all he saw and heard while in that country. No one method of controlling wound infection was in use, but irrigation with hydrogen peroxide was extensively practiced in the German military hospitals. Vaccinations were used for small-pox and enteric fever. Well equipped hospitals were visited where considerable attention was given to the mental state of the patient on the principle that "the more hope and courage the better the healing and shorter the convalescence." Also the after care of the wounded soldier was emphasized with a view of returning him to the ranks, if possible, or making him self-supporting.

Among the developments of modern war-surgery has been the demonstration of the close relation between anesthesia and the extent of mortality and morbidity. "Giving the wrong anesthetic or giving the right anesthetic wrongly." As a result of experience new methods have been devised and old methods improved upon. The author discusses local and regional anesthesia; gas and oxygen, oral anesthesia, spinal anesthesia, and rectal anesthesia.

New methods of treating joint lesions and fractures have been found to obviate the necessity of amputation in many cases. C. Williams of the Belgian Military Hospital at Hoogstade has done some remarkable work that the author considers important enough to warrant the report in full of his technique. Special hospitals for fracture cases have been found necessary in order that the best treatment be assured. Certain surgeons have developed new methods which the author discusses, such as Sinclair's method of treating fractures; Willens Screw Extension Apparatus; and the apparatus of Le Clercq and Varigard.

Prof.

A difficult class of cases to treat have been the trephined ones. Babinski, the leading neurologist in France, gave as his opinion of treatment for trephined patients with symptoms-" do a cranioplastic operation but do not promise too much." The use of cartilaginous grafts to repair the gap left in the skull has given good results.

War surgery always involves amputations, and in the early days of the present war there were many unnecessarily done. Better methods of treating wounds, joints and fractures have resulted in a great saving of limbs. The opinions of the leading surgeons as to the best type of amputations for the use of artificial limbs is discussed.

Plastic surgery has been one of the great developments of the war, but we must not forget the advances made in this field for the past 25 years. The ancient Hindoos were credited with performing plastic operations 2000 years ago. Restorative surgery, such as bone grafting, nerve suture, tendon transplanting, etc., has been gratifying, but the most remarkable results have been obtained in plastic surgery of the face and jaw, owing to the cooperative work between the surgeon and dentist. The author describes the work and methods used at the leading reconstruction hospitals he visited.

Trench fever has been one of the great problems of the war. The author discusses the symptomatology and measures to prevent its occurrence, especially the destruction of the louse which was found to transmit it.

The problem of evacuation of wounded from the firing line to convalescent camp, as handled by the British, is set forth at length. This includes the surgery of the forward area and transportation from the trenches to regimental aid post, advanced dressing station, field ambulance, walking wounded post, main dressing station, casualty clearing station, ambulance train, stationary hospital, ambulance transport to England, ambulance train to base or special hospitals, and finally to convalescent camps. Experience has shown the degree of surgical procedure that may be adopted at each station. Special notes of hospitals visited and surgical methods in use are given in detail. The organization, administration, and results accomplished by convalescent camps are also discussed. The author states that France and Britain early in the war recognized their responsibility for the reeducation of the disabled and we should learn from them and Belgium the lessons that four years of experience have taught. Functional re-education should begin in the hospital before the wound is healed or before habits are formed conducive to permanent helplessness and reliance on others. Functional re-education by work has proved to be the most helpful, although gymnastics and special machines are useful. Vocational re-education gives a man an opportunity to learn some other trade or profession which will enable him to be self-supporting. In Europe, almost from the beginning of the war, this has been recognized and special institutions provided, some of which the author describes.

For the purpose of comparing methods and results in war surgery the American Red Cross, through Major Alexander Lambert, organized a research society which meets monthly in Paris and publishes its proceedings in a journal. The general principles guiding the treatment of wounds of war and the best accepted methods for each class are outlined.

In completing his report the author discusses miscellaneous subjects, such as the modern treatment of burns by ambrine; suggests plans for an evacuation hospital; gives a proposed organization of educational service in war surgery; and offers special suggestions regarding disposal of U. S. Army casualties.

Finally, as a result of his survey, the author makes several recommendations which he believes may be helpful. Medical officers should read this excellent report in full, as it is worth careful study.

D. N. C.

NOTICE TO MEMBERS

Attention is invited to extracts from the constitution on the opposite page as to the requirements in making applications for life, regular and associate membership.
Members and associate members are liable for the payment of the annual dues until the date of the receipt of their resignation in writing. Annual dues $2.50.

member of the U. S. Naval Institute from this date.

The U. S. Naval Institute was established in 1873, having for its object the advancement of professional and scientific knowledge in the Navy. It is now in its forty-sixth year of existence, trusting as heretofore for its support to the officers and friends of the Navy. The members of the Board of Control cordially invite the co-operation and aid of their brother officers and others interested in the Navy, in furtherance of the aims of the Institute, by the contribution of papers and communications upon subjects of interest to the naval profession, as well as by personal support and influence. On the subject of membership the Constitution reads as follows:

ARTICLE VII

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ARTICLE X

Sec. 2. One copy of the PROCEEDINGS, when published, shall be furnished to each regular and associate member (in return for dues paid), to each life member (in return for life membership fee paid), to honorary members, to each corresponding society of the Institute, and to such libraries and periodicals as may be determined upon by the Board of Control.

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