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Reports in which the suprarenal extract had been used with benefit were also cited, viz., Addison's disease (Olliver), also one case of his own, anemia and diabetes mellitus (Potter), exophthalmic goitre and cyclic albuminuria. Since its action was tonic or contracting to the general muscular system, especially the skeletal, vasomotor, and cardiac muscle (Schæfer and Olliver), it was probably indicated in all conditions attended with loss of muscular tone, neurasthenia, the same cardiac diseases in which digitalis was of use, anemia, melanemia, and conditions requiring vasomotor stimulants.

Lastly he quoted authors who had found the ovarian extract of service in ovarian dysmenorrhea, amenorrhea, the climacteric, neurasthenia, hysteria, mental disorders, lack of development, and after ovariotomy. He reported the case of an hysterical girl of twenty, who had been castrated at the age of eighteen, in whom the administration of the ovarian extract was followed by a slowing of the pulse from 100 to 80 beats per minute and a lessening in the frequency of the convulsions. The ovarian extract was believed to be in too transitional a state to do more than invite investigation. He emphasized the fact that these animal extracts when used upon isopathic principles were palliative rather than curative, and that their continuous use had been necessary in those cases reported as cured.

He believed this was necessary since they supplied a constant demand of the system, just as food. There was probably a complimentary action, he believed, between the thyroid and suprarenal principles. Whether malınorphosis was prevented by the secretion of these glands acting through the nervous system, or by chemical means, or by both, was as yet undetermined; but he hoped, until their exact limitations were understood, indiscriminate use would not cause them to pall upon the profession.

Pathology and Diagnosis of Diphtheria was the title of a paper presented by Dr. C. W. Aitken, of Flemingsburg.

Dr. S. G. Dabney, of Louisville, then read a paper entitled The Treatment of Diphtheria, paying special attention to serum therapy and intubation. He divided the subjects into (1) prophylaxis; (2) treatment of nasal and pharyngeal diphtheria; (3) treatment of laryngeal diphtheria including intubation. (See p. 461.]

Discussion. Dr. J. A. Stucky, of Lexington, emphasized the importance of early diagnosis. He questioned the value of local antiseptic treatment in healthy persons as a means of preventing infection.

He thought protonuclein of value both as an immunizing and curative agent. He has used the drug with excellent result in tonsillitis.

Dr. Letcher, of Henderson, said the importance of early diagnosis and the use of antitoxin could not be overestimated. He knows that deaths are constantly taking place in his part of the State from laryngeal stenosis due to failure to recognize the disease and resort to antitoxin and intubation.

Dr. Shoemaker, of Morganfield, said that in his part of the State diphtheria is an uncommon disease. Objections which he formerly had to antitoxin had been swept away by a recent experience in which the results had been remarkable.

Dr. G. G. Thornton, of Gravel Switch, read a paper entitled Membranous Croup and Intubation, with Report of Cases.

The essayist took the view that many cases of pseudomembranous laryngitis were not diphtheria. He has seen many cases, has never isolated them, and has not seen a case which could be traced to infection or from which others developed. Membranous croup seems to be influenced by heredity. Thus two brothers have lost three children, and a sister has had five cases and lost four children from the disease. Of these eight cases only two occurred within one year of each other. In the treatment, believing that antitoxin is specific for diphtheria only, and believing that membranous croup is not diphtheria, he leaves antitoxin out of consideration. He has not been able to find a remedy which has any curative effect upon the disease, and all that is left us is intubation, or tracheotomy, if demanded.

The conclusions with regard to intubation were as follows: (1) He has not seen a case of membranous croup get well without intubation; (2) Any physician skillful enough to catheterize the female should be able to intube; (3) It is best, especially with beginners, to leave the thread in; (4) The tube promptly removes the difficulty in breathing, but should the respiration remain at 30 to 35 per minute, the prognosis is unfavorable.

Dr. W. L. Rodman, of Louisville, read a paper on The Influence of Age, Sex, and Race in Surgical Diseases, with statistics bearing upon the relative susceptibility of the white and colored races to different surgical affections.

Varicocele: In 236 cases he has not found it beginning before puberty and rarely after thirty. While rather uncommon in married men, he has operated in four cases, the oldest case being fifty-six years.

races.

Negroes are practically immune to varicocele and from varicose veins in the leg. In the analysis of 500 cases of varicose veins operated upon by Louisville surgeons, only one was encountered, and that was a mulatto. Prostatic hypertrophy is almost unknown in the negro. There are several anatomical and physiological reasons for the rarity of varicocele. Anatomically the testicle does not hang as low, being built more upon the plan of these organs in the dog, and are not so large as in the white race. The negro begins sexual life at puberty and does not know what it is to be continent thereafter. Varicocele is rare in the Indian.

Gall-stones are practically never encountered in the first decade, and seldom in the second. It is unmistakably more common in womenaccording to statistics of Louisville surgeons, the prevalence is as 5 to 1. In 106 cases analyzed by him only one occurred in the negro. This is explained by their more active life and lessened liability to malaria and other diseases associated with disorder in the liver. Tetanus: Infant mortality from tetanus is heavy in dark-skinned

In negro infants it is explained by racial susceptibility and uncleanliness. In Jamaica and other West Indian islands the mortality from tetanus among negro infants is from one fourth to one half of all negro infants born. Trismus neonatorum is more common in Jewish infants than it should be, which is explained by the uncleanly habits of the mohab.

