These

wound of exit was difficult to see. wounds were sewed up and a drain put in, and the patient recovered.

Of a series of three cases other structures than the intestines were injured; in one a large resection was done but the patient died of pneumonia, having been shot through the lung. Another died of a septic wound of the kidney in addition. The other had a wound of the liver, and died of shock and hemorrhage.

The question in these cases is what are we to do? We all agree upon abdominal Is operation in the low velocity wound. it proper to take out a large amount of intestine, or repair many small perforations? Many say take out much intestine and if done properly it is better since you have but one line of suture to heal. It is a question whether the shock is not worse. I, personally, do not think it is best to resect unless there is a large amount of mutilation. Again shall we do an end to end or a lateral anastomosis. This is a question entirely of judgment and technique. I think more cases are saved by lateral anastomosis. While you are bound to have some infection, there is less liability of leaking. With the intestine cut obliquely, however, it may be all right to do an end to end anastomosis, but the slightest leak means a lot of harm. It is almost certain all these cases will have suppuration.

Washing out the belly cavity is a practise that many observe. I have been afraid to try this and I cannot agree that this is a proper method because of almost certain spreading of the peritonitis. I fear a spreading infection, but some of our New York men wash out the belly and have recoveries. John Deaver, of Philadelphia, never puts in water and he has recoveries. Murphy's idea of only wiping out, putting in a large drain in the pelvis and another small one if necessary, sitting the patient up in bed, and giving plenty of water, I think the best plan.

I have given this extemporaneous report hurriedly, but these are a few of the points I think should be brought out in considering this class of cases.

DISCUSSION.

DR. W. T. REYNOLDS: The question is when to operate. It is suggestive that many when let alone get well. In the Japanese-Russian War, those little yellow boys let their gunshot wounds alone, and did their operating later. The higher per cent of recoveries was in waiting and doing secondary operating.

As to anastomosis. It depends on whether you are dealing with the large or small intestine. End to end is good on the large intestine, but bad on

the small. Lateral anastomosis is best for the small bowel. A case of mine shot with a No. 32 gun had, besides a number of small punctures and wounds, the small intestine above the ileum shattered to pieces. This man had no chance to get well unless operated and operated well. In certain cases it gives the patient the benefit of the doubt to operate.

DR. HOWARD HILL: I did not hear the beginning of Dr. Robinson's report on the effects of the small bore bullets as seen in military practice. I have only had cases wounded by the ordinary missile which are seen in private practice, large bore bullets moving with slow velocity.

Of equal importance to the injury of the intestine is the wounding of the mesentery with the destruction of the blood supply to the intestine. If the bullet has passed through the mesentery close to its attachment to the bowel it only destroys the blood supply to a limited portion of the intestine; but if it has passed through the root of the mesentery, striking one of the primary arches it may destroy the blood supply to the intestine for five or six feet. In such cases the intestine should be spread out and the blood supply traced when possible and a sufficient amount of intestine removed so that none will be left behind without blood supply.

The surgical treatment of gun wounds of the intestines is not so difficult since all of us are agreed on the technique of the repair of the wound. Most of the fatal cases are due to the injuries of other organs, such consisting of wounds to the kidneys, through the great veins or arteries behind the peritoneum, and to injuries of the spinal cord.

In treating the abdomen, if the case is seen reasonably soon after injury, it is likely that cleaning out the abdomen with wet sponges, followed by drainage from the pelvic basin with the patient in Fowler's positton, will do much in preventing peritonitis.

DR. W. K. TRIMBLE: The tearing of the vessels at the base of the mesentery is important. In a case I posted I found severai intestinal punctures, but the cause of death was gangrene due to the mesenteric blood supply being cut off. In another case at St. Margaret's Hospital that died in the same way, I was impressed with the results of such wounds of the mesenteric blood

supply.

DR. ERNEST F. ROBINSON (closing): I believe that Dr. Hill and Dr. Trimble are correct; that many cases end badly on account of the mesenteric blood supply being cut off at the base, and results may be unfavorable even after much resection is done on account of tearing of the veins and clotting in adjacent vessels. All of us have seen the tremendous extravasation of blood behind the peritoneum.

Anastomosis should be lateral it seems to me, being more rational and safer. It is more sure. In reference to using water. I meant the oldfashioned method of pouring and pouring water in. It is like pouring bichloride and wondering why you have peritonitis, which is on account of devitalizing the tissue. Of course we should all use sponges and clean.

Don't fail to examine the nasal cavities in all cases of asthma, hay fever, deafness, and chronic cough.

BACTERIN TREATMENT IN DISEASES OF THE EYE.

JOHN D. SEBA, Bland, Mo.

