contents of the orbit. The roof of this cavity was necrosed. The upper lid, not being as painful nor as oedematous as the lower, was allowed to remain as a curtain to the large and unsightly opening in the face. The hemorrhage was free but was easily checked, and the wound was treated as at the last operation.

The growth, like that removed previously, was soft, juicy, lobulated, and tended to break down in the centre. The microscope showed myriads of small round cells, granular matter, and débris.

In a short time the growth began to project into the mouth, between the alveolar process and the upper lip. The patient could get nothing into her mouth. except liquids, and those only very slowly and with pain. Her sufferings became so intense that she peremptorily demanded an operation for the removal of the disease, willing to take any and all risks rather than live as she then did.

September 24th, three weeks after the last operation, she was again etherized, and the upper jaw was removed by Dr. Gay. An incision was made through the centre of the upper lip, around the left ala, and up the side of the nose. The lip and cheek were quickly turned back, no effort being made to check the hæmorrhage. The alveolar and palate processes were divided with forceps, and the jaw, with a large mass of disease, dug and torn out with the fingers, aided by an occasional touch with the knife or scissors. An enormous chasm now extended from the tongue below to the base of the cranium above, and backwards and outwards to the pharynx and zygomatic fossa. As the tissues were extremely vascular the hæmorrhage was most profuse. It was controlled by washing out the wound with chloride of zinc, and packing it with sponges dipped in ferric alum.

The wound in the lip united by first intention. In two days the patient was more comfortable than before the operation, and has remained so ever since, nearly three months. She is able to swallow easily. She has less pain than formerly, and to all outward appearances the growth is not increasing. The pain and oedema of the eyelid have disappeared. She is able to be about the ward nearly or quite all day, and is comparatively comfortable. She has not only obtained relief from all of the operations, but her life has undoubtedly been prolonged thereby.

This case illustrates the benefit to be occasionally obtained from repeated operations for the removal of malignant disease. Gross narrates a case of sarcoma of the breast which was removed twenty-three times in four years; eleven operations having been done in one year. Fifty-two tumors were removed, varying in size from that of a small almond to that of a pullet's egg. Ten years after the last operation the woman was perfectly well.

LETTER FROM PHILADELPHIA.

MESSRS. EDITORS, -I can hardly begin my first letter of the centennial year of our country's existence more appropriately than by giving you such details as I have been able to gather concerning the international medical con

gress which will meet in Philadelphia next September. Until the publication of the general circular, which you undoubtedly have already seen, there has been the most scrupulous care on the part of the committees to avoid giving publicity to any detail whatsoever of the doings of the medical commission. This will explain any apparently causeless silence in regard to this matter. Even now there is much which would be of interest but which is persistently held back. The reason for this secretiveness seems to be a fear that confused statements will get abroad, for at every new meeting of the medical commission plans previously considered as definite are modified. Indeed, I have been told so late as to-day, by one of the officers of the commission, that the circular already issued and distributed will be again modified. This change will, I believe, relate to subdivision of the sections. The most direct method of imparting information concerning the plan of the congress will be to make synoptic use of the circular which has been sent to the medical and leading secular journals. The following is, then, the purport of this document:

The medical societies of Philadelphia, in order to unite with their fellowcitizens in celebrating the centennial of American independence, have taken the initiatory steps for the formation of an international medical congress by the appointment of delegates from their respective bodies, who were authorized to organize a scheme for the above purpose. This delegation has organized the Centennial Medical Commission with the following officers: President, Prof. S. D. Gross (of Jefferson College); Vice-Presidents, W. S. W. Ruschenberger, M. D., U. S. N., and Prof. Alfred Stillé (of the Pennsylvania University); Recording Secretary, W. B. Atkinson, M. D. (1400 Pine St.); American Corresponding Secretaries, Daniel G. Brinton, M. D., Editor Medical and Surgical Reporter, 2027 Arch St.), and Prof. William Goodell (of Pennsylvania University, Twentieth and Hamilton sts.); Foreign Corresponding Secretaries, Richard J. Dunglison, M. D. (814 North Sixteenth St.), and R. M. Bertolet (113 South Broad St.); Treasurer, Casper Wistar, M. D. The congress will open in Philadelphia on the 4th and terminate on the 9th of September, 1876. The commission propose the following general plan of organization and busi

ness:

I. The congress shall consists of delegates, American and foreign, the former representing the American Medical Association and state and territorial medical societies of the Union, the latter the principal medical societies of other countries.

