medical science is now advancing, many other disease-preventive and curative serums. In conclusion, he spoke of the great necessity of government inspection and control with regard to cattle diseases, milk and other foods, and proper examinations of patent medicines.

The following officers were then elected for the ensuing year:

President, Dr. R. Beverly Cole of San Francisco, Cal.; First Vice-President, Dr. J. J. Chisolm of Baltimore; Second Vice-President, Dr. John C. Legrand of Alabama; Third Vice-President, Dr. Augustus B. Clark of Massachusetts; Fourth Vice-President, Dr. T. P. Satterwhite of Kentucky; Treasurer, Dr. Henry P. Newman of Illinois; Secretary, Dr. W. B. Atkinson, Pennsylvania; Librarian, Dr. G. E. Wise of Illinois.

Those selected to deliver the annual addresses at the next meeting are: Address on Surgery, Dr. Nicholas Senn of Illinois; Address on General Medicine, Dr. William Osler of Baltimore; Address on State Medicine, Dr. George H. Rohé of Catonsville, Md.

SECTION ON MEDICINE. FIRST DAY, TUESDAY, MAY 7. Dr. E. W. Kellogg of Milwaukee delivered the Chairman's Address on the progress of medicine and referred to the many changes and advances since the first meeting in Baltimore. Antisepsis and bacteriology had both been born since that time. The serum therapy is now undergoing the test of experience, and much is expected of it in the treatment of diphtheria and kindred diseases. The public should learn to appreciate the danger of the contagion of tuberculosis.

Dr. John H. Hollister of Chicago then read a paper on a New Departure in Therapeutics, in which he said that medical science formerly conducted a defensive warfare against disease and now it was aggressive. The microscope and the laboratory had been of great help to us. Organo-therapy and sero-therapy have now made a change in our mode of treatment. The use of bone marrow, thyroid and spleen extract had been shown to be of some use. The mortality

from diphtheria has certainly been lowered by the antitoxine treatment of that disease. Many things are still not understood.

Dr. William E. Quine of Chicago had used bone marrow with success and also diphtheria antitoxine, but the latter is still in the stage of probation. This paper was also discussed by Drs. Summers of New York and F. B. Turck of Chicago.

Dr. W. B. Stewart of Atlantic City then read a paper on Calomel, showing his experience with this drug in a large number of cases. The drug should be pure; it often is not. Large doses cause griping. When given with acids, chlorides or when digestion is going on. there is danger of the bichloride formation. Small doses frequently repeated act better. It is best given with soda, which prevents the bichloride formation and aids absorption. He has never seen its diuretic effects. He recommended it in a variety of cases. In reply to Dr. E. Chatwell he did not believe the drug was germicidal but it stimulated the liver cells.

Dr. H. A. Hare of Philadelphia said. that calomel was not converted into the bichloride in the system. There is likely very little contamination.

Dr. Elmer Lee of Chicago read a paper on the Treatment of Asiatic Cholera, in which he reviewed the various therapeutical means and spoke of the failure of the various inoculation methods. Water in abundance by the mouth and rectum was the best treatment. It may be used warm and should be injected by a long nozzled syringe like one he showed.

Dr. John H. Hollister of Chicago related his experience in the treatment of this disease in four epidemics. Injections of tannic acid solutions and the free use of a cinnamon infusion by the mouth had given him the best results.

SECTION ON SURGERY AND ANATOMY.

FIRST DAY, TUESDAY, MAY 7.

Dr. Joseph Ransohoff of Cincinnati then delivered the Chairman's Address on Stone in the Kidney and its Opera

tive Treatment. Stone in the kidney is not rare and yet it is often mistaken for other troubles. Crystals in the urine are not so important as blood corpuscles in the diagnosis. The following conclusions may be drawn:

3.

