sewage farms entirely refute this theory, since they prove beyond a doubt that if the land is well managed it never loses its power of purification.

The reports show that there is no evidence that the sewage farins had any detrimental effect on the health of the cattle kept on them, or on the adjoining land; they are particularly free from disease.

Much has been said and written for and against sewage farms and the question whether chemical treatment or application to land is the better way to dispose of sewage. The real question is not so much whether sewage farming or chemical treatment is theoretically the right way to dispose of sewage; but rather whether in a particular case the one method is more likely than the other to give good results, as every case requires to be dealt with on its own particular merits.

APPENDIX No. IV.

REPORT ON THE EIGHTH CONGRESS OF THE " ASSOCIATION FRANÇAISE DE CHIRURGIE,” HELD AT LYONS, SEPTEMBER 8TH TO 13тa, 1894, WITH SET OF DIAGRAMS.

By Surgeon Lieut.-Col. W. S. PRATT, M.B., Army Medical Staff

The Eighth Congress of this Association was held at Lyons this year instead of at Paris, where all the previous meetings took place. The chief officials of the Bureau du 8me Congrès were-Président, Le Professeur Tillaux, membre de l'Académie de Médicine, chirurgien des hopitaux, Paris; Vice-President, Monsieur Guérin, chirurgien honoraire des hôpitaux, and General Secretary, Le Docteur Picqué. The local committee included Honorary President, the Mayor of Lyons, Professeur Gailleton, ex-chirurgien de l'Antiquaille; President, Professeur Ollier, chirurgien de l'Hôtel-Dieu.

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The meetings were held in the Theatre of the Faculté de Médecine.

The proceedings were opened by Professeur Tillaux in a very able and interesting speech. After After a few felicitous opening remarks, he proceeded as follows: I am certain that I am only expressing the thoughts of the members "of this Congress in saluting, first of all, this grand and noble city of Lyons, "whose history is so intimately bound up from the earliest times with the arts "and sciences, with literature, commerce, and civilization generally. Confining "ourselves only to the subject of surgery, it was here that Guy de Chauliac published his Grande Chirurgie.' Here also Lanfranc collected the "materials for his Chirurgie Parva et Magna.' The immortal Rabelais practised medicine here in the 16th century, and in the first quarter of that century the beautiful work of Jehan de Vigo appeared. Moreover, on the "introduction of the art of printing, Lyons supplied a large portion of Europe "with books. At this epoch surgery played a very inferior rôle. In the "Statuts de Lyon,' 1576, we find it ruled that surgeons could neither bleed nor administer medicine without the authority of a doctor. This humiliating state of things lasted for centuries. Even at the end of the 18th century Desault, of the Hôtel Dieu, Paris, could not perform any serious operation "without the assent of three physicians and in the presence of at least one. "However, surgeons began by degrees to assert themselves. A special school "of surgeons was founded at Paris in the beginning of the 18th century, and "in 1731 was founded the celebrated Royal Academy of Surgery with J. L. "Petit as first director. The surgeons of Lyons quickly entered into close "relations with this Academy, and became corresponding members thereof. Although the surgeons had by dogged perseverance attained to a better position than their predecessors, the barber surgeons, there still existed a "marked line of separation between medicine and surgery, the latter being "considered a merely manual art. Then came the great and fruitful Revolution, which destroyed at one blow the whole medical edifice so laboriously "and artificially constructed. Both the Faculty of Medicine and the Royal "Academy of Surgery disappeared in the revolutionary whirlpool. Nevertheless, doctors were needed, more especially in the army of France, which "6 was being attacked on all sides. It was then that the National Convention "created 'L'École de Santé,' which was installed in the place of the old "Academy of Surgery. The course of instruction now comprised every "branch of the art, much resembling our present curriculum.

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We now come

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"to the modern period, in which Lyons still continued to hold a predominant position. In the first instance we note Antoine Petit, who founded the "Medical Society of Lyons, then Joseph Gensoul, and above all Amedée "Bonnet.

"The surgeons of our present day have assisted at a transformation almost "incredible to those who remember the previous state of things in our hospitals. In the old days erysipelas and hospital gangrene were endemic in "the hospitals, and the mildest operations were accompanied by serious risk "to life. To-day, owing to the advance of antiseptic surgery, these great "enemies have disappeared. Operative surgery has attained a very high "degree of perfection, but at the same time we must be careful to keep "before us as a guiding principle that the most important point of all is diagnosis and the knowledge of when to operate. The physicians and surgeons "of to-day should work together, not separately, towards their common goal, "the good of humanity."

