a laxative given the night before operation. After the patient was anesthetized the abdomen was washed with benzine, dried and painted with three and one-half per cent. tincture of iodine. The operators' hands were scrubbed with green soap and hot water for ten minutes, soaked in lysol solution for two minutes and rinsed in sterile water, dried and covered with rubber gloves sterilized in the autoclave. Fresh gloves were of course donned for each operation, but the aprons were not always changed unless soiling had occurred, the fronts being covered with fresh sterile towels. The wounds were covered with sterile gauze securely fastened in place with adhesive strips and not disturbed for ten days. Patients were permitted to sit up in two weeks and in three or four weeks were discharged to the Infirmary of the Development Battalions with the understanding that they should not be returned to full duty until two months after the operation. There were nine cases of superficial infection, the organism in each case being the Staphylococcus Albus. All the infections were superficial and did not interfere with the wound healing or the success of the operation. The one case of recurrence coming to the attention of this service was not infected. In that case the cord was not transplanted. This was done however, at the re-operation in September. It was not practicable to conduct operations regularly in the afternoon as the nurses required that time to prepare for the next day and the plan adopted June 1st, which made it ossible to perform so many operations in so short a time in addition to caring for the large amount of other operative work, was to place two tables in one room running two operating teams at the same time. One of the Staff had charge of preparing the patients and starting the anesthetics, so that the operators were subjected to no delays between cases. Three anesthetists were always available as well as four nurses and a sufficient number of orderlies. Other operating teams cared for other classes of cases in the second operating room. Ether vas the universal anesthetic used, except in a few cases toward the last of the series when Nitrous-Oxide-Oxygen was used. By this method on some days twenty-five herniotomies were performed between seven-thirty and twelve o'clock. A few cases of pneumonia presenting type IV. pneumococcus developed, and finally a severe outbreak occurred in one ward, nine cases appearing in one day. This led to a survey of the ward by the Laboratory under the direction of the Chief of that Service, Major C. P. McCord. Of forty-eight people connected with the ward, forty-four were found with pneumococcus type IV. in their throats. This ward was quarantined, the inmated caused to use a gargle suggested by the Laboratory consisting of a solution of 1:10,000 Quinine Bi-Sulphate. After three days all the throats being found sterile, operations were resumed from this ward and no further pneumonia occurred. After that experience the rule was adopted that all cases must use this gargle for two days preceding the administration of ether. No case of post-operative pneumonia occurred after this rule was adopted. The disease in nearly all cases terminated by crisis in four days and all recovered. The Surgical Staff acquired so much faith in this simple gargle as an agent to destroy pneumococci in the throat that they faithfully used it during the influenza epidemic in October and attribute to that practice their freedom from pneumonia. No member of the Surgical Staff, nor of the nurses or orderlies connected with the Operating Room contracted pneumonia during the epidemic, although all of them did work on the Medical Service and were repeatedly exposed to the infection. Several of them had influenza. The Quinine Solution is a specific germicide for the pneumococcus, but not for other organisms. It is not possible to report definite results on all these cases on the question of permanent cure of the hernia. So far as this Service is oncerned, only one case has come to its attention with a recurrence. He was operated in July and was sent to the Disability Board at this Base Hospital in September with a request for his discharge on account of recurring hernia. Reference to his history disclosed that he had been operated upon by a competent surgeon, that he had suffered from no infection and had been discharged from the hospital three weeks following operation. It transpired that he had been sent to his organization instead of to a Development Battalion and had been subjected to full duty at once. He was admitted to the hospital and re-operated with satisfactory results. Three hundred and ninety-two of the cases composing this series were transferred to Development Battalion No. 2. The infirmary of that Battalion has the records of all discharged from the service and of the present disposition of those remaining in the Battalion. These records number one hundred and seventy-eight cases, the remainder having been transferred to other camps or to other organizations. That leaves one hundred who were returned to their line organizations or to other Development Battalions. Many of them were members of the Base Hospital Detachment and are still on duty. None of the Detachment men have suffered from recurrence. A Development Battalion classifies its men as follows: Class A-Fit for general military service. Class B-Fit for limited military service, but in good condition; able to march five miles a day. Duty Grade Fit for labor organizations. November 14th, 1918, the Commanding Officer of Co. C, Development Battalion No. 2, kindly informed me that the one hundred and seventy-eight hernia cases remaining in his organization who were operated in May, June or July, which included all the cases operated upon during those months who had been discharged by the Disability Board of the 158th Depot Brigade, were classified as follows: 28 