of great service, but in cases of young children I have been unable to derive much good from either. It should be borne in mind that in every case of foreign body in the lungs especially the prognosis is very grave, and even after the foreign matter has been removed, irreparable damage may have been done from which the patient will never recover. The main dangers are: primarily, suffocation; secondarily, collapse and gangrene of lung, obstruction pneumonia, the formation of an abscess, sepsis, and non-contracting cavities as in case No. 2. Therefore, it is plainly apparent that every effort in the treatment must be exerted towards the speedy removal of the foreign body, whether it be located in the larynx, trachia or lungs. With respect to treatment, the older text books lay much stress on inversion of the patient, and slapping forcibly on the back. This expedient, of course, should be tried by those present at the time of the accident, and generally is. By the time the physician arrives he will find, in practically all cases, this kind of procedure will fail. Forcible slapping on the back may even tend to lodge the substance more firmly, or change it to a more dangerous position. At the present time the tendency is towards immediate operative procedure. The surgeon will often meet with much less difficulty than he anticipated. Foreign bodies in the larynx can usually be removed by the aid of the laryngoscope without operation. Laryngotomy or cricothyreotomy have sometimes to be performed. In case of lodgment in trachia or bronchi the lowest possible tracheotomy is of advantage. For a clearer elucidation of the subject I will report the following cases in brief: Case No. 1: Mr. B., aged 20. While husking corn he attempted the removal of a sandbur from his gloves with his teeth. The bur lodged very firmly on the right vocal cord. When patient was presented to me next day by Dr. Adams there was considerable swelling and intense spasms. The attempt to remove the sandbur under the use of cocaine alone failed, but by the repeated application of a strong solution of potassium bromide, the desired result was obtained without a great deal of difficulty. Case No. 2: A girl, aged 12. History: When eighteen months old, while playing with a cedar twig, some of it passed into a bronchus of right lung. No attempt was made at removal. Present condition: Intermittent fever, expectorating large amount of very fetid pus two or three times in twenty-four hours. A large cavity about the center of right lung was found. Cure by operation was attempted. Accordingly, a section of two ribs in the anterior axillary line was made and the plural cavity opened. Parietal and pulmonary plura were sutured and cavity packed with gauze. Operation was completed in two tempos by opening into the pus cavity by the use of the paquelin cautery on the third day after the primary operation. The cavity could be reached by the finger and was found to have firm, unyielding walls. It was packed wtih iodoform gauze and a drainage tube inserted. While drainage remained no expectoration took place. For three or four months all kinds of procedures and medicines were resorted to to obtain contraction of cavity, but without avail. While the drainage through the thoracic wall remained, the fever subsided and patient's general condition improved. The ultimate result was a complete failure, owing to the unyielding nature of the adjacent tissues and the failure of granulations to fill up the cavity. Case No. 3: Babe, nine months old. While biting at a piece of an apple, sudden symptoms of strangulation appeared which continued severe until next day when I was called by Dr. Adams to operate for some foreign body in the lung. The baby was extremely fleshy and short-necked, so that the operation was somewhat difficult. This was more than compensated for, however, by removal by the use of a Hartman alligator jaw forceps from left bronchis, of a wad of apple pealing at the first attempt. Inflammation of the lungs continued for some time but ultimate recovery resulted. Case No. 4: Girl, aged two years. History: While eating peanuts severe strangulation symptoms occurred. She was brought to the hospital the following day in a semi-comatose condition. A low tracheotomy was done and in the right bronchus, just below the bifurcation, a whole peanut kernel was firmly impacted. It was impossible to remove this without crushing, but most of it was finally extracted and ultimate recovery followed. It is well always before opening the trachia to pass two sutures under one ring, side by side, so as to steady it while making the incision, cutting between the sutures. This will serve as retractors, and if it should be impossible to remove the foreign body at the time of operation these threads should be sutured to the skin and left, in hopes that the foreign body will appear at the opening, which very often does occur, and can then be removed. If Case No. 2 had been operated at the time of accident she would undoubtedly have become a happy and useful member of society, instead of, if now alive, a suffering, helpless invalid. Dr. Grothan, St. Paul, Neb.: DISCUSSION I used cocaine as strong and as much of it as I dared and it did not seem to remove the spasms, while a strong solution of bromide of potash relieved those spasms. Dr. Hildreth, Lyons, Neb.: It does not seem to me that a paper of this kind needs any discussion. We know the symptoms and we all know what to do. It seems to me that the only thing to do is to remove the troublesome entity. We every one of us know the sooner it is done the better. Delays are dangerous. Dr. Larkin: In 1891 I was called to see a gentleman by the name of Anderson, an old gentleman, with whom I could not converse very well. He had swallowed a plum pit and it had gotten into his trachea. I said to him, we will wait until your sons come home and then I can explain to them, but next day when his sons came home he was dead. Dr. Grothan, Concluding: Well, it was just a little sketch, not exactly a paper. Of course, I feel sure that everyone knows what to do in these cases. We are all more or less lazy in one way or another and we keep neglecting to do things and trusting to luck too much. Numerous cases have come under my observation that have gone on from bad