II. The officers shall consist of a president, ten vice-presidents, four secretaries, a treasurer, and a committee of publication, to be elected by the congress at its first session, on a report of a committee of nomination.

III. Morning sessions of the congress shall be devoted to general business and reading of discourses; afternoon sessions to meetings of the nine sections, namely:

(1.) Medicine, including pathology, pathological anatomy, and therapeutics. (2.) Biology, including anatomy, histology, physiology, and microscopy.

(3.) Surgery.

(4.) Dermatology and syphilology.

(5.) Obstetrics and diseases of women and children.

(6.) Chemistry, toxicology, and medical jurisprudence.

(7.) Sanitary science, including hygiene and medical statistics.

(8.) Ophthalmology and otology (will probably be subdivided into two separate sections).

(9.) Mental diseases.

IV. The language of the congress shall be the English, but not to the exclusion of other languages in which members can fluently express themselves. Gentlemen intending to make communications on scientific subjects are requested to notify the commission at the earliest practicable date, in order that places on the programme may be assigned them. In order to make the congress purely international, invitations to send delegates will be extended to all the prominent medical societies in Europe, British Dominions, Mexico, Central and South America, Sandwich Islands, East and West Indies, China, Japan, and Australia. Invitations will also be tendered to medical gentlemen of high scientific position, and distinguished visitors may be admitted to membership by vote of the congress.

The Centennial Medical Commission tender in advance to their brethren in all parts of the world cordial welcome and a generous hospitality during their sojourn in Philadelphia.

The registration book will be open daily in the hall of the College of Physicians, northeast corner of Thirteenth and Locust streets from Thursday, August 31st, twelve to three P. M. Credentials must in every case be presented. Gentlemen who attend the congress can have their correspondence addressed to the care of the College of Physicians as above..

Further information may be obtained by addressing the corresponding secretaries, to whom all communications must be addressed.

Such, in brief, is the circular of the commission. Annexed to it is a list of the executive committees for the States; appointed in Boston and New England, are: Drs. H. J. Bigelow, H. I. Bowditch, Edward H. Clarke, Calvin Ellis, and D. Humphreys Storer, of Boston; Drs. A. B. Crosby, Concord, N. H., E. T. Caswell, Providence, R. I., William W. Greene, Portland, Me., Stephen G. Hubbard and C. L. Ives, New Haven, Conn., Isaac G. Porter, New London, Conn., and Edwin M. Snow, Providence, R. I.

The place of meeting has not yet been positively selected. The judges' hall of the centennial buildings has been mentioned, but it would be inconvenient, not only because of its distance from the city, but also because, in order to obtain admittance thereto, the exhibition fee would be unavoidably demanded in every instance. Probably either Horticultural Hall, on Broad Street, or one of the halls of the university buildings will be the selection of the commission. A registration fee will be required from each American delegate, but none from foreign. The sum total of these fees will assist in paying the expenses of the congress and of the publication of the transactions, a copy of which will be given to each delegate.

During the session there will be a banquet to which foreign delegates will be gratuitously invited. In each of the sections a committee of three has been appointed, whose duty it will be to correspond with men prominent in the various departments of medicine; in order to solicit their coöperation and pres

ence. I am authorized to state that quite a number of eminent foreign specialists have already signified their intention to attend the congress.

The officers of the congress will be selected from the most distinguished individuals present, whether they be American or foreign.

As yet I have vainly endeavored to secure the names of those gentlemen who have been invited to address the congress. The list as at first prepared was published in the daily prints, months ago, but has since been much modified by the refusal of several of the invited, and now is kept out of sight, and will be until it is definitely known who will or will not deliver addresses. I hope to obtain a full list before I close my letter.