There then followed a discussion on different surgical topics, amongst others on Congenital Lipoma by M. Lannelongue, of Paris; on the action of Chloroform on the Heart by M. Guerin, of Paris; and a very interesting paper on operations for Goître by M. Roux, of Lausanne. On resuming the séance in the afternoon the subject of cancer and its etiology was discussed. M. Bard, of Lyons, was of opinion that the differentiation of malignant tumours in a pathogenic sense is wrong, whatever their origin or structure. All the tissues of the body may engender cancer, and there is no reason for applying this term to epithelial tumours. Each cancer owes its origin to a young cell endowed with an exaggerated power of reproduction, and the cell may attack each tissue. It is this extraordinary vitality which differentiates the cancer cell from the normal cell. He entirely repudiated the microbic theory of cancer. A discussion followed in which very divergent opinions were expressed.

After this came a supplementary séance, the subjects being diseases of the genito-urinary system, surgical affections of the neck and chest, and operations on the nerves and muscles.

The following morning, 10th October, at nine o'clock, I visited the great hospital of the Hôtel Dieu. This grand hospital, with upwards of 1,000 beds, was founded in 542 by Childebert, Roi de France. It was built for the use of the sick poor and for sick travellers, and up to the present day still opens its doors to the sick and wounded of all countries irrespective of nationality or place of residence. Poor travellers also receive board and lodging for three days at a time. The nursing service of this hospital, as well as of the other hospitals at Lyons, is carried on admirably by a body of "infirmières," who are called "sisters of the sick poor." Their organisation is a purely civil one, and is attached to no religious order, but the members voluntarily submit to religious rule. They take no vows, use their own names, and can resign their appointments at pleasure. They are supplied with a sort of uniform by the hospital authorities, and receive a yearly sum of 40 francs. They receive also instruction in the different branches of their profession, and obtain various “brevets or gradings as herberistes," "sage-femmes," &c.-these latter being divided into first and second class midwives. The first thing on arrival we were received by one of the hospital surgeons, who explained the methods used to elaborate the practice of antiseptic surgery. Each patient on admission is examined, and then given a ticket stating whether he is to go into the antiseptic wards or not. These wards are kept entirely distinct, and the surgeons, dressers, and nurses have to take elaborate precautions, such as putting on long antiseptic gowns, and making careful ablutions before entering the wards. The arrangements for keeping the instruments aseptic are very complete. They are placed in superheated glycerine before use, and are kept in air-tight glass cases with glass shelves. There is also a steam sterilizing apparatus in the hospital, and all surgical dressings, lint, bandages, &c., &c., are first carefully rendered aseptic and then placed in a copper box, which is locked and sealed, and can only be opened by the surgeon when required for immediate use. This prevents any handling or tampering with the dressings before use. A new kind of metal sature was also shown. This is made of soft iron, nickel plated, and appears admirable in every way, the cost being exceedingly moderate. The arrangement of the beds in the wards seem hardly satisfactory, there being white curtains and hangings, which seem out of date.

We next proceeded to the operating theatre, where M. Ollier showed a series of most interesting cases, illustrating the satisfactory results of the operation with which he has identified himself-sub-periosteal resection of bones and joints. This lecture was of peculiar interest, as M. Ollier has contrived to keep in touch with many of the cases he operates on. Thus several patients were produced, showing the results of the operation after a period of 20 years. One case of excision of the head and upper third of the humerus, for tubercular disease complicated with syphilis, was peculiarity instructive. The patient had a sound and useful arm, and the excised bone was carefully preserved and shown at the same time. Some of the results of excision of all or some of the carpal bones of the wrist were simply astonishing. In the afternoon I was honoured by being asked to sit as president during the séance. The subjects under discussion were the surgery of the stomach and intestines, and of the face and cranium. Amongst the latter a very interesting case was shown by M. Hassler, Médecin-Major of the École de Santé Militaire. The patient had attempted suicide by firing a Gras rifle into his mouth. This resulted in frightful injury and deformity. The lower and upper jaws fractured, the teeth destroyed, the roof of the mouth and the nasal bones completely disorganised, and the muscles and skin of the cheeks and face charred and lacerated. The injuries have been gradually repaired, the teeth and palate artificially replaced, and a nose formed by rhinoplasty. The great difficulty was experienced in forming a bridge to the nose, and M. Hassler contrived a very ingenious steel support for the purpose. The case demonstrates the powers of plastic operations to repair injuries to the face, which without this resource would render the sufferers permanent objects of horror and disgust.

The next day, October 11th, many of the members of the Congress went to Aix-les-Bains on an excursion. I did not accompany them, but visited the Exposition de Lyons. There was a very interesting exhibit by a M. Écot, Médecin-Major de l'École de Santé Militaire, illustrating different methods of utilising portions of men's equipment and articles in general use for improvising splints, lamps, &c. for service in the field. He employs the ration tin carried by soldiers, which is cut into thin strips, also the wood of packing cases for biscuits in forming splints of various kinds. By the method, also well known in our army, of cutting glass bottles by friction he contrives a useful double lamp and various other articles. The accompanying design merely shows the idea and is not intended to be absolutely a correct copy.

