bill. How many subterranean influences were set in motion. against Senator Owen we do not know, but it is safe to say that there were many. His nomination by a vote of about two to one over his opponent is a triumph for Senator Owen and the cause he advocates so earnestly. We congratulate the senator." -Texas State Journal of Medicine.

We also wish to offer sincere congratulations.

Modified Milk in Infant Feeding

The October issue of Pediatrics contains a paper giving a practical resume of existing knowledge upon the modification of cow's milk as a substitute infant food. The author has made a comprehensive study of the subject from all points of view, and dwells especially upon the value of cereal decoctions in the modification of cow's milk. In this issue, there is given a short abstract from the paper, showing its scope and character. The practical nature of the paper will appeal to the general practitioner, and copies can doubtless be had of the author.

Wanted a Share

Proud and pompous the doctor was strolling down the streets, when he was spoken to by a poor woman.

"Good morning, sir," remarked the latter.

"Godd morning, madam,” replied the medico.

"I expect you are making a good thing out of attending to that rich Smith boy," suggested the lady.

"O' yes, a fairly good fee," replied the doctor somewhat angrily.

"Well," whispered the lady, "I hope you won't forget that it was my boy Willie who threw the brick that hit him."-London Answers.

A Forecast

"Our esteemed fellow citizen, John G. Harris, will go to the hospital tomorrow to be operated upon for the removal of his appendix by Dr. Smith. He will leave a wife and three children."-November Lippincott's.

ORIGINAL ARTICLES.

The Surgical Congress of North America.

By A. C. STOKES, M. D., Omaha.

The third session of the Surgical Congress of North America closed in New York on November 16th. The registration was above 2,600. It was the largest meeting of surgeons ever held in the world.

It would require to much space to describe all the interesting features observed by the writer. It would, perhaps, not require such an extent of space to described in detail the things which were most striking.

I was interested in the management of cancer as demonstrated by a number of cases seen in the Skin and Cancer hospital. They illustrated the fact that the early and thorough removal of carcinomatous regions worked wonders and that treatment by fulguration after the surgical removal of these areas no doubt prevented early recurrence at least in a large number of cases if it did not entirely cure the disease.

The most striking case that was presented was one upon whom nine years ago the entire floor of the mouth, the tongue, and all the glands of the neck down to and beneath the clavicles were removed for carcinoma of the tongue. The man was still well and was able to talk and to articulate all of the sounds except the linguals. The operation was done in two stages. The first stage was the removal of the glands of the neck from the region above the thyroid cartilage on both sides down under the clavicles. After this operation had healed the second operation was done, namely the removal of the entire tongue and floor of the mouth, and the new floor made by a plastic operation by slipping a portion of the mucous membrane of the linquol surfaces of the jaw, over into the middle line.

All post-operative carcinomas in the Cancer hospital are treated by fulguration, and while all forms of electricity and light have, in one generation or another, been used for postoperative and pre-operative treatment of carcinoma and all have in time been discarded, yet, it seems to the writer that the use of fulguration as described by DeKeating-Harte is a treatment for carcinoma which must have a real effect upon metastasis. of the disease. As done in the Skin and Cancer hospital it consists of a large high frequency apparatus in which about thirty thousand volts with about four to five hunder ampares with an interruption of about one million times per minute. This does

not not crisp or burn tissue but seems to deaden and wither the region to which it is applied. It struck us favorably as indicated in very large operations for malignant infiltration of glands of the neck, although we are prejudiced against electricity as a method of treatment for this disease as a general rule.

One thing that seemed to prevade the atmosphere of the surgeons at the Congress was that we must develop a more perfect and exact technique in anesthesia.

I had thought that the use of ether on the open Esmark mask was the best anesthetic that could be obtained, but when I see the wonderful anesthesias given in the Roosevelt Hospital by the use of gas, and oxygen and ether mixtures I began to think that the use of anesthetics is as yet in its infancy. Intratracheal insufflation anesthesia is becoming more and more popular and in several clinics the use of ether vapor by an intratraceal method was the only anesthetic that was used, and the reports were invariably good. The patient breathes in spite of himself, and in no case has enough ether vapor been given to cause death. It is not like pouring ether on an Esmark mask and inhaling it in large quantities. It has been proven that enough ether vapor cannot be given a dog to kill it by this method. In this way it was also shown that the use of nitrous oxid while it has its place and is an anesthetic from which patients recover easily, yet, it requires extreme skill to use it properly and everyone agreed that cyanosis should never occur in the giving of nitrous oxid.