I have been told that in Boston it is understood that inferior men have been asked to supply the places of those who have declined the invitation to address the congress. This is an error.

It has been frequently reported that the hotel accommodations of Philadelphia will be insufficient for the needs of visitors. This is another error, and one which might act against the interests of the city as well as of the exhibition. The hotels will provide not only for those who attend the congress, but for all centennial visitors as well. All the regular hotels have added thirty to fifty per cent. to their ordinary accommodations, and special hotels have been built, or are in process of erection, which will suffice for not less than twentyfive thousand to thirty thousand guests. Besides the ample hotels there will be hundreds of apartments to be obtained from the lodging-house bureau of the centennial commission, which has advertised largely and sent circulars to every house of the better class, requesting all citizens who have or will have spare rooms which they are willing to lease during the exhibition to send their names to the bureau. Agents then visit the various apartments, and ranking each room, according to its convenience and furniture, in one of three classes, set a price upon it. These rooms will be obtained in this way: a visitor wishing a sleeping apartment will apply to the lodging-house bureau. The price of the rooms according to class will be named. The visitor will select the class. Tickets, bearing street and number of the house, one ticket serving for a single day and night, will then be sold to him.. Provided with these cards he will seek out the proper house and secure the room. Each day he will surrender a ticket to the proprietor of the house, whose servants will care for the room. Meals will be obtained elsewhere. In this simple manner all will be provided for. To complete this plan of the bureau, each ticket in the hands of a housekeeper will be equivalent to a draft upon the bureau for the sum stipulated in their agreement with him.

In addition to this abundant accommodation, delegates to the medical congress will meet with a generous hospitality at the hands of private medical

men.

Dr. William Pepper has been appointed medical director of the international exhibition. His duties will mainly comprise the direction of a hospital to be erected on the centennial grounds, for the aid of visitors or exhibitors who may require medical or surgical aid. Such relief in some cases will necessarily be only temporary, but patients will be put into the proper condition for removal by ambulance to hotel, to apartment, or, in case of bad accidents, to some

permanent hospital. Dr. Pepper has nominated a staff of six assistants, whose appointments have just been issued by the director-general of the exhibition (Mr. Goshora). They will take alternate charge of the centennial hospital either during an entire day or for a fixed number of hours, as may be hereafter decided.

Hugo's ceratoptera vampyrus could not have possessed a greater power of clutching than have those who hold the list of names which I hoped by this time to secure for you. It appears that certain gentlemen who have been requested to address the general congress have also been proposed as the proper persons to read papers before, and open discussions in, the sections. And since it has been decided that no invitee shall be given a double duty, this matter will be righted before the names of the speakers are given for publication. Hence more waiting!

PHILADELPHIA, December 28, 1875.

X.

MESSRS. EDITORS, -The following is a copy of a letter from General Washington in regard to his artificial teeth, which will supplement the one published in the centennial number of the JOURNAL of June 17, 1875. The letter is now in the possession of Mr. Henry Austin Whitney, and was written to "Mr Jn° Greenwood, Dentist, New York." It is franked "President, U.S." S. A. G.

Philadelphia, July 1st, 1792.

SIR, Your letter of the first of May and the box which accompanied it came safe, and duly to hand on the eve of my departure for Virginia; which is the reason why I have not acknowledged the receipt of them sooner.

The contents of the latter (with the alteration which were necessarily made) answered very well and enclosed you have, in Banknotes, twenty dollars, the sum I have usually sent you, but if it is insufficient let me know it and more shall be forwarded by

Sir

Y' Obedt Hble Servt

Go WASHINGTON.

WE copy the following from The Boston Weekly News Letter, September 6, 1770:

"A few Weeks since the Operation for the Hare-Lip was performed to great Perfection on a young Man in Milton near Brush-Hill; and a child in Boston has received as much Benefit from the Operation as the Case would admit of, by Mr. Hall Surgeon to the 14th Regiment.

"The Impression these unhappy Sights are apt to make on married Women, should be an Inducement to have this Defect in Nature rectified early in Life, as there are numerous Instances of the Mother's Affection having impressed her Offspring with the like Deformity."