nosis for the surgeon as well as the general practitioner, and as has been pointed out all but 10 per cent consult the physician first.

This subject might be very profitably considered before the medical section and I am glad of the opportunity of having the privilege of presenting this subject to the general session.

So far only typical types have been mentioned. If every case were easily recognized by cardinal symptoms, so flagrant mistakes would not be made by general practitioners, obstetricians, gynecologists and, lastly, the surgeons, the court of last appeal, held to be infallible by the laity and practitioner.

The irregular or atypical types become the most important of all. For instance, the surgeon has only very short time to consider the tragic form, to see the patient in the non-tragic form he is often in the embarrassing position of taking over into the surgical column what has been considered and received treatment for a number of weeks as a medical case, while it is in the main easy to make the diagnosis still the basic expression of Dorsett's, as follows: "There is no intra-abdominal condition that is more frequently shrouded in mystery and so devoid of pathognomonic symptoms as extra-uterine pregnancy."

Years ago a healthy tube, after long years of sterility, was considered to be more likely to become gravid. My experience is that a history of salpingitis robbing the Fallopian tube of its normal epithelial lining, just as gonorrhea denudes the male urethra of its normal epithelium and occludes the seminal vesicles, so does the result of gonorrhea work its injury on the Fallopian tubes short of sterility, but at the same time admitting of the occurrence of pregnancy. A diagnosis previous to rupture of the gravid sack has never been made so far as my knowledge goes. The time to operate on these cases is as soon as the diagnosis is made.

It is common history that a considerable stretch of time will lapse with the busiest medical men without seeing a case and sooner or later they will meet the condition when least expected. A failure to diagnose may mean a fatal result to the patient; as nearly as I am able to tell from my limited experience one in every eight or practically 12 per cent are of the tragic character, admitting of no delay, from a surgical standpoint.

And now in conclusion of the subject I desire to say that the so-called abdominal and all of these freaky conditions seem to indicate that the impregnated ovule must find tubal soil to

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grow, even if it becomes apparently transplanted, and like all evils, does not lack for encouragement of development. Most invetsigators believe that it is necessary for the fimbria to become detached in connection with the developing embryo before the development can take place. Each operator is left to choose his own way in dealing with these cases. I desire, however, to register my protest against vaginal puncture to relieve any condition involving pelvic viscera.

For twenty-two years I have been a member of this society; it is with pleasure I have witnessed the growth of the state association as a whole and more particularly that the size of the association has made it imperative to segregate the meeting into different sections that the time may be more profitably spent by its members in branches of most interest to them.

In repairing to the council chambers set aside for surgery let us not forget the labors of the all round men who labored so diligently in the past and have contributed no little amount to the success of our organization. The labor performed by our predecessors has not only contributed to our betterment, but has added to the dignity of our profession. In unity there is strength and while we, as surgeons, feel our importance, let us not be unmindful that gradually the internal man is redeeming what surgery has held in trust for him for many years.

A survey of the field before me recalls the past and I feel that I would be at fault and be amiss in the discharge of my duty if I failed to remind you that there are many of the everpresent, stalwart absent today.

The present opens up a bright future.

The many new and strange faces present with us gives promise for the future. To those who have accomplished, those who are now accomplishing and those who are to exalt our labors, I feel that the programme prepared on surgery, when ended, will be written in medical history of the state the best yet rendered.

Oration On Medicine.

*By RODNEY W. BLISS, M. D., Omaha, Neb.

In reviewing the progress of scientific medicine during the past year we find that an enormous amount of work has been done and that in several fields distinct progress has been made.

The last four years have brought us marked advances in our

*Delivered before the Nebraska State Medical Association, at Omaha, May 2, 3 and 4, 1911.

knowledge of syphilis. During this period the causative factor has been proven by Shaudin, Hoffman and others to be the spirochetae pallida and today the organism is easily recognized by the Giemsa azure stain, the silver nitrate method of Levadit, the India ink method and lastly from the use of the dark field illuminator. Our knowledge of the uses and fallacies of the Wasserman reaction has increased greatly, but by far the most striking announcement since our last meeting has been that of Ehrlich and Hata on the subject of cure of syphilis and other diseases due to spirillae by the aresenic derivative dioxydiaminoarsenobenzol. This discovery was the result of the painstaking scientific investigation of Ehrlich and his co-workers on the chemical side, together with animal experimentation carried on by Hata.

Ehrlich's work grew out of the use of atoxyl as a curative measure in the treatment of diseases caused by trypanosomes, especially sleeping sickness. It was found that the arsenic compound killed a large number of these organisms, but unfortunately left some alive, and these developed an immunity toward the injected drug. Optic neuritis and other evidences of arsenic poisoning followed its use and the drug has been largely given up. With this drug as a basis Ehrlich began his work and it was not until the 606th experiment that the desired combination. was obtained. His experiments were carried on with spirillosis of chickens and then with syphilitic monkeys and rabbits. On finding the results in animals striking, the laboratory workers then determined the proper dose for humans by first injecting themselves, with no bad results, thus proving that the drug was not organotropic, and the work on animals proved it to be parasito-tropic. The preparation was then given to many scientific observers for further investigation and finally to the entire medical world.

The belief of Erhlich is that it is possible to sterilize the entire body with one or two injections of salvarsan, a process which he calls "therapia magna sterilizans." The process makes possible an entirely new field in the therapeutics of infectious diseases, as it may be that this combination of arsenic may be used in other infections or that some other drug may be found which will kill all parasites in the body with one "master stroke." Good results have already been reported in relapsing fever, frambesia, sleeping sickness and malaria.

In connection with syphilis it is noted that Hubbes (Munchener Medizinische Wochenschrift) reports remarkable results with our time honored mercury. He heats cinnebar (red mer