count ventral herniæ are much too common even in aseptic primary union. For this reason deep interrupted, thru and thru silkworm gut stay sutures have been used. Infection too often follows. Immobilization of the abdominal walls is secured by long strips of adhesive plaster extending twothirds around the body. these questions decides when to operate. Based upon a careful knowledge of anatomy there must be added to it an equally careful knowledge of pathology. I was for a long time assistant of Prof. J. B. S. Jackson. of Boston, considered by many the first authority in pathologic anatomy in America. Later, in Ber These are carefully applied after steriliz-lin, I was the special student of Prof. ing the wound; cut about three inches inside and overlap by about one-third "clapboarding" the entire abdomen, much as these boards are applied to the exterior of houses. My friend, Dr. Carstens of Detroit, has recently published his very valuable experiences in their use; undoubtedly other surgeons have used them. I know no better way to immobilize the abdominal wall and have used them for years. The contrast between such a wound and the surgical treatment of an earlier day is well illustrated by the difference between a simple and a compound fracture. The iodoform in the collodion is usually superfluous, especially if the wound is dry before the application of the seal. Bloody or serous exudate from the wound is protected by the iodoform from possible infection. Mr. Lister builded well upon sure and logical premises, clearly demonstrating that wound infection is the surgeon's constant danger and also a protection from it must be obtained. His faithful devotees have modified the technic and rendered results more certain. His fame rests upon a safe foundation. Wherever surgery is practiced, his fundamental teachings are accepted as a primal law of procedure. The function of the various organs must be determined for the greater safety of the patient, to know if his vital energy is in a solvent state, and that the mortgage thereon may be assumed without too heavy risk. The answer to Virchow in 1869-70, and I have made, greatly to my profit, about a thousand postmortem examinations. However, I soon learned in my abdominal surgery that the operation upon the living subject opened a new and most interesting chapter of anatomical knowledge. When the vital machanery is still at work it teaches many most profitable lessons of function and repair and opens the way for the salvation of many lives otherwise doomed. Surgery of the Present War. It is too early to pronounce with any degree of accuracy upon the permanent benefits to medical science, arising from the late European War. Much of the surgical work has been done of necessity under most disadvantageous conditions. The range of the artillery fire is so great that men wounded on the fighting line are often beyond immediate assistance. We have reason to be proud of the medical departments attendant upon all the forces engaged. Suitable surgical aid has been given to minor wounds whenever the soldier has been able to report for early treatment. Injuries have been of such an enormous number that the good results are surprising. All penetrating wounds are regarded as infected; all foreign material as bits of clothing, small pieces of shell and bullets have been removed; more than ordinary care exercised to control bleeding. If such service has been rendered within twelve hours wounds are generally closed with primary sutures and usually followed by aseptic repair. Compound fractures are converted into simple fractures and treated as such. An enthusiastic surgeon writes of this type of injury: "One stands in awe and wonder at results as he compares the present with the past; primary union without suppuration; only a lineal scar; no gauze packing or constant irrigation; pain minimized, followed by the peace of being let alone." How have these things come about? By the formation of a trust composed of the radiologist, the bacteriologist and the surgeon, all working harmoniously and constantly together. Dr. Hugh Cabot, of Boston, who has recently returned from Europe, gave a most interesting address before the Massachusetts Medical Society, upon the lessons of surgery learned, of special value during the war. The later methods are specially by free incision and thoro cleansing of the wound with primary and delayed sutures. "During six weeks from August first to the middle of September, No. 22 General Hospital received 5,539 wounded and operated upon 2,047 (36 per cent.). Of these 2,047 operations, 933 cases were thought appropriate for suture and 741 were primarily sutured. It was further demonstrated that cases could be treated which were from 24 to 48 hours old with at least 84 successes. This was true in a series of over 700 cases; many of them were more than 48 hours old. In 479 cases, involving only soft parts, 410 (86 per cent.) were complete successes; in 184 cases involving bones and joints, 146 (79 per cent.) were complete successes. In the early period after injury the penetrating wounds of the knee joint are similarly treated. The reports of other surgeons coincide with Dr. Cabot. Primary suturing has been successfully accomplished in over 80 per cent. of the cases operated upon within the first twelve hours; infection is mainly due to the streptococcus; the infected wound must be opened and treated immediately. Progress in surgical interference depends upon the knowledge of wound infection and of the means of rendering a wound aseptic. The plaster splint has been adopted for the immobilization of fractures both simple and compound, finding a much wider use in the recent war than ever before. The profession is indebted to the late Louis A. Sayre, of New York, for this important addition to surgical appliances. In important fractures where infection. and suppuration are factors, splints should be fenestrated to allow free access to the wound, the edges are protected with collodion or some other substance to prevent absorption; melted paraffin serves very well. To change infected compound, fractures into aseptic simple fractures at the outset, is to do away with one of the greatest dangers in war surgery. Compound fractures must be operated upon by the technic of primary, or delayed primary suture, at the latest, twelve hours after the casualty. A plaster splint should be applied for a compound fracture of the leg; it may reach from the toes of the injured side quite to beneath the arm-pit. In such a splint, the bed-pan can be used and the patient transported with comfort to any distance. Thus treated both life and limb are usually saved. The French surgeon, Lemaitre, in a series of 121 compound fractures of all bones (he annexes a list), including 51 compound fractures of the humerus and 26 of the femur, most difficult of war wounds to treat, reports there is a complete cure of Medical as well as surgical victories should receive proper recognition. The military surgery of this war has proven as never before, not alone the dangers of infection but the marvelous results of treatment applied. I repeat, to change an infected compound fracture into an aseptic simple fracture, within eight to ten hours of the injury, means the mastery of