Kausch has found that it is impossible to determine whether or not the intestines or other viscera have been injured, by the discovery of free air in the abdominal cavity. This is an almost certain sign of perforation, according to his experience, which has been wide and varied. The army corps to which he is consulting surgeon has served in turn in Belgium and France, Alsac, Galicia, Russian Poland and Serbia. A very small incision will reveal whether there is free air in the abdominal cavity. He makes the exploratory buttonhole for the purpose in the epigastrium under local or general anesthesia. The thicker the abdominal wall, the longer the incision, from 1 to 3 cm. The peritoneum need be only punctured; a pinhead hole is enough. If air streams out, he proceeds at once to a regular laparotomy. If not, the patient is spared a major operation for the time being at least. He has had cases in which a bullet passed through the abdomen, front and rear, without perforating the gastro-intestinal tract. When there was perforation, death was inevitable without operative relief, and he is convinced that his prompt operating saved a certain proportion of such cases. No one was ever harmed by the operation after an abdominal wound. Kausch was kept informed by telephone where fighting was under way, so that he was on the spot, ready to operate, before the wounded began to come in.—_The Journal of the Amer. Med. Asso._ MEDICAL DIPHTHERIA CARRIERS. A recent investigation of diphtheria carriers in Detroit is reported by Goldberger, Williams and Hachtel, in Bulletin No. 101, of the Hygienic Laboratories, of the United States Public Health Service. The problem of diphtheria carriers has become one of considerable importance and has been given special prominence of recent years by the studies of von Scholly, Moss, and Nuttall and Graham Smith. The writers of the report mentioned above studied 4,093 people in the city of Detroit, and found that 0.928 per cent harbored bacilli identical morphologically with the Klebs-Loeffler bacillus. This figure is rather lower than those of some other investigators, but would indicate, as stated by the writers, that there were from 5,000 to 6,000 diphtheria carriers in the city of Detroit.