When your distinguished President of last year conveyed to me a cordial invitation to be present at this meeting of the American Medical Association, I accepted at once, thinking of the opportunity which I should have of seeing for myself and profiting from the work of the many in your country whose fame has spread across the sea. When I came to seek for a subject on which to address you, however, I realized the rashness of my ready compliance. So much work has been done here on that branch of surgery in which I am especially interested that I felt that, were I to dwell on any purely surgical aspect of gastric disease, I should be going over ground already familiar to you, and so should be trespassing too far on that indulgence and leniency which I have heard you so invariably extend to those who are your guests.