I Mil \. '-' ( »"i 



past 20 years. ( (iill'anl. ) Elephantiasis of the scro- 

 tum is very l'i-< ■< | ii»'ii t ly operated on in this hospital. 

 Lieut.-Col. Maitland lias performed litis operation L60 

 times with mosl excellent immediate and remote results. 

 Stone in the bladder is very common in this part of 

 India. Crushing is the favorite operative procedure. 

 Many surgeons, among them Professor GiiVard, prefer 

 to perform the operation through a median perineal 

 incision instead of the lateral, and in ease the stone is 

 too large to be removed by this method it is extracted 

 whole or in fragments through a suprapubic incision. 



CARCINOMA IN INDIA. 



An unusual number of cases of cancer of the mouth 

 find their way into this hospital and its frequency is 

 attributed by the surgeons to betel chewing. Two 

 pathologic forms are distinguished, the papillomatous 

 and ulcerative, the latter being much more malignant 

 and pursuing a very acute course. Capt. W. J. Xiblock, 

 I.M.S., surgeon Government Hospital, has contributed 

 a very important article to the literature of "Cancer in 

 India," published in the Indian Medical Gazette. May, 

 1902. The paper is based on the clinical records of this 

 hospital. He has the following to say regarding betel 

 chewing as a cause of carcinoma of the cheeks and jaws : 

 "On looking at Table 1A, one can not avoid being struck 

 very forcibly by the enormous number of patients 

 shown as admitted for carcinoma of the cheek and 

 jaws. Carcinoma of the cheek alone accounts for al- 

 most one-third, and carcinoma of the cheek, jaws and 

 tongue taken together for more than one-half of the 

 total admissions of carcinoma cases. The cheek- 

 is the part most commonly affected in Hindus 

 and Mohammedans, males and females. The dis- 

 ease affects the buccal surface of the cheek, gen- 

 erally commencing opposite the teeth of the 

 lower jaw and spreading with varying rapidity. The 

 frequency of carcinoma in this situation, in my opin- 



