patient in trench and covering him with loose dirt; 55, tea made from the bark of Mesquite bush; 56, a mixture of olive oil, salt and lime juice; 57, green tea and Cognac; 58, pint of lime juice after meals; 59, "Antidotum Ultimatum"; 60, treatment of the case by a homeopathic physician"; 61, "Caldwell Remedy"; 62, hotwater baths; 63, vapor of "crude oil"; 64, a diet of salt mackerel; 65, "Cooper's Embrocation"; 66, fluid extract of Eucalyptus; 67, "Amarin"; 68, "Maya 68, Indian Cure"; 69, "Gaseo-Chemic Treatment"; 70, the intravenous injection of raw onion juice.

Many of the above remedies were recommended by a number of individuals; sulfur, in some form or other, being especially popular, and its use in the shoes being strongly urged upon this office by no less an individual than the president of the American Humane Society. Many of these alleged remedies are stated to have been handed down as heirlooms for generations, or to have been originally derived from some old sea-captain or some Jesuit priest who had voucht for their efficiency.

In regard to typhoid fever, one individual urged the employment of onion poultices to the soles of the feet as never failing to abort the disease, while another wrote to call attention to the fact that a diet of well-browned peanuts would prevent small-pox. The office was told that the troops, while in the tropics, must be given a daily ration of Tabasco Sauce; that every light-complexioned man going to Cuba should take a daily dose of sodium phosphate; that the free use of garlic would ward off all diseases, and that the city water of Orange City, Fla., was a febrifuge in malarial fevers. It was urged to purchase "Lincoln Spring Water" for the cure of insomnia, and to require each soldier to wear a flannel bag containing camphor to avert malaria. One woman wrote to express her surprise and indignation that the troops were not provided with houses. A Doctor of Medicine called attention to his device to make each soldier breathe thru his nose and so escape the inhalation of microbes. A "Doctor of the Laws of Nature" offered her services; the maker of the "Wonderful Ten Minute Pile Cure" askt the best and cheapest way of bringing his product before the public, and the inventor of a patent "Flea-catching Machine" urged that a number be purchast for the comfort of the soldiers in the tropics. Another wrote the President to

request Congress to appropriate a sum for the purchase of his remedy for piles, and offers to take the Chief Magistrate into partnership for its manufacture in return for such action. A man from Michigan desired the contract for supplying slipperyelm bark; from California came a letter urging the adjutant-general to prevent malaria by the "medication of the feet" of the soldiers, and a New York chemical company wisht company wisht to introduce "Liquid Killem," a parasiticide, among the troops at Chickamauga. at Chickamauga. One individual surprist the office with a box full of dirty bottles of various shapes and sizes, filled with the most unpleasant looking decoctions of domestic manufacture, which were warranted specifics for everything under the sun, one bottle "curing tisix, scroffalo, stome ache trubbles and stop that tiard fealing." Another specimen is a "Great Blood Purerfier," and is stated to "Wark Merricals." Merricals." The box was accompanied by the following letter:

66

May 30th 1898

TO THE SERGEONERAL,-Dear sir I find that these Medisons that I Send yau, have bean so useful And doing so mutch good, that I Would if yau Would per mitme, that I Would Continure finding that I have removed paims And Curered people Who have been suffering for years but of Course I Want not conflict With the Law And Would be pleased if I could Continure."

Another wishes to introduce his preparations into the army, and sends samples of his villainous compounds. He evidently is convinced that the office has nothing better to do than to solve the riddles presented to it, so the following letter is sent by him:

66

TO THE SURGEON GENERAL'S OFFICE

Dear Sir,-I Write to Ask some informtinon, About that Box of Sample Medison that I sent in the Month of June 1898. And you told me that on account of War With Spain that it Would be uterly Imposible to Anellize, And I thought that I Would Ask you When or at what time that you thought that the Doctors Would be Able to Anellize or wheather that you had Annellized or not.'

One enterprising M. D. requests that the Government obligate itself to pay him money (sum not specified) in case a thoro test of his treatment for typhoid fever proves of value, generously leaving a loophole as follows:

"After testing the treatment if it cures as claimed, then the Gov is due me the amount agread up-on, if not she is not due me anything."

Another approaches the subject from a religious standpoint.

"Mar. 21, 1898.

DEAR BRO. MCKINLEY Honored Sir,-Jesus says, Whatsoever ye shall ask in my name it shall be done. We know that Jesus will fulfil his promise. Now I do ask in the name of Jesus that the soldiers of the United States Army may have a medicine that is a sure cure for rheumatism & many other complaints. You will see by this circular what it has done & what it will do. I have sold it to many people & there is not one that have taken it according to directions but what speak very much in its praise. It is manufactured by the Rheumatic Cure Co., Dearborn St., Chicago, Ill., Where you can get it."

A gentleman from West Virginia who desires to sell a remedy for driving away flies from the sick for the sum of $50,000 prefaces his request by:

Gents: Please donte take me to be a

crank in regarde to below as you See I ante no college graduate-as i am amkwarde in my explanation-But I mean Square & Honest. Business."

