first-class hospitals, the city, with 250 beds, and St. Joseph's with 50 beds. Both of these institutions are splendidly equipped with modern appliances, and over 3,000 patients are treated annually in the wards, and about the same number are treated as out-patients. The surgical work has increased by leaps and bounds, and the results have been excellent.

Two years ago a Sanatorium was established on the mountain, for the treatment of incipient cases of tuberculosis. It has accommodation for 35 patients. The results obtained there have been very encouraging.

Another very important institution is being erected, thanks to the generosity, of one of our citizens, Mr. William Southam, namely, a hospital for advanced cases of tuberculosis. We will henceforth be in a position, we hope, to successfully cope with the ravages of this terrible disease. It is thus a great pleasure for us all to have the members of the Association meet here.

Now, in regard to the Association itself. We felt that owing to the tendency of its members to devote themselves to special branches, new sections should be formed. The various subjects could not be fully discussed in the two sections, Medical and Surgical, consequently three additional sections have been formed, namely, Preventive Medicine, Eye, Ear, Nose and Throat; Obstetrics and Diseases of Children. Two additional sections could easily be added, namely, Mental Diseases and Diseases of the Nervous System and Pathology. I firmly believe that if this plan were followed, and the different sections were placed in the hands of enthusiastic men, our annual meetings would be very much better attended.

With 2,500 practitioners in this province, we should have more than 10 per cent. of them at our meetings. Some parts of our Ontario are seldom represented on our programmes. This should not be allowed. During the year hundreds of interesting cases are seen by the different physicians, which are never published. The rule to take careful notes of cases should be more generally adopted. It would then be a very easy matter to get up a short paper which would lead to good discussion with marked benefit to all present.

During the past two years several county medical societies have been formed, and if the officers of these societies were to interest themselves in getting their members to write papers and present them to the Ontario Medical Association, the duties of the officers of this society would be lightened very much.

We want every physician, whether practising in village, town or city, to come to our meetings, and give us the benefit of his experience.

Many of the papers on the programme this year are by Canadians practising in different parts of the United States. Thus, there are two from New York, two from Johns-Hopkins Hospital, Baltimore, and two from Detroit. Montreal has sent some of her best physicians and surgeons to assist us at this meeting, and last, but not least, our brethren across the line, who unfortunately are not Canadians, have graciously laid aside their work and come to us with the best fruits of their labors.

For the preparation of this programme, gentlemen, we are chiefly indebted to the untiring energy and faithful work of the chairman of the Committee on Papers, my friend, Dr. Wallace.

As there are a large number of excellent papers to be read this afternoon I shall not take up any more of your time, but will proceed with the programme.

AN IMPROVED STOMACH TUBE.

BY RICHARD F. CHASE, M.D., BOSTON, MASS.

Instructor in Clinical Medicine, and Lecturer on Gastro-intestinal Diseases, Tufts College Medical School; Physician to the Boston Dispensary, Member of the American Medical Assocition.

THE degree of favor which this tube has met in the United States during the past two years suggests that it might be favorably received by physicians of other countries, if it were known to them. The tube consists of (1) an Ewald stomach tube, to which is attached (2) a saliva shield, (3) a glass connector, (4) a 30-inch plain tube, on one end of which is connected (5) a valveless rubber bulb.

The Ewald stomach tube is 30 inches long, marked at 23 inches with a white band to show the average distance of introduction in normal cases. It has an end and extra large side eye, opposite which are five small eyelets. The sharp edges of eyes (common to most tubes) are avoided, each tube, in this respect, being finished by hand. Fleiner's criticism of English tubes is equally applicable to those of American make :

Fleiner (in Diseases of the Digestive System, of Modern Clinical Medicine, 1906, pages 49 and 50) says: "these English tubes have glaring defects which for some unaccountable reason the manufacturers do not remedy. Their openings are frequently not large enough, and the margins of the openings, without exception, are so sharp that they readily injure the mucous membrane, particularly the mucous membrane of the stomach. It is to be hoped that the manufacturers will speedily place on the market more serviceable tubes, with rounded polished edges, that will meet practical requirements."

The saliva shield is adjustable and detachable; it directs the flow of saliva from the patient's mouth into a basin held by patient, thereby preventing it from mixing with the gastric contents or flowing on to office floor. The valveless bulb on end of tube is the chief feature of the apparatus. It is strong enough; it fits the average hand; its capacity is 3 ounces or 90 cc, so that the amount of fluid used is readily determined.

With this tube (a) aspiration or "expression" of stomach contents, (b) inflation of the stomach, and (e) lavage or douching of the stomach may be done without disconnecting any of its parts and without the aid of a stop-cock or shut-off. So much can hardly be said of any other apparatus, because, like the Boas Aspirator, the Leube Lavage Apparatus, etc., they are intended for one purpose only.

The tube is used much as a bulb syringe, except that suction or injection may be induced at the will of the operator without reversing the bulb. The thumb of right hand most conveniently supplies the place of an otherwise necessary valve. To wash out or douche the stomach, water is injected with the bulb (3 ounces at a time) with the amount of force desired, then allowed to siphon out in the usual way. If the return flow is delayed, it may be hastened by inducing suction with the bulb. If the eyes of tube become plugged with food particles, the injection of one bulb of air or fluid clears the eyes.

To distend stomach, air is injected in the same manner as water, the tube is simply pinched to retain it. By allowing patient to pinch the tube, the operator's hands are free to percuss or palpate stomach. The air may be allowed to escape at any moment, simply by releasing tube.

To obtain the stomach contents, siphonage is started by applying suction with the bulb.

After a test meal, or in poison cases, the contents may be more thoroughly and more expeditiously removed than with various other devices.

By substituting a Rosenheim tube for the Ewald tube, one has an ideal douching apparatus. By this means, 33 small forceful streams are thrown upon the walls of the stomach.

By substituting a colon tube for the Ewald tube, one has an apparatus for inflating the colon and administering rectal injections and high enemata.

Riegel (in his Diseases of the Stomach, 1903, page 260), says: "Mild and slight degrees of motor insufficiency are particularly amenable to treatment by douching. According to Rosenheim the procedure can also be employed with advantage in mild degrees. of Chronic Catarrh of the Stomach with or without reduction in the motor powers, and, finally, in severe states of irritation affecting the sensory and secretory apparatus."

In self lavage, the patient sitting, holds tube at mouth with left hand, while, with the right hand, he injects the fluid into stomach from a basin, placed upon a chair or table. The fluid is allowed to siphon out in the usual way.

The tube or apparatus meets every requirement of the specialist. It is simple in construction, more easy to operate, and far more efficient than the tube with bulb in the middle, so much used by the general physician in the United States.

One who is familiar with the technic of lavage, inflation, etc., requires no directions for the use of this tube, but they are given inside of box cover containing tube for those who need them.

The tube is carried in stock by all of the larger dealers in surgical instruments in the United States, and would probably be procured by any local Canadian dealers on request.