conscious and apparently in a dying condition; skinned, bruised and bleeding, and it seemed that every bone was broken. So here I was, without a thing in the surgical line but a small pocket case with a lance, pair of small forceps, two or three needles and a few lengths of silk. Well, it looked discouraging, but I was expected to fix him up off-hand and "do it now." So I pulled off my coat and waded in. I got every clean rag in the mill camp, and about all the dirty ones, too, heated water and sterilized everything in sight, got a lot of thin strips of boards and a lot of other things I needed, and some I didn't need. Then I went after that busted young man and set a broken leg and two busted arms, one broke in two places; put a bandage on to help out five broken ribs and a collar bone, then sewed up four lacerations in the scalp, from 1 to3 inches long, also gashes scattered over the body, then laid him out on the bunk and gave directions to let me know how he was at exactly 8 o'clock next morning. Then I left, sure the man would be dead by 8 next morning, but he was not, and the messenger said the patient was feeling fine and sent a request that I bring him a little booze if I didn't think it would hurt him he got well. a scious, temperature 106, pulse 140, respirations about 35, with a very offensive odor prmeating the air in the room. So I saw at once that I was caught in a very bad case of puerperal sepsis, with absolutely no proper instruments or assistance as laid down and deemed as essential in such cases, by our city brother, when giving the country doctors advice, surgical-but I saw plainly that I must do something for the relief of that womand, and do it now, and this is the way I solved this difficulty. I found an old file and cut out a piece of wire from the fence and made me a double hook to drag uterus down; then I fashioned a dull curett out of the same wire and took a baking powder can and the ancient remains of an old household syringe and made this douching machine, using a large pipe stem for a nozle, then I got ready about five gallons of boiled water, sterilized all my hardware, wireworks, the patient, my hands, etc., then being all ready for war with the grim. reaper, I said a silent prayer and sailed in with no one to help but the ladies' husband and mother. I did not use an anesthetic-I had none, and none was needed, as the patient was unconscious. Well, the first minute after opening the ball I removed a 3-months fetus, dead and badly decomposed. (Here it is.) That confirmed my diagnosis and I worked with much better heart. After removing fetus I brought the woman across the bed, inserted my wire tractor by touch, and when sure I had a good hold I drew the uterus down and thoroughly curetted with a stream of bichloride solution from my patent douch, constantly playing inside the uterus. When I was sure I had the uterus clean I gave a thorough uterine and vaginal douch, placed a strip of sterilized cotton cloth to the fundus and replaced uterus, made the patient comfortable, then waited; gave strychina and cactin hypo and bathed with cold water to reduce temperature. I finished my impromptu operation at 2:30, and at 5 the temperature was 103, pulse 106, respiration 30, and the patient was beginning to regain consciousness. Well, to shorten the story I will say her recovery was uneventful and complete in three weeks from day of operation. On May 10, 1906, I was returning from a call I had made eight miles in the country, when about five miles from Winslow I met a woman running up the road carrying a child about two years old. She was screaming and very much excited. I stopped and got into the road, inquiring what the trouble was, and by much persuasion I finally induced her to explain. She said she was working around the house and the child was sitting on the floor playing with some beans which she had discarded from some she had prepared for dinner, when she stepped on the child's hand. She said the child had made one yell, then seemed to get choken and could not brathe good, and she had started with the child to a neighbors, where there was a woman who was a pretty good doctor, to see if the doctor woman could "unchoke" the baby. Well, upon looking at the child, it was all very plain. The child had put beans in his mouth and when he yelled had sucked one or two of the beans into the trachea, and was slowly but surely suffocating, as all the symptoms plainly showed. So telling the woman who I was I hurried her back to her home, about a quarter of a mile, and on the way I was thinking very hard, trying to evolve some plan to get that bean. I tried to remember some easy method or any other, but could think of nothing but the small lance in my vest pocket case. So upon arriving at the house I hurriedly examined the child and saw that what I did must be done in a few minutes or the child would be dead. I so informed the mother. Then that brave little woman set there and held her baby across her lap, while I split the baby's trachea from the sternum to the cricoid cartilage. The child was unconscious, for which I was thankful, as I had no anesthetic and had no time to use it if I had, neither do I think it would have been safe in such a case. Well, I found a bean sure enough, tried to remove it with the knife, but could not and I was afraid to work with it much, for fear of pushing it out of reach, either up or down. I thought of pushing the bean out into the mouth, but had no catheter or anything else to do it with safely. Now for about ten seconds I was in deep trouble. Here was my bean in easy reach but no instrument at hand that I could possibly remove it with. In my despair I straightened up, then I did a very queer thing for a man under such circumstances; I smiled, chuckled, then laughed outright, for right there within a foot of my hand, in the woman's hair, was a hair pin, and my hilarity was caused by remembering the thousand of funny jokes about the universal usefulness of a hairpin, and the thought that Iwould add one more use. Within ten seconds I grabed that hairpin and straightened it, then turned a hook on the end, by wrapping it around my finger, then within five seconds I had that bean in my hand, then I explored up and down for beans, but fond none. Then I turned my attention to resuscitating the child, as I saw it was very near death. Well I used every means possible; all were of no avail and I was chagrined to see my