Each day from eight a. m. until six p. m. we attended clinics at one or the other of the many New York hospitals. From eight until eleven in the evening addresses were made by various celegrated foreign and American surgeons.

I suppose the most talked of address was Mr. Lane's address on intestinal stasis. While no doubt, Mr. Lane is somewhat erratic in certain cases, yet, we must admit that there seemed to be a great deal of truth in the position which he is taking and has taken. There was nothing in the address that has not been published before, except that Mr. Lane laid stress on the intestinal stasis in the duodenum. This has been spoken of before from a physiological standpoint but Mr. Lane regards it as an anatomical condition due to either improper development of the duodenum and pyloris or to a resistance to the passage of the fecal current underneath the large intestine and through the mesentery. This produces not only general auto-intoxication but also local infections such as diseases of the gall-bladder and pancreas.

Many movements of general interest to the profession were inaugurated at this Congress.

First a committee was appointed to investigate the methods and possibility of establishing a degree or special examination for those desiring to make a speciality of surgery i. e., a minimum requirement for those desiring to practice surgery as a specialty.

Second, arrangements were made to establish an international abstract bureau, the business of which will be to abstract all articles referring to surgery published in any journal during the preceding month.

Third, the appointment of a committee of five to consider the advisability of attempting the standardization of hospitals.

Fourth, a motion asking the executive committee to determine the advisability of limiting the membership of the Congress to 2,000.

Fifth, the appointment of a committee of five to execute the plans of education among the laity and the general practitioners on the subject of cancer.

The great objection to the Congress was the crowds and the impossibility of obtaining a seat. One was compelled, therefore, if he wished to see and hear, and oftentimes to obtain entrance, to be on the ground from fifteen minutes to half an hour before the beginning of the clinic.

I was greatly interested in the refinements in the aseptic operative technique of the New York surgeons as compared with what it was eleven years ago.

I feel that this Congress will, ultimately, become a great factor for the development of surgery and surgical standards in the United States.

The Congress as a body, was fully aware and fully alive to the need of standardization of surgeons by a minimum qualification as well as the standardization of hospitals by requiring that hospitals have some rules, and that a code of ethics on the part of hospitals be established, in which the business part of the hospital is governed by a board of trustees, and the medical part of the hospital is governed by the staff of the hospital.

There was a general concensus of feeling that the haphazard establishment of irresponsible hospitals must stop.

The spirit of better medical organization and higher medi cal standards was everwhere seen and heard and felt.

SYMPOSIUM ON SYPHILIS.

Syphilis in Diseases of the Eye

*By D. C. BRYANT, M. D., Omaha.

No organ of the human body is so susceptible to, and so prolific of syphilitic troubles as the eye and its appendages.

All parts of the visual organ itself, the eyelids and the orbital cavity, the muscles, and the lachrymal apparatus, protections which nature provided to prevent harm reaching the eye, are prone to become affected by syphilitic diseases.

Beginning with the eyelids, the initial sore is occasionally found here, all of the skin affections caused by syphilis, that occur in other parts of the body can occur here, the muscles are often paralyzed from the same cause, even the tarsus does not escape, although infrequently affected. The mucous membrane lining the eyelids and covering the anterior part of the eyeball is subject to the same syphilitic lesions that affect mucus membranes in other portions of the body. The orbital cavity is subject to the luetic lesions prone to attack periosteum and osseous tissue elsewhere.

Coming to the eyeball itself, no part of it is found immune from the inroads of this disease.

In the anterior part, the cornea, syphilis manifests itself nearly always in the form of interstitial keratitis, which is usually the result of luetic inheritance, although a small per cent of these cases are due to acquired syphilis. Probably about 75 per cent to 80 per cent of interstitial keratitis is due to inherited syphilis, while 5 per cent will no doubt cover the number of cases occurring from the acquired. Interstitial keratitis caused by the inherited form may occur at any age from five to forty years, although the greater per cent are found in childhood and early youth.

In acquired syphilis the keratitis may occur from a few weeks to twenty-five or thirty years after the initial infection. Syphilitic involvement of the sclera is rare, but does occasionally occur. It takes the form of gumma, and may attack any part of the sclera, but usually the anterior portion. It occurs in the tertiary stage and is often mistaken for a malignant growth. The second tunic of the eye, the vascular one, seems to be a favorite ground for syphilitic invasions. The first

*Read before the Nebraska State Medical Association at Lincoln, May 7-9, 1912.