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The vast majority of cases of transposition of the great vessels can be diagnosed in the first few weeks of life with electrocardiogram, x-ray and fluoroscope. The clinical pattern and the diagnostic features are described in detail. The degree of cyanosis, the characteristic heart shape and progressive increase in size coupled with generous hilar shadows all suggest this diagnosis. A new suggestion is made regarding possible surgical therapy using an extracorporeal circulation.

One of the relatively rare conditions met in urinary surgery is that in which, due to a diverticulitis of the sigmoid, we find a communication between the sigmoid and the bladder. I have in my records accounts of four such cases, two of which I published some years ago and two of which have not been reported. The reported cases both came under my observation in 1910 and an account of these cases was presented at the meeting of the American Association of Genito-Urinary Surgeons in 1911* Briefly, the first of these patients was a man of 53, whom I cystoscoped for the late Dr. M. H. Richardson in 1910 and who wasoperated on by him in March and again in July of that year. Following the first operation there was a period of some months of freedom from symptoms after which the condition recurred and was again operated upon. The patient developed a purulent peritonitis on the fourteenth day after operation and died within 48 hours.The second ease was a mail of 60 that I operated upon in July, 1910. He had passed gas by urethra for eight months and bowel contents for a somewhat shorter time. This man had sugar in his urine, which disappeared under treatment. Operation showed a communication between the sigmoid and the bladder, very low in the pelvis. It was separated and the openings in the sigmoid and the bladder closed. This patient died four days after operation. Autopsy showed a collection of pus deep in the pelvis; a part of the line of suture of the sigmoid had given away. The third case was that of a woman of 66, whom I saw in 1914. She had been constipated for years. Three weeks before I saw her she took a dose of castor oil and following active catharsis she had pain in her bladder with burning urination. She passed gas by urethra and some bowel contents. As a test she ate some figs and recovered the seeds from her urine. The cystoscope showed a small opening low down in the bladder on her left, intowhich a ureter catheter could be introduced I14 inches and from which bowel contents now and then appeared. The patient was unwilling to submit to operation and died in 1915, probably of some intercurrent disease, said to be "septic poisoning and arteriosclerosis."The last case of this sort that I saw was of especial interest and I shall ¡report it in detail. It concerned a man of 50 whom I saw in March, 1919. He had the history of a urethritis many years before when he was between 20 and 30 years old. Twenty years before he had had an attack of jaundice, likewise another attack of the same sort five years before. He had recovered from both these attacks under no treatment other than the use of a restricted diet. He had always been constipated and had attacks of rather vague abdominal discomfort, the seat of which was the lower part of his abdomen on the left.From about the time of his urethritis he had had times when it had been difficult for him to urinate and other times when he had suffered from frequency of urination and from discomfort referred to the region of his bladder. He (had bejieved that this discomfo...

wonderful and they brought stores of new knowledge and material to our profession, especially botanical ; they were not as startling in their effect upon philosophy as popular history has generally led readers to suppose. All that Columbus found supported philosophical deductions common among the learned for centuries ; he himself mentioned Averroes as one of the philosophers who led his thought toward the attempt to discover " new worlds."Finally, as to the Reformation : Cusa's life again shows that the movement was in full swing within the Church for more than a century before the stupidity .of some of the popes causing the misfortunes of Italy, .abusing all decent Christian sentiment of Europe, and allying themselves with narrow Spanish fanaticism brought the movement to a crisis.There is no satisfaction in attempting to account for Paracelsus by any of these movements; the influences were too general to give us any conception of his special thought. The hero worshipper loves to create a man of power who causes all that follows him, or who is a child of the gods for whom all great movements were especially ordered. Artistic use of great generalities is the powder for their rhetorical pyrotechnics. They resent the analysis which proves that the sulphur, the nitre, the charcoal were slow productions of nature and art which man was long in learning to combine. Closer study generally brings the hero into the human ranks, and, if he is real, respect and veneration is only made warmer and deeper ; debate on uncertain points is rendered less extreme ; an atmosphere better fitted for existence of truth and justice is created. Partisan spirit, fanaticism, sectarianism, dogmatism are the only sufferers and in their present flourishing condition we may spare our compassion.Paracelsus is often blamed for his contempt of the ancients ; we must endeavor to realize the spirit of the reformer of his time. Savonarola felt and spoke in much the same manner when he said, " The philosophers are in hell, and an old woman knows more of saving faith than Plato." In spite of all the singularity and originality which characterize Paracelsus, in spite of his boasted independence, he, like the other sixteenthcentury physiologists, was confined in a system of cosmology which probably he adopted from Cusa. He was more original and independent in his relations to chemistry than to medicine, but on every side were the bars of his prison ; all his attempts at original observation, all his inductions were rigidly shaped and adjusted according to the metaphysical ideas in which he had enveloped himself. His struggles for freedom were more energetic, his flights bolder than those of most of the sixteenth-century physiologists, even judging him by the standard of the most advanced school of Padua. In this respect all were in a common plight, -the rule of the systems had existed from the beginning and nothing of the strength of the rule was abated at the Renascence. The birds might exhibit more restlessness, they might sing louder and sweeter, bu...