1. An absolute diagnosis of stone cannot be made. 2. Nephro-lithotomies must be divided into those of necessity and those of choice. In anuria and previous hematuria delay is fatal. Pyuria and microscopic hematuria, as destructive changes, are positive indications for operative expulsion. 4. The oblique incision is to be preferred for the ease with which it permits the expulsion of the entire kidney. 5. Acupuncture is not to be relied upon. 6. Incisions. should be made when the circulation is controlled by digital compression. 7. Incisions into the pelvis after expulsion and after removing a stone are to be avoided. 8. Primary nephrectomy for stone should be reserved for extreme cases. 9. Primary union by suture, when possible, makes nephro-lithotomy a feasible operation. 10. Tight packing a kidney endangers the nerve-supply of the colon. 11. Nephrorrhaphy should form the closing act of every operation that has seriously disturbed the relations of the kidneys.

Dr. Howard A. Kelly of Baltimore then read a paper on Ureteral Catheterization, in which he explained his well known methods of cystoscopy and of catheterizing the ureters and renal pel

vis.

Dr. W. K. Otis of New York read a paper on Aero-Cystoscopy, with the Exhibition of a New Instrument.

Dr. Ferdinand C. Valentine of New York read a paper on Modern Cystoscopy and Urethrescopy, in which he demonstrated instruments.

Dr. Homer Gage of Worcester, Mass., and Dr. W. E. B. Davis of Alabama each read a paper on Movable Kidney.

Dr. D. C. Hawley of Birmingham then read a paper on the Radical Cure of Hernia, in which he preferred the incision to the injection method.

Dr. De Forest Willard of Philadelphia read a paper on Excision, Erosion, and Amputation in Joint-disease.

SECTION ON OBSTETRICS AND DISEASES

OF WOMEN.

FIRST DAY, TUESDAY MAY 7. Dr. Franklin H. Martin of Chicago delivered the Chairman's Address on Some Mooted Points in Abdominal Surgery, in which he spoke of the various methods used in the surgical treatment of fibroid growths. He had used galvanism in some cases but not as much now as formerly. In some patients it was used successfully and it is an antiseptic method. In many cases he would prefer the knife. In hysterectomy he always used drainage with a glass tube and a suction pump.

Dr. Joseph Eastman of Indianapolis read a paper on the Treatment of Bad Fibroids by Good Operators, in which he advocated a method of supravaginal hysterectomy.

Dr. Nicholas Senn of Chicago then read a paper on the Techinique of a New Method of Abdominal Hysterectomy, in which he proposed to remove the dangers of shock, hemorrhage, septic poisoning, etc. The principle was to operate as quickly as possible with safety to the patient and expose little of the organs. By his method he exposes the uterus very little.

The uterus is brought into the wound and the peritoneum is incised across and the pieces stitched to the parietal peritoneum. The operation is then completed and in all his thirty-five. cases he had good results.

Dr. C. C. Frederick of Buffalo read a paper entitled Vaginal Ligation of the Broad Ligaments for Fibroids, in which he preferred the simple operation of tying the vagina uterine arteries to hysterectomy. He described his method of cutting down on the arteries and tying them. This he called an extraperitoneal and not an intra-pelvic operation.

Dr. A. H. Tuttle preferred the total extirpation as safer in case of hemorrhage.

Dr. H. A. Kelly of Baltimore has not often tied the uterine arteries for fibroids. He only took out fibroids when it was absolutely necessary. He describes his way of ligating the arteries and finding the uterine vessels.

Dr. I. N. Stone of Washington, D. C., said he had a recurrence of the growth after the use of electricity.

Dr. Charles P. Noble of Philadelphia advocated removing every fibroid causing unpleasant symptoms. Fibroids may become cancerous. He had not had good results with Martin's operation and did not care for Senn's. Kelly's will save time.

Dr. J. M. Baldy would remove every fibroid. Ligation of the arteries, like castration, by Tait's method is only temporary. Collateral circulation will set in and the fibroid will grow again. He did not think much of Senn's operation and Kelly's was not good for a beginner.

SECTION ON DISEASES OF CHILDREN.

