ganized profession like that, and you would go down here to your state capitol and propose legislation it would be accepted by every member of that body without question. They have been poisoned by divisions and dissensions in our own ranks.

If we can have a profession organized along these lines, the good that will come to the profession and the still greater good that will come to the community will be worth all the effort we well expend in doing it.

Before I close I want to refer to one of the evils we have to contend with. We have lost the influence of one of the great professions of this country because of a fault of our own. I feel so kindly towards the clergy that I refer to the matter with delicacy, and yet it is the clergy which supports quackery in the country. I believe we have driven them largely that way because we have made objects of charity of them, we have placed them in our charity list from one end of the country to the other. I believe the time has come to win this great profession back to us, and I am sure we can do it. I believe they should be restored to the pay list of our profession. They are as well supported as any other profession in this country. At least there should be some reiprocal relation. The younger men of the medical profession when they get married ought to have the same reciprocal courtesy extended to them, but we never hear a minister say, "I will reciprocate by returning the marriage fee.” If you gentlemen are members of a church organization you pay your assessments like gentlemen, and it seems to me when you have done that your duty ends to the minister of your church, and as you pay him for his services to you he ought to pay you for any service you render to him in your professional capacity. A short time before I quit the practice of medicine a minister sent for ine night after night, in the middle of the night, to attend his wife. After that had gone on for a long time, and he had apologized for sending for me so frequently, I said to him one day, "It is a comparatively small matter, but I charge double for night calls." "Do you charge for your services?" he inquired. I said certainly I did. "Well,"

he said, "I did not know that, I could have sent for you in the day time just as well as not." (Laughter.) He asked, "When would you like to have me settle the bill?" I said, "You can give me a check now and again when your wife recovers." He did so, and he sent for me frequently after that, but always in the day time. Charity patients, as a rule, send for us more in the night than in the day time.

Speaking of the question of organization, just one moment more. I have outlined in a very rambling way, and I feel that I have done it imperfectly, some of the benefits that will come to us from so perfect an organization. It is entirely practical and professional, and it makes it to the interest of every physician to come into the society. This establishes the basis for another important step contemplated, which is the publishing of a medical directory of the United States as soon as the data can be collected. We expect to furnish to the profession of this country a complete medical directory of the medical profession of this country, and when that is done, if you are a member of your county society and of your state society, your name will be run in that directory in bold-faced type, with full information regarding your literary degrees and your official position, if any, the name of your college and the year of your graduation. You can see in that way it will be a guide for insurance companies.

Now the association is prepared to put a uniform plan into operation, and it has prepared blanks for charter societies and blanks for returns, and these will be furnished by the association at the bare cost of work and material.

I simply present to you these matters of detail to give you an idea of the far-reaching plans the association has in view. It means a real organization of the profession. This makes, I think, the twenty-fourth state that has accepted this plan unanimously by a rising vote and by a suspension of the rules, and the advantages to them and to you will be so great you will never have cause to regret the change, and if there is any question in your minds as to the wisdom of it it will be entirely removed by the benefits almost beyond comprehension that will come to you.

I thank you, gentlemen. (Applause.)

SECTION OF SURGERY.

H. B. SWEETSER, M.D., Minneapolis, Chairman.

CASE OF SARCOMA OF THE FEMUR RECURRING AFTER AMPUTATION AND CURED BY INJECTIONS OF COLEY'S FLUID.

H. B. SWEETSER, M.D., MINNEAPOLIS.

Sarcoma of the femur treated by operation is almost sure to recur. This appears to be true, whether resected or amputated in continuity or disarticulated at the hip-joint. Nor does the type of tumor seem to make much difference, whether round, or spindle, or giant-celled, medullary or periosteal, confined to the condyles or invading a large part of the bone and soft tissues. In all the papers and discussions on the subject, to which I have had access, this same hopelessness is expressed.

Almost the only cases that have not recurred, or, if recurring, have disappeared again, are those which have freely suppurated after operation, or which were inoculated with erysipelas poison, or which were subjected to injection with the toxins of streptococcus erysipelatis and bacillus prodigiosus, the so-called Coley's fluid.

