have come from somewhere in the bowels, where there was considerable irritation, and probably the seat of impaction.

Remarks. The teaching of the six above cases is, to add some emphasis to the practice of withholding purgatives and giving opium or morphia in cases of intestinal obstruction. Of whatever the kind or character of the obstruction, to whatever cause it may be due, only harm can come from giving purgatives. The more insurmountable the obstruction, the greater is the harm done by purgatives, as was well illustrated in the autopsy upon the case of stricture of sigmoid flexure (Case iii.) No one who had seen the conditions there presented would ever want to give purgative medicine in a case of intestinal obstruction.

more

While obstruction due to more trivial causes, as Cases i and vi, do better and are rendered more comfortable by opium, they are safely conducted to a favorable issue by the "splinting" treatment of opium than by the whipping, lashing treatment of purgatives. The opium treatment with irrigation, and in some cases probably massage, is the best that we can do for these cases short of laparotomy. And here a word upon irrigation: Judiciously employed it is a most valuable aid, second to none in many conditions. Properly used the matter should be carried up the colon by a long rectal tube, allowing a little to escape at the end, so as to distend the gut in front of the advancing tube. By this means a tube, or rather a soft, flexible rubber pipe may be passed through the entire length of the colon, down into the cecum, delivering the fluid there, and affording the surest means of passing water through the ileo-cecal valve, if desired. The common, stiff, hard rectal tubes sold in the shops are worthless, and worse, they are dangerous, and should not be used under any circumstances. A piece of soft, flexible rubber drainage-tubing, the end beveled with scissors, twenty-four to thirty-six inches long, answers every purpose, and makes an excellent instrument.

TOLLESBORO, KY.

THE RECORD says there are 170 female physicians practicing medicine in New York City.

Societies.

OHIO STATE SANITARY ASSOCIATION.*

This Society held its annual session at Toledo, February 9 and 10, 1888, with Prof. E. T. Nelson, Ph. D., of Delaware, President; R. Harvey Reed, M. D., Mansfield, Secretary.

The first paper read was one by Mr. D. L. Stine, of Toledo, on Sanitation in Architecture. The chief thing considered in this paper was the disposal of the soil and wastes of the home without offense to the occupants or their neighbors. This was discussed by Drs. Ashmun and R. Harvey Reed.

Cremation as a Sanitary and Economic Measure was the next paper, by Dr. Lew. Susser, of Canton, O. He thought complete combustion and consequent annihilation the only method by which the micro-organisms can be destroyed. Persons who have died from smallpox and lain in the ground for thirty years, when disturbed, have become the means of producing a local epidemic. The unsanitary aspect he considered not the only objection to inhumation, but the neglected graveyards, which are the eye-sore of every community, come in for their share of the disapproval. The old Romans, whose sayings we are wont to quote, Cæsar, Antonius, Brutus, Octavius, Augustus, Tacitus, and many other distinguished citizens of their day were cremated. Why was the custom not continued? The only objections to cremation are sentimental, but we certainly should not prefer corruption and putrefication in the place of purification by cremation. "Ashes to ashes" is the appropriate finale of humanity. Most of the friends of incineration belong to the medical profession, and the writers in favor of the new departure are comforted by the words of encouragement from Le Mogne and Dio Lewis and Gross. The movement has been indorsed as a sanitary necessity by the American Public Health Association, the American Medical Association, the Society of Medical Jurisprudence and State Medi*Reported by Dr. E. S. McKee,

cine of New York. A number of gentlemen took part in the discussion, all favoring cremation.

The Effects of the Present Sytem of Educational Methods on the Health of Women was the subject of a paper by Dr. C. A. L. Reed, of Cincinnati. He drew a pen-picture of the course of the young girl through school and the ruin of her health. He estimated that more than two thousand five hundred school children in Ohio die of causes emanating from the school room. He dwelt on school hygiene, particularly that with reference to female pupils and teachers. He recommended as a remedy for the terrible destruction of health that the custom of Germany be imitated, and facilities for physical culture be established at each schoolhouse.

Dr. A. Hult, of Waverly, read a paper on Village Boards of Health. He urged their necessity, and recommended such changes in the law as would give to each incorporate village a health organization.

Dr. George A. Collamore, of Toledo, read on The Duty of the Public to Sanitary Sciences. The paper was discussed by Dr. Nel-on and Dr. Weaver.

