These operations were performed July 3, 1906, Dr. Coon amputating the leg while I amputated the arm. I submit to you

also the chart which indicates the course of his temperature, pulse and respiration.

He was exceedingly nervous after his operation and the dressings, somewhat painful of course, were made with difficulty. For a time there was considerable contraction of the stump of the leg, but this was overcome by the application of proper splints and free motion was ultimately restored to the joint. Some sinuses persisted in both stumps for a little while, due to the presence of small fragments of necrotic bone which were cast off or removed; after which these entirely healed. His recovery

though slow is complete. The boy was dismissed from the hospital Oct. 10, 1906.

I present this brief history as well as the patient because I know of no recorded instance of such extensive gangrene following contact with a live electric wire. In a paper presented by Dr. Carlos F. MacDonald to the New York State Medical Society at its annual meeting in 1892 the history of the first seven judicial electrocutions in this state are given in detail. I quote from his paper as to the voltage and amperage of the fatal electric current used in these executions.

"The electromotive pressure as shown by the readings of the voltmeter taken by Prof. L. A. Landy of Columbia College varied from 1458 to 1716 volts while the ammeter showed a variation in current of from two to seven amperes."

Our patient received a charge of electricity enormously greater than that found necessary to destroy life in these judicial executions. Why the boy was not killed outright I cannot say, receiving as he did more than four times as many volts and from fifteen to forty-five times as many amperes of electricity as are used where death by electricity is premeditated. Probably there was but imperfect contact. Another interesting question is why the force of the current was expended on the extremities of one

FIG. 3. Showing lateral destruction of tissue of left leg.

side of the body. Is it possible that the current did not travel through the entire body; that is to say, through the central nervous system?

There are many recorded deaths resulting from contact with wires carrying only the current used for house lighting. This varies in the different cities from 100 to 110 volts with the alternating current, while the amperage is rather uncertain being usually figured as equivalent to one-half ampere per lamp.

The probability is that where death has resulted under these conditions the wires had become crossed, the dosage of electricity received having been therefore much greater than that which usually passes through the wires. It is a matter of common ob

servation to note that where the hand or fingers, for example, have been burned from contact with a live wire that there is a coincident burn upon the sole of the foot; in other words at the points of contact which render the circuit complete.

Our case is not to be regarded as an electric burn. In some way the arterial blood supply was immediately cut off, either because of the contraction of the arteries through vaso-motor stimulation or the blood in the vessels at once coagulated. But, however induced, it is certain that the circulation in both extremities on the left side was suddenly and permanently arrested.

After a very thorough search through our literature, I am unable to find a case similar to the one here presented, where a patient surviving such a powerful charge of electricity suffered from gangrene so extensive as to require a double amputation. 430 SOUTH SALINA STREET.

Epilation is of great importance in all follicular inflammations of the skin, since it not only removes a host of microbes but also affords access for antiseptics to the deeper parts of the follicle. -Int. Jour. Surgery.

Why Not? A Plea.

BY JAMES A. GARDNER, M. D., Buffalo, N. Y.

Attending Surgeon to the Genito-Urinary Department, Emergency Hospital.

HE most powerful aid to the progress of preventive medicine is the education of the public to an appreciation of the need and value of prophylaxis. The more extensive the medical knowledge of the laity, the greater are the benefits they receive from the medical profession. This has been markedly demonstrated in recent years in the care and prophylaxis of tuberculosis. Such being a fact, why is it that a department of medicine as important to the human race as that of venereal diseases is looked upon by the public with indifference, if not actual opposition to any enlightenment? The general public knows little or nothing respecting the dangers of these diseases.

The experience of all medical men shows that ignorance is responsible for a large proportion of infections in the young, and that enlightenment, which engenders a wholesome fear of these diseases, would preserve thousands from their contraction. Education in this direction would not only serve as a preservative against exposure to infection, but would constitute the most valuable safeguard against the introduction of such diseases among the married. The large majority of men who carry disease and death into their families from uncured venereal diseases do so through ignorance. A general diffusion of knowledge regarding the nature and danger of such diseases, the duration of their contagious activity and the terrible consequences to wives and children would be largely instrumental in preventing these social crimes.

Think of the many lives wrecked by venereal diseases! The The tabetics in our streets, the paretics in our asylums, the dead or disfigured children; think of the laparotomies for pus tubes that occur daily in our hospitals; the impotence, the sterility, the sexual neurosis that fill our offices with vagrants wandering from physician to quack and back again in the vain hope of cure, and then question the necessity of the education of the public as to the care and prophylaxis of venereal diseases! Does it not seem absurd?

Since the medical profession is the repository of this knowledge, it is evident that physicians must be its chief purveyors to the public. In dealing with a class of cases whch are contagious during a prolonged period, the prompt suppression of the sources of contagion by treatment is the most effective measure to prevent the spread of infection. The cure of the individual and the prevention of disease should go hand in hand. The physician must not only realize the serious responsibility of the case,

but must be prepared by a theoretical and practical knowledge of these diseases to apply up to date methods and appliances of diagnosis and treatment.

How often do we find the gonorrheic patient received by the physician with a smile of levity, and his "little misfortune" made the subject of a joke. No wonder the popular mind considers that the treatment of venereal diseases requires no special medical knowledge or skill and that those infected do not hesitate to entrust their cases to the drug clerk, the advertising quack, or the merest novice in medicine; or that they even avail themselves of the prescription of an obliging friend, all with the deplorable result that the vast majority are improperly and insufficiently treated and not definitely cured, but go on scattering broadcast the seeds of dangerous infection which by proper treat ment might have been sterilized.

I dare say there is no class of disease in any department of medicine, which in the past has been so neglected, mismanaged or which has received such a routine or unscientific treatment as the venereal class. Many physicians are derelict in the performance of their duty by declining to treat the patient; they do him an injury which is so far reaching as to affect the general public. The average patient knows so little of venereal diseases that the fact that the physician in whom he has confidence will not treat him, makes him apprehend that he has an ailment which is beneath a dignified consideration by the medical adviser. This inference readily leads to the conviction that he has a "shameful” disease. The patient is entitled to treatment, as much at least as the individual who acquires a disease in consequence of drunkenness or other infraction of morals or ethics.

Gonorrhea is still looked upon by many physicians as a trivial affection and their entire equipment consists of a glass syringe and half a dozen formulæ for injections. We chide the public for that ridiculous prudery which looks upon education in sexual hygiene as improper, as demoralizing even for the young, and for that traditional prejudice, which surrounds sexual disease with an atmosphere of shame. From the standpoint of science there can be no greater satire upon creative wisdom than the idea that the knowledge of the organs that transmit life is shameful, or that the education which would lead young men to live according to the physiologic laws of a healthy nature is profane.

We censure the public for its insensibility to the significance of the venereal peril, its indifference, its hostility, even to measures of prevention. Does not the public take its cue from the attitude of the sanitary officers who are charged with the health of the people and yet entirely ignore the existence of these diseases in the registration of those included as contagious? Are not these diseases excluded from our hospitals when they are