dying from operation or as dying from some other cause? If a case is operated on for an acute appendicitis and it contracts pneumonia on the second day and dies on the seventh day, how should the death be reported on the chart? Died from acute appendicitis, died of operation, or died of pneumonia? If a case of ileus comes in after one week's duration, and is operated, and the case dies six hours after operation. what shall go on the death record? Died of ileus, or died from operation or shock? If a case dies on the table, shall the certificate be made out, "Died from operation?" Shall any case be reported as dying from operation? Shall operation be added as a contributing cause? Shall all cases operated on be classed as surgical deaths, whether they have a medical disease or not at time of death?

When shall it be said a case is cured? Is a case operated upon to-day and discharged to-morrow to be entered upon the discharge sheet as cured? Tonsil cases practically all leave the hospital on the second day with open wounds. Shall they be reported as cured? Certainly a case of appendicitis. could not be discharged from the hospital with an open wound as cured. If a case is operated upon and receives subsequent treatment at home, should it be classed as a cure when discharged? How can the condition on discharge of mechanical operations like uterine suspensions, nephropexies, and gastro enterostomies, when it takes months after leaving the hospital to determine a cure, be classified? How shall the condition of discharge of malignancies be classified? It can not be said they are cured, neither can it be said they are improved.

Shall just the major infections following operations be counted on the monthly report and the minor stitch infections not counted? Should cases with leukocytosis, where there is not a localization of pus, coming into the hospital, be classed as infected entries? Shall cases of stillborn be entered on the hospital death report? If a child lives five minutes after birth, is it a stillborn child? And should it be reported as stillborn?

The actual cause of death, and the contributing cause, be it operation or what, should always go on the record. If a case of appendicitis is operated upon and it develops pneumonia and dies six days later, the cause of death is pneumonia, and appendicitis and operation contributing causes, because they each contributed to the death. If the case has been operated and has not been discharged as cured, and turned over

to the medical service as a surgical cure, the death is a surgical death, and should be reported under the surgical head. If a case of ileus of six days' duration is operated, and dies in six hours, the case should be reported, "Died of shock, ileus and operation contributing." If a case dies on the table, it may be from embolism, ether, acute dilatation of heart, or from hemorrhage or accident in operation, and in case of either of the latter, the case should be reported as operation being the cause of death. If from either of the other three causes, it should be so reported.

A surgical case is cured when the pathology has been relieved, and the wound healed. Medical cases are cured when the pathology no longer produces symptoms. This means that tonsil cases are not cured when they leave the hospital on the second day. That drainage cases are not cured when they leave the hospital, and have to be dressed afterwards. Suspensions of uterus, and nephropexies are reported cured on discharge when all symptoms are relieved and wound healed before leaving. Cancer cases can only be recorded on the report as improved on discharge and after three years add them as cured if still living with no return. Leutic cases should come under this head also.

All infections occurring in closed wounds, no matter how small, should be classed as institutional infections. Any case that comes in with an infection, or has to be drained, is an infection on admission; leukocytosis only should not determine a pus case.

All stillborn cases are entitled to entry on hospital records and must be reported as a death on the record. If a child takes a single breath it is not a stillborn child, and cause of death should be recorded.

All reports of deaths on the hospital reports should correspond to the reports given to the State Board of Vital Statistics.

All these questions should be settled by a committee and an explanatory sheet should be given each hospital. These reports should be sent monthly to the Hospital Association secretary, or standardizing committee. The reports should give number of cases admitted during the month, number of cases discharged, daily average, and death rate. Those admitted should be divided as to surgical, medical, diagnostic, obstetrical and newborn. The discharge should include the number of surgical, number of medical, number of diagnostic,

number of obstetrical, number of newborn, and number of dead. It should then include the number of diagnoses in which the pre-operative and post-operative diagnosis agree and the number that disagree, the number of infections admitted, number of institutional infections, number of deaths, surgical, medical, obstetrical, and newborn, number of autopsies, and the explanation of all deaths.

At the end of the year the summary of the twelve monthly reports could be published with a total of all the hospitals, and it would show just what each hospital in the State is doing. It would show the rating of each hospital. It would give valuable statistics that we could not get any other way. It would be valuable to know how many people enter the North Carolina hospitals yearly. How many people die in hospitals yearly and what the percentage is. It would be interesting to know how many of our people are operated on yearly. It would be exceptionally interesting to know how many of our pre-operative and post-operative diagnoses agree. It would create hospital pride. It would increase the efforts of all hospital staffs, and promote more actual interest in good work and secure better hospitalization in general, and an accuracy yet unapproached.