Dr. William Owens, of Cincinnati, read a paper on House Drainage and Sewer Connections. He thought no house having average sewer connection could be completely protected against sewer gas. He proposes to correct this by establishing a ventilator between the sewer and traps on the soil pipes, thus allowing the gas to escape into the open air.

Dr. John McCurdy, of Youngstown, read on the subject, Ventilation of Sewers.

Dr. Victor C. Vaughn, of Ann Arbor, read on Foods and Food Adulteration, in which he handled the various kinds of foods and the adulteration of the same.

Dr. E. T. Nelson, of Delaware, made the presidential address, in which he reviewed the progress of sanitary science, and compared the present with the past condition of Toledo as an example. He described Hygeia, the city of health, the city of the millennium.

4*

Dr. R. Harvey Reed, Secretary of the Association, read a Association, read a paper on Passenger Coaches, How they should be Heated and Ventilated. He considered the prime factors to be efficiency, safety, simplicity, durability, economy. He recommended pipes to carry heat about the sides of the car, also pipes to supply fresh air, and others to remove the cold foul air from the bottom of the car, and thus dispense with ventilators at the top and the opening of windows.

Prof. Search, of the Sidney public schools, read a paper on Pure Air Within-doors and How to Obtain It. He thought there was certainly no reason why we should not have pure air. It is abundant, inexpensive, and easily obtained. There is no excuse whatever for the lamentable ignorance which deprives us of that great necessity

of life.

Isaac D. Smead, of Toledo, read on How far has the Science of Ventilation Advanced, and seemed satisfied that it was making its share of the progress of the nineteenth century.

Cholera, Its Prevention and Limitation, by Dr. D. H. Beckwith, of Cleveland, was the next subject on the programme. He discussed the knotty problem of the quarantine, and in a very interesting resume traced the spread of several epidemics throughout this country. He considered dread to be a potent factor in the dissemination of the terrible disease. The old proverb is full of truth," Whom the gods would destroy, they first make mad."

Daniel Segar, of Toledo, made a report on Toledo's water-supply.

Dr. J. A.Chesney, of Bucyrus, read on Meat Poisoning. The subject of trichinæ spiralis received merited attention, and several cases of the dread disease were cited.

The Duty of the Public to Sanitary Science was the subject selected by Prof. John Simpson, Ph. D., Mansfield, O.

The following officers were elected: President, G. C. Ashmun, Cleveland; Vice Presidents, Dr. John McCurdy, of Youngstown, Prof. Orton, of Columbus, Dr. S. S. Thorne, of Toledo; Secretary, R. Harvey Reed, of

Mansfield; Treasurer, Dr. D. H. Beckwith, of Cleveland.

Canton was chosen as the place for the next meeting, which will be held the third Thursday in November.

BERLIN MEDICAL SOCIETY.*

Meeting January 18, 1888, Prof. Virchow, President, in the chair.

had a severe attack of spasm of the larynx, December 17th, with symptoms of stenosis. The patient went into a comatose condition. Prof. Fuerbringer found a tumor on the left side of the larynx, and a thickening of the vocal cords on the right side. He was placed in the surgical ward on account of a severe dyspnea. Tracheotomy was done and the larynx removed. Still no sure diagnosis could be made. It was evident that the little tumor which lay near the arytenoid

Since his report in November last, the doctor had opportunity to again see the patient from London, whom he had mentioned in his report. A small whitish tumor was found on the wound, which was not larger than the point of a lead pencil, and in the course of six weeks it had not increased in size.

Dr. Hahn, as well as Dr. Frankel, who had examined the patient also, are inclined to consider the tumor an enchon

droma of the trachial ring. They had advised against an operation, as the patient did not suffer inconvenience from the tumor, nor did it seem to be growing.

Dr. Hahn then presented the patient on whom he had operated the day of his last report. After the operation the course was quite typical. In ten days nourishment could be taken through the esophagus. On the thirteenth day the patient left the bed, and the wound has been completely healed for a number of days. This patient is able to speak plainly in a sort of whispering voice. The doctor also presented the other patient on whom he had operated in 1880, removing almost the entire larynx. This man was able to make himself understood, though he also spoke in a soft whispering voice.

In conclusion the doctor showed a preparation, which was interesting from the fact of the difficulty of the diagnosis of intralaryngeal tumor. This was from a patient who entered the Fredrichain Hospital, about the middle of November, for a severe diabetes; eight per cent of sugar. Without any previous indications of larynx stenosis he *Reported by Dr. E. S. McKee.

was undermined. Afterward a larynx fissure was found posteriorly, and it was plainly seen they had to deal with a perichondritis on the ring cartilage, and that the undermined border went on to abscess.

