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The adoption of steam engines for oceangoing vessels in the mid nineteenth century revolutionized shipping. On the face of it shipbuilders were presented with two choices. They could either strive to improve the sailing ship, or they could design a vessel that employed steam as the primary source of power. In fact, the choice was not that straightforward. There was another alternative; to design (or fit) sailing ships with an auxiliary steam engine. The significance and commercial importance of auxiliary steamers has been largely overlooked. This article reviews the role of these vessels and assesses their financial and logistical advantages in comparison with sailing ships or fully steam powered ships using the business of William Schaw Lindsay as a case study.1

Cognitive behavioral therapy (CBT) is an evidence-based treatment for bulimia nervosa and binge-eating disorder and is regarded as the first-line treatment for both eating disorders. An enhanced version of the treatment (CBT-E) appears more effective in treating patients with severe comorbidity. There is less evidence that CBT is effective for the treatment of anorexia nervosa. Evidence suggests that CBT-E is no more effective than specialist care involving regular medical follow-up and supportive psychotherapy in the persistent adult form of anorexia nervosa (AN). Early studies suggest that CBT-E may be useful in treating the adolescent form of AN.

For a number of years I have had it in mind to call attention to the particular method of employing silk ligatures and sutures which has been practiced in the surgical clinic of the Johns Hopkins University since the opening of the Johns Hopkins Hospital in 1889, but have hesitated and also been eager to do so for the same reason, namely, that our school seems to be almost alone in its advocacy of the use of this material.Theodor Kocher, however, has for many years employed silk quite to the exclusion of catgut and our position is greatly strengthened by the support of such eminent authority.Surgeons, old and young, those who have been active and masterful in the marvelous period of development of antiseptic surgery, and the medical student who takes for granted the healing of wounds per primam and the achievements of modern surgery as he does

For a number of years I have had it in mind to call attention to the particular method of employing silk ligatures and sutures which has been practiced in the surgical clinic of the Johns Hopkins University since the opening of the Johns Hopkins Hospital in 1889, but have hesitated and also been eager to do so for the same reason, namely, that our school seems to be almost alone in its advocacy of the use of this material.Theodor Kocher, however, has for many years employed silk quite to the exclusion of catgut and our position is greatly strengthened by the support of such eminent authority.Surgeons, old and young, those who have been active and masterful in the marvelous period of development of antiseptic surgery, and the medical student who takes for granted the healing of wounds per primam and the achievements of modern surgery as he does

For some years I have thought that the hyperplasia of the remaining thryoid tissue which has followed excision of a portion of the thyroid gland might be due to infection of the wound, and was, in most cases, not a compensatory hypertrophy; and for the following reasons:1. In 1888 I found that hyperplasia of the thyroid glands of dogs occurred after the injection of several c.c. of a bouillon culture of Staphylococcus aureusinto the peritoneal cavity, and also when a mild form of peritonitis had been produced in these animals—a peritonitis which was not rapidly fatal.2. Experiments conducted in 1906 and 7 in the Hunterian laboratory seemed to prove that for the successful transplantation of a parathyroid glandule, a considerable deficiency must be created.3. Have observed that symptoms of hyperthyroidism and even exophthalmic goiter may develop promptly after tonsillitis, appendicitis, pneumonia, typhoid fever and other infections.4. Twice in the course of the past five years I have had the opportunity to examine the remaining lobe of the thyroid gland after excision of the other in dogs whose wounds had healed throughout without suppuration and have noted that there was no hyperplasia of the former.5. The inconstant results obtained by other experimenters. Last October I proposed to Dr. Hunnicutt, my assistant the Hunterian laboratory, that he undertake a series of experiments with view to determining the matter definitely. Observing aseptic precautions in the strictest manner Dr. Hunnicutt has made a large number of experiments and we are able to report that in the nine dogs whose thyroids thus far have been examined there has been not the slightest evidence of hyperplasia in a single instance. The average time allowed to elapse between the removal of the first and second lobes was 55 days, the shortest interval being 30 and the longest 81 days.

It has been my custom every year or two to request our patients operated on for mammary cancer and living in or near Baltimore to come on certain mornings to the surgical clinic of the Johns Hopkins University in order that we may observe the ultimate result, particularly with reference to the function of the arm.For about sixteen years our practice has been to cover the fresh defect, made as small as feasible in various ways, with large Thiersch grafts. The available skin was tucked high into the armpit in order to cover the axillary vessels, to obliterate the dead space under the clavicle, and to elevate to the highest possible point the axillary fornix.The tip of the axillary flap was usually cut away. Notwithstanding this precaution a little necrosis of the badly nourished flap was not infrequently observed, and as a consequence there occurred an occasional but