and stamp out small-pox; furthermore, that if proper safeguards be thrown around the selection of virus, and the performance of the vaccination, that the danger of death, or serious illness resulting from the measure is almost infinitesimally small.

In the face of all this overwhelmning evidence, however, the misguided anti-vaccinationist, allowing his imagination to run away with his judgment, holds up his hands in horror, and with bated breath, and a scared look, calls our attention to the horrible diseases and occasional deaths caused by vaccination.

For the sake of argument, let us admit that an occasional death has been caused by impure virus, and that blood poisoning has, in the past, happened in rare instances (and they are exceedingly rare indeed, compared with the whole number of vaccinations), still, the evil is but a tiny, trickling rill alongside the great river of beneficence which this grand discovery has brought to soothe and save suffering humanity.

What would you think of the argument that because an occasional preacher goes wrong, or that some chuch members are immoral and dishonest, that therefore churches should be abolished and religion declared to be a fraud. What would you say to the proposition that because a few lawyers are venal, and betray their trusts, that our whole system of jurisprudence should be overthrown, and we be allowed to lapse into a state of lawlessness. I believe every reasonable person would declare such a course to be unwarranted by the facts, and prejudicial to the best interests of humanity. If this be true of religion and law, why should it not apply with greater force to the preservation of health, and the prevention of disease. Because a few doctors are dirty, careless, make mistakes and have accidents follow their work, is that any reason why the work itself, or life-saving measures, should not be continued, or that they should be condemned?

Because physicians are obliged to operate on many persons with inherited disease and poisoned blood in order to give them a chance for their lives against some serious disease, which in all probability they would have contracted and died, had they not been protected against it, are these physicians, or the preventive means they employ to be decried if an occasional bad result occurs under such circumstances?

With approved modern methods for the production and the marketing of pure bovine vaccine virus; with proper antiseptic or aseptic precautions in making vaccinations; with the

rapid disappearance of the dirty, careless doctor from the field of modern medicine and surgery, I believe I am justified in reiterating the vaccination creed adopted by 150 Minneapolis doctors a short time ago, viz. :

First. "That true vaccination is an absolute preventive of small-pox."

Second. "That true vaccination with pure lymph, followed by cleanliness and proper care of the vaccinated surface, never did, and never will produce a serious sore."

Third. "That true vaccination leaves a characteristic scar that follows from no other cause."

Fourth-"That no serious effects ever follow true vaccination, and that, on the contrary, thousands of human lives are annually saved by it."—(Journal A. M. A., April 12, 1902.)

A CASE OF RHINOPLASTY.

By H. N. MAYO, M.D.,

Salt Lake City, Utah.

This case gives the following history: He is 24 years old and in the best of health. When 9 years of age he was kicked in the face by a horse. His nose and cheek were lacerated. The entire bony structure of the nose was crushed inward and upward. The columna nasi was torn from its attachment at the point of the nose and deflected from its normal position in the median line. The deflection of the septum was so great that one nostril was nearly occluded. The bridge was crushed in to such an extent that there was no elevation at all. The tear ducts were obliterated. The tip of the nose was elevated and drawn in by cicatricial tissue, showing the uneven nostrils. The illustrations show what a disfigurement this injured nose was to its unhappy

owner.

He was operated upon and the following method employed to improve his appearance: An incision was made transversely across the nose, five-eighths of an inch above the tip, extending from cheek to cheek and in depth to a level with cheeks. The septum and columna nasi were cut from their attachments at the tip of the nose and a proper place denuded for a new attachment, which was made by a horse hair suture at once. This transverse incision allowed the tip of the nose to be carried downward to the desired extent.

A triangular flap, two inches long and one and one-half inches wide, with its base upward, was then cut from the forehead immediately above and in a line with the nose.

An attach

ment of this flap was left for blood supply at the root of the nose. The flap extended in depth to the periosteum, except at its center where a strip of bone three-fourths of an inch long by

three-eighths of an inch wide, consisting of the outer table of the skull, was chiseled out and left adherent to the periosteum. The strip of bone was intended for a new bridge. The flap, consisting of skin, enough periostum to cover the bone and the bone itself were turned down, not twisted, but with the skin surface turned in to form a good, healthy surface to the nostrils. If the flap had been twisted there would have been a large raw surface internally that would have contracted and lessened the diameter of the nostrils. The whole was stitched in place with horse hair suture. Skin grafts were then taken from the arm and planted over the raw surface. The edges of the wound on the forehead were loosened from their attachment and brought together with silk worm gut, leaving a T-shaped scar on the forehead. Union was ideal, both of the transplanted flap over the nose and the inicsion from where it was taken on the forehead. Two weeks after the first operation the attachment of the flap was cut, its under surface and the skin at the root of the nose where they came in contact were removed and the flap bound down. Union was successful and the extra amount of tissue formed a good full root for the nose.

A little trouble was experienced from the transplanted bone, a portion of it sloughing away. Both nostrils are free, the patient breathing through them easily. The tear ducts were completely obliterated, there being no chance for repair.

The accompanying cuts show the improvement in the young man's appearance.

REPORT OF A CASE (POST MORTEM) OF HEART ON THE RIGHT SIDE (CONGENITAL).

By HENRY DALTON, M.D.,
Denver, Colorado.

Man died suddenly May 29, 1902. No history. He was evidently a laborer about 40 years of age, weighing 140 pounds. Was considerably emaciated and skin of a bronze color. The dura mater was adherent to skull, pia mater closely adherent to brain and on inspection the membrane and its vessels looked normal. Brain was very soft and pale, the cerebellum was so soft that it fell to pieces and could not be handled. No hemorrhagic points on section; considerable fluid in the ventricles.

The lungs were slightly congested on posterior surface, probably hypostatic congestion. The heart was on the right side

of body, in the thoracic cavity and probably a congenital malposition. There was considerable enlargement of the right side of the heart and fatty degeneration. The ascending and descending vena cava were gangrenous, black, brittle and easily torn. The stomach was considerably enlarged, its surface was very smooth and entirely denuded of mucous membrane. There were two gastric ulcers on the posterior wall of the stomach close to the pyloric orifice. The coats of the small and large intestine were very thin. The appendix veriformis was normal. In looking for the pancreas, after locating the spleen and duodenum, small fibres were found adherent to the spleen, corresponding to the position of the tail of the pancreas, and these fibres or stroma extended to the concavity of the duodenum, corresponding to the head of the pancreas, and intermingled in the stroma were a dozen or more lumps of fat, evidently the remains of the pancreas. The spleen was enlarged and congested and bled freely on section. The liver was very large in size and weight, filling the right side of abdomen and almost filled the left side. The thicker portions of liver were hard and nodules could be felt all over the hardest portion of liver. On section it was hard, grating in sound and in substance was very dry and a dark reddish-brown color. The liver was filled with fat; scattered through its substance, ranging in size from a marble to the size of a man's fist.

Both kidneys were reduced in size, and their capsules thickened and adherent in spots, when an attempt was made to peel them off. Small nodules could be felt through their substance. On section the whole structure of both kidneys were coarse and fibrous. This condition was probably due to cirrhosis. No microscopic examination of kidneys made. The bladder was normal. Death was thought to be caused by cancer of the liver, secondary to cancer of stomach. A section of the liver was stained and examined microscopically and revealed great thickening of the connective tissue and fat in the hepatic cells. So it was determined that death was caused by cirrhosis and fatty degeneration of the liver and kidneys, due to alcohol.

VIENNA LETTER.

Some of your readers may be interested in a few notes regarding medical matters in Europe, and I send you a few of my first impressions.