Oculist and pathologist are aware that many diseases of the eye are due to an auto-infection, the real cause originating in another part of the body. Iritis and keratitis are very often due to an infection arising from an unsanitary condition of the alimentary canal, due either to constipation, indigestion, with subsequent fermentation and absorption of effete material. This is generally designated as rheumatic iritis. Acne, however, has as far as I know, never been named as a causative factor in either keratitis, or iritis. For this reason and on account of the treatment, which proved very beneficial, I beg leave to report the following case:

Miss L.L., age 17 years, single, living in the country thirty miles away, was referred to me for treatment of an obstinate eye trouble. The most prominent symptoms were: Severe photophobia and lacrymation. Patient would bury her face in a pillow to avoid the light. Examination of the eye was difficult on account of the pain pro duced by light entering the eye. Her face was covered with acne. The eruptions consisted of small papules and pustules, they came in crops, at each recurrence of the acne eruption the eye symptoms were aggravated. The symptoms failed to improve under the ordinary treatment for rheumatic iritis. A saturated solution of boric acid with one grain of atropine distilled into the eye failed to give relief. The use of atropine was however continued through the whole course of the disease. The following treatment, however, seemed to give immediate relief: One ampule containing 250,000,000 staphylococci and 25,000,000 acne bacterin was injected with a hypodermic syringe every four or five days until she had taken six injections in all. At the same time she took internally every morning one grain of potassium permanganate in pill form, and every evening she took one grain of ichthyol also in pill form. above stated, the atropine was used sufficiently to keep the pupils dilated. Improve

As

ment of the eyes was rapid as well as of the general health condition.

The potassium permanganate was given with a view of correcting some slight menstrual irregularity and the ichthyol was given with a view of putting the alimentary canal in a healthy sanitary condition. A report of this case is published with a view that other practitioners may apply the same remedies in similar cases, and I am satisfied that equally good results will be obtained. The bacterin used in this case was manufactured by H. K. Mulford Co., of Philadelphia.

Definition of a Skeptic.

"Pop, what is a skeptic?" "A skeptic, my son, is a person who can read a patent medicine ad' without feeling that he has any of the symptoms described."

Deprecate Fee-Splitting.

The following resolutions were passed by the Western Surgical Association, December 21, 1912:

Resolved, That it is the intention of this association not to countenance the practice of fee-splitting in its members nor in its applicants for membership, and that we incorporate in the application blank for membership in this association a clause to be signed by the applicant stating that he does not now practice and will abstain in the future from the practice of fee-splitting in any form and that he will not countenance it in others.

It is further suggested that this association would be pleased to receive the resignation of any member, if such there be, who feels that he is not willing to live up to this provision.

Resolved, That the Western Surgical Association ask the co-operation of the various American Surgical Associations, the State and Interstate Medical Associations and the regents of the State universities to co-operate with this association in the suppression of both the secret and open fee-splitting evil in its various forms.

K

THE ACTIVATING MOTIVES OF PROFESSIONAL CONDUCT.

(Continued from February.)

Is it not time that we should awake from our long sleep? Maybe we will learn to do better after awhile. Organized society will demand more of us as soon as it has become more intelligent. Speed the day of its enlightenment, so that it will require of us more and better work. Perhaps, then, the physician will arrive.

The nine years spent by the writer "showing physicians how to put people to sleep" resulted in a discovery of a professional need far more important than that which he had set out to supply. He found that the physicians themselves were asleep, specialists and general practitioners alike, and this discovery is activating him to efforts more far-reaching than he had ever dreamed of attempting.

After thirteen years devoted to helping to equip the general practitioner to meet the crisis now impending he is devoting himself to this task. The conflict between the claims of the world and the claims of the individual was forced upon him so strongly as to command the future direction of his efforts in this broader field; hence "Psychotherapy, Psychiatry and Neurology."

Free from alliance with medical school; in a position in which he can dare to be himself at all hazards; with instinct unfettered and with reason playing the part of spectator he proceeds to the task. has no ambitions to gratify; no reputation to make and none to lose.

He

To have been privileged to become intimately acquainted with thousands of American medical practitioners and be encouraged by witnessing their loyalty to duty, to justice and honest service to humanity is compensation enough for one man, matters not what the future may have in store. But having witnessed the struggles of the men who are rendering service to the people who need most a physician's help, regardless of whom I may offend if facts must hurt, I esteem it a privilege to throw all the light possible upon the deplorable condition which is causing such disrespect by the people for the noblest of professions. Should a real man ever let the possibility of what might affect his individual "success" benumb his social conscience?

Success to me can mean nothing less than the complete rehabilitation of the

General Practitioner; the equipment of the physician in the field where the real work of the medical profession is most effectively accomplished qualified to meet the demands that are required by the new conditions confronting us. To this end I am ready to devote the next half century and may I not dare to express the belief that compassion, a sense of wrong and a "desire" for justice are the driving forces to my endeavor.