one of the most serious problems confronting the surgeon in peace as well as war. Sanitary science practically unkown half a century ago has made the tropical zone of the earth a safe home for the white man, and opened to him the vast store-houses of its wealth. Our late Surgeon-General Gorgas eliminated yellow fever from Cuba. The Philippines and the Panama Zone are safely habitable. Under such supervision the Panama Canal has been completed for the commerce of the world. Typhoid fever has been banished from the Army and it is the duty of the medical profession, in a similar way to protect the civil population. Diphtheria is largely robbed of its terrors. The cause of tuberculosis has been discovered and its ravages lessened. The hook-worm-disease, for centuries an known and widely extended scourge, has been placed under control. un Dr. Richard Strong of Boston, now colonel U. S. A., has added valuable knowledge for the control of epidemic diseases, and has recently demonstrated that trench. fever is one of a group of diseases trans mitted thru the agency of the louse, as the intermediate parasite. Dr. Horsley, in a recent address upon the value of biologic principles in surgical practice closes as follows: "Real progress in surgery lies not so much in cultivating the art of surgery and in striving after mechanical dexterity as in the study of biologic concern nutrition, meprinciples that tabolism, and repair of tissues and in the thoughtful application of these principles to every operation and to every method of surgical treatment." The surgeon must not alone be a scientist, which includes a familiarity with the technic as outlined, to be carried out with the automatism of a well mastered ritual, an equal knowledge of the anatomy of the structures involved and their relationship; but to this should be added other almost equal acquirements, those of the artisan and the artist. The work of the surgeon for good or ill has its finality at the single period of manipulative intervention. 180 Commonwealth Avenue. Origin of Pepsin.-Pavlovsky (Semana Medica, March 11, 1920) reports research which has apparently demonstrated the important share of the spleen in the formation of the gastric ferments, and that injections of spleen extract increase the quantity and improve the quality of the secretion in the stomach. Injections of fresh leucocytes and red corpuscles from the horse acted in the same way. All confirm the rôle of the spleen in normal digestion as well as in blood production, and sustain the principle that the secretion of an organ is perhaps the best stimulant to promote its secretory function. He gives the details of series of tests on dogs with a Pawlow gastric pouch, given an intramuscular injection of 25 c.c. of a 25 per cent. decoction of spleen tissue, the blood count recorded over long periods, and the units of gastric digestion. AMERICA'S GIFT TO POLAND'S WOUNDED. BY DR. FREDERICK W. BLACK, Huntingdon, Pa. The Military Surgical Hospital which was established in Vilna, Poland, early in 1920, has been turned over to the University of Vilna as a gift of the American Red Cross. The plan in establishing this hospital was to make it a permanent, fully equipped, modern hospital to be used solely for the operation and treatment of the Polish Army. The hospital was to be in charge of American medical personnel and was to function according to American methods. I was appointed to establish this hospital and to act as chief surgeon. When I arrived in November of 1919 the City of Vilna presented a very dilapidated and moth-eaten appearance as a result of the successive siege, capture and occupation by the German, Russian and Bolshevik armies. The picturesque mountain scenery surrounding Vilna only accentuated the forlorn aspect of the city itself. Little remained of its former grandeur except here and there the great golden domes of the Russian mosques and glittering spires of cathedrals pointing skyward. Lawlessness, hunger and crime reigned in the city. Destruction had followed in the wake of the armies. Homeless, halfnaked women and children roamed the streets, hunger driven. Desperate men prowled at night. Hold-ups, robberies and murders were common nightly occurrences. Gunshots could be heard during all hours of the night in various parts of the city. An inadequate force of military police patrolled the streets at intervals, but seemed entirely unable to cope with the situation. After inspecting some ten or twelve buildings a final selection was made of a very large, three-story structure, built around a court, which had formerly been used as a military training school for Russian officers. The place was vacant and deserted and had been stripped of everything that could be carried away, and all that remained had been destroyed except the walls and roof. This place was large enough to accommodate an 800-bed hospital. The problem, however, of converting it into a hospital under the existing conditions was a very difficult one. The glass and frames for five hundred and sixty odd windows had to be procured and replaced. Many changes in the interior construction of the building were necessary. Doors had to be cut and rooms divided in various places. The entire place had to be replastered and all the walls calcimined or painted. A complete lighting system had to be installed, including wiring and fixtures. The building had never had any plumbing so it was necessary to install a complete modern plumbing system for toilets, operating and sterilizing and preparation rooms, baths, wards, kitchens and laundry. A complete kitchen, including stoves of the Russian tile type, had to be built in. A central heating plant was necessary and forty-nine large Russian tile heating stoves which had formerly supplied the building were all rebuilt and supplied with doors and grates of metal. Complete modern washing, drying and ironing rooms were operated by a large steam tractor engine, which was procured from France, shipped to Vilna and installed. A delousing apparatus, after much effort, was obtained from the Austrian Army equipment and installed. A complete steam ster The American Red Cross hospital at Vilna, Poland, which has recently been given to the University of Vilna, by the Red Cross. It was a military training school for Russian officers before Dr. F. W. Black turned it into an American hospital. The writer, tho merely a surgeon, luckily had some knowledge of engineering and so for a time became plumber, carpenter, painter and steam-fitter, in turn as required, and finally after about three months of desperate effort was able to get the place converted into a modern, fully equipped hospital ready to function. The question of procuring material in this desolate, stricken land with which to make all of these repairs presented almost treatment of fractures by means other than plaster casts was practically unknown in Poland, of course no such apparatus was available from any source in that country. Again the Chief Surgeon's mechanical ability was tested in making models of Balkan frames, Blake, Thomas, Hodgins, Jones and various other types of splint, and all of the numerous kinds of suspension apparatus used and developed during the war in France on the western front. From these |