Dr. B. Frankel reported a case of expulsion of polypus of the larynx by coughing. This had been reported to him in a letter by Sanitary Councillor, Dr. Swiderski, of Posen. In 1862 the patient first suffered from hoarseness and dyspnea, but nothing pointing to disease of the lung could be discovered. He went to Salsbrunnen for his health, and while there a polypus of the larynx was found. He consulted a number of authorities, among others, Bruns, of Tubingen. This gentleman diagnosed a laryngeal fissure. The patient disappeared, but came to Posen in the year 1870. On the way a severe hemorrhage occurred. At this time Dr. Swiderski found the larynx much reddened on the left side, and beneath the left vocal cord a pear-shaped tumor. The bleeding discontinued on the subcutaneous injection of ergotine. The dyspnea was very severe. very severe. The danger from the dyspnea did not disappear, notwithstanding the fact that the tumor was touched daily with the solid stick of nitrate of silver. The patient refused tracheotomy, but on the 12th of May the dyspnea became so great that it was most urgently demanded. He still forbade it. On the 13th Dr. Swiderski found him sitting on the side of his bed smoking a cigar. The severe coughing had forced the polyp out. Microscopical examination showed a fibrous polypus. Dr. Frankel had never observed such a case, but remembered

one where the polyp disappeared. An occurrence of this kind is of the greatest rarity.

Next followed the discussion on the subject presented by Prof. Virchow at the previous meeting, namely, emphysema pulmonum.

Dr. Paul Guttmann gave the statistics from the city hospital (Moabit) in the eight years from October 1, 1879, to October 1, 1887. Out of 23,994 patients received, 446 or 1.85 per cent of cases of emphysema were noted. This number is decidedly larger than the statistics given by Prof. Virchow. It is partially explained by the fact that the cases of internal medicine in the Charite are only about one third the whole number of cases, while in Moabit they reach about four fifths. During this same time, out of 4,949 postmortems, exactly 0.69 per cent were found to be emphysema. From this all cases of partial emphysema pulmonum which occur in various diseases were excluded.

In regard to the absence of carbon pigmentation, to which Prof. Virchow referred, Dr. Guttmann questioned if it were not on account of the disappearance of the interlocular septum, which is known to contain deposits of carbon.

Dr. Schadewaldt broached the question, which has occupied much attention in recent times, whether emphysema pulmonum and tuberculosis exclude each other or not. He also wished to be informed if some pneumothorax is not frequently present, which, perhaps, is overlooked.

Dr. Sandman has noticed that the lower part of the thorax is really compressed, while the upper parts are distended. Here the conditions for extirpation were more favorable.

Prof. Virchow, on the contrary, said that when parts of the alveola or still larger parts soften and become liquified, they relieve the carbon deposits which they contain. As he had already intimated, Prof. Virchow would not exclude the mechanical movement, but he can not receive this as the sole cause. He thought that inflammatory processes were not excluded by emphysema. Pneumonia is sometimes present in an emphyse

matous lung, and even caseous pneumonia and emphysema have occurred together. On the contrary, he had never seen a case where the formation of tubercles in the tissue of an emphysematous lung had taken place. He had seen one case where an emphysematous vesicle had burst, and out of it was formed a pneumo-thorax.

Dr. Munter presented a patient with amyotrophic lateral sclerosis. Patient, aged fiftyeight, is a stone carrier, married, has one living child, three dead, no hereditary troubles and no symptoms of syphilis, drinks, but not to excess, and in 1871 had smallpox, but has always been healthy otherwise. For about two years has felt stiffness and weakness, and been unable to work for nine months. Present condition: bladder, rectum, and sensibility intact; vaso-motor disturbances absent; indeed, decided trophic disturbances present, which were more pronounced on the upper than lower extremities. Electrical examination showed decreased faradic as well as galvanic sensitiveness in numerous muscles, but no degenerative action. The diminution of sensibility is greater on the left than the right side. All the muscles exhibit better reaction from mixed currents than single ones. The skin reflexes were scarcely lessened, but showed wellmarked phenomena, especially on the lower extremity. Foot clonus absent, foot phenomena present. The therapeutics consisted only in the use of the constant current in the different modes of application. Dr. Munter exhibited the very well-developed spastic appearances in this patient.