And what's more the psychotherapy that we are endeavoring to carve out of the crude mass of material brought forward by the accumulated knowledge of the ages shall be constructed after the model prescribed by science based on facts as they really are in harmony with all other departments of scientific knowledge and it shall not be perjured by the creed of any religious cult, as seems to be the endeavor of Appleton's Walsh falsely labeled "psychotherapy" but better named Catholicism in disguise actually dedicated to the Jesuits and advertised to have been "the first time in the history of medicine that an attempt has been made to write a text-book of the whole subject of psychotherapy for the man in the field" appearing six months after the third edition of my monograph on the subject, which is devoted to the needs of the general practitioner, to say nothing of his failure to give heed to the experience of the host of able men whose contributions have aided in the development of a scientific psychotherapy.

There can be no scientific psychotherapy that ignores the sexual or religious component or that emphasizes the one to the exclusion of the other, since sexuality and religion as scientifically comprehended are one and the same thing. Both are expressions of one of the fundamental instincts correlated and interchangeable and are normal and wholesome just in propor• tion as they are guided by reason or intelligence for the evolution of the individual and for the preservation of the species.

Modern science is monistic and amalgamates or unifies the two supposed entities called mental and physical or spiritual and physical or soul and body respectively.

All of the elements of the animal life, psychic and physical, are inseparably correlated; they are expressions of the same thing or organism in function.

"Mind" or "spirit" or "soul" each being an arbitrary tool of the creative specialist exists wherever we find a sufficiently or

ganized being in action, and the self in action, the personality or ego, is the sum total of the combined functions and faculties of the cells comprising the individual in action.

The time has come when the sexual component, or religious instinct, which is one and the same thing, should be guided by science and not by the antiquated ideals of religious superstition, handed down to us from an age of barbarism.

Ellen Key truly remarks: "It was not until health came to be regarded as the will of God that individuals considered it their duty to promote it; and it was not until life on earth came to be regarded as a good thing that society conceived it to be its duty to apply the achievements of science to laws of health, the overcoming of disease, and the prolongation of life. prolongation of life. Health gradually became an end in itself, happiness, which we are justified in striving for, for its own sake, irrespective of whether it may be made useful for other purposes or not."

She further says: "Either we believe that man must bend his reason, his will and his conscience to the decrees of authority, or we believe that man may find his own way through repeated experience and many and various trials of power. Either we believe that obedience is the sole road to a higher culture or we believe that rebellion may be just as essential as obedience. Either we believe that the sensual instincts are pitfalls and obstacles, or we regard them as guides in the upward movement of life on a par with reason and conscience. If we hold the latter opinion then we know that in sex life, right and wrong, growth and decay, sacrifice of oneself and sacrifice of others are more closely connected with one another than in any other province of life; that in sex life, 'right' often becomes 'wrong'; that he who sacrifices the other is perhaps secretly the victim of his victim; that passion' produces great and beautiful effects which duty cannot achieve."

Immoral asceticism is just as immoral as is immoral sensuality, because it is not uplifting to the individual or to humanity.

So it seems that in religion, medicine and business alike, deception and falsifying are still in fashion Too many able men are at work in all departments of practical realism for any business concern, or religious sect, or individual, to much longer play the game of "gullers of the gullible."

No one man has a monopoly of wisdom and every one has a right to his convictions; but let us remember that "convictions" are complex indicators" and are

footprints in the evolution of the individual. "Religious complexes," conserved as the result of education, or environment, are no exception to this rule. The people of this world are too wise to have a defunct religion palmed off on them under the guise of psychotherapy." Even in the world of science, generally regarded by the ignorant as the peculiar sphere of dispassionate and cold thought, complexes play a vast part. The discussions of any medical society provide most instructive illustrations of this point. Watch for the motive in the remarks of every writer, in book or medical journal, and how often will you see the "for self" so predominant that it appears as evident as the fangs and claws of the most blood thirsty carnivore.

A complex" is the hypothetical name given for any group of ideas expressed with deep emotional or feeling tones. I would have the reader regard my articles in this department as the indication of a "complex" fighting for psychotherapy for the general practitioner. At some time in the future I propose to give the history of this complex.

I am perfectly willing to have my position in the profession regarded as indicating a strong similarity to insanity, since the most marked manifestation of insanity, as understood today, is the refusal of the individual to conform to the rules prescribed by the herd. In the end I propose to show that the "rules of the herd," the established order of things pertaining to medical and religious education may be at fault, thus showing the contribution of environment to the maintenance of insanity, as well as to maintenance of "disease" in gen.

In order to accomplish my purpose, I must make this matter a personal affair. Since I have succeeded in nagging the reader, if he has followed my previous articles, into a state of interested attention, reason may now have a word to say. I have no chip on my shoulder for the medical pro fession. Where I have had a personal grievance, I have expressed myself in plain language to the incompetent offender. I am here taking the part as attorney for the thousands of general practitioners, and the millions of people who are individually and personally concerned for life, for health, for sanity, and for a fair show in the world.

If my remarks are directed as if in antagonism to the medical and religious specialists, who like parasitic growths continue to thrive, no matter how the rest of the organism of humanity fares-like true parasites drawing all that they require for them