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On Friday, the 12th, in the morning, the discussion was principally confined to fractures of bone and operations thereon, and in the afternoon the second question of the day, officially sanctioned by the Congress, was brought forward. This was a report on the present state of surgery as applied to the spinal column, and was introduced by M. Kirmisson, of Paris. He began by saying: "Now that antiseptic surgery is firmly established the field for operative "interference is widely increased. With regard to injuries of the spinal cord “and vertebræ, the results published by M. Chipault are scarcely encouraging, "out of 150 cases in which operative interference by resection of one or "more vertebral arches was attempted, there were 12 recoveries, 24 slight "improvements, and out of the remainder 80 deaths occurred. Even in cases "where after fracture of a lumbar vertebra an operation has been successfully performed, with slight hæmorrhage, and where there was no apparent injury to the cord itself the patient died in five days. In cases, however, of "injury lower down, which are followed by paraplegia from pressure, Dr. "Thorburn quotes two cases in which a cure was obtained on removal of the "cause of compression. In fractures complicated with wounds, such as from firearms, Mr. Walter Pyle relates the following case:-A young man was wounded by a bullet in the vertebral column, the entrance wound was "situated at the level of the last dorsal vertebra. One hour after being struck "there was complete loss of movement in the lower limbs, though sensibility "remained unimpaired. During the day sensibility was entirely lost below "the knee, and there was complete paralysis of the bladder and rectum. "Later on the paralysis became more extended showing the existence of "hæmorrhage within the vertebral canal. An operation was decided on; a "piece of bone was found which had penetrated between the last dorsal and "first lumbar vertebræ, there was extravasation of blood in the canal, and the

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"cord showed evident traces of contusion. The results of the operation were "most satisfactory. We may take it, then, as a rule, that in fractures of the "vertebræ, where portions of the arch are forced in and press on the cord, an operation for relief is indicated. In cases also of partial dislocation, also, "where prudent and careful attempts at reduction have failed, we should not "hesitate to operate, remembering that the injury to the cord is likely to be "less sharply inflicted than in the case of a penetrating wound or a fracture. Many successful cases of this nature have been published by Boyll, "Arbuthnot Lane, and others.

"Now as regards Potts' disease. This may be divided into two categories, "those in which the aim of the operation is directed against the disease of "the bone itself, in order to eradicate the tubercular virus, and those where "the object is to relieve the paraplegia.

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"In the immense majority of cases any operation on the bony structure "should be avoided as useless or worse than useless. Absolute rest and the ensurance of complete immobility of the parts offer by far the best chance "of recovery. This fact is illustrated by numerous examples. In cases where "profuse suppuration exists iodoform injections form the safest and most "useful treatment. It is only in cases where the tubercular lesions are on the posterior part of the spine, where the alterations of the bone are easily accessible, or where the anterior portion of the spine is affected and iodoform injections prohibited, that operative interference is justified.

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"Another question arises when paraplegia exists, where the danger is so threatening, or where pain renders the patient's life intolerable. Here operation is frequently rendered necessary, though it must be admitted "that the results are the reverse of encouraging or satisfactory.

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"In cases of neo-plasms or tumours of, or pressing on the cord, if it is "certain the disease is not syphilitic, operative interference may be considered. "In spina-bifida the operation of excision appears to offer the best chance "of success.

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"In conclusion, in spite of all our modern improvements and increased knowledge, the surgery of the spine is still full of unsolved problems, full "of the most formidable difficulties, and dependent in a great measure upon "chance circumstances." A series of interesting papers on the subject were then read and discussed.

On the morning of the 10th there was a repetition of M. Ollier's cases of sub-periosteal surgery at the Hotel Dieu, and in the afternoon the final sitting of the Congress took place, the subjects under discussion being mainly the surgical diseases of women.

Through the kindness of the Director-in-Chief I was permitted to visit this admirable institution. I venture to give a short history and explanation of its working, in contrast to the system of training medical officers for the British Army.

The "École de Santé Militaire" replaces the school that was established in 1853, and came to an end after the war of 1870. The new school was founded in 18 8. It is temporarily established in the military hospital of Besgenettes, but the new buildings are nearly completed. The object of the school is to ensure the supply of surgeons for the army, to assist them in their university studies, and to give them a military education prior to their admission to the final military medical school at the Val-de-Grâce at Paris.

From 1871 to 1888 several methods of obtaining army surgeons were tried. From a scientific point of view the results were fairly satisfactory, but the methods of study were found not to give the necessary practical knowledge, and the military training was absolutely insufficient, more especially since the law passed in 1882, making the army medical department completely autonomous under its own chiefs. By this law the medical officers hold the military command over all ambulances, hospitals, &c., and over the military personnel thereof, as well as over all sick and wounded under their care. Hence the necessity has arisen for a military education extending over several years, commencing at the " École de Santé Militaire" at Lyons, and terminating at the Val-de-Grâce at Paris. The young candidates are received at the École