Harelip, clubfoot, and other congenital deformities are much less common in the negro. But a single case of harelip in the negro has been operated upon in Louisville in twenty years. Congenital deformities are rare in Indians, but this may be partly explained by the custom in Indian tribes of destroying puny or ill-formed children.

Erysipelas is not so rare in the negro as some suppose. deaths reported in Louisville in ten years, 17 were negroes.

Stone in the bladder: Johnson, of Richmond, has found that the negro is not so rarely affected as some believe, but it is five times more common in the Caucasian race.

Speaking of susceptibility to tuberculosis, he said that writers up to fifty years ago spoke of the infrequency of this dieease in the negro. At the present time the proportion is far greater than among the whites.

Discussion. Dr. S. G. Dabney: Trachoma is rare in the negro. Phlyctenular ophthalmia is much more common, and is the most common cause of blindness among them. Dr. Thaddeus A. Reamy, of Cincin

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nati, said that observations led him to confirm Dr. Rodman's observation as to the rarity of varicocele in the negro. He had a negro in his employ who had a clubfoot, and knew of one more; the latter also had harelip. He knew of three negroes and one mulatto affected with harelip. Rickets is very common in the negro.

Dr. Rodman, in closing the discussion, said that he also believed harelip not to be so infrequent in the negro as many authors would lead us to believe, but the statement in his paper was made with reference to the experience of Louisville surgeons.

The Midwife and Midwifery was the title of a paper presented by Dr. L. C. Wadsworth, of Newport, Ky.*

He said that on account of the standing of the class of women who practiced midwifery in this country very little aid can be expected from them in any effort to raise the standard of efficiency. American women do not take kindly to this work, which offers but little remuneration and no professional standing, professional nursing giving them a more lucrative calling. Most of the women who practice midwifery in this country are of foreign birth. There are a number of American schools of midwifery, so called, which for a consideration promise to make midwives of washerwomen in a short length of time.

The city of Newport, three years ago, adopted an ordinance regulating the midwives, requiring these women to register their names, age, residence, and time in practice, but it was not enforced. He thought all inidwives should be examined by a board of physicians before being permitted to practice. In a letter the Secretary of the State Board of Health informed him that the legislature of Kentucky would take no action looking to regulation of the practice of midwifery.

Dr. F. F. Bryan, of Georgetown, read a paper on Extra-Uterine Pregnancy, in which he reviewed the history of ectopic gestation, theories of the cause, treatment and technique of operation. Expectant treatment plans having for their object the destruction of the life of the fetus, and such as faradism and injections of morphine or other drugs into the tumor, were mentioned only to be condemned.

Dr. Edward Ricketts, of Cincinnati, in discussing the paper rebuked physicians for presuming to treat an affection which could be successfully dealt with only by surgical interference.

Dr. Letcher, of Henderson, speaking to the paper of Dr. Bryan, mentioned a case of abdominal pregnancy which went on to full term.

** This paper will be published in an early issue of this journal.

The child is now living and four years of age.

He delivered the woman through the abdomen after she had been in labor apparently four days. The placenta was so extensively and firmly attached to the small gut that it could not be delivered. The mother died thirty-six hours after the operation. At the autopsy the placenta was found adherent to the intestine and could not be detached without injury to the coats of the gut.

Dr. Thaddeus Reamy, of Cincinnati, also recalled one case of abdominal pregnancy in which the child lived. Discussing the paper of Dr. Wadsworth he said seventy per cent of all the children born in Cincinnati are delivered by midwives, probably not fifteen per cent of these midwives are educated or know any thing of asepsis. If the midwives be trained in aseptic processes and in the anatomy and physiology of the parts, why not allow them to practice? But we should demand that they be trained.

Dr. James B. Bullitt: The midwife should come rather than go; and those who come should be thoroughly equipped for the work. In midwifery there is a great field for women physicians. In Louisville this practice does not go to the midwives to any thing like the extent attributed to Cincinnati, although in some parts of the city the “hebamme" signs are not very far apart.

Dr. Henry E. Tuley, of Louisville, presented an obstetrical outfit prepared for him by the Henry Drug Co. The outfit, which is neatly gotten up and hermetically sealed, has been selected with care and is one of the best devised. It contains lochial pads, made after the style of those used at Sloane Maternity Hospital, an obstetrical bed quilted and large enough to protect the matress after delivery. The outfit also contains safety-pins, gauze, nail-brush, nail-file, a bottle of chloroform, and bichloride tablets, if desired, a tube of white vaseline, boric-acid solution for cleansing the child's mouth, and a bottle of nitrate of silver solution. The essayist called attention to the value of balsam of peru in castor oil as a dressing for the cord after delivery. According to his experience the time of separation of the cord with this dressing has been three and one half days, and there results a wound which is easier cared for than when a dry dressing is used.

Dr. T. C. Evans, of Louisville, read a paper on Deflections of the Nasal Septum.

After enumerating the disturbances which follow deflections of the septum the diagnosis and various procedures for its cure, the essayist

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