little patient expire about twenty minutes after the operaion, but I had done my best under the circumstances, for which I received the gratitude of that family. *NASO-PHARYNGITIS. Of the more common and widespread diseases, none receive the same neglect and indifference, from the patient as well as the physician, as the acute and chronic inflammatory conditions of the upper respiratory tract, notwithstanding that abnormal conditions of these parts have a great influence on the general systemic condition of the patient. The nasal fossa, the naso-pharynx and pharynx, anatomically speaking, are separate cavities, but so closely related as a continuation of the upper air passages, that from the standpoint of the physician who is not a specialist, they must be considered as one. The act of respiration commences here, and the air is lead through the tortuous passages that it may be purified or filtered by the vibrissa, altered in temperature by the rich blod supply and moistened by the profuse secretion. The turbinal bodies offer a greater area of surface to the air current and the patency of the nasal passage is sub *Paper read before the Frisco Medical Association at Kansas City, Mo., May 26, 1908. ject to alteration by the temporary erection of the inferior turbinate. The lining membrane, composed almost entirely of Ciliated Epithelium, is continuous with the sinuses, nasal det and Eustachian tube. Of all of the mucous membranes, that of the nose has the greatest tendency to catarrhal inflammation. It is the general belief that most of the infectious diseases enter the body through the lymphatic tissues of the naso-pharynx. Greater exposure to extreme cold and mechanical injuries reduce the power of resistance of the tissues giving disease easy access to the system. Disease of these passages may greatly affect the sense of smell, taste, hearing and speech. Owing to general systemic weakness, certain persons seem to possess a predilection to nasal catarrh. Children are more frequently afflicted than adults. Certain abnormal conditions, such as polypi, hypertrophy and deflections of the nasal septum are among the exciting causes. The most frequent disease of the naso-pharynx is the acute rhinitis, caryza or cold as it is commonly termed. The attack has the usual symptoms of dryness, irritation of the mucous membrane and sneezing, followed by congestion with an acrid serous exudate, which varying with the virulence of the infection, becomes mucus, then mucopurulent, slight fever is noticeable, the face is flushed, pain in the head and general discomfort. It is seldom that one nasal cavity is affected singly. An acute rhinitis will extend to the nasopharynx and pharynx more rapidly than the reverse had the pharynx been first affected. Without treatment the attack may not be troublesome after a few days, but usually traces of the infection may be found after several weeks. With thorough antiseptic treatment, by means of sprays and douches, several days will suffice to remove all traces of the inflammation, provided there has been no involvement of the lachrymal duct, sinuses or eustachian tube. The recrrent attacks produce a condition of chronic inflammation with hypertrophy of the tissues and thickening of the membrane, resulting in partial stoppage of the sinuses. Development of polypi and adenoids may be expected. Many of these cases have some enlargement of the tonsils. With these obstructions to the free passage of air, is developed the habit of mouth breathing. While it is thought that the air passes through the nose for the purpose of being warmed and moistened, it is found that while it passes through the mouth it is warmed and moistened to nearly the same extent as if passing through the usual channels. To every one who has observed the mouth breather, it is very evident that he is physically sub-normal. The dull, listless expression, flat broad nose, open mouth, stooping shoulders, undeveloped chest, illy nourished body are symptoms not easily overlooked. Various causes may be assigned for this lack of physical development, and the plausible is that the air passing through the mouth is not of a temperature best suited to the lungs, there is irritation and contraction, causing shallow breathing. The blood is not sufficiently oxygenated, leaving the patient in a state of partial poisoning by the carbon dioxide in excess. In the young more especially are these symptoms displayed. In the classes, the mouth breather will not lead and often is the cause of the class being held back from rapid advancement. In nearly all these cases the hearing is not acute and questions must frequently be repeated, the child soon becomes shy, not seeking amusement with companions, having a joyless existence. In short, the chronic naso-pharyigitic sees, smells, hears, thinks and feels poorly and consequently must work poorly, a great handicap in the struggle for advancement and exist ence. With greater facility other diseases are acquitted, owing to the lowering of the power of resistance of the body. The bronchial mucous membrane may become chronically inflammed and by swallowing the secretions from the nasopharynx, intestinal derangements may supervene, giving rise to indigestion and diarrhoe. Further complications may arise in the shape of deep ulceration, ozena, tumors, great thickening of the walls, the glands in the vicinity may be invaded. Hyper-sensitiveness and even hysteria may not infrequently be engendered by these abnormalities. In both the acute and chronic forms, involvement of the middle ear may be expected, and the greater number of cases of partial and even total loss of hearing may be charged to the extension of the inflammation from the nasopharynx to the middle ear. Not only is there danger to the auditory apparatus, but the infection of the mastoid cells may soon place the patient beyond the aid of the surgeon, generally due to delayed diagnosis or negligence on the part of the patient or attendant. In these cases the demand is for early active work, for should the pus enter the mastoid several hours may change the entire aspect. A great many cases of middle ear disease may not give rise to alarming symptoms, and after a short time all trouble seems to vanish, but the auditory apparatus has certainly been damaged and it will appear gradually, in the form of noises, ringing, roaring, partial loss of hearing and occasional pain. All these symptoms become