From Alleghany, Pa., comes a very urgent invitation for the surgeon-general to be present at the exhibition of a new apparatus, of which the inventor says:

"It is said the germ of yellow fever is not yet known if so I will say that my in

struments will reveal it if it exists in na

ture. If it is smaller than the smallest known microci then it will very likely prove to be one of the ever living Atoms which manufactures the poisonous substance of "gass" that produces the disease."

From the State of Maine comes the announcement of the cause of leprosy, with a modest renunciation of the honor of its discovery as follows:

NAPLES, ME.

March 25, 1898.

an intimate knowledge is entertained of first causes. Then their effects are better appreciated, and dealt with. The very obscurity of the first causes of "Leprosy is perhaps the reason of the previous undiscovery of a preventive, or cure.

The discovery that I desire to call to your attention is my discovery of the first causes of "leprosy" and its cure. To be very brief:-My method is the subcutaneous injection of serum of animal blood. The patients body should enjoy the exposure to air and sunlight. The first treatment is to be followed by the adoption of the blood baths of the ancients. I may add in conclusion that the first cause of leprosy is cannibalism. I prefer its introduction-and tests-to be made by the Institution. I desire no further personal identity with the discovery nor the honor."

A physician residing on Henry Street, Brooklyn, N. Y., writes:

BROOKLYN, N. Y., May 15th 1898. Dear General:-In my forty years of medical experience I have met with nothing more certain than the curative effect of bean water upon punctured wounds, & in the interest of our soldiers, I feel it my duty to inform you of a remedy at once so simple, attainable, & efficient."

Then a note of advice and warning from a lady of New Bedford, Mass:

Dear Sir:-Whoever you are, this war strikes a wild terror to my heart, and I fear that my countrymen will be tortured by the Spaniards. If I were a soldier, and could get it, I would carry morphine enough to know nothing more very soon

after it became evident that I should be

captured by the Spaniards, who are very

cruel.

I fear Blanco's great confidence may lay in some under water plot similar to that which caused the destruction of the Maine.

"Were half the power that fills the world with terror,

Were half the wealth bestowed on camps and courts,

Given to redeem the human mind from error,
There were no need of arsenals or forts."

The office was in full accordance with the sentiments expressed in the following extract, especially the last clause: "FT MADISON Iowa

Jan 27 1899 MR ALGER, Dear sir:

Dear sir... they sent all through the country for Doctors to come and see what

For a long time past I have had many patients each year who came to be treated for permanent stricture, incurable ulceration, and unbearable pruritus, caused by their having been operated upon for hemorrhoids by the excision method. On inquiry, I find that other rectal specialists have had a similar experience. On the other hand, I have never seen or heard of such unpleasant sequelæ following the clamp and cautery or ligature operations in spite of the fact that they are made daily by the specialist, general surgeon and general practitioner. Such being the case, something must be wrong with the operation, and it should be discarded or relegated to its proper sphere. It is my opinion that during the past 10 years quite as many of our countrymen have been rendered permanent invalids by it as have received lasting injuries during our war with Spain.

Under the term excision, it is my intention to include all operations upon the bowel where the lower one, two or three inches of the mucous membrane of the rectum is excised in order to destroy the so called pile bearing area. Operations made with this purpose in view should bear Mr. Whitehead's name. I mention this because Pratt, of Chicago, has modified and named it "The American Operation," and has led many to believe it original with him and of recent origin. Although my practice has been confined, for a number of years, to surgery of the rectum, I have not reacht the high standard of some writers, who claim they can cure asthma, lung and other chronic diseases by this operation, and I cannot help but think that patients deceived and robbed by such deceptions should hold their mutilators criminally liable.

Before discussing the subject further, I wish to describe the operation of excision in Mr. Whitehead's own words:

"By the aid of scissors and a pair of dissecting forceps, the mucous membrane is divided at its junction with the skin around the entire circumference of the bowel-every irregularity of the skin being carefully followed. The external and internal sphincters are then exposed by rapid dissection of the mucous membrane and attached hemorrhoids. Thus separated from the submucous bed upon which they rested, they are pulled bodily down-any undivided points of resistance being

snipped and the hemorrhoids brought below the margin of the skin. The mucous membrane above the hemorrhoids is now divided transversely in successive stages. and the free margin of the severed membrane above is attached as soon as divided to the free margin below by a suitable number of silk sutures, after the hemorrhage has been arrested by torsion."

Mr. Whitehead claims the following advantages for his operation:

1. That it is the most natural method, and is in perfect harmony with surgery.

2. Excision, in addition to its simplicity, requires no instrument not found in an ordinary pocket case.

3. It is a radical cure. It removes the peculiar pile bearing area.

4. It is not more dangerous than other methods recommended for the removal of piles.

5. Pain is less severe than that following any other operation.

6. The loss of blood during the operation probably exceeds that of the ligature or clamp and cautery, but the dangers of secondary hemorrhage are unquestionably less.