In

FIRST DAY, TUESDAY, MAY 7. Dr. Wm. B. Noyes of New York read a paper on Typhoid Fever in Infancy and Childhood, in which he said: The subject of typhoid fever in infancy has been much discussed in the past, but has recently been brought forward anew. The older writers on the subject said that typhoid fever occurred in scores of children, but comparatively recently this has been strenuously denied. In the New York Foundling Asylum, the New York Infant Asylum and in the Children's Hospital of Philadelphia there has never been a case of typhoid fever in children under three years. epidemics of typhoid fever in England, there have been quite a number of cases under five years of age, also in the American hospitals. On the continent the percentage of cases under five years seems to be larger. In the Berlin Hospital, of 625 cases, 98 were under 5 years, while between 1 and 2 years only 3 per cent. In the Pennsylvania Hospital, of 1071 cases, 220 were under 10 years of age. In the Providence Hospital, of 220 cases, 15 were under 5. Hence, Dr. Noyes concludes that in epidemics it undoubtedly does occur in a small number of cases under five years. And also occasionally when no epidemic exists. The morbid changes resembled those of typhoid in adults, except in Peyer's patches. For in infants there is swelling, hyperplasia and fatty degener

ation of the follicles, but very rarely ulceration under five years of age. In those cases where ulceration did occur, the ulcers were very small and imperfect. From this fact it is argued that typhoid fever is essentially an infection of the lymphatic system, for if an animal be infected with the germs of that disease no bacilli will be found in Peyer's patches, while the enlarged mesenteric glands and lymphatics are loaded with them, the toxine which they produce causing the general symptoms. As regards the symptoms in a fever continuing over several days, not diminished by quinine, is highly suggestive of typhoid, especially if it increases day by day, with some approximation to the typhoid cause. Diarrhea is usually present, though in quite a number of cases constipation has existed throughout the entire course of the disease. The stools may be semi-fluid, approaching the pea soup consistency, though in many cases they appear nearly normal. The tongue becomes dry, hard and coated. The lenticular rose spots have been found by different examiners in from 66 per cent. to 78 per cent. The spleen is much enlarged. The cerebral symptoms often predominate to such a degree as to render the diagnosis difficult. It is often difficult to demonstrate any marked tympanitis. Epistaxis in infants is

rare.

The bacillus typhosus is not demonstrable in the stools until the eighteenth day and is often confounded with the bacillus coli communis, but it often may be detected before this in the abdominal lymphatic system and the study of the blood yields one important point. It excludes malaria. Relapses in infants are rare. Convalescence in infants is more rapid and less liable to complications than in adults. As a rule it is a milder disease in infancy than in later life and often tends towards the abortive form. There is in many cases stiffness of the muscles, twitchings, etc., even extending to pronounced opisthotonos, caused by cerebral congestion. In conclusion, Dr. Noyes said: Typhoid fever in infants is very rare in this country, outside of epidemics, though it is common abroad.

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horse could do it, and with perfect freedom from responsibility. Thus was it thought that the usefulness of that noble creature was at an end.

But the praises of this animal were sung too early and it is only recently that another use of the old gray mare has come into notice, or rather to our knowledge. The horse is a useful animal not only on account of his strength in helping the tired doctor about his daily work, but has lately come into use as a living test tube and culture medium combined; and here his strength again serves us, for the dose of the poison which is strong enough to destroy most animals of experimentation is not large enough to "kill a horse."

While the most recent aspect of the serum question has taken a turn against antitoxine, this is probably only temporary and the general belief of those who have given the subject any attention is that the mortality of diphtheria has been decreased and its mor. bidity period has been much shortened by the use of this serum. Comic papers have shown pictures of the horse with a spigot in his side from which the dealer is drawing the "heilserum" into pitchers and cans for his customers, the animal looking on indifferently all the while.

The first wave of enthusiasm of any discovery is apt to take most persons by surprise and carry them farther than they expected; but now that the matter is viewed with a calm deliberation and the excitement has worn off, some of the dangers of this remedy are appearing. At this very time scoffers and unsuccessful men have a fine opportunity to repudiate the whole remedy and say that it never was worth anything. There is no doubt that it has been of inestimable benefit and it is still used with various modifications and in a more careful manner and while the number of cures is not put down at so high a figure as at first, still it is generally conceded to be superior to any other form of treatment in this dreadful disease and it has certainly been of great benefit in giving hints as to the treatment of other diseases.