aggravated with each new attack. While every physician does not care to take up a thorough study of these diseases and become proficient in their treatment, some by reason of location have it forced upon them. Not every patient can reach the specialist, distance and lack of money may keep them apart, and there are times when the symptoms are alarming and demand treatment at once. The sinuses may be giving the greatest pain, likewise the drum may be bulging fro mthe pressure of pus behind it, and a hurried incision may be needed, these things cannot be delayed. The instruments necessary for the diagnosis and treatment of these inflamma tory conditions are few and do not require exceptional skill in their use. They should be in the equipment of every practitioner, yet how many are prepared for these emergencies. The education of a community to the dangers of infectious diseases of the naso-pharynx and the complications that may arise, is the duty of the physician, and where no treatment has hertofore been given, it will not take long to get a fairly good and remunerative practce started, and one will receive many calls to relieve the painful otitis media and inflammations of the accessory cavities of the nose, where it had been their habit to treat them by poultices and time. Much good will be done these patients in the saving of tissue and the preservation ofthe special senses which are affected by these local troubles. The future welfare and happiness of the victim may depend upon the advice and treatment offered by the physician. How frequently, especially among the females, do we see the young who have had a nasal and pharyngeal trouble, develop a radual and ever increasing deafness, which almost completely ostracises them from the social pleasure of life, and may possibly be the cause of their not marrying. Case 1. Young lady, bright, intelligent, of a fine family. In early life contracted nasal catarrh, several repeated atacks without treatment soon affected the middle ear. After several years, loss of hearing was very evident. Much time and money has been spent to restore the hearing power, but as yet no favorable results have been obtained, and the loss of hearing is ever increasing. At present she has given up all hopes of ever being benefitted and has even almost given up the use of many advertised remedies for restoring the hearing. After it became known that she was growing deaf, hundreds of letters were received from those desiring to furnish a sure cure. Artificial drums and numerous other devices, medicines, sprays, pastes, etc., were used but have been of no avail. Now she is wearing a machine patterned after the telephone, iwth a receiver held to the ear by a head band, the transmitter being placed on the chest with batteries carried in the pocket. This is a very cumbersome device and does not get results. Duringthe last two years she has developed mouth breathing. I can find no cause for it, the nasal passages being unobstructed nor is the pharynx giving trouble. Her hearing and and social pleasures seem to have gone together. Case 2.-Boy aged nine. At age of four had acute rhinitis with otitis media, rupture of drum and free discharge from both ears. I saw him one year ago, weak, poor, emaciated, indigestion, no appetite, did not learn fast at school. Complained of frequent headaches and pain in the ears; purulnt discharge from both ears. The symptoms abated soon after commencing treatment, directed to the naso-jharynx and accessory sinuses, and the administration of tonics. His improvement was still more noticable after tonsillotomy. Case 3.-Lady came over fifty miles. to have "bug" removed from the ear. Her family physician had not found it, and she "just knew that it was there." a The bug was there and easy to see, but was of the form of abhesions due to former mddle ear infection from chronically inflammed pharynx. Intion removed bog at first treatment, and after a few days she returned home greatly relieved physically as well as mentally. After fifteen months there has been no return of the trouble. GALL STONES IN THE COMMON A. H. CORDIER, M.D., The classification of gall stones, according to their location, has not been given the importance that their presence in special localities demand. From a clinical, pathological and operative. standpoint this division of the discussion is essential. Many wrters in discussing this topic, discuss the subject in a general way and thus fail, in a measure, to call attention to, or lay stress upon the most important phases of the pathology. Complications engrafted upon the original pathology are often more serious than the cause of the complications. In no locality is this more true than in neglected common duct gall stone cases. The majority of individuals who have gall stones in the gall bladder are not made aware of their presence by any direct clinical manifestations. This is not the case. when the stones are using the common duct as their resting place on their journey to the duodeum. A stone when once in the common duct, with rare exceptions, begins making mischief that is quickly noticeable by the patient and his physician, this evdence wth short intervals of quiescence, will continue until the offending foreign body is gotten rid of by nature, the surgeon or by death of the death of the patient from chronic cholemia, carcinoma or other complications. Recognizing the great importance of prophylaxis, the surgery should, especially in this locality, be timely and complete. I know of no clinical picture more perfect in its symptomatic details than that of a lithoginous complete or partial occlusion of the common duct. Most gall stones have their origin in the gall bladder. However, the purpose of this discussion is to treat of their effects, etc., etc., after once formed and while in the common duct. I am firmly of the opinion that when a stone has once invaded the common duct that it never returns to the gall bladder. I do not wish to be understood as in any way depreciating the importance of surgical treatment of stones in the gall bladder when known to exist. I cannot fully agree with some of the noted authorities when they say that ‚“An inflammatory process is ever present and necessary to put a common duct stone in motion and that the wedging of the stone in the duct is a direct result of this process." I see no reason why a stone too large to pass through the duct should not become lodged as in |