of Finney and of Kocher are ideal theoretically, but, as a matter of fact, as I said in my paper, they do not accomplish what gastrojejunostomy does, so far as we know at present. They fail to stop the bleeding, and they will not cause an active ulceration to heal. Until they bring about these results gastro-jejunostomy as a therapeutic measure must hold an important place. I am very glad Dr. Chase spoke of the incision he did. This is what is known as MayoRobinson's incision, carried out with a sand-bag underneath the back to throw the liver forward and allow the intestines to bag downward, the Trendelenburg position, so to speak, of the upper abdomen. This is the incision that I personally am in the habit of calling the one over the storm center. It exposes the outlet of the stomach and the head of the pancreas. It enables us to turn up the liver and inspect and palpate the bile ducts throughout their entire course. In other words, it exposes all the lesions in the "storm center" of the upper abdomen. In regard to those villous or weeping patches, as they are called, the opinion of surgeons who are doing work in the abdomen is that we should not meddle too much. For instance, we say the patient has gastric ulcer. We open the abdomen and cannot find gastric ulcer. Sometimes we will be able to recognize a so-called sentinel node, just like a node of carcinoma. That tells us inside the stomach there is a round or fissured ulcer. In those cases we cannot feel or see anything that will lead us to suspect that there is ulceration inside of the stomach. The same is true in regard to villous patches. We cannot see or feel anything on the outside of the stomach that would lead us to suspect there might be trouble within. I believe the conservative treatment of operators in these conditions would be not to hunt for these ulcers, not to hunt for these villous patches. If I remember rightly, the gentleman referred to by both the previous speakers, Wm. J. Mayo, is the very man who says, "Don't look too far." If I remember rightly, he says, "A good prognosis is better than a good diagnosis." Don't hunt for the ulcers you can't see on the outside. Don't hunt for weeping patches, but go ahead and apply the indicated remedy-gastro-enterostomy. REPORT OF THE SECTION OF SANITARY SCIENCE. Sanitary Clothing, by R. L. Piper, M. D. The Salt River Climate (Arizona), by Bernard E. Bigler, M. D. SANITARY CLOTHING. R. L. PIPER, M. D., TYRONE. Ever since the days when Adam and Eve trod the Garden of Eden clad only in the raiment of undefiled innocence, and by their transgression against the laws of God created the necessity for more material clothing, the question of what we shall wear and how we shall wear it has proven a source of never-ceasing anxiety to the human race. Shall it be full dress (characterized especially by lack of material), undress or redress? That is the question. There must be a dress for the weather, a dress for the time, a dress for the occasion, a professional dress, a business dress, a social dress, a menial dress, a religious dress. Because you and I well know, although we may agree with Robert Burns that— "What though on hamely fare we dine, Wear hoddin' gray an' a' that; Gie fools their silks and knaves their wine, A man's a man for a' that." Did I We are very frequently judged by the clothes we hear you say: "What should a physician wear?" Just let me in a quiet sort of consultation way tell you. A physician should wear a suit of armor, covering his body so completely that not even the tendon of Achilles would be exposed, so thoroughly welded and firm in its structure that it would be utterly impervious to the shafts of ridicule and slander, yet so delicate in its mechanism that it would be susceptible and sympathetic to the minutest rays of suffering and Are the Amens unanimous ? sorrow. But laying aside all figurative expressions, we, as physicians, are vitally interested in the question of clothing for ourselves and our patients. The almost constantly varying climatic changes occurring throughout the State of Pennsylvania, especially throughout the mountainous portions of the State, render its inhabitants susceptible to catarrhal and rheumatic ailments, unless the wisest and most diligent precautions are taken to prevent them. These precautions consist not only in preserving a proper mental and physical equilibrium by observing and practicing sanitary and common sense rules in regard to exercise, eating, drinking and sleeping, but especially in regard to clothing. And I venture the prediction that more people acquire disease by being over-clothed than by being under-clothed. The "barefoot boy with cheeks of tan" can give away a few years of good solid health to his pale-faced, spindle-legged, silk-stockinged, money-to-burn city visitor and still live the required three score. years and ten. Life, that little word that is spelled with four letters, whose definition no one in this assemblage has ever dared to correctly interpret, is constantly producing heat. The chemical changes taking place in that beehive of industry, the human body, produce a sufficient quantity of heat to cause death within a few hours if part of this heat were not eliminated. The normal temperature of the human body, regardless of seasons, should be about 981⁄2 degrees F. Hence we must eliminate all heat produced above the quantity, which is necessary to preserve that temprature if we desire to remain in a normal condition