The hospital that stuffed or doctored its reports would be detected by the hospital inspector upon examining the records and should be penalized. This would insure such disgrace that correct reports would always be submitted.Southern Medicine and Surgery.

OSSIFICATION IN A CHARLAZION

The case seen by Walter Scott Franklin and Frederick C. Cordes, San Francisco (Journal A. M. A., Feb. 16, 1924), clinically had all the characteristics of a charlazion with a history of seventeen years' duration. The question of trachoma can be ruled out, as both conjunctivæ were negative, no lines of atrophy being present. Microscopic examination showed true bone formation. An osteoma can be eliminated, the condition not being congenital but having developed following a "stye." It is assumed that this was an old charlazion in which the granulation tissue during a period of years took on the properties of ossification. Search of the literature failed to show a similar case.

THE GREAT RED PLAGUE

LLOYD THOMPSON.

"Next." The tired-looking dispensary physician turned to the next patient, who was a girl-mother, not yet out of her teens. She held rather awkwardly in her arms a small baby, which she was trying to quiet.

"Which is the patient, you or the baby?" the doctor asked, not unkindly, as he arranged the papers on the table beside him.

"It's baby, Doctor," the young mother replied, slipping the dress from the little one, "she's all broke out."

The doctor needed only a hurried inspection of the puny, little body, which was covered with dark, red spots, to tell him the nature of the trouble.

"How old is the baby?" he asked.

"Four weeks to-morrow."

"And how long has she had this eruption?"

"It began a week ago, but has got worse in the last two days."

"How about you," the doctor asked, a little sharply this time, "have you had anything wrong with you? Any breaking out?"

"No, Doctor."

"Any sore throat?"

"No, Doctor."

"How long have you been married?"

"I was married ten months ago, but-but-I-I'm-my

husband's not here now."

"Where is he?"

"I-I don't know Doctor.

baby got?"

But-but tell me, what has

"She has a serious disease. You will have to be examined, too, and have your blood tested."

BABY HAS CONGENITAL SYPHILIS.

The young mother learned from the soft-voiced, motherly social service worker in the next room that her baby was the victim of congenital or hereditary syphilis, that she, herself, undoubtedly had become infected from the husband who had deserted her, and that both must undergo long and careful treatment.

Of this terrible scourge the girl had no knowledge, or at least had heard only vague, unreliable statements. She had

been told that there was a blood disease, known as syphilis, which often attacks women of the underworld and is transmitted by them to others, but that it could come to her or her baby she never dreamed. But now the motherly nurse explained to her that while this is a disease of the underworld, and while it is contracted through immoral acts, it also claims its tens of thousands of innocent victims. She told her that the sufferer from syphilis may deposit the germs on a common drinking cup to infect the next one using it; that the common face towel has been the source of many infections; that kissing, even the kiss of youthful games, has transferred the disease many times.

OFTEN TRANSMITTED THROUGH KISSING.

And here the girl-mother was told of a most distressing epidemic of syphilis transmitted through kissing which occurred in one of our large cities a few years ago. It seems that a number of young people gathered one night at the home of one of the party and as the evening wore on someone suggested a kissing game. Little did these innocent young girls realize that one of the young men of the party was suffering from this dread disease. Seven of their number and one other young man developed the disease on the lips, and through the ignorance or viciousness of one wayward youth eight young lives were doomed to long distress, if not to early death.

And then the pitiful facts of hereditary transmission of syphilis were explained to the mother: How she must have contracted the disease from her worthless husband, even though she never knew it, and in turn she gave it to her unborn babe. She was told that a very large per cent. of babies which are born dead are the victims of congenital syphilis, and that this dread disease is responsible for a great deal of feeblemindedness and idiocy in the land.

LONG TREATMENT NECESSARY.

But the picture which the nurse painted was not altogether hopeless. For she explained to the girl that if she would do just as she was told and keep coming to the dispensary for months, even after all symptoms had disappeared, both she and the baby could probably be cured, or at least that the disease could be held in check.

The case of the young mother and her baby is not at all unique. Almost every day in the large dispensaries of the country similar cases are observed. Of course the vast ma