A SINGULAR CASE OF GLANDERS IN MAN. According to the Syn Otetchestva (December 10, 1887), a man has just died from glanders at one of the St. Petersburg hospitals. The deceased never kept, and never came in contact with any horses in his life. Symptoms of glanders made their appearance in him shortly after his face and eyes had been profusely bespattered with foam from a passing cab-horse, the patient being in the act of crossing the street at the time.

Reviews and Bibliography.

Chemical Analysis of Diseased and Healthy Urine, Qualitative and Quantitative. By T. C. Van Nuys, Professor of Chemistry, Indiana University. With thirty-nine wood engravings. 8vo; cloth; pp. 187. Price, $2.00. P. Blakiston, Son & Co. 1888.

The Rectum and Anus; their Diseases and Treatment. By Charles B. Ball, M. Ch. Univ. Dublin, F. R. C. S. I., Surgeon to Sir Patrick Dun's Hospital, etc. Fifty-four illustrations and four colored plates. 16mo; cloth; pp. 410. Philadelphia: Lea Brothers & Co. 1888.

Nasal Polypus with Neuralgia, Hay-Fever, and Asthma, in Relation to Ethmoditis. By Edward Woakes, M. D., London, Senior Aural Surgeon and Lecturer on Diseases of the Ear at the London Hospital, etc. With illustrations. 16mo; cloth pp. 140. Price, $1.25. Philadelphia: P. Blakiston, Son & Co. 1888.

Practical Lessons in Nursing. Fever Nursing. Designed for the use of Professional and Other Nurses, and especially as a Textbook for Nurses in Training. By J. C. Wilson, A. M., M. D., author of A Treatise on Continued Fevers, etc. 12mo, pp. 210; cloth. Price, $1.00. Philadelphia: J. B. Lippincott Company. 1888.

Doctor and Patient. By S. Weir Mitchell, M. D., LL. D., Harv. Introductory; The Physician; Convalesence; The Moral Management of Sick or Invalid Children; Nervous ness, and its Influence on Character; Out door and Camp Life for Women. 12mo, pp. 177; cloth. Price, $1.50. Philadelphia: J. B. Lippincott Company.

The Rules of Aseptic and Antiseptic Surgery; a Practical Treatise for the use of Students and the General Practitioner. By Arpad G. Gerster, M. D., Professor of Surgery at the New York Polyclinic, etc. Illustrated with two hundred and forty-eight engravings and four chromo-lithographic plates. 8vo., cloth; pp. xi and 332. New York: D. Appleton & Company. 1888.

The New York Medical Journal Visiting List and Complete Pocket Account Book, Prepared by Charles H. Shears, A. M., M. D. The following, from the publishers' advertisement, states fairly the plan and merits of this new departure in visiting lists: "This list is based upon an entirely new plan, the result of an effort to do away with the defective method of keeping accounts found in all visiting lists hitherto published. Each page is arranged for the accounts of three patients, to the number

of thirty-one visits each, which may have been made during a current month, or may extend over a number of months, according to the frequency of the visits. Arrangement is made for 375 accounts. Thus the practitioner can at a glance, and without the trouble of tracing the narrow columns found in the ordinary lists, ascertain the condition of the account of any patient; when and how many visits have been made; what has been paid, and how much is still due. It is provided with an index, and can be commenced at any time." Price, $1.25. New York: D. Appleton & Co., Publishers, 1, 3, and 5 Bond Street.

A Synopsis of the Physiological Action of Medicine. Prepared for the use of the Students of the Medical Department of the University of Pennsylvania. By Louis Starr, M. D., Clinical Professor of Diseases of Children, University of Pennsylvania, and J. B. Walker, M. D., assisted by W. M. Powell, M. D. Third edition, enlarged. Price, 75 cents. Philadelphia P. Blakiston, Son & Co. 1888.

Correspondence.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

Drs. Pitres and Vaillard, of Bordeaux, have conjointly made researches on peripheral neuritis in chronic rheumatism, the results of which have been published in the Revue de Medecine. Their work is based on observations made in two subjects who had suffered during life from chronic rheumatism. In a paper communicated to the Société de Biologie last year, the authors,

are distinguished neurologists, suggested the possibility of the peripheral nerves being the seat of structural changes in chronic rheumatism. They have since had opportunities of carefully examining the nerve trunks (articular, muscular, and cutaneous) in three cases of this disease, which proves that the peripheral nerves are very often the seat of important alterations, as in all cases more or less marked nervous lesions were found. In two of the cases some diffuse sclerosis of the white columns of the spinal cord was found, and in one case posterior spinal meningitis, but the authors think that it would be illogical to consider the lesions observed in the nerves of