per cent. Class A. "Of those discharged 4 per cent. were for other causes than hernia. Of the 43 per cent. Class B men, 40 per cent. will be placed in Class A within the next thirty days. The 23 per cent. duty Grade will be placed in labor organizations and are so placed for other reasons than their herniotomies." It appears then that in an average period of four and a half months there have been 2 per cent. recurrences in one hundred and seventyeight cases. This, however, includes all the known recurrences in three hundred and ninety-two cases, the remainder having been transferred to other camps, free from recurrence. In course of time recurrence will take place in other cases no doubt, but it is not likely to exceed 2 per cent. of all cases operated. This result compares very favorably with the results obtained by individual operators in large series of cases. No death occurred in the series. In conclusion the writer expresses the opinion that the most important thing to consider in performing a herniotomy for inguinal hernia If the sac 's thortissues of the cord is the treatment of the sac. oughly separated from the and ligated at the reflection of the peritoneum the hernia is not likely to recur whether in subsequent proceedings the cord is transplanted or not. Many of our cases were of the incomplete type and it is necessary in such cases to raise the cord in order to locate the sac which invariably comes out of the abdomen underneath the cord. Many of the operators transplanted the cord in all cases of this kind and did not transplant if they found it unnecessary to raise the cord from its place in the canal. Exposure of the shelving edge of Poupart's ligament freeing it from fascia and securely sewing it to the conjoined tendon whether underneath or over the cord, is considered vital to the permanent cure of the hernia. PEACE AND WAR IN THE HUMAN ORGANISM.* F. MCD. HARKIN, M.D. MARQUETTE, MICHIGAN. *Read at meeting of Michigan State Medical Society, held at Houghton, Michigan, August, 1916. Life lapses into Death, and Death to Life, Mr. President and Gentlemen: If I have dared to caption this paper with those introductory lines from an old collegeday fugitive poem, it is because it fairly well expresses the constant struggle of the human organism, from the cradle-aye and before it to the grave, to live in that state of stable equilibrium which we know as health, or peace, or harmony with its environment. In the Universe itself, with its sidereal systems, suns, moons, planets and other bodies, gaseous and solid, we observe that by attraction and repulsion, these various systems and bodies. live in quite a state of harmony-yet even here collisions occur, and sometimes the smaller body meets absorption or destruction by one of its larger neighbors. Still the ideal striven for, is that of peace-of live and let live-of health --of harmony. When we consider our own little planet and its chief living occupant-homo sapiens-we find here also a desire or innate ideal of peace which however embryonic in the early stages of man's existence still has been making itself more and more evident as the centuries progress but how imperfectly the ideal is as vet developed, can be easily demonstrated by the present great conflict of nations-the greatest of historic or perhaps all times. The enemies of the human organism itself may be divided into two great classes (1) External or those operating from without, and (2) Internal-or those operating from within. Of "External" enemies which operate against mankind as a whole we have, firstly, the great external causes which might be called cosmic such as earthquakes, volcanoes, tidal waves, floods, famines, cyclones, fire, frost, and electrical storms; secondly, those which might be termed animalistic, such as wild beasts, poisonous reptiles, centipedes, lizards, tarantulas, sharks, etc.; thirdly, those which for want of a better name might be classified as mobilistic -and the result of accidents during transportation by railroad, boat, automobile, horse, and latterly, aeroplanes, and their like; and lastly, we have the fatalistic or those which are the result of violence exercised by man himself—against himself or his neighbor-such as suicide, rape, murder, legal execution and war.. Of "Internal" enemies operating on a large scale, we have disease epidemics-now mostly under control in times of peace, such as plague, cholera, smallpox, typhoid, yellow-fever, malaria, etc.; and also have we the great universal triad of human destroyers-Tuberculosis, Cancer and Venereal Diseases. Taking a closer view of the human organism in its struggle not only for life itself, but for peace during life or what is otherwise called health-we find oftentimes, that war is declared upon the prospective human adult, from the very moment of conception, and continued until mortality claims its own. Thus, we might further classify enemies of the human organism into (1) Pre-natal and (2) Post-natal. Pre-natal enemies might be further subdivided into those operating (1) at conception (2) during gestation and (3) at birth. Under the heading "at conception" the first fatal error of the embryo is to locate itself in a wrong habitat otherwise known as an extrauterine pregnancy. We can also list here such enemies as syphilis and the hereditary diathesis of such diseases as tuberculosis, leprosy, carcinoma, scrofula, gout, insanity and many others. "During gestation," the perils of the growing foetus are indeed numerous, for besides the many unavoidable and accidental dangers of miscarriage, there is frequently added the murderous assault of both lay and professional abortionists. "At Birth," if our homunculus has survived the pitfalls of a diseased placenta or a placenta previa, it may now succumb to one of the dangers of dystocia—such as uterine fibroid, ovarian cyst, deformed pelvis, or it may furnish its own offensive weapon