If bacteriology can give such practical results no man should ever look on it as of little use and even the smallest medical school

will begin to see that a medical course without a bacteriological training is worth but little at the present day. Serum therapy, thanks to that noble animal, the horse, has shown itself to be of incalculable good in one disease and probably other means in other diseases may give equally good results.

***

THE hackneyed subjects of medical remuneration and hospital and dispensary abuse,

received a fair share Medical Remuneration. of attention at the hands of the members

of the American Academy of Medicine at its late meeting. It was shown that the great increase in the number of hospitals, institutes and dispensaries had a pauperizing effect and that too many persons were obtaining free medical services who paid for all other services and could pay the physician too if the free attention were not made so tempting.

Such subjects cannot be discussed too frequently, and yet it is that very desire on the part of a set of men who come together and start a medical school and open a hospital and dispensary to have clinical material at any cost and this material bid for, as it were, and interesting cases actually paid to be brought before the class, that pauperizes the people.

An English writer in the British Medical Journal says in this connection: "The laborer is worthy of his hire," and in most vocations of life this seems to be accepted as true. When, however, the facts of professional life are taken into consideration, and we estimate by this rule the ordinary earnings of practitioners of medicine, it is necessary to confess, either that medical skill and knowledge are worth very little, or that gross injustice is too frequently meted out to members of our profession. From every side come reports of continual lowering of medical fees, and while in the case of the working classes the public have been treated ad nauseam to comments and articles on the "living wage," we look in vain throughout the daily press for any sympathy with the underpaid doctor, or for timely admonition, that it is hardly in accordance with public policy that the doctors of the community should have their remuneration reduced below this. One of the most disheartening sides of this state of affairs is the apparent apathy displayed by many practitioners, who would be thought to be gravely affected by the lower

ing of fees, and in this alone is the chief extenuation of the callousness of the public; for the latter might naturally urge that if members of the class most affected seem to be satisfied, there can be little occasion to agitate for reform. This apathy and apparent content can only be accounted for on the theory that such individuals have other sources of income, which enable them to take starvation professional wages without demur. Two reports of friendly societies lie before us; one is from the Lincoln Gazette of January 26, and refers to the Odd Fellows' Medical Institute. Dr. Johnston, the senior medical officer, appears to be quite satisfied, and gives a glowing description of the present state of the institution. Among the details he mentions that the medical officers (two in number) and dispenser have received between them £500 17s. ($2500), and that the drug bill was £161 5s. ($805). For this remuneration 6934 visits appear to have been made in 1894, 24,173 consultations were given to members, 288 accidents attended to, 297 teeth extracted, and 31,431 prescriptions dispensed. It can hardly be denied that the members of this Institute have had their money's worth, but when £500 ($2500), is the full remuneration paid to two qualified practitioners for all this work, and out of this has to be deducted the salary of the dispenser, we cannot congratulate the medical officers on the high estimate placed on their services, judging from the rate of payment, particularly when we are told that the bare cost of the drugs supplied comes to nearly a third of this sum. Still more gloomy is the story told by the Ardrossan and Saltcoats Herald of January 25. From it we learn that Dr. Beveridge, as a result of an agitation amongst the members of the "Hurlford Fig Tree Lodge of Free Gardeners," has just intimated his willingness to accept members at 2s. (50 cents), per annum instead of 2s. 6d. (62 cents), which had previously been paid. "Everybody seems pleased," says our contemporary, "with the concessions so willingly made by Dr. Beveridge."

It is high time that physicians were putting a fair value on their professional services and not be dictated to by corporations and individuals. One leading life insurance company attempted a reduction of its examination fees and its best examiners promptly sent in their resignations. It is only by concerted action that physicians can obtain their rights.