Gentlemen.-According to the custom of this body that at the close of the year the retiring presiding officer make an address, it is with reluctance I interfere with the festivities of the evening, but always conscious of my sense of duty, I shall request your attention but a few minutes.

This society is the official organization of the medical men of Luzerne county. As members of this society we may pride ourselves in practicing our profession at an age when the science of medicine is no longer founded only on empirical observations or deductions; at an age when traditons, theory, and authority are no longer barriers to human perceptions. Speculation and metaphysics which have so long clouded the intellectual world have to a great extent vanished before the light of more substantial reason and methods based upon the discovery of demonstrable facts.

The great masses of the people are awakening to this progress and are manifesting interest in its growth. Educated men and women to-day recognize the broad foundation on which medicine stands and are cognizant of the fact that in it truth is being searched for by the same means used in physics and the development of other sciences. The progress made in surgery, together with the more profound knowledge gained in medicine, is truly marvelous.

It has been said that every addition to true knowledge is an addition to human power. Our medical society meetings keep us abreast of the times by especially aiding us to realize the practical applications of new discoveries in medicine and better enabling us to diagnose our own case "whether we are serving humanity or our own personal ends". The benefit gained by the society meetings is not only the acquiring of scientific knowledge, but they stimulate us to examine our medical consciences to find if we are in reality living up to the high ideal and dignity of an honorable profession.

Whatever our ambitions and aim in life may be, pray let us ever remember that we are members of an organized society with numerous relations to those about us. We are governed by the inexorable laws of supply and demand. We have our rights within these laws, but so have others. We do well to

obtain what is due us, but only so long as we do not endeavor to trespass on the rights and freedom of others.

The duties and responsibilities of the members of a live County Medical Society are manifold. In the first place, the interest of the officers of the society is absolutely necessary and essential in the progressive society. Every member should deem it his duty, if not his privilege, to contribute his share towards the scientific work of the society. Many of us may not have the ability to prepare a paper equivalent to that of some of our colleagues or fellow-members, but this should not deter us from contributing to the work and doing what we can.

Upon the Secretary, mainly, evolve the duty and responsibility of devising the programs. Great care is exercised in not placing any member on the program without first securing his consent. When this consent is given, no member should fail to read his paper or perform his duty only for the most urgent reasons. This, I regret to say, has not always been the case in this society.

Our Secretary, Dr. Barney, deserves our highest commendation for his painstaking and inde fatiguable work in this direction, and for his ability in getting out of a tight place and providing for us an interesting program after being disappointed by some one who fails to materialize.

In the discussion of the various papers, it has been the custom of the chairman to call upon different members to participate. Notwithstanding the fact that in this I have followed in the footsteps of my predecessors, I believe this practice detrimental to a live discussion of the subject. The members usually called upon need, or should need, no stimulus, and I feel confident the discussion will be better, more interesting and varied if this custom is abolished.

The year's work has, I think, been a successful and profitable one for the society. During the year the society met nineteen times in regular sessions. The average attendance during the year was thirty-five; the highest number that attended any one regular meeting was fifty-one and the lowest twenty. Fifteen active practitioners, most of whom are young men, 'were admitted to membership. There were read during the year thirteen papers, eight of which were prepared and read by our own members, and five men of note and prominence who came here by invitation. In addition to these papers

many of our own members reported exceptionally interesting and instructive cases, thus adding materially to the programs of the society.

Once during the year, The Great Ruler of the Universe saw fit to remove one of our number. In the death of Dr. Levi I. Shoemaker the society mourns the loss of a faithful member and a devoted friend.

And now, fellow-members, in concluding, I would say that in this day of commercialism and specialization, let us not be afraid of our neighboring co-worker. Let us strive to gain and maintain his friendship. Let us guard well our independence, but always possess too much self-respect to interfere with that of any one else.

In our daily labors among the sick and suffering may our hearts be generous, our ways gentle, and may we always be deeply impressed with the enobling responsibility of our profession.

Some years ago, in one of the western medical journals, appeared two communications, one entitled, "Does the practice of medicine pay?" in which the writer dwells upon the many hardships of a physician's life and dismisses the subject with the words: "Therefore, taking everything into consideration, I think I am perfectly safe in saying that it does not pay financially to be a physician."

The second paper is entitled, "Does it pay to live?” in which the intellectual pleasures constituting "the soul's calm sunshine and the heartfelt joy" are dwelt upon and it is pointed out that no greater reward can come to a physician than the ability to look back upon time well spent and the consciousness of a good example stamped upon the community. The writer says: "The opportunities of relieving suffering and inspiring hope in the despondent are so numerous in the daily rounds of a doctor that any physician who has spent his life in the conscientious discharge of his duties may answer the question in the affirmative."

I wish to thank you for the honor conferred upon me in electing me to the highest office within the gift of this society. More especially do I thank you for your hearty support during my administration and for your kind indulgence and patience for my shortcomings and mistakes. Gentlemen, again I thank you.

THE DYSPEPTIC TYPE OF CHRONIC APPENDICITIS. (PYLORIC SPASM) WITH DIFFERENTIAL DIAGNOSIS.

BY DR. CHRISTOPHER GRAHAM,

Physician to St. Mary's Hospital, Rochester, Minn.,

AND

DR. DONALD GUTHRIE,

Surgeon to Robert Packer Hospital, Sayre, Pa.

READ FEBRUARY 9, 1910.

GENERAL CONSIDERATIONS.

Cases of chronic appendicitis in which the stomach symptoms predominate have been a stumbling block in the past to both clinician and surgeon, and to-day the symptomatology of the condition is far from being definitely settled. In the early days many of these cases were operated on by surgeons in general for ulcer of the stomach, and while no lesion was found in the stomach, a needless gastroenterostomy was performed for the so-called medical ulcer, which operation brought the patient trouble rather than relief. In our earlier experience we frequently were at fault. These patients were made worse by the first operation, and had bile regurgitation added to their former distress, necessitating a second operation for their relief.

It has long been noted that chronic dyspepsias have been cured in patients who for years have been treated for chronic stomach disorders, in whom an acute appendicitis necessitated operation. This attack at the time was thought to have been a separate trouble. Indeed the profession has been slow in grasping the point that the stomach picture was due to chronic appendicitis.

In the last few years the French have written extensively on dyspeptic appendicitis, and in this country the earlier writings gave chronic dyspepsia and intestinal intoxications as etiological factors of appendicitis. Murphy, Ochsner, Richardson, Deaver, Eggleston and many others in their later writings have recognized the part played by the appendix and gall bladder in causing chronic digestive disturbances, and have made many valuable contributions to the subject.