and frenzied populace. This, too, was overcome by tact and diplomacy, and without recourse to police clubs or militia bayonets, and from the time when hospital accommodations were completed to the present day every case has been removed to the Isolation Hospital. This is, without doubt, the first time in any considerable epidemic that this has been accomplished. By these and similar methods the general sense of alarm and danger in the public mind was relieved and confidence was restored.

How thoroughly all obstacles were overcome and with what efficiency and faithfulness the work was prosecuted is best told by the fact that within sixty days from the date of the appropriation of money by the city council the disease as an epidemic had passed away. That the work was done economically you may know from the fact that it cost the people of the city for the year 1894, a sum but little more than one-half the amount spent every year by the Department of Health of the city of New York whose territory is but one-third as great as ours, and whose population is about the same.

This achievement of sanitary effort which has been quoted all over the world as the most striking example of preventive medicine on record, could not have been accomplished if politics had played its usual part in the selection of the men who did the work. In this great campaign against smallpox the politics of appointees were unknown to the commissioner, and our triumph over a loathsome disease is alike a lasting credit to the medical profession and a striking example of the wisdom of Civil Service Reform.

Without doubt the application of the merit system to the Department of Health would result in as much if not more benefit than in any other department in the city, not excepting the police and fire departments.