to worse until we simply could not do. anything with them. The only excuse I have for bringing up a paper apparently as insignificant as this is, is simply because we do not know what we know. Undoubtedly many patients in this state would be living today if we had bestirred ourselves and either got a competent surgeon to operate on them or some of these skilful specialists to remove the object. President's Address *By HENRY FARRELL, M. D., Axtell, Neb. My first duty, as I conceive it, is to thank you for electing me your president for the ensuing year. I consider it a privilege and a pleasure to preside over a progressive body of medical men whose membership comprises the greater part of the fraternity of eleven counties in southwestern Nebraska and has also for members some of the leading surgeons and internists in the large cities of the state. I do not believe there is another medical society in Nebraska whose members are more pro *Delivered before the Republican Valley Medical Association, at Hastings, May 29th, 1913. gressive and less influenced by politics than the society to which you and I belong. We endeavor to recognize what is best for the society and try to forget the petty jealousies of the few cliques and clans, which, I am happy to say, are fast seeking and passing into an oblivion. We are living in a marvelous age and no medical or any other society can hope to survive and prosper which does not push forward and be progressive in everything that is for the betterment of the fraternity and the whole people in general. Our motive for attending these semiannual meetings is to stimulate us for the better in things medical. To obtain new ideas, to receive and impart inspiration, to keep abreast of the times, to enjoy the friendship of our fellow members-these are the thoughts uppermost in our minds. I have little use for the proverbial "knocker," but the intelligent critic commands my respect. As I see it, one of the great drawbacks with the medical profession as a whole today is that too many are "standpatters" and not enough are of the progressive type. To be sure the latter are greatly in the majority but the former are a continuous drag and block many reforms in medical education. In that future day when there is unity and solidarity and the two minorities harmonize with the majority will the medical profession make their greatest progress and their masterly efforts be appreciated and possibly rewarded. There is going on in this country at present and for some time past a system of education along the lines of specific and preventive medicine, hygiene and sanitation, that is making a revolution in the mortality tables from the various diseases that afflict mankind. This perhaps is more noticeable in the large cities than in the rural districts but, nevertheless, in cities and out, the general condition of the public health has never been better, population considered, and a lessening of mortality to a greater degree, than at the present date. And I might say that this system of education is merely in its infancy as far as results are concerned for as the years roll on and the public becomes educated in the right ways of living and diseases are treated more scientifically, the greater will be the longevity and lowering of mortality. The people can thank the medical profession for their larger share in this wonderful reform and progress for the betterment of the public health but with the exception of a small proportion of the better read very few of them will or care to. I may be somewhat premature but that day is not far distant when the general practitioner will have little else to do but attend emergency calls, assist in confinement and sign death certificates with "old age" as the cause. The future problem and chief line of duty for the medical man will be that of preventing rather than assisting in the cure of disease. I am a general practitioner myself and I speak in this manner for the reason that I am addressing a medical society of whom the great majority are men in general practice and if I can open up a trend of thought for your benefit and mine—that is my purpose. I make a direct appeal to you today that while you are performing your mite in the just and noble cause for the general welfare of the masses that you protect and further the interest of yourself and your brother practitioner by charging in proportion for services rendered. My information and personal observation leads me to believe that at least 50 per cent of the medical men of this state, and what is true of Nebraska is true of other states, are not charging enough for their professional knowledge and attendance. I know of a few good men who charge what they are worth, but I am sorry to say they are in the minority. On the other hand I know of a number of well qualified internists who in order to make respectable livings are obliged to cut a reasonable fee in two, and this partly on account of a surrounding competition who do a cut-throat busines and who reach almost the border line of quackery. This is not a pleasant state of affairs but if you are a careful observer you will acknowledge its truthfulness. There is absolutely no excuse and at the same time no hope for the doctor who dispenses his medicine at drug store prices and charges little or nothing for his professional knowledge. There is the same amount of hope and excuse for the practitioner who gives to his patient two or three prescriptions at one visit and charges for the whole, and his diagnosis thrown in, the price of a single prescription. If time would permit I could relate several illustrative examples of this kind of professional service but I do not wish to burden you with details which not unlikely are familiar to you. Almost every physician has the experience of doing a certain amount of charitable work in attending the poor and needy, which to a limited extent is just and right, but otherwise the doctor should be guided by a reasonable table of fees such as we have in our own society, and which every other medical society should have, and live up to the fee table as near as one can conscientiously do so. In this way you will receie a just financial reward and command the respect of the people at large. I want to call your attention briefly to a class of adver |