of health. As you know this elimination is produced in three ways, namely; by radiation, by evaporation, and by conduction, which shows that nature believes in having reserve forces on hand for emergencies. The loss by radiation amounts to more than one-half of all heat lost, and is produced by the difference in temperature of our bodies and that of the surrounding objects, atmospheric or otherwise. Evaporation is produced when the surrounding object is warmer than our bodies. It is intensified by dryness and impaired by humidity. You all have noticed the fact that we are much more comfort able on a summer day with a dry atmosphere than on one with great humidity, although the temperature be the same. Conduction is regulated and controlled by the extent of the air current, and it is also a well known fact that we feel excessive cold as we feel excessive heat, much more in a moist than in a dry climate. Hence, to maintain as nearly as possible, a normal condition of temperature, it is necessary for our skin, as well as the air and clothing immediately surrounding it, to be kept as dry as possible. To do this we must wear clothing which will not interfere with a proper elimination of the amount of heat of which our body has to dispose. The protective feature of clothing depends upon its porosity or airholding capacity. Experience and observation have taught me that garments composed of linen or cotton loosely knit and porous in their structure are much more efficient for this purpose when worn next the skin than those composed of wool. The most ancient authority I can give is Moses, who, in Ezekiel, 44th chapter, 17th and 18th verses, says: "They shall be clothed in linen garments and no wool shall come upon them; they shall not gird themselves with anything that causeth sweat." Woolen garments are deficient in the power of absorbing and eliminating moisture; consequently, while a woolen undergarment will impart a feeling of warmth and comfort to a dry body, when by reason of exercise or excessive surrounding heat evaporation is increased, the woolen garment becomes moist, further evaporation is seriously interfered with, and then necessarily follows a feeling of oppression caused by retention of heat. Then let our bodies be exposed to a draught of cool air and a cold almost invariably results. The same process of reasoning would make woolen garments the best material for over-clothing in winter, while those composed of loosely knit and porous linen or cotton, linen especially, would be the ideal undergarment. Of course, the proof of the pudding is in the eating. Theories often build beautiful air castles, but facts come along and knock them into smithereens. The doctor who covers too many sheets in expatiating upon his hobby may be accused of having a diarrhoea of words and a constipation of ideas. But we all have patients who are extremely susceptible to nasal and bronchial catarrhal conditions and aggravations. A sudden change in the weather, a little violent exercise producing perspiration, a draught of air means work for the doctor. It does not seem right to throw away a good thing, especially when we need the cash, but we are the conservators of the public health even at the expense of our pocketbooks. About a year ago I experimented with several patients of this class by advising them to wear porous linen underwear and cotton stockings instead of the time-honored wool. gratification the consequence was that during the extreme weather of the past winter and spring and our cool summers they have enjoyed a degree of health far superior to that previously experienced. Another abomination which should be entirely abolished is the patent leather shoe. The reason is exactly the same as that given for the clothing, interference with proper elimination of heat and moisture. In regard to the so-called medicated underwear I have had no experience with it, consequently I cannot give an intelligent opinion. In fact, my experience with linen mesh and cotton fabrics for winter underwear is as yet in the experimental stage. But I believe they are advocated upon proper hygienic principles and will prove -of far-reaching benefit to the majority of our patients. Unfortunately these patients are born with certain idiosyncrasies. In many cases these idiosyncrasies are aggravated by dissipation. To be successful physicians we must make a careful study of each individual case and prescribe accordingly, not only medicinally, but hygienically. For this reason I earnestly solicit a full discussion and criticism of my few thoughts upon sanitary clothing. DISCUSSION. DR. AUG. KORNDOERFER, SR: The subject is one that has interested me for a number of years, though I had not expected to open the discussion upon it until the doctor spoke to me this morning and asked me if I had any interest in the subject. About thirty years ago I was led to examine into the influence of wool, cotton and linen goods upon the health of human beings, and was led at that time to adopt cotton by preference for myself, since which time I have recommended it and later on linen. Since linen mesh became a commercial garment and could be procured regularly I have recommended it in many cases. The great objection I have to linen is its harshness. Many patients find it is harsh and uncomfortable. The softer linen mesh is not economical, it breaks, and the harder is very apt to break and run into holes, before age should have worn it out, making it very |