In the preaseptic days when operative wounds almost invariably suppurated the results were better than they are now. Wyeth reports five very interesting cases of inoperable sarcoma which were subjected to inoculation with erysipelas poison, and all of the tumors had disappeared when the erysipelas was cured. Coley reports that 50 per cent. of spindle-celled and 5 per cent. of round-celled sarcomas disappeared under injections of Coley's fluid. Dr. O. K. Winburg of Lake Park, Minn., reported last year a most interesting case of inoperable recurrent and metastatic sarcoma of the superior maxilla, which entirely disappeared under the influence of Coley's fluid.

I herewith wish to add another one to the not large number of reported successes from the use of this fluid.

CASE.

Mr. D., aged 33 years, of German descent, seen Aug. 9, 1902, with Dr. A. N. Bessessen. Family history negative, there being no case of malignant disease known; parents living and healthy, as are also his brothers and sisters, excepting one brother who died of tuberculosis. The patient had always been rugged and strong, weighing 196 pounds, never had syphilis or rheumatism or any severe illness. Bearing on the disease the following facts are of interest: In 1898, at the battle of San Juan, he was kicked over the right knee by a cavalry horse, but he entirely recovered from the effects of this in a short time. Again in February, 1902, he was struck over the inner condyle of the right femur by a tailor's goose, but the effects of this also were quickly recovered from and almost forgotten.

In March, 1902, he began to suffer from pain in the right knee, most severe at night and almost disappearing during the day. No swelling appeared, however, until some time in June, but since then this has gradually increased in size. His treatment had consisted in administration of salicylates, potassium iodid and immobilization of the knee, but entirely without benefit. When seen by me in August he stated that he had lost some in weight; that the pain was marked; and that he was able to get very little sleep. Over the right inner condyle was a soft, fluctuating, globular tumor about the size of a small orange. It was very tender, and the skin over it was reddened. The leg was held at nearly a right angle; temperature 99.5, pulse 100.

A probable diagnosis of sarcoma was made, but the patient was given the benefit of any doubt, and subjected again to the influence of antisyphilitic medication, but without benefit. On August 25 the tumor was opened, the patient objecting to amputation without positive proof of malignancy. The tumor was full of bloody fluid, with free masses of fleshy tissue. It had eroded the bone and invaded the soft tissues over the inner condyle. The microscopic examination was made by Dr. J. Frank Corbett, who reported it to be a large

spindle-celled sarcoma.

In some of the sections there were

numerous giant cells, but in others none at all.

On September 3, Dr. A. N. Bessessen assisting, the thigh was amputated eight inches above the lower end of the femur. Union was practically by first intention, except that a small abscess formed in the soft tissues where drainage was made. Following the amputation the pain continued and gradually grew worse and more severe, requiring several doses of morphin daily to control even to a slight extent. Loss of weight also was progressive, the extreme loss being about 80 pounds, for after he had recovered sufficiently to get out of doors on the 1st of January following, his weight was only 126 pounds.

Early in October, about five weeks after amputation, recurrence was noted, a small hard lump appearing on the anterior aspect of the distal end of the femur. This rapidly increased in size, projecting as a well-defined spherical mass, as large as a goose-egg or larger. The whole leg also became swollen, and attained a circumference of twenty-two inches, or four inches more than that of the sound side. His temperature went up to 102 F., and the pulse to 130 per minute. The pain became unendurable, especially in the night, and 3⁄4 of a grain of morphin was ineffectual in relieving it.

On October 14 1⁄2 minim of Coley's fluid was injected, and the record the following morning showed that the pain was more easily controlled. The significance of this, however, was not appreciated apparently, for no further injections of this were given until later. Disarticulation at the hip-joint was refused; nor did I urge it, because of the early recurrence and its very rapid progress. About November 1 the use of Coley's fluid was resumed, and injections made every second day. The initial dose was 1 minim, and it was increased until on the 12th 4 minims were given. Following this the injections were given every second, third or fourth day, depending on the amount of reaction obtained. The dose was increased gradually until 10 minims were reached, but this dose was not exceeded. Except on a few occasions the reaction consisted in a temperature of about 100 F., and a pulse rate of about 100 per minute, occurring usually five hours after injection. On