in the form of a hydrocephalic tumor. It may be further endangered by a mal-presentation or it may hang itself by the neck until dead. Escaping all these perils, it must now run the gauntlet of the unqualified midwife and the careless or inexperienced physician, who may bury the poor little "toddlekins" through ill-timed or misapplied instrumentation-or by the faulty ligation of the unbilical cord. Now, when we come to consider the "postnatal" enemies of mankind, we find amongst others in the early months of life, the inability to secure breast-food-the ignorance about infant feeding and management-a hard problem at best, and especially where poverty, filth and squalor abound, in other words, where exists an unfavorable environment. At this time, were it not for the inextinguishable devotion and self-sacrifice of parental love, there would be many more of the infant human organism that would never see maturity. Of "internal enemies," even the infant is soon beset by many foes-principally, those of the digestive tract, from defective nutritionand microscopic antagonists either of intestinal origin, or those of the so-called zymotic diseases. It is now, also that if the luetic embryo is world-born, that arch-enemy of humankindsyphilis, strikes fearfully and abhorrently at the citadel of life, or conquered temporarily, awaits a more favorable opportunity for further attacks. During the early years, i. e., of childhood, the human organism has to contend with such external enemies as accidents of various kinds blows, falls, cuts, burns, explosions, drownings and so on, ad infinitum-but still the internal enemies are the most formidable: un balanced secretions, intestinal toxaemias, perverted metabolism, zymotic diseases, pyorrhoea, adenoids and infected tonsils with all their disastrous sequelae of secondary infections. During adolescence, besides the usual accidents, we have the external and internal injuries resulting from strenuous athletics, while from within we must note the greater incidence of tuberculosis, the liability to venereal disease, and oftimes, the entering wedge of alcoholism. During the third and fourth decades, with the exception of the perils of child-bearing, mankind enjoys a comparative immunity from many internal enemies, and this period might I well be called the "Golden Age" of man. It is about the fortieth year of life that the wear and tear of human machinery usually begins to manifest itself, by disturbing the peace of the human organism with a new set of internal enemies, of which many are of so slow, insidious and chronic a nature, that they evoke in the recipients of their attacks, all the refinements of suffering-in other words-all the horrors of war. Amongst these might be mentioned, the products of perverted cellular morphology, such as cancers and sarcomas, with cysts, tumors and growths galore, ulcerations and obstructions of the digestive tract-the scleroses, with lesions of heart, kidney, liver, gall-bladder, spleen, pancreas, uterus, ovary and so on whilst from childhood to old ageMr. Little Old Appendix, in ambush all the time, Keeps his finger on the trigger that may make your life sublime. In old age for those few who reach there, as if hungry for its prey, there lies in wait the troubles of the prostate, with hypertrophies, dystrophies, atrophies and degenerations of all kinds not excepting those of the brain, now growing useless to the lambent soul within; and here we will leave the human organism as Shakespeare describes him: "Sans teeth, sans eyes, sans taste, sans everything." Now, to meet the onslaughts of so many varied and powerful antagonists, let us consider what the human organism can do to maintain peace and avoid destruction. To be brief, for the subject in detail is well nigh inexhaustible: (1) The first and most powerful defender of the human realm is the big policemanMr. Vis Medicatrix Naturae, and were it not for his able and efficient administration of internal economies and life-processes, the incompetency of the medical profession and other second lines of defence, would soon be thoroughly demonstrated. The existence of this guardian of human welfare has been known for centuries, but it is only of late years that we are learning something of his weapons and methods of defence such as the functions of internal secretions, the process of leucocytosis, thermic regulation, elimination, and antitoxin-formation by the blood. Unfortunately, this great protector of the organism has also been the screen under which all manner of "pathies" and "isms" have flourished, and formed themselves into cults and basically wrong schools of Medicine. Of ulterior methods of defence we should have: (1) A constant raising of the standards of the medical profession with a greater dissemination of the benefits of specialization. A right move in this direction has been the formation of the American College of Surgeons which, though it may for a time, work some discriminating hardships on numerous surgeons of excellent ability, will ultimately, prove of great and lasting benefit. (2) We should give the human organism a clean heredity, by legislation controlling marriages, and permitting the asexualization of the manifestly degenerate. But better still, would be a propaganda of education, beginning in the school-room and based on the biblical injunction "Know Thyself." (3) Utilizing and improving upon every existing measure of child protection and social reform, from Fresh Air Funds and the prohibition of exhausting child-labor, to sanitary housing, playgrounds for old and young, social centers more attractive than the saloon, and popular education on vital subjects by the "lectured" moving picture show. (4) The greater prominence attached to the full-time Health Officer whose work in the school-room and in matters of sanitation is not yet half appreciated and who should be amongst the best paid and