I shall discuss these claims in rotation: 1. Excision is not more than natural. neither is it more in harmony with surgery, than are other operations.

2. Instead of being a simple operation. it requires a longer time, more ingenuity on the part of the surgeon, and the best instruments.

3. Granting it is radical, just as good results can be obtained quicker, with less pain, fewer complications, by less difficult operations.

4. It is equally, if not more dangerous than the clamp and cautery or ligature, and is certainly more often accompanied by complications.

5. Bleeding is profuse during the operation, and secondary hemorrhage is not lessened by it.

Mr. Whitehead's operation is original. and will always hold a prominent place in surgery of the bowel. It is not, however.

a suitable one for ordinary or bad cases of piles, for two reasons:

First. Piles can be permanently cured by less difficult operations.

Second. It is accompanied and followed by many complications and sequelæ.

It is fitted only for those cases where there is a prolapsus of the entire circumference of the bowel, accompanied by fre

quent and profuse hemorrhages. Here one has no distinct piles, but a condition where spongy angiomatous masses coalesce so as to include the entire lower rectum. Excision is just the thing here, for nothing short of amputation of the involved area would effect a cure.

If the operation was confined to selected cases, I would have only words of commendation for it. Unfortunately, it is being done promiscuously by surgeons to the exclusion of more simple and better operations irrespective of the number and size of the piles. As a result, rectal specialists are constantly besieged by their victims for whom they can do nothing to cure and little to alleviate.

Failure to get primary union is the principal difficulty. There are several reasons for this: (a) The tension is great, the membrane delicate, and the stitches cut their way out; (b) the straining from coughing and vomiting after anesthesia is greatest at the anus; (c) infection is of frequent occurrence because of the feces.

When primary union is obtained, these patients assume their vocation at the end of two or three weeks. When non-union follows, the membrane retracts, exposing the submucous tissue around the rectum for one or two inches above the anus. A stricture and ulceration follow, and the suffering is made worse by an irresistible pruritus, aggravated by the consequent discharge. Other operations are never followed by such unhappy results, because the exposed surface is in patches or islands, surrounded by healthy mucous membrane, whose elasticity and dilatability suffice to compensate for any citcatricial tissue left.

Mr. Whitehead claims that where one vein of the rectum becomes dilated or diseased, all will soon become similarly in volved. Hence, they must all, even down to the smallest radical, be excised. Such teaching to me appears absurd. Surgeons when operating for varicosities in other portions of the body never remove sound veins and tissues for their prophylactic effect. Again, I have seen hundreds of patients who have suffered for years with distinct pile tumors, and yet the intervening veins were normal. Further, all piles are not the result of dilated veins, but frequently are formed by the rupturing of a healthy vein during a strain, and the emptying of blood into the neighboring tissues, thus forming a tumor that will be temporary or permanent, depending upon

the rapidity with which the rent in the vessel heals.

I ask the question, Does Whitehead's operation insure the patient against hemorrhoids in the future? I unhesitatingly answer that it does not do so more than other recognized operations properly performed. formed. I recently saw a patient who had been operated on several years before by the excision method and primary union obtained. He now has three large tumors that I shall remove by the clamp and cautery. I mention this to show that excision is not infallible under the most favorable circumstances. Hence, I think that that method should be discarded for the treatment of piles in general. It is, however, the operation par excellence for angiomatous masses involving the entire circumference of the lower two or three inches of the rectum.

In conclusion I will briefly state my criticisms of the Whitehead operation: 1. It is not suited for ordinary or bad cases of piles.

2. It is difficult and bloody.

3. Patients are detained in bed from six to fifteen days longer than after the clamp and cautery or ligature operation

4. Owing to tension, the post operative pains are severe and may continue for several days.

5. Infection is frequent and terminates in a stitch or deep abscess and fistula.

6. Because of non-union, ulceration, stricture, and pruritus are common sequelæ.

7. The portion of bowel between the anus and the end of the retracted intestine looses its sensitiveness, and there is also an absence of the normal secretion.

8. The nervous and mental state of these sufferers is pitiable to behold, and many contract the morphin habit, while others turn up as chronic invalids in some sanitarium or asylum.-S. G. Gant, M. D., in Va. Med. Semi-Mo.

College of Physicians of Philadelphia,

N. E. Corner Thirteenth and Locust Streets. The William F. Jenks Memorial Prize. The Fifth Triennial Prize of Five Hundred Dollars, under the Deed of Trust of Mrs. William F. Jenks will be awarded to the author of the best essay on "The Various Manifestations of Lithæmia in Infancy and Childhood with the Etiology and Treatment."' The conditions annexed by the founder of this prize are, that the "prize or award must always be for some subject connected with Obstetrics, or the Diseases of Women, or the Diseases of Children;" and that "the Trustees, under this deed for the time being, can, in their discretion, publish the successful essay, or any paper written upon any subject for which they may offer a reward, provided the income in their hands may, in their judgment, be sufficient for that purpose,