most respected of our citizens. The functions of this office should be enlarged, so that the poor especially could have opportunity at any time, in sickness or in health, for adequate instruction in preventive measures and competent diagnosis of diseased conditions, with recommendations to the proper therapeutists for care and treatment. (5) The employment of all legitimate means of exploiting the truth regarding fake medical nostrums from "oxydonor" tin-tubes to Christian Science adumbrations of the spirit -which latter cult with its ostrich-like head-in-the-sand nescience, never seems to recognize the limitations of the basic centuries-old-fact, that faith and a cheerful spirit are but factors and not always essential in numberless therapeutic measures that are positively indispensable. Before closing I am tempted here to draw an analogy between the attempts of the various fluids, organs and tissues of the human organism, to maintain a stable equilibriumwhich means peace, and the semi-conscious strivings of the various races, nations and governments to attain the same thing amongst themselves, viz. peace or harmony or social equilibrium. Though spasmodic experiences of peace on earth and good-will to men, have demonstrated to all the great desirability of such a condition, the enemies of such an idealistic state are numerous and a few may be mentioned as follows: First One of the greatest enemies of peace on earth is prejudice, i. e., prejudice of race, religion or nationality. When a Caucasian for instance, is brought suddenly into contact with another man of a different ethnological group, such as a Malay, Negro, Indian, Chinese or Japanese unlikeable differences in physical appearance, manners, customs and methods of government are quite sufficient when emphasized in conflicting interests to provoke enmities or even war. It is the same with religious faiths for as each expects to gain everlasting rewards through the exercise of his particular faith, he is naturally at variance with the other fellow who says he has the only authorized road to heaven. By the same token, religious sects of the same faith, who may differ on matters undemonstrable and therefore unessential often act as disturbers of the peace of communities, if not of nations. Amongst nationalities, as has frequently occurred in the past, as well as at present, a nation may assert its selfbelieved dominancy and try to inflict its own self-asserted superiority of "Kultur" upon a people, a continent or a world if need be, while at the same time, it is not averse to a few items of indemnity, colonial expansion, extraterritorial rights and so on. Second-As a provocative cause of envy, malice, jealousy and hate-and therefore of enmity-is Mammon-worshipping, or desire for great wealth, which is limited to no one nation or individual, but possessed in varying degrees by all, is perhaps one of the greatest enemies of the peace of the world-for it breeds the festering sores of commercial jealousy and economic rivalry. A third enemy to the world-harmony is the existence of a non-producing so-called nobility class of barons, dukes, earls, princes, et. al.generally possessed of great landed estates which should be owned by the people who work them. This privileged class or aristocracy seldom has any other occupation than that of military or governmental service, and when allied with its congener the plutocracy-we have a combination that is very much interested in the production and maintenance of that other great menace to a state of social equilibrium-vast armaments on land and sea, under the sea, and latterly, in the air. I would mention a fourth great enemy to the peace of nations and that is-oligarchical forms of government-with one-man controlling power, be he czar, emperor, king or chief of a savage tribe, and it is quite conceivable how the personal ambitions, envies and petty jealousies of these autocrats, might disturb the peace of the world under pretexts quite plausible to the countries they govern. A precedent of this kind can be cited-for a king of France once received a good trouncing for sending to the king of England a set of tennis balls with a hint that such a game was better suited to his prowess than the stern game of war. Now, with all these formidable adversaries and age-long antagonists to the comity of nations, who is he-and where can be found that wonderful being-who from the alchemy of thought can devise a remedy that will purge the world of all its vast uncleanness, and restore and maintain its numerous and diversified component parts, in a state of health which is peace, which is social equilibrium? One great statesman might fight for national disarmament as the only effectual panacea; another bright mind might plead for a greater toleration of religious thought and respect for the manners and customs of others; still another man might offer socialism as the sovereign remedy, while some one else might be content with the universal establishment of democracies. The latest proposed specific for all these ills of the body-politic, is the federation of all countries under one central government, with a system of international police. Aye, you will hear these and a hundred other remedies prescribed as specifics for this great malady of the times, but let me venture to assert to you, my co-workers in a noble profession, that all will act but as placebos for an undiagnosed condition, for this is a disease of the head and not of the heart; the heart of the world is all right-but its head has gone a-maundering after false gods and false ideals; like the vix medicatrix naturae in the human organism, the sovereign remedy is ready at hand in the mind of man himself, and never shall we find on earth that peace which the world desireth, until, in perfect unison, the nations of this benumbed sphere acknowledge the authority and obey the mandate of the Great Physi |